Hearing Assistance

I don’t find having a hearing disability fun! Anonymous

Modern hearing aids, with rechargeable batteries and T-coils allowing use of hearing loops.

V2

This weblog post is about technical devices that will ease the difficulties a hearing disability places on a person. These devices can only ease a burden, they cannot eliminate it, Hearing loss will always result in deprivations.

This is the second version of this post, with thanks to Art Vaughan, for finding 14 situations that needed to be enhanced in various ways. There are undoubtedly more. Thank you, Art!

Modern hearing aids are computerized electroacoustic systems that transform sound as it exists in a user’s environmental into sound that can be perceived, using audiometric and cognitive rules. Modern devices also utilize digital signal processing to improve speech intelligible, yet comfortable for the user. Such signal processing includes feedback management, wide dynamic range compression, directionality, frequency lowering, and noise reduction.

Hearing aids are still equipped with the basics from a century before: a microphone, amplifier and a receiver. Hearing aid manufacturers, confusingly, use receiver to refer to the micro speaker – a sender – inside each hearing aid. The microphone senses the environment, listening to sound vibrations in the normal range of human hearing. The amplifier processes signals from the microphone, and the receiver sends the signal to the ear.

Since the audio circuit and the additional control circuits are fully digital on modern hearing aids, they can be connected to a computer. Characteristics can then be adjusted individually, provided the hearing professional knows what they are doing. It is often easier to implement circuits digitally than to construct equivalent analog circuits. A typical example is that specific frequencies can be amplified more than others to provide better sound quality. Users can select between multiple programs that operate automatically and adaptively. Among the advantages are: reduced acoustic feedback and background noise and the use of multiple microphones to improve spatial awareness. Frequency transposition allows frequencies that a user may not hear to be reconstructed in frequency regions where hearing is better. Control signals on a hearing aid on one ear can be sent wirelessly to the control circuitry in the hearing aid on the opposite ear to ensure that the audio in both ears is either matched directly or that the audio contains intentional differences that mimic the differences in normal binaural hearing to preserve spatial hearing ability.

At one time streamers were popular. These were small devices worn like a pendant, that allowed audio signals to be sent wirelessly to and from other external devices, such as music players. This capability is now built into apps found on smartphones. With the addition of speech recognition and internet capability in the mobile phone, the wearer has better control over communications, and in many more situations than with hearing aids alone. Voice activation – think Siri – has becoming more common and is now used everywhere.

Digital hearing aids have existed since 1984. The first practical, wearable, fully digital hearing aid was invented by Maynard Engebretson, Robert E Morley Jr. and Gerald R Popelka. Their work resulted in US Patent 4,548,082: Hearing aids, signal supplying apparatus, systems for compensating hearing deficiencies, and methods. The patent was issued 1985-10-22, and expired 2005-10-22. This patent formed the basis of all subsequent fully digital hearing aids.

A telecoil is a tiny copper wire coiled around a metal rod. It is used to capture electromagnetic waves, much like an antenna. Circuits inside a hearing aid will convert these waves into an audio signal. Telecoil listening systems bypass hearing aid microphones, to eliminate most background noise and to transmit a clear audio stream.

At one time acoustic feedback was a major issue for hearing aids wearers when using the telephone. With a telecoil, hearing aid users can tap directly into the electromagnetic signal instead of the acoustic one, preventing feedback.

The last significant change has been the use of rechargeable batteries. These are charged by placing the hearing aids in their case, and then attaching the case to a power source, using a connector. In Europe, the use of USB-C connectors on new devices, including hearing aid cases, will be required by the end of 2024.

People with moderate-to-profound sensorineural hearing loss are often provied with a cochlear implant (CI) neuroprosthesis. This is surgically implanted. It bypasses acoustic hearing by direct electrical stimulation of the auditory nerve. Therapy teaches CI users how to interpret signals as speech so they understanding speech better in both quiet and noisy environments. CIs can be equipped with telecoils.

In Australia, Europe, North America and many other places in the world, hearing loops have been mandated for use in spaces used by the public. Previously, some jurisdictions initially allowed other, cheaper technologies. Unfortunately, this meant that hearing loops were an afterthought to disability infrastructure.

In contrast to other approaches, some of the advantages of hearing loops combined with telecoil equipped hearing aids are: there is no maximum number of users that can be served at a venue, they are simple to use, improve the signal-to-noise ratio (SNR) and signal quality, reduce background noise and reverberation, allow users to retain their dignity and privacy by not requiring them to remove hearing aids to use of forms of hearing augmentation. Despite this, there can be legitimate complaints that hearing loops are not designed for listening to music, because of distortion at higher frequencies.

Joseph Lazarevich Poliakoff (1873 – 1959), a Ukrainian-born British telephone and sound engineer and inventor, particularly of hearing aids. He founded the Multitone Electric Company in 1931. They produced their first hearing aid, a desk-top model, in 1933. In 1937,  Poliakoff was issued a patent for an induction-loop hearing assistance system. It remained valid until 1958, when it entered the public domain.

When a telecoil is activated, it senses magnetic fields, replacing (sometimes supplementing) the microphone, sensing for sounds. Telecoils can be used with hearing loops, individual amplifiers and smartphones.

In Norway, and undoubtedly many other places, no landlines exist, since all phones are connected to the mobile network. Telephone providers can supply a device with limited functionality that looks like a landline. It is permanently plugged into an electric circuit. It also costs about twice as much as a smart phone. There are also dumbphones that are specifically designed for elderly users. Acoustic coupling settings allow a phone to be used normally, with paired hearing aid microphones automatically picking up sound coming from the phone. Cellphones with a M rating of 3 or 4 have this capability. Bluetooth is also used for communication between hearing aids and a phone. This requires the two devices to be paired.

Some phones have telecoils built in. These can be set to send magnet signals to hearing aids without using microphones. These can improve the signal-to-noise ratio while eliminating feedback distortions. Phones with a telecoil capability have a T rating of 3 or 4 have this capability.

A hearing loop = audio induction loop = audio-frequency induction loop (AFIL) is assistive listening technology that uses hearing aid telecoils.

We have a hearing loop at Cliff Cottage, an electrical cable with a pair of 0.75 mm2 = 19 AWG wires. This type of cable is typically used for extension cords for lamps. The hearing loop was placed around the perimeter of our living room in the ceiling . It is almost 30 m = 100 feet long. The loop starts and ends in a wall connector, close to where a hearing loop amplifier is located. A hearing aid will be able to pick up audio inside a hearing loop, as well as up to several meters outside of it.

The loop was first installed in 2009, by the local branch of NAV = Hub (literally), the Norwegian super-agency that, in addition to far too many other duties, provides assistive devices to residents. Before fitting new ceiling tiles in 2021, I took it down and reinstalled the loop after the tiles were in place. Later, I discovered that when such a system is installed in a new house, it is hidden in the floor. Unfortunately, I was unaware of this at the time, because I could have placed it in the floor when I replaced the living room flooring in 2022.

On the left is the original Univox DLS-380 hearing loop amplifier with wiring attached. To the right is a S/PDIF splitter/converter. A S/PDIF Toslink optical audio stream is taken from a television and sent to the splitter. There the signal is split into two analogue streams of stereo signals. One stream goes to an active bass speaker, that plays low frequency founds. Mid-frequency and high-frequency sounds are sent in stereo to two (L & R) bookshelve speakers.

Working forward from a television’s S/PDIF Toslink digital optical connectors, a stereo digital audio stream was sent to a S/SPDIF splitter, that sent two RCA analogue signal streams onward. One stream was sent to the original Univox DLS-380 hearing loop amplifier. That amplifier sent the audio to the loop system. In addition, another stream was sent using RCA connectors to an active bass speaker, that plays low frequency sounds. Mid-frequency and high-frequency sounds were then sent in stereo to two (L & R) bookshelf speakers.

The current system has the same function, but with details that differ. The CLS-5 telecoil amplifier can operate with a wide range of operating voltages. In residential/ institutional/ commercial applications, it will most likely use 110-240 VAC. However, it can also be fitted into buses and recreational vehicles as well as boats, where it most likely will use 12-24 VDC. It comes with optical (digital) and coaxial (digital and analogue) inputs. It also has a setscrew that allows for adjustment of time delay between the audio and video signals (TV Sync). It provides easy connections to modern (and not so modern) flat screen plasma/ LED/ LCD TVs.

When these components were replaced at the end of 2023, none of the replacement units came with RCA connectors. HDMI, S/PDIF and USB-C audio connectors were common to both the (new) smart television and the sound bar. While the new Univox CLS-5 amplifier works with several types of connectors, the installer said that S/PID Toslink optical connectors created the least challenges. So these were used.

Once again a single digital audio stream was sent from the television to a splitter. From the splitter, two identical audio streams emerged. One was sent to the hearing loop amplifier, while the second audio stream was sent to the sound bar. Both used digital Toslink optical connectors. .The splitter is powered with mains electricity.

This cable generates an electromagnetic field throughout the looped space which can be picked up by: 1) telecoil-equipped hearing aids, 2) cochlear implant (CI) processors, and 3) specialized hand-held hearing loop receivers for individuals without telecoil-compatible hearing aids. So while this technology was installed specifically for one person using one technology, it is equally useful for other people, most likely visitors, using the other hearing assistance technologies.

In order to transmit the clearest possible sound source to a hearing-impaired listener, free of distracting noise, a hearing loop carries baseband audio-frequency signals without a carrier signal.

Installing the cables is not difficult, and can be installed by almost anyone. However, one should read amplifier documentation, and understand the process, before doing so. I am unsure of the reason for this, but the user’s manual states that one should twist the wires 180 degrees at some point. In this way a wire that was on the right at the beginning, will be on the left once the wire is turned, and vice-versa.

The Hearing Loss Association of America (HLAA) has commented on hearing loops:

Loop technology was pioneered in Europe where it is widely embraced and highly successful. When hearing accessibility in the United States was made a requirement of law in 1990 under the Americans with Disabilities Act, no distinction was made between loop systems and less expensive FM or IR systems. Although the ADA did require that systems provide access to “effective communication,” people with severe to profound hearing loss—for whom FM and IR systems often fall short—were slow to mobilize advocacy for hearing loops.

The ADA Standard for Accessible Design was updated in 2010 requiring that for renovation and new construction that at least 25% of receivers provided are hearing aid compatible—meaning that users do not have to remove their hearing aids to use the system. This dramatically raised the interest in and availability of hearing loops because loops are the only assistive listening systems that connect directly to telecoil-enabled hearing devices. (End of HLAA comment)

Tinnitus

Tinnitus is the perception of sounds that are not the result of an external source. There is no cure for this, but there are ways to manage the condition.

