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Patients undergoing surgery do not often receive practical advice about what to do and what to expect during the recovery process, says a surgeon who has been on the giving and receiving end of post-op instructions. 

These directions need a more commonsense approach to rest, diet and pain, J. David Richardson of the University of Louisville School of Medicine in Kentucky writes in the Journal of the American College of Surgeons. 

“We give patients these catchphrases about how they’ll feel better, but that’s not always true,” Richardson told Reuters Health. 

After 40 years of practice as a surgeon, and having undergone 40 operations himself, Richardson sees the need for practical advice, especially as minimally invasive procedures become more popular, and patients are discharged from the hospital quickly to recover at home. 

“For a long time, surgeons have been happy with surgical outcomes as long as a big issue didn’t come up, such as an infection,” he said in a phone interview. “Patients are concerned about the small aspects of recovery, and we should be attuned to that.” 

One of the most important tenets of recovery, he writes in his commentary, is that it is not a progressive linear process. The advice that “You will feel better every day” is not true, for example, and it often makes patients uneasy when they do not recover as they believe they should. Instead, patients tend to have a “stuttering progression to wellness”, Richardson writes, which means three steps forward and two steps back. When patients are aware of this, they are less apprehensive and less discouraged when they have a “bad day”. Rather than measuring progress daily, he advises tracking progress from one on Friday to the next. 

“Some days just don’t go that well, which is the way the body functions,” he told Reuters Health. “Patients need to know that what they’re going through is normal”. 

Richardson also disagrees with the advice to recovering patients about activities, “You can do what you feel like doing.” Although it sounds practical, this often backfires or discourages patients as they go through the healing process. Some feel great after waking up but then have fatigue or adverse reactions later in the day. Those who try to drive, shop or return to work too quickly may “hit a wall”, he notes. 

The body needs a physical recovery as much as a mental recovery, he notes, so he often tells patients to be cautious about performing mental tasks after a significant operation. Avoid “trying to work in a fog” or making important decisions in early post-operative stages, Richardson said. 

“Earlier in my career, patients were in the hospital for days and would come in the night before surgery to prepare and discuss more details,” he said. “There’s a time pressure difference now and an enormous push to get people out of the hospital.” 

Diet is another aspect that is often misrepresented, and the advice to “Eat what you feel like eating” can be too vague. Instead, a slower progression to a full normal diet could prevent nausea, vomiting, bloating, constipation and other gastrointestinal issues that occur during the early recovery phase. This is particularly true when patients are taking new pain medications, Richardson added. 

On a related note, pain management can also be misleading, he said. The opioid crisis speaks to the dangers of over-prescribing pain drugs, and points to the fact that pain is an individual response. Some patients require fewer doses, and others need heavy doses, but prescriptions are often given “by the book” where one size fits all. A more nuanced, individualised approach would help, taking into account previous pain medication use, psychotropic medication use and previous operation recovery experience. 

“Patients have little information about recovery in part because patients’ experiences are unique depending on their operation, fitness and psychology,” said Richard Kwasnicki of Imperial College London in the UK, who was not involved in the commentary. 

Kwasnicki studies how wearable sensors can help patients during post-operative care through reassurance and motivation to complete their rehabilitation goals. 

“When recovery is slow, it is often difficult to see the small incremental improvements,” he said in an e-mail. 

WASHINGTON — An American adventurer has become the first person to complete a solo trek across Antarctica without assistance of any kind.

Colin O'Brady, 33, took 54 days to complete the nearly1,600-kilometre crossing of the frozen continent from coast to coast.

In an Instagram post, he explained his journey ended upon crossing the edge of the Ross Ice Shelf: The point where Antarctica's land mass ends. It lies at the head of Ross Sea, a deep bay of the Southern Ocean.

"I accomplished my goal: To become the first person in history to traverse the continent of Antarctica coast to coast solo, unsupported and unaided," O'Brady wrote in an Instagram post after covering the final 124 kiliometre in 32 hours.

"While the last 32 hours were some of the most challenging hours of my life, they have quite honestly been some of the best moments I have ever experienced," he wrote.

"I was locked in a deep flow state the entire time, equally focused on the end goal, while allowing my mind to recount the profound lessons of this journey. I'm delirious writing this as I haven't slept yet."

His voyage was tracked by GPS, and live updates of the trip were provided daily on his website
colinobrady.com.