Despite being a person who was diagnosed with tinnitus at the age of about 50 in 1998, I have never considered using hearing aids as a treatment. I have had one counseling session. However, as a teacher I have regularly attended seminars with a focus on assorted disabilities, including hearing.

My approach to self medication has been to engage in activities that require concentration. This puts tinnitus into the background. At other times I rely on low intensity music. Over the past 25 years I have tried various genres. As I approached 60, I reduced – almost eliminated – listening to classical music and started listening to less melodic music. These are better able to mask my tinnitus. When tinnitus is at its worst, my music choices are the trashiest metal. My understanding is that everyone is different.

Many hearing aids offer some form of tinnitus relief. Often this is an app delivered to the hearing aids, from a phone. If this is the case, it is important that the phone and hearing aids are compatible with each other. Sometimes, it is a computer program inside the hearing aid, that has to be activated. It is also important to know if this program can be altered to reproduce the specific sounds needed by the user. Sounds that are enhanced for a particular users are more effective for therapy than more generic sounds.

Cognitive behavioural therapy (CBT) focuses on thoughts, beliefs and attitudes to improve emotional responses to help a person develop a strategy to help a person cope with a current problem. It was originally developed to treat depression, but its use has been expanded to include the treat other conditions, such as tinnitus.

MindEar is an app that provides CBT through a chatbot. The goal is to empower people so they regain more control over their lives. Often the use of such an app is combined with counseling with a clinical psychologist, either in person or online.

People with tinnitus often enter negative thought cycles. Many people need some form of counselling to help them cope with it.

Hearing aid styles

There are several hearing aid styles. Small hearing aids may be less visible but they may lack the power to improve hearing. These are referred to as Completely in the canal (CIC) or mini CIC. This is molded to fit inside an ear canal, but is only useful for mild to moderate hearing loss. One of its advantages is that it is less likely to pick up wind noise. Yet, because of its small size it uses very small batteries, which have a shorter life and can be difficult to install and remove. They often lack features, such as volume control or directional microphones. Earwax can clog the speaker.

An in-the-canal (ITC) hearing aid fits partly in the ear canal. Again, it is for mild to moderate hearing loss and is less visible than larger styles. It has many of the same problems as CIC hearing aids.

An in-the-ear (ITE) hearing aid is custom made either with a bowl-shaped area occupying the outer ear (full shell) or one that fills the lower part (half shell). Both are for people with mild to severe hearing loss. They are available with two directional microphones, volume control, longer battery life including rechargeable batteries. Again, earwax may clog the speaker, wind noise may be present, It is more visible but may be easier to handle.

Behind-the-ear (BTE) hearing aids rest behind the ear. A tube connects the hearing aid to a custom earpiece = ear mold that fits into the ear canal. This is the generic style appropriate for everyone, with any hearing condition. Since this is the largest type of hearing aid, it can fit in more electronics and batteries, has directional microphones, increases amplification, picks up more wind noise, and typically uses rechargeable batteries.

Receiver-in-canal (RIC) and receiver-in-the-ear (RITE) are similar to BTE hearing aids, but with the speaker = receiver in the ear canal, connected to the hearing aid with wire.

People with better low-frequency hearing and mild to moderate high-frequency hearing loss may want to use an open-fit hearing aid with an open dome in the ear.

People with hearing disabilities should think through the capabilities they want before deciding on a style. While younger people, especially, may want their hearing aids to be invisible, smallness introduces limitations. Growing one’s hair longer may be a better approach to concealing hearing aids.

Features to consider

Some features may improve one’s ability to hear in specific situations. All hearing aids have some amount of noise reduction available. The amount of noise reduction varies. Some also offer wind noise reduction.

Directional microphones are aligned on the hearing aid to provide for improved pickup of sounds coming from the front, and with reduced sounds from behind or from the side. These are particularly useful in a noisy environment.

Rechargeable batteries can make life easier by allowing batteries to be charged, rather than replaced.

Telecoils make it easier to hear when talking on a telecoil-compatible telephone or listening in an environment served with an induction hearing loop.

Another approach is wireless Bluetooth connectivity, achieved by pairing hearing aids with cellphones, music players, computers and televisions. Sometimes an intermediary device = a streamer is used to pick up the signal and send it to the hearing aids.

Some hearing aids are equipped with a remote control, that adjust features without hearing aid contact. Increasingly, a cellphone app is used for this.

Direct audio input allows audio from a television, computer or a music device to be attached, with a cord.

Some hearing aids can store several preprogrammed settings for various listening needs and environments. Trish has four settings on her hearing aids: normal, restaurant, hearing loop and silence.

Since most people use two hearing aids, these can be synchronized = function together so that adjustments made to one hearing aid will also apply to the other aid, simplifying control.

It takes time to adjust to a hearing aid. There is evidence showing that listening skills improve gradually as one become accustomed to using amplification. One’s own voice sounds different when wearing a hearing aid.

Studies

Currently, I am spending considerable time daily to understand hearing and hearing loss. My aim is to provide people in my immediate family (possibly extending outwards to friends) with better advice than they can obtain from profit motivated hearing professionals.

Modern hearing aids have to be configured to match the hearing loss, physical features, and life situation of the user. The starting point is an audiogram. So one of my first goals is to be able to produce these. My next goal is to be able to fit a hearing aid, so I am also learning more in general about audiology and audioprosthology.

The reason for this is that my potential first client is dissatisfied with the fitting and other services she has received from professionals. I have no intentions of working with anything other than digital hearing aids. Thus, I will not be working with anything resembling an osseointegrated auditory prosthesis = bone-anchored hearing aid or cochlear implant.

I am particularly interested in hearing other people’s experiences with hearing assistance. Those who want, can post a comment. Those who prefer to remain anonymous, can send me an email.

Meditation

A bullfrog near Saint Joseph, Missouri, USA. Photo: Austin Santaniello, 2017-07-03.

Fifty years ago, back in the 1970s, I practiced a form of transcendental meditation. This weblog post provides some basic information about it, along with lists of mantras. I am referring to this content as open-source meditation. It comes without any guarantees. While there are undoubtedly differences of opinion, I do not think most people need a guru, or any form of instructor in order to meditate. People who disagree about this, or other matters, are encouraged to provide enlightenment, by writing a comment.

Among the books I am currently, but reluctantly, reading is Johann Hari (1979 – ) Stolen Focus: Why You Can’t Pay Attention – and How to Think Deeply Again (2022). Hari has had a history of ethical issues, including plagiarism, related to journalism, and like much of his work, this book has also received criticism. The topic of the book is important, and there is no harm in reading this book, as long as one is aware of its limitations.

While reading this book with respect to the challenges of multi-tasking, as well as sleep deprivation, I began wondering if other animals also suffered from these problems. Crows, I recently learned, are capable of using probability. This is why a photo of a bullfrog appears. Is it a secret meditator? I also wondered if some form of meditation could be useful, for aging humans, such as myself.

Claimed benefits of Meditation

Physical

  • Improved cardiovascular health: Studies have shown that TM can help reduce blood pressure, improve circulation and increase oxygen flow to the heart.
  • Reduced response to pain
  • Reduced insomnia and improvement in sleep: TM has been linked to an increase in the production of melatonin – a hormone thought to be responsible for promoting good sleep.

Mental Health

  • Reduced stress and anxiety.
  • Reduced symptoms of depression.

Cognitive

  • Increased focus and concentration.
  • Increased productivity and creativity.
  • Improved short-term and long-term memory.

Emotional

  • Improved emotional regulation and resilience.
  • Improved self-awareness
  • Improved self-confidence
  • Improved emotional well-being and happiness

Preliminaries

Choose a mantra. Mantras help the mind enter a state of inner stillness and peace, preventing active thinking. Select one that resonates with you. A number of mantras are listed below. Choose a location for meditation. It should be a place where you won’t be disturbed. Twenty-first century reminder: switch off that hand-held device that accompanies you, or put it on silent mode.

Meditating. First, sit comfortably. The spine should be upright but not rigid. The back can be supported. Second, close eyes. Third, silently repeat a mantra. Some forms of meditation use mantras that are religious words, typically with origins in Sanskrit. Others use sounds without any meaning. The advantage of a meaningless mantra is that it is easier to switch off thoughts. Meditators often claim that they enter a state of deep relaxation. Fourth, continue for twenty minutes.

Conclusion (once the 20 minutes are up). First, slowly open your eyes. Second, bring your attention back to your surroundings. Third, take some deep breaths and slowly stand up. Fourth, the real world awaits you. Return to whatever needs to be done. Fifth, remember to meditate twice a day.

Sleep Meditation

Meditating to help a person to sleep requires modifications to be made to the standard procedures. Instead of sitting, continue to lie down on your bed. Allow your body to sleep if and when this is possible.

Walking Meditation

Some people are not particularly good at sitting still. They may prefer a walking meditation, where they can develop an awareness of their surroundings and, in so doing, calm the mind and relax the body.

  • Find a safe place to walk.
  • Start to walk slowly.
  • Pay close attention to the physical sensations of walking: the way your feet feel when they touch the ground; the way your muscles contract and release as you move; and the rhythm of your breath.
  • Possibilities: Notice the air on your face and hands. Notice how the humidity and heat feel on your body.
  • When your mind wanders, gently bring attention back to your body and to the physical sensations of walking.

1969 Transcendental Meditation mantras

AgeMantra
0-15Ing
15-30Aing
30-45Shiring
45+Shiam
0-15Im
15-30Aim
30-45Shirim
45+Shiama

1972 Transcendental Meditation mantras

AgeMantra
10-11Ing
12-13Im
14-15Inga
16-7Ima
18-19Aying
20-21Ayim
22-23Ayinga
24-25Ayima
25+Shring

1976 Transcendental Meditation mantras

AgeMantra
3-10Eng
10-12Em
12-14Enga
14-16Ema
16-18Aeng
18-20Aem
20-22Aenga
22-24Aema
24-30Shiring
30-35Shirim
35-40Hiring
40-45Hirim
45-50Kiring
50-55Kirim
55-60Shiam
60+Shiama

1987 – Present Transcendental Meditation mantras

AgeMantra
0-11Eng
12-13Em
14-15Enga
16-17Ema
18-19Aing
20-21Aim
22-23Ainga
25-25Aima
26-29Shiring
30-34Shirim
35-39Hiring
40-44Hirim
45-49Kiring
50-54Kirim
55-59Sham
60+Shama

Other mantras are words or sentences in Sanskrit. These include: 1) Om (or Aum) is the prime symbol of Hinduism and one of the most important spiritual sounds. It is the sonic representation of the divine in Indic traditions. It is often chanted during spiritual recitation or used as a mantra during meditation in Hinduism, Buddhism, and Jainism. 2) Sat Nam is a combination of two ancient Sikh words, “Sat” meaning “truth” and “Nam” meaning “name” – essentially it means “I am truth”. 3) Om Mani Padme Hum is a Buddhist mantra to invoke the blessings of Avalokiteshvara – the bodhisattva of compassion. It’s commonly translated from Sanskrit as, “The jewel is in the lotus.” 4) Ra Ma Da Sa is a Kundalini yoga that combines four sounds to create a positive vibration that helps release stress and tension as well as to bring balance to the body and the mind: “Ra” represents the sun and the masculine energy; “Ma” represents the moon and the feminine energy; “Da” represents the Earth and the healing energy; “Sa” represents infinity and the enlightenment energy. 5) Aad Guray Nameh is a Sikh meditation mantra meaning, “I bow to the primal wisdom”: Aad Guray Nameh = I bow to the Primal Wisdom, Jugaad Guray Nameh = I bow to the Wisdom of all the ages, Sat Guray Nameh = I bow to the True Wisdom, Siri Guroo Dayvay Nameh = I bow to the Great Invisible Wisdom.

Note: No weblog post will be published on 2023-09-23. The next one will be published on 2023-09-26.

August Insights

Some notable events have taken place in 2023-08.

Women’s World Cup 2023

I do not follow sports, but sometimes read results so that I can interact with normal people. There are two counrties that are natural for me to support, Canada and Norway, not to mention Ireland, that has provided citizenship to the others in my immediate family. With the Women’s World Cup, I felt I could impress these people by reporting a select few game results. Already near the start, on 2023-07-20, with Norway losing 1-0 to New Zealand, and Ireland losing 1-0 to Australia, I realized that backup could be necessary, in order to be on the winning side. Fortunately, Denmark and Sweden were also playing. By the end of group play, Canada and Ireland were out, but the Scandinavians were still in. On 2023-08-05, Norway lost 3-1 to Japan, and was out. The next day, Sweden beat USA on penalties, and was still in. The day after that, Denmark lost 2-0 to Australia. All hopes were on Sweden. In the end, on 2023-08-19, Sweden ended up in third place. On 2023-08-20 Spain won with England in second place. The scene was set for the main drama…

Dear Luis Rubiales: sportswomen are not dolls to be kissed, touched and patronised. Those are the words of Barbara Ellen in The Guardian.

Yes, I eagerly awaited the resignation of Luis Rubiales (1977 – ) for forceably kissing Jenni Hermoso (1990 – ), a Spanish professional footballer who plays for Liga MX Femenil club CF Pachuca (Mexico) and for the Spain women’s national team. She has previously played for teams in Spain, including Barcelona, and is the all-time top scorer for both Barcelona and Spain, at the end of the Women’s World Cup. She did not consent to be kissed.

Rubiales is president of the Royal Spanish Football Federation (RFEF) and one of the Union of European Football Associations (UEFA) vice presidents. He refused to resign, and was dumb enough to say, “A social assassination is taking place. I don’t deserve this manhunt I have been suffering.” It took Fédération Internationale de football association = FIFA to remove him, if only temporarily. FIFA will look at whether his actions constitute violations of Article 13 in its disciplinary code, concerning offensive behaviour and fair play.

The Spanish government was also taking action to force his removal. It was asking Rubiales to explain himself to a Spanish administrative court as soon as possible. If it deems he violated the professional sports code, he could then be suspended.

Hermoso stated: “I want to make clear that at no time did the conversation to which Mr Luis Rubiales refers to in his address take place and, above all, his kiss [was n]ever consensual.”

She added his claims were “categorically false and part of the manipulative culture that he has generated”.

“I feel the need to report this incident because I believe no person, in any work, sports or social setting should be a victim of these types of non-consensual behaviours. I felt vulnerable and a victim of impulsive-driven, sexist, out-of-place act, without any consent on my part”.

“Quite simply, I was not respected.”

She was put “under continuous pressure” to help with a “statement that could justify” Rubiales’ actions – and so were her family, friends and team-mates.

“These types of incidents add to a long list of situations that the players have been denouncing. This incident is the final straw and what everyone has been able to witness on live television also comes with attitudes like the one we saw this morning [Friday, 2023-08-25] and have been part of our team’s daily life for years”.

81 players confirm they will not play for Spain’s women’s team until he is removed from his post. In addition, two Spanish men’s national team and Real Betis players, Héctor Bellerín and Borja Iglesias, criticised Rubiales on social media, with the latter refusing to play for Spain until Rubiales resigned.

By Saturday, 2023-08-26, RFEF had threatened to sue Jenni Hermoso, accusing her of lying and defamation, and the women football players who signed a letter in which they refused to play for their country as long as Luis Rubiales remained its leader. Obviously, a lot more people in the RFEF need to be replaced.

Then, Ángeles Béjar (? – ), Rubiales’ mother, entered the Church of the Divine Shepherdess in Motril, Granada, Spain on Monday morning, 2023-08-28, to begin a hunger strike to protest what she describes as her son’s unwarranted, inhumane and bloodthirsty hunt.

2023-09-11 Update:

Ángeles Béjar was taken to hospital on 2023-08-30.

On 2023-09-05, Jorge Vilda (1981 – ) was fired as head coach of the Spanish women’s national team.

According to a Guardian article, Luis Rubiales’ uncle, Juan Rubiales, told El Confidential: “We Rubialeses are absolutely committed to the idea of dignity. And dignity is to defend Jenni, to understand her, and to reproach the shameful behaviour of this president…. I think [Luis Rubiales] needs a social re-education programme and a re-education in his relationship with women.” He described his nephew as a man “obsessed with power, luxury, money and women”. In a separate interview with the newspaper El Mundo, he added that his nephew was a “man with a clear machista [sexist] tinge”.

Irene María Montero Gil, MP is a Spanish politician and psychologist, member of the Podemos party. She has been the Spanish Minister of Equality since 2020-01-13. She described the kiss as a “lower-intensity” form of sexual violence that is often invisible and normalised in society.” On 2023-09-10 she tweeted: “Se acabó [It’s over].”

On 2023-09-10, Gary Lineker, former England footballer turned BBC broadcaster who played in Spain for three years, tweeted about Rubiales resignation: Rubiales: “No voy a dimitir. No voy a dimitir. No voy a dimitir. No voy a dimitir.” “Voy a dimitir [I resign].”

Rich Men North of Richmond

Oliver Anthony, playing Rich Men North of Richmond

At the start of the first American Elephant Party television debate on 2023-08-22, an excerpt was played of Oliver Anthony’s (1992 or 1993 – ) song, Rich Men North of Richmond, then discussed. Fox News host, Martha MacCallum, said Anthony’s “lyrics speak of alienation, of deep frustration with the state of government and of this country. Washington DC is about 100 miles north of Richmond.”

On stage stood seven current or former governors and congressmen and one venture capitalist, all members of the Elephant Party.

McCallum asked: “Governor DeSantis, why is this song striking such a nerve in this country right now?”

Ron DeSantis, replied: “Our country is in decline. This decline is not inevitable. It’s a choice. We need to send [Donkey Party member and US president] Joe Biden back to his basement and reverse American decline.”

However, on Friday 2023-08-25, nonpartisan Anthony released a 10-minute video, in which he rejected that answer and denied that he was a conservative figure. “The one thing that has bothered me is seeing people wrap politics up in this. I’m disappointed to see it. Like, it’s aggravating seeing people on conservative news try to identify with me, like I’m one of them. That song has nothing to do with Joe Biden. You know, it’s a lot bigger than Joe Biden. That song’s written about the people on that stage and a lot more, not just them.”

It was hard, Anthony said, to “get a message out about your political ideology or your belief about the world in three minutes and some change. But I do hate to see that song being weaponized, like I see. I see the right trying to characterize me as one of their own. And I see the left trying to discredit me, I guess in retaliation. That’s got to stop.”

He said the response to his song had crossed party lines and that he welcomed a diverse audience.

“If you watch the response videos on YouTube, it’s not conservative people responding to the song. It’s not even necessarily Americans responding to the song. I don’t know that I’ve seen anything get such positive response from such a diverse group of people. And I think that terrifies the people that I sing about in that song. And they’ve done everything they can in the last two weeks to make me look like a fool. To spin my words. To try to stick me in a political bucket.”

Wikipedia tells us, that Anthony is the first songwriter to debut at the top of the Billboard Hot 100 with no prior chart history in any form, Anthony is the first male songwriter to chart 13 songs all simultaneously in the top 50 Digital Song Sales while still alive—Prince and Michael Jackson exceeded that count only following their deaths.

Confession 1: I have not actually listened to Oliver Anthony’s track. After about 10 seconds I find the raspy voice and Piedmont dialect , along with a resonator guitar so unpleasant that I turn it off. I was able to listen to Johnny Cash (1932 – 2003), or more likely his artificial intelligence alter-ego, singing it.

Confession 2: I find the names of political parties difficult to accept. I am not sure what makes, say, the Democratic party, more democratic than another party. I frequently avoid that aspect of political debate, by codifying their real names. In this alternative universe, the party that is closest to me is the Marmot party. Why? The marmots I know best, those living on McArthur Island in Kamloops, British Columbia are enthusiastic and engaged, but without direction. I often rename parties after party symbols.

Wildfires

The effects of the Lahaina, Maui, Hawaii wildfire. Photo: 2023-08-17 at 10:02, taken by Glenn Fawcett, for the United States Department of Homeland Security, and released into the public domain.

Wildfires have become an issue. To call them a serious problem is to undermine their destructiveness. I think especially of the village of Lytton in British Columbia, but also Yellowknife in the Northwest Territories, not to mention Lahaina, on Maui. On 2023-08-19, West Kelowna, across Okanagan Lake from Kelowna, where I spent most of my childhood summers, was experiencing wildfires. Kelowna, was being threatened by them. They experienced the wildfire of a century twenty years earlier, on 2003-08-16. Yes, I too am amazed at how short centuries have become!