O'Brady and an Englishman, army Captain Louis Rudd, 49, set off individually on November 3 from Union Glacier in a bid to be the first to complete a solo, unassisted crossing of Antarctica.

In 1996-97, a Norwegian polar explorer, Borge Ousland, made the first solo crossing of Antarctica but he was wind-aided by kites on his voyage.

Finishing 'in one go' 

O'Brady and Rudd set off on cross-country skis dragging sleds called pulks which weighed nearly 180 kilogrammes.

O'Brady reached the South Pole on December 12, the 40th day of his journey.

He arrived at the finish point on the Ross Ice Shelf on the Pacific Ocean on Wednesday after covering a total of 1,482 kilometres.

Rudd is about a day or two behind.

O'Brady said he made the decision over breakfast to finish his journey in one continuous push — which he dubbed an "Antarctica Ultramarathon".

"As I was boiling water for my morning oatmeal, a seemingly impossible question popped into my head," O'Brady wrote on Instagram. "I wonder, would [it] be possible to do one straight continuous push all the way to the end?”

"By the time I was lacing up my boots the impossible plan had become a solidified goal," he said. "I'm going to push on and try to finish all 80 miles [129 kilometres]  to the end in one go."

The New York Times described O'Brady's effort as among the "most remarkable feats in polar history", ranking alongside the 1911 "Race to the South Pole" between Norway's Roald Amundsen and England's Robert Falcon Scott.

"To complete the final 77.54 miles [124 kilometres] in one shot — essentially tacking an ultra marathon onto the 53rd day of an already unprecedented journey — set an even higher bar for anyone who tries to surpass it," the Times wrote.

In 2016, an English army officer, Lieutenant Colonel Henry Worsley, died while trying to complete an unassisted solo crossing of Antarctica. 

A new technology is making it more and more difficult to believe what we see on the web, and even on regular satellite TV channels. The Internet is already full of much audiovisual content that aims to deceive us. The next phase, however, may prove to be even more incredible.

Forget about fake news, made up videos and Photoshopped photos. This is nothing compared to the much more deceptive digital material that is coming your way.

And it is coming from Nvidia, the well-known US-based maker of computer graphic cards, (the graphic card inside your computer is the part that generates the image you see on the screen). The importance of that card, also called video card or more formally GPU (Graphics Processing Unit), cannot be overestimated.

Such cards range from simple to extremely complex, and consequently from inexpensive to very expensive, or from as low as $100 to as high as $1,800. Therefore, the GPU inside a computer that is intended for intensive work or advanced gaming may end up costing as much, if not more than a good laptop computer.

Nvidia recently released news that by building on a specific artificial intelligence (AI) technology, which began about five years ago, the company has shown virtual “human” faces that were completely generated by a system called “generative adversarial network”. These faces are so real that even a trained eye cannot say for certain that they are virtual.

In other words, these are faces of people who simply do not exist but who look absolutely, perfectly, like people who could exist; like real human beings. Those curious to see how exactly they look can go to this URL https://petapixel.com/2018/12/17/these-portraits-were-made-by-ai-none-of-these-people-exist/

Obviously, these portraits are nothing like the robotic or humanoid faces we often see in movies or games. The technology that Nvidia uses to generate them is complex and employs several powerful GPUs at one time to get the job done. The above web URL gives some information about the process. It uses a combination of real portraits and then several criteria, along with a description, to “construct” the new faces.

Understandably, Nvidia’s technology can be applied to generate not only human faces but also animals, objects and places that, again, do not exist but look perfectly believable, as being real.

As with any new, sensational technology, there will be legitimate use for it, alongside less legitimate. We can easily imagine for instance, how entirely fake Facebook accounts could be created this way just by using a rather attractive profile photo generated by Nvidia’s new phototechnology.

In addition to off-the-shelf laptop and desktop computers that use Nvidia GPUs, the company’s powerful graphics processors can be found in specialised, custom-built computers, like for instance those employed in the flying or driving simulators that are used in training. The Royal Automobile Club of Jordan operates a driving simulator that uses Nvidia’s powerful GPUs.

In countless cases, advanced digital computer technology is already making it hard to draw the line between the real and the virtual. This is nothing new. However, Nvidia’s new image generating technology is taking the challenge to new heights, to a new dimension in virtual imaging.

Who will use it in legitimate constructive applications, and who will use it for deception, remains to be seen.

There is also little doubt that other designers and manufacturers of graphics cards for computer will follow suit, like AMD with its Radeon GPUs.