We have to improve the terms used to describe wildfire events, removing the time scale. A once in a century fire, could be more accurately described as a 1% chance wildfire event. This, has now become a more common 5% chance wildfire event. In another ten years that might increase to a 10% chance wildfire event. These percentages indicate that there is no regularity to these events.

Historically, there have also been large wildfires in the past, such the Peshtigo fire in Wisconsin in 1871 and the Sudbury fire in Ontario in 1916. At times in Australia, Indonesia and other places there have seen multiple fires burning simultaneously, causing significant harm and loss of life. Cities have also burned, notably, the Great Fire of London on 1666-09-05 and Chicago, that started the same day as the Peshtigo fire, 1871-10-08. New Westminster, where I grew up has experienced two massive fires that started on 1898-09-10 and 2020-09-13, respectively.

While I avoid expletives, I am thinking of introducing one for dramatic effect, combustion! (with variants). For example, “It was a combustive mess”. Like most other expletives, it adds no truthiness to a basic statement. Here, a mess is a mess. Combustive simply adds emotional flavour. While some forms of combustion are necessary, the world in my lifetime has produced too much of it. My hope is that by making it an expletive, people will reflect on their combustive behaviour and reduce or eliminate it.

Despite being as much of a NIMBY (not in my backyard) as the next person, I am a proponent of decarbonization, including the total elimination of fossil-fuels, such as natural (and unnatural) gas from houses. Induction stovetops are a more effective (but not necessarily cheaper) way to cook. Hydro, geo-thermal, solar and wind are effective ways of producing clean electricity.

Hawaiian Electric irresponsibly claimed that they could not turn off the electricity on Maui because some customers were dependent on electrical power for medical devices. In addition Maui uses electricity to provide water for residents. My reply is that batteries have been invented that can provide power to medical devices, in situations where it is unsafe to have grid power on. Yes, I am aware that someone has to think of that solution, and that batteries cost money. So does an enormous loss of life, with so many people unaccounted for! Where I have lived water relies on reservoirs and tanks at higher levels, and uses gravity feed to provide water to consumers. Admittedly, water may have to be pumped into these storage places.

Somewhat later, I received the following reply from a friend: Appears Hawaii Utility removed downed power poles, equipment, suspected of possibly causing the devastating fire …. therefore jeopardizing offficial investigation. Cover up?

Maui County is suing Hawaiian Electric over the fire that leveled Lahaina, The lawsuit includes a demand for a jury trial. It alleges the destruction could have been avoided if power lines had been shut off. This is part of a growing critical focus on the utility with videos apparently showing downed cables setting fire to vegetation. There were ample warnings of strong winds from a nearby hurricane, but Maui County claims which that Hawaiian Electric and its subsidiaries negligently kept power lines live. Some quotations: “These power lines foreseeably ignited the fast-moving, deadly, and destructive Lahaina Fire, which completely destroyed residences, businesses, churches, schools, and historic cultural sites.”; “Defendants knew that the high winds the [National Weather Service] predicted would topple power poles, knock down power lines, and ignite vegetation.”; “Defendants also knew that if their overhead electrical equipment ignited a fire, it would spread at a critically rapid rate.”

Maui County is not free of blame. Critics say it was not prepared for the event, and provided an inadequate response. In other place, such as California, electric utilities routinely shut down large stretches of above-ground power lines in strong winds. One has to question whether above-ground power distribution is suitable in the 21st century.

This 2023-08-08 fire was the deadliest wildfire in the United States for more than a century. It burned through about 800 hectares destroying the historic town of Lahaina, a former Hawaiian royal seat. It has rendered thousands of people homeless. Maui County released a list of 388 names of people who remain unaccounted for. Recovery is expected to take years. Federal estimates suggest the fire caused $5.5 billion of damage.

Popularity contests

At the end of August, Tim Anderson has written something I could never write, It has to do with the popularity of computer languages. This topic is easiest to explain by looking at fruits. Different fruits have different uses. Personally, I avoid apples and cherries because they don’t like me. I do consume citrus fruits, but they are not substitutes for each other. I would never eat a lemon or a lime with breakfast, like I would eat an orange or half a grapefruit.

Computer languages also have different uses. I regard scripting languages, such as JavaScript or Lua, as a type of glue, typically used to hold the components of websites together. There are database languages used to manipulate and organize data. In my mind, these are special purpose languages to be used restrictively, much like lemons or limes are used in cooking.

Then there are general programming languages, that can actually be used to make a software product. These are a totally different ilk, much like an orange or (for some people) an apple or a handful of cherries. There have been many generations of these, with Python being the most popular today. It was named after the British comedy group whose first name is Monty, rather than a snake. It first appeared in 1991. C, the language I use most, first appeared in 1972. Fortran first appeared in 1957.

I am now changing the advice I am giving to young people about which general purpose language to learn and use. My new favourite is Rust, named after the plant pathogenic fungi (order Pucciniales) with about 7 000 species. This programming language first appeared in 2015, but originated some years earlier at Mozilla, makers of the Firefox browser. It is supported by a number of large tech companies including Alphabet (Google), Amazon and Microsoft. Apple uses Swift, a competing language and successor to Objective-C, in most areas, but uses Rust in robotics.

Overwhelmed

Kevin Dooley 2016 Anxiety reigns. Note: Dooley states that this is not a drawing, but a photograph/ image of a plastic toy from Mary’s Nativity Scene 2016, straight out of the camera, a Sony RX100 using its watercolor feature.

There are times, when I actually believe that people can learn to cope with stress/ anxiety, and offer myself as an example. To cope with stress, I divide activities into six categories: Routine, Infrequent, Novel, Challenging, Frustrating and Overwhelming. As I approach an activity, I categorize it, as best I can. I have no problems changing a category, should it be necessary. I use the above terms because I can mark each activity I have planned with a single letter category code, without conflicts arising.

The category determines how the activity will be engaged. Routine activities can be performed at any time. The others, including infrequent activities, will be started when I am fresh, usually in the morning. Novel activities require me to write notes about the activity. Challenging activities require me to consult these notes. Frustrating activities require to me consult with another person about the activity, as well as notes. Overwhelming activities, require me to ask others to help.

In this weblog post, I will be looking at these with respect to dealing with some recent computer software and hardware issues, but they also apply to many other areas in life.

Routine Activities

Routine activities are those performed regularly, with little risk of extraordinary situations arising. Typical examples include: updating application and system software, which can occur many times in the course of a year. Some software manufacturers think their updates should take precedence. Thus, I remember one weather broadcast on television that was interrupted because Microsoft had decided that the computer being used to present a weather animation, should be updated, while the animation was being broadcast. I believe companies like Microsoft, now offer their customers the opportunity to specify time slots for updates.

If one is concerned, one can use expired software that is exempt for updates, such as Windows 7 as long as that part of the system is not exposed to the internet. One can also use software with better manners, such as assorted Linux distros. Because routine activities take place so often, there is usually no need to consult a user manual or check list, although pilots, surgeons and others may disagree.

Infrequent Activities

Some routine activity take place infrequently. When the frequency is about once a year, such as a major upgrade of an operating system to a new version, a different approach may be needed.

A typical annual event is the writing and sending out of an annual letter. While writing emails is a routine activity, an annual letter is often sent to many people. Hopefully, everyone has one or more computer address books used for assorted purposes, filled with contact information for family, friends, colleagues and providers of goods and services . One does not send an annual letter to everyone in one’s address book. Instead one makes lists for assorted groups of people. For the residents of Cliff Cottage, one such list involves people to be sent an annual letter in Norwegian. A second list is for those to be sent an annual letter in English. These lists have to be updated annually.

This year I had a strange experience working with these lists. The first one went fine, I was able to add and remove people from it, without any complications. I then waited ten days to work on the second list. By then I had forgotten how to add a person from an address book entry to a list. It did not take long to look up the procedure in the operating manual, and to remember. When working with infrequent activities, it is often appropriate to have a manual or check list available.

Novel Activities

Initial/ novel/ original/ unique activities are those that are being performed for the first time. It is important to write down the sequence of steps used in such activities, so that these notes can be consulted later, if this turns out to be repeated. I have folders of notes on various topics. There is always room in the folder for one more topic. Frequently, I copy then edit instructions from an online source, then paste them into a LibreOffice Writer file, complete with a link to its source. I often edit the file to suit my style of writing, because not every one writes well.

In order to reinstall Windows onto a 2015 Asus AiO computer, I attempted to burn an ISO file onto a USB stick = pendrive = flash drive, from my Linux desktop. This was a routine task, but somewhat irritating, because I had run out of 16 GB USB memory sticks, and felt I was having to waste a 32 GB stick for the installation of an old operating system. Then Linux gave me a warning that the program I had selected was inappropriate for burning a Windows ISO file, and invited me to investigate Ventoy.

I found that Ventoy was an improvement. It allowed multiple ISO files to be installed on a single USB stick. So, I was able to store several: Windows XP, Windows 7, Linux Mint 21.1 with Cinnamon desktop, despite a suspicion that Windows XP will not install from this drive. In the future, I intend to store other Linux flavours for specific purposes on this stick, especially related to CNC control and robotics. Should Mageia ever release a version 9, it will also be included. Then there are other tools, such as GParted (for creating partitions).

From one source, I made appropriate notes about working with Ventoy.

Challenging Activities

An electric vehicle should soon start occupying our carport. Once it arrives, it will have to be fed! The most convenient way is to have a charger in the carport. An Easee Home charging robot was installed 2023-01-04. To control the charger, a smartphone app is required. Installing this app was a challenging experience. There was no problem in downloading or installing the app itself, but it there was a problem opening an account, because a control number failed to arrive.

In the end, I used Easee’s chatbot, and explained the situation. While the chatbot could not offer any solutions, the issue was soon resolved. Easee seemed to have more data about the charger than I expected. They knew who I was, where I lived, even the serial number of the charger, and its pin number. Thus, they were able to open an account for me without me having to do anything.

Frustrating Activities

Recently, Trish and I discovered that our main communication channel, Signal, was disabled on our laptops, because Signal had not been updated. It was still working on our hand-held devices, and on my desktop machine. Signal provided instructions, involving three simple steps, on how to correct this issue. I decided that the most gallant approach was to solve the problem on my laptop, before fixing Trish’s.

After completing these steps, Signal still failed to work, and a message was received that the Linux Mint operating system on my laptop was compromised. Then, and only then, did I ask for advice from my son, who is more experienced than I am working with Linux. He suggested that I uninstall Signal on Trish’s machine, then reinstall it. I followed this advice, and her OS continued to work. Signal accepted the updates, and started working.