I do not know how it is these days, but during my time, no student really liked being handed the annual report card at school— that official looking folder, you know, which communicated a pupil’s academic performance for the year. 

There was no joy in being told, especially by a stern looking bespectacled nun that one’s work was substandard and one could do better by putting one’s heart into it. 

How exactly to put your heart into solving unsolvable mathematical calculations, was never explained. It was just assumed that by rigorous practice and by repeated trial and error, one would somehow grasp the basics of Sine, Cosine, Tangent and Theta of trigonometry.

But, many of us never did manage that, and ended up avoiding anything involving arithmetic — for the rest of our lives. 

Childhood traumas take a long time to heal. I had a friend in South Africa who ran a successful restaurant business because he failed his 10th exam at school. Even after a span of three decades, he recounted the incident to me as if it had happened yesterday. 

Math was his weak subject, he said, so he had slogged doubly hard for it during his board examinations. He thought that he had done pretty well in the test, so when the results were to be announced he dressed in his favourite white shirt and trousers, and waited at the entrance of his house for his father to get the report card at home 

When his Dad got out of the car, my friend rushed towards him, hoping he would get a congratulatory hug, but as he got closer, his father swung around and gave him a tight slap! 

In those days, it was not illegal to smack your kids if they did badly at school, and my friend had failed miserably. 

He walked out of the house immediately following that event, asked around and got a job as a waiter in a coffee shop, and subsequently worked his way up to become one of the wealthiest restaurateurs on the continent. 

Meanwhile, my personal annual report, documenting the year I have spent on Paradise Island in Mauritius is rather sketchy. I have succeeded in putting my house in order (took two months), clearing my car at customs (ten months), planting a flowery bush by the desolate front porch (took five months) and hanging the paintings and pictures on the appropriate walls (several months). 

What I have been completely unsuccessful in doing is figuring out the predictions of the weather-people, especially when he or she forecasts a cyclone. 

Cyclones are a regular feature here. Berguitta visited us in January while Alcide, Bouchra, Kenanga and Cilida made their presence felt during the next few months. 

In fact, Cyclone Cilida was supposed to cause severe devastation this weekend, with the metrological department raising the cyclone to a class 3. 

Accordingly, on Sunday I secured the doors and windows, kept a lot of candles handy, stored drinking water, followed the cyclone bulletins on TV and waited. Nothing happened!

“The sun’s shining brightly,” my husband announced.

“Must be the calm before the storm,” I told him. 

“It has stopped raining too,” he continued. 

I picked up my diary. 

“What are you doing?” he asked. 

“Making an annual report,” I mumbled. 

“What does it say?” asked my spouse. 

“Next year, whatever you plan,” I scribbled. 

“Never trust a weather man,” I read out. 

Isotretinoin, a drug for severe chronic acne, has long been linked to miscarriages, birth defects and other serious problems, but a research review suggests much of data on the drug’s safety, effectiveness and side effects may be unreliable. 

The analysis in the Cochrane Database of Systematic Reviews concludes that the available evidence is of such low quality that it is hard to say for sure how well isotretinoin works or how dangerous it may be. 

“After 35 years of use, oral isotretinoin is widely accepted among dermatologists as the most effective available treatment for acne,” said a coauthor of the analysis, Edileia Bagatin of the Universidade Federal de Sao Paulo in Brazil. 

“But lack of high quality evidence observed in this systematic review raises uncertainties regarding its real effectiveness and safety,” Bagatin said by e-mail. 

Almost a decade ago, Hoffmann-LaRoche stopped selling its brand-name version of isotretinoin, Accutane, in the wake of lawsuits over side effects and diminishing sales. Generic versions of isotretinoin are still prescribed for severe acne and carry a “black box” warning, the strictest issued by the US Food and Drug Administration (FDA), barring use by women who are or may become pregnant, because of the risk of birth defects. 

The FDA also warns that isotretinoin may increase the risk for inflammatory bowel disease and psychiatric side effects including depression, psychosis and suicidal thoughts. But the American Academy of Dermatology maintains that evidence for these risks is inconclusive and still supports use of isotretinoin for severe acne as long as doctors monitor patients for side effects. 

More than four in five teens eventually develop acne, Bagatin and colleagues note, usually on the face but sometimes also on the back and chest. Untreated severe acne has been linked to depression and other mental health problems. 

For the Cochrane analysis, researchers examined data from 31 previous studies with a total of 3,836 patients. Most were male. 