The main reason for this problem arose was that I had failed to install TimeShift, a backup and syncronization tool used on Linux systems that protects that system from corruption, by taking incremental snapshots of file system at regular intervals. Should an unfortunate situation arise, TimeShift can roll back the file system. It is the equivalent of System Restore in Windows and Time Machine in Mac OS.

Correcting the errors on my laptop proved to be more challenging. After three failed attempts to reinstall Linux 21 as the operating system, I had to examine what was happening. I had originally used this same USB stick to install Linux Mint on the two new laptops. Then I upgraded them to Linux 21.1. I decided that remnants of the system didn’t want anything to do with Linux Mint 21(.0). Thus, I burned Linux Mint 21.1 onto the stick. This simple change was all that was needed to get the laptop up and running.

Overwhelming Activities

The last situation involving overwhelming activities happened at the end of 2018. In an Email dated 2018-12-30, I admitted to feeling overwhelmed by some imminent digital technology transitions. When I was in my forties, that started in 1988, I had more serious mental health issues related to anxiety and depression. I was not going to allow this to happen again, as I entered my seventies.

  1. Internet changes: a) technology changing from asymmetric digital subscriber line (ADSL) to fiber cable; b) digging a trench, laying then burying forty meters of orange jacket from our property line to our house, Cliff Cottage; c) preparing an indoor wall for placement of a fiber modem. Professionals would then insert the fiber cable into the orange jacket, and put the wiring into the house, and install the modem.
  2. Telephone changes: d) smartphones = hand-held devices replacing a landline; e) transitioning from two different mobile network/ SIM card providers to yet another provider; f) transitioning from two different smartphone models (Huawei 9 Lite & 10 Lite) to a single model from a different company (Xiaomi Pocophone F1).
  3. Server changes: g) technology changing from one server (Asustor AS1004T) to a completely different type of server (retrofitted Dell enterprise rack equipment, with ; h) new server components; i) transitioning from one brand of hard-drive (Western Digital Red) to another brand ( Toshiba N-300); j) transitioning from server access using WiFi to Ethernet cabling throughout the house, including placement of – k) Ethernet (RJ-45) wall sockets, and l) a network of Unify U6 Lite access ports; m) a new server operating system FreeBDS; n) a new file system OpenZFS; o) new server software FreeNAS (now called TrueNAS core).
  4. Printer changes: p) technology changing from inkjet to laser; q) change of supplier from Epson to Canon; r) change from wireless to Ethernet connectivity.
  5. PC changes: s) Transitioning from one laptop (Acer Chromebook 11.5″) to another (Asus Vivobook 14); with a change of operating system from t) Chrome OS to a more familiar Linux Mint.
  6. Media player changes: u) Relocating the media computer and screen; v) accessing the media player via ethernet, rather than WiFi.

Thus, I wanted to alert people close to me, that twenty-two technological changes (a – v) were demanding attention, and asked for help in dealing with them. These fell into six categories:

Then I also commented on other things that to be done, including a need to replace the media player computer. Then added that this would not be happening during the next few months, as the entire computing budget for 2019 has been used up, before we even entered the year.

Control

People can legitimately ask why there were so many changes happening, in such a short space of time? The answers are grouped. Categories 1 to 3 involve changes initiated by others. Categories 4 to 6 increasingly involved my own decisions.

Much of the time a person does not have control over technological choices. Their role is that of a technological bus passenger. At some point they decide to enter that bus and take a ride, not knowing precisely where the route goes, or even where they want to transfer to the next bus. Adventures happen.

For example, we have never had any real options about an internet service provider (ISP). We could either accept ADSL provided over a copper cable network by Telenor, the Norwegian telephone company, or we could use a lower speed, but more expensive local solution, that failed to operate when it was windy, with communications equipment on a tower of Skarnsund bridge. There was no real choice.

Then, Inderøy municipality decided that our rural area would have internet served by fibre cable, provided by our electrical power supplier, Nord-Trøndelag elektrisitetsverk (NTE). We were further told that after it was installed, support for landlines would be terminated, and we would be dependent on smartphones and cellular base stations for telecommunications, including internet, if we didn’t opt in to the fibre solution. Again, there was no real choice.

Some of these transitions felt minor, some felt less so. Most of the transitions went well:

  1. Additional backup onto external hard-drives.
  2. The transition to fiber went well, despite a couple of misunderstandings, where the supplier enrolled us into using numerous television packages, and an internet speed in excess of what we asked for. These were resolved with a telephone call.
  3. The decommissioning of landline equipment.
  4. Installing new SIM cards on new cell phones.
  5. Physically installing hard drives onto the new server.

Some involved assistance that was appreciated:

  1. Copying data from an old phone to a new phone.
  2. Setting up Signal messaging on computers.
  3. Setting up mail servers.
  4. Installation hardware and software on the new server.
  5. Creating new backup procedures on the new server, since the old server was not backing up data properly.
  6. Copying photos from hand-held devices, so they were available on personal computers, and also saved on the server.
  7. Setting up the printer.

Notes:

When I look at the original floor plan for Cliff Cottage. I don’t understand the placement of anything. I feel the house should have been rotated 90 degrees , counter clockwise, with the kitchen and living room facing the view. It wasn’t, and I have spent the first years of my retirement improving not just the relationship between the house, and the property it sits on, but also changing access between different parts of the house. Among the changes was a better location to access to the living room from the hallway. This was straight forward, but also required the home theatre/ media centre to be moved to a completely different location.

For those who do not know me, I am a sliding/ pocket door junkie. If a conventional door can be replaced with some form of sliding door, it will be replaced. Cliff cottage has seven sliding doors, as well as four sliding doors in the kitchen cabinets. This will increase to thirteen, when the kitchen remodelling is complete.

On 2023-01-13 a 10 year old Acer Revo mini PC computer complete with Windows 7 arrived in the mail. This was acquired to work with a 10 year old 24″ Acer screen, and to work specifically with our household’s library system, BookCAT, with about 4 000 records, and our 35 mm PlusTek OptiFilm 8200i SE slide scanner, and our 4 000 slides. Except, when the computer arrived, I realized that it could be better put to use as a CNC controller in the workshop. I decided that it would be better to use an existing Asus AiO (All in One) computer for the library system and slide scanner. This had had its original Windows system removed, which meant that it needed to have it reinstalled.

Music Anhedonia

This artwork reproduces the Melophobia sleeve for the 2013 album by Cage the Elephant.

The reason for writing this weblog post is not because of this webloger’s competence in psychology, which is – at best – elementary. Rather, it comes from an attempt to understand music therapy as an approach to relieving depression. It seems to help some people, but not others. Another challenge is to find out why some people find one type of music pleasurable, while something kindred does not produce this type of response, in the same person!

Foreground

French psychologist Théodule-Armand Ribot (1839 – 1916) introduced the term anhedonia in 1896. Prior to this, symptoms were described in 1809 by the English physician John Haslam (1764–1844). Some describe anhedonia as a reduced ability to experience pleasure. Others refer to it as an (emotional) numbing of a reward. Some researchers suggest that anhedonia may result from the breakdown in the brain’s reward system, involving dopamine. They characterize anhedonia as an impaired ability to pursue, experience and/or learn about pleasure. About 70% of people with a diagnosis for depression show signs of anhedonia.

Many researchers distinguish between wanting and liking something. In wanting, it is the anticipation of something such as food/ sex/ music that provides a reward. In liking, it is the consumption of that reward that is pleasurable. These may have biological/ pathological considerations.

Anhedonia is common in people who are dependent on drugs, including alcohol, opioids and nicotine. While anhedonia becomes less severe over time, it is a significant predictor of relapse. People with Parkinson’s disease and Alzheimer’s disease show increased levels of anhedonia. Post traumatic stress disorder (PTSD) patients and schizophrenics display symptoms that correlate strongly with the wanting aspects of anhedonia.

At this point, it could be helpful to distinguish between auditory agnosia, amusica, melophobia and musical anhedonia.

Auditory agnosia is inability to recognize or differentiate between sounds. It is not an ear or hearing defect, but a neurological inability to process sound meaning.

Amusia is a musical disorder that appears mainly as a defect in processing pitch but also encompasses musical memory and recognition. Two main classifications of amusia exist: acquired amusia, a result of brain damage, and congenital amusia, a music-processing deficiency present since birth. Some people with amusia, lose the ability to produce/ understand musical sounds but retain the ability to produce/ understand speech. Other forms may affect rhythm, melody, pitch as well as the emotional aspects of music.

Melophobia refers to a fear of music. Non-academic sources typically want to add irrational to the description, and then describe symptoms as increased heart rate, an increased breathing rate, higher blood pressure, increased muscle tension, trembling and excessive sweating. Also included are increased anxiety thinking about or listening to music, as well as the avoidance of music. Proposed treatments include exposure therapy, cognitive behavioural therapy, anti-anxiety medications, meditation, yoga, exercise and caffeine reduction.

The reason why I take melophobia seriously, and the main reason why I dislike the term irrational being used with it, is the use of melophobia as a mechanism to control violence, in A Clockwork Orange (1962). The protagonist, Alex, is subjected to aversion therapy. He eventually becomes severely ill at the mere thought of violence, but is also prevented from enjoying classical music. The book’s author, Anthony Burgess (1917 – 1993), was a composer, as well as a novelist. Some of the depicted violence in this works can be considered a re-creation of the rape of his pregnant wife, Llewela Isherwood Jones (1920 – 1968), by four American soldiers in 1942, that resulted in the loss of their unborn child.

A film version of the book, directed by Stanley Kubrick (1928 – 1999), appeared in 1971. Another version, depicting even more violence, can be found in a fan-made version of the computer game, Grand Theft Auto 5: Online, from 2015.

While it is fifty years since I have seen the film and attempted to read the book, which remains an uncompleted task, the world seems to imitating the worst aspects of A Clockwork Orange. As I study Ukrainian on Duolingo, I am periodically reminded of Nadsat = -надцать = -teen, a fictional language used in the book and film, with many terms originating in Russian.

Fortunately, there are also positive developments. Natallie Kopp (ca. 1992 – ) provides a different, 21st century, feminine perspective on Melophobia that counterballance A Clockwork Orange. First, she informs readers that she is listening to Melophobia by Cage the Elephant [in 2013] for probably the 325th time.

Then she comments: Cage the Elephant didn’t mean a literal fear of music when naming the album Melophobia. In an MTV interview, [Matt] Shultz [(1983 – ), the group’s frontman] said he viewed the term more as denoting “a fear of creating music to project premeditated images of self, like catering to cool…rather than just trying to be an honest communicator.”

Kopp provides her own definition: a fear of looking bad musically, messing up in public, making the mistakes required for experimentation in a society where your projected image is supposed to bring grown men to their knees.

While I don’t accept the definitions provided by either Shultz or Kopp, I appreciated Kopp’s story, towards the end of her essay. She tells about volunteering at a week-long rock camp for girls and gender non-conforming youth, to lead a comedy workshop. Despite, some of the campers never playing a musical instrument before, in the course of this week they form bands, write an original song, and perform it in front of the rest of the camp in a joyous final concert.

She concludes by admitting that she experiments with sounds: some raw, some weak, some beautiful, some original, and allows her mind to fill in what is missing: accompanying instruments, perfect pitch, a sense of belonging, missed opportunities regained. The resulting music becomes louder than the words. She thinks about what it means to be loud and to be a woman, to be heard/ listened to with authentic imperfection. Her essay gives hope.

For many years, when I wanted to relax I listened to modern classical music, exemplified by Henryk Górecki’s (1933 – 2010) Symphony 3, Op. 36 = Symphony of Sorrowful Songs = Symfonia pieśni żałosnych (Polish) (1976 ). It is not as if I have only listened to classical music. I have allowed other people to impose their musical tastes on me when working, especially students in classroom situations. At home, children had a similar effect. In addition, I have sometimes chosen to listen to other varieties of music, but not normally to relax!

Yet, by constraining myself to listening to a narrow band of music for relaxation purposes, I had imprisoned myself. When I abruptly shifted to listening to other forms of music, exemplified by Nirvana’s Smells Like Teen Spirit (1991) music video, I discovered something unexpected. This forbidden fruit, as it were, eased unwanted mental states, including anxiety and depression. Soon after, I took an interest in music anhedonia, and then other related audio challenges.

Recently, I purchased a synthesizer. It was not to become a musician, but to experiment with sounds. Like Kopp, I expect some sounds will be raw and weak. I don’t expect many to be beautiful or original. Yet, I agree with her that such an instrument allows the mind to fill in what is missing. It has also freed me from some of my expectations. I felt better able to enjoy my present situation, and to accept my fate.

Background

I am a person who has had a tinnitus diagnosis since the age of 50. I learned to live with it fairly quickly. I also live with a person (Trish) who has experienced another hearing disability since about the age of 40: a hearing loss that prevents her from comprehending mid-range sounds, essential for understanding speech. This disability has also eliminated her previous interest in music. Until she lost her hearing she played the piano and guitar, and sang.

To help Trish cope with her hearing situation, there is no background music played in our household. When I listen to music alone, it is always through a headset. I am careful not to play any type of music loudly, because this can worsen my tinnitus.

When Trish and I watch videos together, it is an activity that could involve up to 100 hours a year. I tried to track viewing hours for the past two weeks, but the total number of hours was zero. When we do watch something it is usually a single documentary, lasting up to an hour. I can’t recall the last time we watched a movie or a television series. I do remember watching Tiger King, with my son, Alasdair, although some would also classify this series as a documentary.

Most video content contains incidental music. To watch videos we use a media centre that supplies audio content to a hearing loop that allows heading aid users to receive signals directly in their hearing aids. In addition it is connected to speakers that, optionally, allow signals to be transmitted to a headset.

Many people editing videos do not seem to realize just how disruptive music can be for a person with a hearing disability. Music often overwhelms the spoken content. Thankfully, most videos we watch are now texted. In the worst cases, we turn the sound off, and read the text.

For those obsessed with clinical details

Some researchers report that while wanting or anticipatory deficits correlate with abnormalities in hippocampal, dorsal anterior cingulate cortex and prefrontal regions. while liking or consummatory deficits correlate with abnormalities in the ventral striatum and medial prefrontal cortex.

Auditory agnosia is caused by bilateral damage to the anterior superior temporal gyrus, part of the auditory pathway for sound recognition. In some patients deficit was restricted to spoken words, environmental sounds or music. There is evidence that each of the three sound types (music, environmental sounds, speech) could be recovered independently.

Determining if a person has amusia involves taking a battery of six subtests assessing pitch contour, musical scales, pitch intervals, rhythm, meter, and memory. An individual is considered amusic if they perform two standard deviations below the mean of musically-competent controls.

This weblog post was originally written: 2021-06-05 at 10:20. It was revised 2022-11-06 starting at 20:30.

Extreme Heat Belt

The counties marked in red are expected to experience temperatures of 125 °F = 51.67 °C at least one day a year, by 2053. This area is referred to by some as the Extreme Heat Belt. Screenshot of an Axios map, without the underlying data provided at the county level by the First Street Foundation.

The mission statement of the First Street Foundation reads: Make climate risk accessible, easy to understand and actionable for individuals, governments, and industry. A changing climate is impacting the risks facing American properties, communities, and businesses as perils like flood, fire, heat, and drought become more common, and more severe…. First Street Foundation is a non-profit research and technology group dedicated to quantifying and communicating those risks by incorporating world class modeling techniques and analysis with the most up to date science available in order to simply, and effectively, inform Americans of their risk today and into the future from all environmental changes.

Extreme heat refers to a maximum heat index greater than 125°F. This refers to a temperature reached at least one day a year. Currently (that is, in 2022) 8 million Americans are exposed to it. By 2030, some additional coastal areas in the Southeast and Mid-Atlantic may also experience a heat index at or above 125°F. By 2053, the number of people exposed to extreme temperatures, is expected to increase to 107 million people.

Dangerous days have a heat index greater than 100 °F = 37.78 °C. The Gulf Coast and Southeast will see the highest chances and longest duration of exposure to these. While many place experience more than 20 consecutive days with heat indices above 100°F, by 2053, these streaks could involve up to 74 consecutive days.

Local hot days are days that exceed the temperatures typically experienced for a particular area. The West will have the highest chance of long durations of these.

Future cooling-driven increases in carbon emissions could aggravate warming further. Texas, Florida, California, Ohio and Missouri are the top 5 states with the greatest cooling demand expected increase in CO2 emissions between 2022 and 2053.

As a missionary for SI, the international system of units, temperature always presents a quandary. In this official system, temperature is measured in kelvin, with symbol K. Both the kelvin and celsius systems use a 100 K/ °C difference between the freezing and boiling point of water, at a standard/ sea-level air pressure reading.

0 K is set to absolute zero, which is -273.15 °C, while 0 °C, in the celsius system, is set to the freezing point of water. In the Fahrenheit system, water freezes at 32 °F = 0 °C and boils at 212 °F = 100 °C, resulting in a 180 °F difference between these two points.. Thus, 125 °F = 324.8167 K.

SI clergy undoubtedly use many nights, sleeplessly pondering if the extreme heat value should be increased to 325 K = 125.33 °F, or if 50 °C = 122 °F, should be used. Those prioritizing as little change as possible will support the former. Those wanting to use rounder values, ending in 0, will opt for the latter. The reason for this proposal is that the world needs a mechanism to compare extreme heat locations, which will require heat to be expressed in degrees celsius. This is why, personally, 50 °C holds greater appeal, even if more locations in the world will fall into that category.

Those wishing to be further perplexed by this topic, are invited to read the Wikipedia article on thermodynamic temperature. In an imperfect world, every gram of improved understanding is worth the effort.

WBT

WBT = wet-bulb temperature. Yes, I appreciate short, cryptic post titles. That said, there is a serious point to this post, with life-saving potential, related to heatwaves.

A digital psychrometer (combined dry and wet-bulb thermometer).
The functions available with a modern psychrometer.

When a wet cloth/ wick covers the bulb of a thermometer, evaporation of the water cools the thermometer. This results in a WBT, which is equal to or below the dry temperature, measured on a thermometer without a wet cloth. The WBT reading reflects the humidity in the atmosphere. Humidity refers to the relative saturation of air with water. Low humidity means there is not much water in the air; high humidity means lots of water in the air. When the air can hold no more water, it is totally saturated. It is referred to as 100% relative humidity (RH). Air at a higher temperature is able to hold more water vapour, than air at a lower temperature.

A related concept is that of dew point = the temperature to which air must be cooled to become saturated with water vapor, at the current relative humidity. At, and below this temperature, water vapor condenses to form dew, a liquid state of water.

WBT is important because it can measure heat-stress conditions, that affect many people. In fact, a high WBT can kill them. This happened mainly from 2021-06-24 to 2021-07-01 in British Columbia. At 100% RH, the WBT will equal the dry temperature.

A combined dry and wet-bulb thermometer is referred to as a psychrometer. While analogue models are available, they require either calculations or the reading of graphs to determine values. One should not overestimate the ability of a person to perform even simple calculations, when they are potentially dying of heat stroke. Digital models can be purchased at relatively low cost that do all of the calculations automatically. The model illustrated above costs NOK 255 = US$ 26.38 = CA$ 33.72, including taxes and delivery charges to Norway (as of 2022-08-01). The quality of this particular model has not been evaluated.

At Cliff Cottage, we have recently received temperature and humidity sensors that will be part of our weather station, a subsystem of our home automation system. These components are considerably cheaper than the Habotest model, but require electrical and mechanical work, as well as programming, to implement as a system. Thus, the first iteration does not produce a cost effective system, may be frustrating to make, but will give satisfaction when completed.

From 2021-06-20 to 2021-07-29, the British Columbia Coroners Service, reported the following heat related deaths, in the table below. There are some who feel the number of deaths were under reported. Note that 445 of the 569 deaths (78%) occurred during the transition week, between June and July.

Age Group# of Deaths 
<40 2
40-49 13
50-59 42
60-69127
70-79160
80-89149
90+ 76
Total 569
Heat related deaths during the summer of 2021. Source: British Columbia Coroners Service.

British Columbia, was only one of many jurisdictions, that faced heat challenges in 2021. Temperature records are being broken regularly, throughout the world. In the United States, every state and territory had a maximum temperature that exceeded 37 °C. Of these 46 entities, only six had recorded maximum temperatures below 40 °C. Four states, had maximum temperatures at or exceeding 50 °C: New Mexico, 50 °C; Nevada, 52 °C; Arizona, 53 °C; and, the highest, California, 57 °C. In Canada, Lytton, British Columbia, distinguished itself with 49.6 °C, on 2021-06-29, the maximum ever recorded in the country. The next day, a wildfire destroyed most of the town. In Norway, the highest temperature recorded is 35.6 °C, at Nesbyen, on 1970-06-20.