Three studies comparing oral isotretinoin to antibiotics for 20 to 24 weeks found no difference in the reduction of acne, but the researchers felt the evidence was low quality. 

Fourteen studies compared different doses of isotretinoin for 12 to 32 weeks and failed to detect serious side effects; again, researchers said the evidence was low quality. Less serious side effects, including dry skin, hair loss and itching, were assessed in 13 studies but researchers were uncertain whether there were any meaningful differences based on different doses of the drug. 

From clinical experience, however, doctors consider isotretinoin the “gold standard” for treating severe acne, said Felix Boon-Bin Yap of the University Tunku Abdul Rahman and Sunway Medical Centre in Selangor, Malaysia. 

“The studies included in this analysis are of low evidence and should be taken with a pinch of salt,” Yap said by e-mail. 

Although the Cochrane analysis found isotretinoin might not work better than antibiotics, long-term use of antibiotics can contribute to antibiotic resistance and make these drugs ineffective against infections, Yap, who was not involved in the Cochrane study, said by e-mail. 

If anything, the Cochrane review highlights the need for standardised research on acne, said Megha Tollefson of the Mayo Clinic in Rochester, Minnesota. 

Most patients taking isotretinoin have tried antibiotics and other medications without success, Tollefson, who wasn’t involved in the Cochrane study, said by e-mail. 

“Isotretinoin is an excellent [both effective and safe] medication for the treatment of acne in the correct setting, and is very appropriate to use in patients including teenagers with moderate to severe acne,” Tollefson said. 

Launched last year as a 2018 model and more recently arriving in Middle East markets, the Bolt EV is the golden bowtie’s gambit into the increasingly popular compact electric vehicle (EV) market. 

A convincing entry which crucially boasts a healthy electric drive range and brisk performance, the Bolt is largely developed by Chevrolet’s Korean wing of operations, which used to be known as Daewoo. 

Driven in Jordan, it proved unexpectedly better and more rounded as an electric vehicle than some other small Chevrolets in their respective niches.

Designated as a “small wagon” in the US, the Bolt is in fact a smallish hatchback with a narrow and tall body, owing to its large and heavy batteries being positioned under its floor. 

A less extroverted design than some other EVs and hybrids that try, and often fail, to make a statement with an unconventional design, the Bolt, however, remains distinctive from other Chevrolets in its flurry of design detail, including a largely blocked out grille and lower intake segment, as well as high-set rear lights that are integrated with the rear hatch.

Compact and confident

Space efficient and practical in many ways, the Bolt’s design allows for good front headspace and rear legroom, but its rakish roofline does reduce headroom for tall adults in the rear. Its upright and high driving position and short stubby and ridged bonnet allows for terrific front visibility, but thick heavily slanted A-pillars can slightly obstruct front-side cornering sight lines. 

A sharply rising waistline provides good side visibility yet reduced rear-side sight lines, but this is compensated for by a reversing camera which allows for confident parking maneuverability.

Powered by a front-mounted electric motor which is integrated with a single-speed automatic gearbox and differential into a modular and compact dive unit, the Bolt is, as its name would infer, a relatively quick car. Generously powered for a small electric car of its segment, the Bolt develops 200BHP and a muscular and almost ever-present 266lb/ft torque.

Quick off the line with a chirp of the tyres, the Bolt’s responses are literally electric, with maximum torque available from virtually zero revs. Brisk through zero-100kmph in just under 7 seconds, the Bolt pulls confidently to its estimated 146kmph top speed. 

Flexible and frugal

Given more than a single gear, one would expect a high top speed, not that there is much chance to legally go faster. Effortlessly flexible on the move, when overtaking and on steep inclines, despite being weighed down by a hefty 1,624kg weight, the Bolt’s delivery is instant, largely consistent and near silent, bar a distant motor whine that actually serves to give the driver some sense of mechanical connection. 

Rated as delivering a generously useful combined 383km range by the US Environmental Protection Agency, the Bolt has been quoted at being capable of 520km by more liberal rating methods.

While possible to achieve the higher figure were one to drive obstructively slow and careful of every input, the Bolt’s real world range goes a long way to assuage much of the range anxiety typical of many electric vehicles. 

On an extensive test drive that included several untypical segments of high output driving on steep inclines and high elevations, as well as steady motorway speeds and slow city driving that EVs excel at, the Bolt still impressively managed a distance of 250km from near full charge to near empty. Charging time is rated at 9.3 hours when using a 240v charge.