The challenge with these high temperature values, is that they do not take into consideration humidity, which determines how people experience heat. Some locations on planet Earth may be approaching values that prevent human survivability. The countries most affected are Saudi Arabia and other Arabian Gulf states, Pakistan, India and Australia. What is not fully appreciated, is that indoor climates in temperate zones, can also create conditions that kill people during heat waves.

The difference between WBT and dry temperature, measures how effective people can cool themselves by sweating. Admittedly, this is a simplification because, in addition to humidity and temperature, solar radiation and wind speed are other factors that affect survivability. Yet, WBT is especially important in indoor environments, where deaths often occur in heatwaves.

Sweating above WBT will no longer cool down a person, but lead to a steady rise in body temperature. This is the limit of human adaptability to extreme heat. If a person cannot escape these conditions, their body’s core temperature will rise beyond the survivable range, and organs will start to fail.

The critical WBT value for humans was usually considered to be 35 °C, indicating a situation where a healthy person could survive for six hours. One representation of this is an air temperature of 40 °C, and a relative humidity of 75%. This value comes from a 2010 theoretical study. However, research by Vecellio et al., found that this value only applied to young healthy people. Real-world data indicates that the critical WBT value is closer to 31.5 °C.

This means that the numbers of people exposed to potentially deadly combinations of heat and humidity across the world would be vastly higher than previously thought. Many older and compromised people will experience dangerous conditions far below the threshold WBT.

In Canada, the humidex = humidity index has been used since 1965 to describe how hot the weather feels to the average person. It is a nominally dimensionless quantity, calculated from °C and the dew point. Values of: 20 to 29: little to no discomfort; 30 to 39: some discomfort; 40 to 45: great discomfort, avoid exertion; above 45: dangerous; heat stroke possible/ probable.

Humidex plot (Source: Morn, using Matplotlib code)

The American Heat Index (HI) was developed from the Humidex in 1979. It is calculated using °F or °C and relative humidity. It makes assumptions about: human body mass, height, clothing, level of physical activity, individual heat tolerance, sunlight exposure, ultraviolet radiation exposure, and wind speed. Significant deviations from these will result in heat index values which do not accurately reflect the perceived temperature.

Heat Index plot (Source: Morn, using Matplotlib code)

In many situations, building construction results in indoor temperatures exceeding outdoor temperatures. Construction methods may prohibit water saturated air from leaving a building. In climates with high humidity, such as along the Gulf of Mexico coast and even on the Atlantic coast of Florida, in the United States, it is often common to use a vapour barrier close to the outer wall, with negative consequences during heatwaves. Sometimes the best solution is to omit a vapour barrier. This is the opposite of the approach used in cold climates, such as Canada, Norway and northern United States where the vapour barrier is located on the inside of the outer wall.

Heatwave Precautions

Since many of the readers of this weblog are older, it is important for them to know what to do when temperatures rise.

A first step is to realize that an indoor environment can be particularly deadly, in part because there is no wind to increase evaporation rates, needed for effective sweating/ perspiration.

A second step is to track indoor temperatures. Even without a psychrometer or wet-bulb thermometer, one knows that the WBT will be below this dry temperature. This means that temperatures should probably not be allowed to rise above, say, 30 °C, without taking some action. Thus, moving to a shady, outdoor location, may reduce risk, compared with staying indoors.

Air conditioning units are another solution, but not everyone can afford them. Their acquisition typically has to be planned well in advance of a heatwave. Fans can be effective at increasing the quantity of air available for evaporation, but they usually should be used with an open window.

In some places, special shelters have been built/ commissioned, that people can visit without charge to find heat relief. While many people will search for information online about shelters located near them, there are other sources of information available. Public libraries are a great place to find this sort of information.

World Plumbing Day

Friday, 2022-03-11 is world plumbing day 2022! Starting today, I am using this day, once a year, to inspect the plumbing at Cliff Cottage. It was inspired by an event on Sunday, 2021-07-25 when wastewater from the washing machine started to back up over the bathroom floor. The piping leading from the washing machine was clogged. It had probably gone at least a decade since the piping was last checked.

After an hour’s work spread over two days, everything worked normally again. To prevent these sorts of emergencies in the future, I decided that the best way was to perform preventative maintenance once a year. I googled plumbing day, and discovered it was an event happening around the world, on this date that started in 2010.

There are several similar days throughout the year that I won’t be celebrating, in part because they are too similar: World Water Day = 03-22; World Cleanup Day = 09-15; Global Handwashing Day = 10-15; World Toilet Day = 11-19. Yes, on this weblog, International Standard ISO 8601 is used for dates, in the format YYYY-MM-DD. Here, only MM-DD appear.

It is very easy to avoid/ postpone preventative maintenance activities. Thus, a fixed date, once a year, helps people schedule activities. In Norway, 12-01 is set aside as Smoke Detector Day. Batteries on all of the smoke detectors in the house are replaced once a year on that date, with the older batteries recycled to power less critical operations, or given to the public library that has taken over the techno workshop.

Other days that could be useful for doing related maintenance and other work, include: Global Recycling Day = 03-18; World Gardening Day = 04-14; Naturalists may prefer Naked Gardening Day, which is the first Saturday in May, In 2022 that is 05-07.

Voluntary Assignment: Are there other days in the year that should be set aside/ used for various maintenance activities? If so, please share these as a comment.

Not just days, but years and decades

Since this is 2022, it is the International Year of Artisanal Fisheries and Aquaculture. Artisanal fishing consists of various small-scale, low-technology, low-capital, fishing practices undertaken by individual fishing households, often coastal or island ethnic groups that make short fishing trips close to the shore. In 2023, it will be the International year of Millets. Millets are highly variable small-seeded grasses, widely grown around the world as cereal crops or grains for fodder = animal feed, and human food. Millets are important crops in the semiarid tropics of Asia and Africa (especially in India, Mali, Nigeria, and Niger). 97% of millet production occurs in developing countries. The crop is favoured due to its productivity and short growing season under dry, high-temperature conditions.

The period from 2021 to 2030 is the United Nations Decade on Ecosystem Restoration. It would also be fun to hear from other people on how they are approaching this task.

World Water Day (03-22) was an event I managed at Leksvik senior secondary school. The municipality of Leksvik (now amalgamated with Rissa to form Indre-Fossen) is adjacent to Inderøy. It hosted numerous companies making water related products, everything from domestic faucets, long-length infrastructure piping and and valves for ship ballast systems, to containerized desalination equipment. Many of the companies producing these products have now sold off their product lines, or moved, either abroad or to other parts of Norway. The school received funding to start a project with a focus on energy and water. In 2008, I was hired as project manager. My focus was on building and using submersibles = remotely operated vehicles (ROVs). I also transformed the building housing the project into Nautilus, a virtual submarine. It took its name from the Jules Verne’s (1828 – 1905) fictional submarine featured in his novels Twenty Thousand Leagues Under the Sea (1870) and The Mysterious Island (1874). When I worked there, the school celebrated World Water Day from 2009 to 2015.

Note: When published it was claimed that World Water Day and World Goth Day shared the same date. They do not. World Water Day is 03-22, while World Goth Day is 05-22. Updated: 2022-03-23 at 19:30.

Nightscout

The Nightscout logo and motto/ hashtag.

Today’s weblog post focuses on Nightscout, a social movement for Type 1 diabetics, and their parents, that enables them to access and work with continuous glucose monitor (CGM) data and open-source tools, so they are better able to manage their condition. They describe themselves as CGM in the Clouds,

In healthy people the pancreas regulates blood sugar. It works continuously without intervention. Diabetics have to take control, and inject insulin using syringes, although in recent years it has become more common to use an insulin pump connected to the body and providing an even base dose. It is difficult for people to adjust insulin levels which have to continuously monitored and adjusted for the rest of the patient’s life.

There are three main types of diabetes mellitus (DM): 1) Type 1 results from the pancreas’s failure to produce enough insulin due to a loss of beta cells; 2) Type 2 begins with insulin resistance, a condition in which cells fail to respond to insulin properly, but may result in a lack of insulin, as the disease progresses; 3) Gestational diabetes occurs when pregnant women, without a previous history of diabetes, develop high blood sugar levels.

According to the IDF Diabetes Atlas, 9th edition, an estimated 463 million people had DM worldwide (8.8% of the adult population), in 2019, with type 2 making up about 90% of the cases.

Legacy medical equipment companies, much like legacy automotive companies, perpetuate their market share by making it intolerably expensive for new companies to become established. In the automotive world, this is in part because of the extreme cost of setting up manufacturing facilities. With medical equipment, it is the cost of gaining approval in assorted jurisdictions. In the USA, for example, the Food and Drug Administration (FDA) regulates the sale of medical device products. Manufacturers (or their sales agents) must present evidence that the device is reasonably safe and effective for a particular use.

The high cost of market participation, means that legacy manufacturers can avoid/ discourage innovation, which helps improve profit margins, but denies patients access to improved technology. This is what nerds, patients and relatives have now managed to solve with Nightscout, for diabetics. It is a do-it-yourself DM tech community. It first developed data-sharing tools. More recently, an open-source closed loop artificial pancreas system has been developed.

Wikipedia says that Nightscout began in 2013-02 , when the parents of a 4-year-old boy newly diagnosed with type 1 diabetes began using a CGM system. When the child was at school there was way to access this data in real time. The boy’s father, John Costik, a software engineer, developed software to access and transfer CGM data to cloud computing infrastructure. Lane Desborough and Ross Naylor added a blood glucose chart display. A community of developers emerged to make the software generally accessible. Because this software amounted to an unlicensed medical device, it was not released immediately as open source code to address legal concerns. After this was done, the combined code was released in 2014 as the Nightscout Project.

In another part of cyberspace, Loop started off as an Apple-only framework and algorithm that runs on an iPhone, worked with older Medtronic insulin pumps and requires a small box, the RileyLink, to communicate between the pump and smartphone. It was created in large part by Pete Schwamb. An unknown number of people use this technology.

OpenAPS

The Open Artificial Pancreas System project (OpenAPS) is an open and transparent effort to make safe and effective basic artificial pancreas system technology widely available. It began in 2013, when Dana M. Lewis and Scott Leibrand became aware of the software created by John Costik. The OpenAPS software can run on a single-board computer, such as a Raspberry Pi.