Stability and control

Riding on a Macpherson strut front and torsion bear rear suspension set-up, typical of most combustion and electric cars of its segment, the Bolt places its significantly weighty 435kg battery pack under the floor and features a relatively long wheelbase and short overhangs. 

With weight concentrated so low and centrally, the tall Bolt drives with a noticeably grounded and stable manner, whether confidently at speed or through corners where body roll is well controlled and minimised. Comfortable and absorbent in most situations, the taut control, low centre of gravity, low profile tyres and small size do, however, make its ride slightly firm over rougher roads.

A more agile and eager car through corners than one would expect, the Bolt’s turn-in is tidy and it feels nippy and maneuverable through tight corners, while its electric-assisted steering is quick, light, direct and flickable, if not layered with nuance and texture. 

Dynamically best driven at a modest or brisk pace, the Bolt’s muscular and immediate output can induce noticeable torque-steer under heavy acceleration from stand still. Enter a corner too quickly or sharply, especially on some less grippy local roads, and the heavy Bolt will tend to understeer if stability controls are not engaged.

Well-packaged

With a more engaging drive and better handling than typical for a tall, small and heavy EV, the Bolt’s acceleration pedal is more intuitive than some EVs, but not as much as a petrol-powered car, and neither is the brake pedal feel. 

However, braking is reassuringly good, with kinetic regenerative braking helping to recharge the battery. 

Under normal driving a steer-mounted lever can be used to increase regenerative braking resistance and works well to modulate speed, while an ”L” mode significantly increases resistance and regeneration, which is very useful on steep descents, but less effective on level ground, where it stifles coasting. 

For emergency braking, however, it is essential to use the traditional mechanical disc brakes.

Airy and well-packaged inside, the Bolt has an alert upright driving position with a chunky steering wheel, good front road view and a slight but comfortable driving seat. 

The floating centre console provides good knee room, but the seat could do with more lumbar support for longer journeys.

 Finished better inside than some previous small Chevrolets, the Bolt’s harder plastic surfaces are designed and textured to look lively and youthful. Meanwhile, equipment levels are decent and the infotainment system and driving information is user-friendly. Its boot also features a lower storage compartment in the absence of a spare wheel, and accommodates 478 litres of cargo that expand to 1,603 litres with the rear seats folded. 

Chevrolet Bolt EV

Engine: Front-mounted magnetic drive electric motor

Gearbox: single-speed automatic, front-wheel-drive

Final drive ratios: 7.05:1

Power, BHP (PS) [kW]: 200 (202) [149]

Power-to-weight: 123.1BHP/tonne

Torque lb/ft (Nm): 266 (360)

Torque-to-weight: 221.6Nm/tonne

0-100kmph: under 7-seconds

Top speed: 146kmph (estimate)

Driving range, city / highway / EPA: 410/349/383km 

Charging time, 120v / 240v / DC fast charger: 6.4km/1-hr / 9.3-hr/full 145km/30-min

Battery: Lithium-ion, 60kWh

Battery weight: 435kg

Length: 4,166mm

Width: 1,765mm 

Height: 1,594mm

Wheelbase: 2,600mm

Track: 1,501mm

Kerb weight: 1,624kg

Headroom, F/R: 1,009/962mm

Legroom, F/R: 1,056/927mm

Shoulder room, F/R: 1,387/1,340mm

Cargo volume, min/max: 478/1,603 litres

Steering: Electric-assisted rack & pinion

Turning circle: 10.8 meters

Suspension F/R: MacPherson struts / torsion beam

Brakes, F/R: Ventilated discs 276mm / solid discs 264mm

Tyres: 215/50R17

Price, on-the-road: JD29,900

A Sky So Close to Us

Shahla Ujayli

Translated by Michelle Hartman

US: Interlink, 2019, 303 pp.

This is a novel that was shortlisted for the 2016 International Prize for Arabic Fiction, but it has the feel of a memoir.

This is partly because it includes snatches of real history from the early days of Syria’s independence until the present war, as well as the Palestinian Nakba and more. Yet, the ultimate focus is on the personal stories of those living in these tumultuous times, first and foremost from the protagonist and narrator, Joumane Badran, a Syrian woman in her 30s.  

The author, Shahla Ujayli, who currently teaches Modern Arabic Literature at the University of Aleppo and the American University in Madaba, perhaps chose this memoir-like style to give the novel an intimate tone to reveal the hidden side of the book’s themes of love, family, nostalgia, illness, war and displacement. 