Lewis, who has a DM Type 1 condition, was dissatisfied with her commercial device, because its hypoglycemic status alarm was too quiet to wake her. To address this, Lewis and Leibrand extended the CGM-in-the-cloud software to create a custom high volume alarm. They then used the same CGM-in-the-cloud software to create Do-It-Yourself Pancreas System (DIYPS) software, which provided a decision assist system for insulin delivery. This become a closed loop system using open-source decoding-carelink software created by Ben West to communicate with Medtronic insulin pumps, enabling data retrieval and issuance of insulin-dosing commands to pumps that support it. With this update, the DIYPS system became OpenAPS.

Its stated aim of OpenAPS is “to more quickly improve and save as many lives as possible and reduce the burden of Type 1 diabetes.” Their website states that “community efforts will be open source and free for use for other people, open source projects, researchers, and non-profits to use, and available on an open and non-discriminatory basis for all commercial manufacturers to use in proprietary products if desired.”

OpenAPS differs from other APS currently in clinical trials in two significant ways: 1, it is designed to use existing approved medical devices, commodity hardware, and open source software, and 2. it is designed primarily for safety, understandability, and interoperability with existing treatment approaches and existing devices. Those concerned about safety issues are encouraged to read this statement of principles.

An aside: In researching this post, one article in particular highlighted the need for professionalism in the production of code. In this case, the anonymous coder was unable to understand contextual issues. Obviously, many of the projects mentioned here have been professionally run. However, it is very common to encounter code written by amateurs, that is unsuitable for real-world use. The advantage of using people with a medical condition is that they have internalized much of the contextual information needed to produce appropriate code, even if they are amateurs.

Closed loop artificial pancreas systems integrate a glucose monitor with an insulin pump, using connecting controller software (such as assorted varieties of Loop). The system’s purpose is to keep blood glucose levels within a specified desired range for as long as possible. This can reduce damage to kidneys, retinas and nerves.

Since Nightscout is Do-It-Yourself (DIY), the onus is on the user to provide and deploy any and all resources needed, such as the MongoDB database, a web host and other software. This can result in many barriers, that prevent potential users from enjoying Nightscout’s benefits.

Recently, on 2020-11-20, Medical Data Systems LLC met with and formally petitioned the FDA for clearance of the service product “T1Pal.com.” T1Pal.com is a hosted Nightscout platform that runs copies of the latest Nightscout software on its servers for the benefit of individual subscribers.T1Pal is a hosted Nightscout platform running the latest version of Nightscout on its servers. It provides subscribers with Nightscout as a Service. This means that Medical Data Systems LLC takes responsibility for maintaining and updating the site. T1Pal was designed by Ben West, a member of the original CGM in the Cloud team and lead core developer for the Nightscout Project. A subscription costs US$ 12/ month and upwards, depending on the services provided.

Tidepool

Originally, this post had intended to focus on Tidepool, a Palo Alto, California based nonprofit company founded by Howard Look in 2013. The company works with medical equipment manufacturers, such as Dexcom and Medtronic, to create interoperable automated insulin pump systems, communicating with iPhone and Android apps.

Tidepool wanted to build a database where people with insulin-dependent diabetes could store and analyse data about their condition. Its iOS and Android apps and web system, allow users to add and view CGM related data to gain better insights into their condition. This data can be shared with health personell.

As stated in the previous weblog post on telemedicine, some equipment and software providers assume they own patient data. These companies have very disturbing privacy policies. Tidepool encouraged equipment manufacturers to develop systems that would work with Tidepool software. They elminated some of the friction, by setting up a (not-for-profit) foundation to administrate collected data.

Tidepool Loop will be its next big step, What I have been unable to discover is wny users would prefer yet another open-source closed loop artificial pancrease system, where the openAPS already seems to feature one, not to mention the RileyLook.

Developing open-source software can be messy. Sometimes, work is duplicated, and at other times, nobody is doing the work at all. The people who have a vested interest in mitigating a health condition, or in the case of Type 1 diabetes, their parents, will develop breakthrough improvements that manufacturers seldom prioritize. Software is cheap to produce, especially if development time is freely given. My expectation is that additional improvements in hardware will also come in the future, as open-hardware, as increasing numbers of people invest in CNC hardware, that can build precise equipment inexpensively.

Some sources:

Off topic: Wyze Watch

This blogger has pre-ordered two Wyze smart watches using a facilitator in the United States, for delivery in 2020-03. This pre-order opportunity is restricted to addresses in USA, and is ending a week after the planned publication of this weblog post, on 2020-12-22. The unit price is about US$ 20, excluding taxes, shipping, non-black watch strap and who knows what else. These two watches will be used initially for experimental purposes.

Telemedicine

The Psion Organizer II (1986) was one of the first hand-held devices, later referred to as a personal digital assistant (PDA) when Apple launched the Apple Newton (1992). Other important devices that led to today’s ubiquitous smartphone, include the Nokia 9000 Communicator (1996) and the Palm Pilot (1997) . Throughout this time frame many companies and organizations developed medical content to support the use of these devices in medical situations, including physicians’ offices and hospital wards.

Telemedicine? Telehealth? eHealth? Different people and organizations use different terms to describe the same subject. The World Health Organization (WHO) uses telemedicine to describe all aspects of remote health care including preventive care. In Europe, the more general term is eHealth, which is more than just Internet medicine, but almost everything related to computers and medicine. There is a branch of this referred to as mHealth, with a focus on hand-held devices (smartphones aka – in Europe – mobile phones = cell phones). In USA, the operative term is telehealth which also includes non-clinical services. There, telemedicine refers to remote clinical services. Here, the WHO definition is used.

The purpose of this post is to encourage people to engage in a dialogue about telemedicine, generally, but especially with the appropriate authorities where they live. They should let the world know what telemedicine services they need and want … along with additional insights and information, incorporated in the usual questions: Where? When? Why? and How?

Unfortunately, most people do not know very much about telemedicine. Thus as a first step it may be useful to read the Wikipedia article on it.

The pandemic has shown that many things need to be done differently, including health care. No prospective patients should have to travel to a (crowded?) doctor’s office to have a prescription renewed, or blood pressure measured. The first, could just involve a simple e-mail request, the second – an example of remote monitoring – could involve a patient attaching the cuff of a blood pressure monitor to their upper arm at home, in such a way that the device can measure systolic and diastolic pressure, keep track of the results in a home medical journal, and send them onwards to the appropriate health centre, especially if there is an apparent need to adjust medications or discuss lifestyle changes. In general, the advantages of telemedicine are: greater patient satisfaction and cost-effectiveness, with comparable health outcomes.

At the time of writing, Trøndelag county has the lowest incidence of COVID-19 in Europe, with less than 20 infected people per 100 000. Why? First, there are very few immigrants and other foreigners, which means that almost the entire population understands the relevant rules. There have been problems in other areas of Norway because the Norwegian government has insisted in communicating unilingually in Norwegian, and – until recently – has not made provision for translations. This means that immigrants have not been given information, in a language they understand. Second, and more importantly, people have followed the rules. They may not like them. They may complain. Yet, they follow them. Because they are followed, and the COVID-19 infection rates are reduced, there is a lighter touch in terms of regulations, than in many other areas of the world.

Update: 2020-12-08 11:34 (Less than half an hour before this is scheduled to be published). There has been a new COVID-19 outbreak in Trondheim. Maybe our county is no longer best in Europe, I don’t know. However, the outbreak seems to affect many Eritrean immigrants, and the government specifically asked them to get tested. So, even governments are learning how to do things differently.

Why is USA so different from Trøndelag? The answer may lie with Maggy Thatcher, and her good buddy, Ronny Reagan. “There is no such thing as society: there are individual men and women, and there are families,” Margaret Thatcher (1925 – 2013) said, as reported in Woman’s Own, 1987-10-31. Libertarians such as Thatcher, Ronald Reagan (1911 – 2004), Donald Trump (1946 – ), Boris Johnson (1964 – ) and more, don’t seem to believe in society, social norms, or in following rules. When people fail to follow rules in the middle of a pandemic, bad things happen.

Another problem in the US is that so much of the health care is provided by for-profit businesses, that have their own vested interests and approaches to the pandemic. They are not so much interested in reducing/ eliminating the pandemic, as they are in maximizing their profit, or at least reducing their loses. Even in Norway, there has been privitization in the health sector, that has had negative consequences.

For twenty years, or so, I had B12 injections, every three months. For the first twelve years or so, it was possible to make an appointment for an injection. Thus, I would visit the medical centre, wait perhaps five minutes, receive an injection, then leave. Then, suddenly, about the time the municipal run health service became a privately owned one, appointments for injections were no longer possible. Patients just had to take a chance and meet up. Personally, I didn’t appreciate this new system because the time spent waiting increased significantly. The health service no longer valued my time. Then, one August, I discovered that I had failed to receive an injection in May. I had met up, but the nurse was so overworked that I was asked to come back another day. Unfortunately, I quickly forgot about that, and my calendar showed a B12 shot being given. There had been no follow up from the medical centre alerting me to the missed injection. There is no reason for this lack of follow-up. It is very easy to implement in a data system. In fact, I had worked on this very type of problem earlier.

Back in the late 1980s I had worked with HUNT (Helseundersøkelse i Nord-Trøndelag. Now known in English as the Trøndelag Health Study, after the merger of Nord- and Sør-Trøndelag in 2020) and had made a mock hypertext version of their standard procedures for hypertension (high blood pressure) and diabetes. This demonstrated how data-mining of a patient journal could be used to collect data about these two conditions, and alert the patient’s doctor (and ultimately, the patient) when anomalies emerged. In 1991, one of my former students received a grant to start a company InfoTech AS, to make a real-world version of this. The major problem was that the privately-owned providers of patient journals regarded patient data as their own personal property, and would not co-operate. This was, in part, because the Norwegian government had not taken privacy concerns about patient data seriously.

Now, in 2020 in the middle of a pandemic, nobody is allowed to just meet up at a medical centre, for an injection, or anything else. Appointments have to be made for everything. When I had my annual check up with my GP, he looked at my chart, and could see immediately my one and only medication. With a new national change in policy away from B12 injections to B12 tablets, he asked me if I wanted to take B12 pills, instead of an injection? There was no doubt in my mind that I would prefer them, and so it was arranged.

What is irritating about this situation is that there should be absolutely no problem alerting everyone with a B12 deficiency problem (or any other medical situation) about tablets being allowed to substitute for injections, or any other improvement. It is simply that the medical profession is living in the past, and is not aware of the potential offered by data-mining, and similar computing techniques.

It is important for people to keep abreast of new developments, and to reflect over their own needs. They also need to contact politicians and others to make changes that will improve society. Health is important.