The somewhat rambling style and frequent transitions in time and place occasionally make the story hard to follow, but they do serve to enhance its emotional impact and graphically convey the themes of war and displacement. 

In beautifully flowing prose filled with original imagery, Ujayli records experiences and feelings that are surely shared by many other Syrians and citizens of the surrounding countries, especially in these years while the cruel war has rages on. 

“This was a war where no one had rights. There were no treaties, no conventions concerning prisoners, women and children. All values were suspended”. (p. 278)

Lovely descriptions of Aleppo and Damascus in the late 1940s are matched by Joumane’s childhood memories of growing up in Raqqa, thus restoring a positive image to the city which had the misfortune to serve as Daesh’s headquarters in Syria. 

The passages on Raqqa are quite unique, at least among Syrian novels that have been translated to English, few venture into the eastern desert, despite its crucial importance to Syria as a whole. Ujayli gracefully makes up for this omission with Joumane’s telling about her US-educated father who “signed on to work as an engineer on the Middle and Lower Euphrates projects, the latter of which ended in the village of Tabqa, 40 kilometres to the west, where they built a dam. The dam was a dream that would illuminate the furthest village in Syria with electric light, not to mention the resulting development,” (p. 58) 

Though the novel opens in Aleppo in 1947, most of the narrative actually unfolds in today’s Jordan post-2011. Joumane is living in Amman and working for an NGO helping refugees. In some ways, her life proceeds normally, but like all who have escaped a war zone and left loved ones behind, she agonises over any piece of bad news from Syria, worrying how her father and sisters in Raqqa are faring and sometimes being unable to reach them.

Quite by chance, she meets Nasser Al Amireh, a climate expert, as they return to Amman on the same plane. As a Palestinian, he represents a different variety of refugee than the fellow Syrians she meets in Zaatari. As he says, “My origins are in one place, I grew up in another, my life is scattered between many different places.” (p. 81).   An immediate rapport springs up between the two, as they discover they both have grandparents from Aleppo: “Through our conversations, Nasser and I began to create a special little history that we nurtured amidst the grief gripping the world around us. We built a house of words.”  (p. 79). At first this is simply a pleasurable affair, a distraction, but after Joumane is diagnosed with cancer, Nasser becomes an irreplaceable source of support. 

Joumane’s telling of her battle with cancer is direct, poignant and devoid of platitudes. Her panic is palpable, yet, a strong character even as she feels at her weakest, Joumane turns her treatment into a learning experience, making new friends and gaining new insights. The story poses many questions without answering them directly: Can different kinds of pain be ranked? How do the pains of disease and of war and separation interact? What are the psychological repercussions of pain and fear?

The novel dissects many of today’s global problems as they have played out in the Syrian war, such as what it means to be a refugee and the hypocrisy involved in the aid game.  As Joumane quickly realises, some “countries were supplying the camp with aid while they were the ones who played a major role in displacing them to begin with, only to reassemble them later, plastering the refugee label on them”, (p. 102). 

Though concentrated in Syria, Jordan and Palestine, the story also has interludes in many cities of Europe, Asia and the US. As Michelle Hartman writes this “demonstrates how Ujayli plays with the reader’s expectations in order to destabilise them and create the unexpected in her novel”, (p. 300). At the same time, she pays tribute to the human spirit which strives not only to survive but to love and create beauty.

SAN FRANCISCO — Millions of users of Amazon’s Echo speakers have grown accustomed to the soothing strains of Alexa, the human-sounding virtual assistant that can tell them the weather, order takeout and handle other basic tasks in response to a voice command. 

So a customer was shocked last year when Alexa blurted out: “Kill your foster parents.” 

Alexa has also chatted with users about sexual acts. She gave a discourse on dog defecation. And this summer, a hack Amazon traced back to China may have exposed some customers’ data, according to five people familiar with the events. 

Alexa is not having a breakdown. 

The episodes, previously unreported, arise from Amazon.com Inc.’s strategy to make Alexa a better communicator. New research is helping Alexa mimic human banter and talk about almost anything she finds on the Internet. However, ensuring she does not offend users has been a challenge for the world’s largest online retailer. 

At stake is a fast-growing market for gadgets with virtual assistants. An estimated two-thirds of US smart-speaker customers, about 43 million people, use Amazon’s Echo devices, according to research firm eMarketer. It is a lead the company wants to maintain over the Google Home from Alphabet Inc. and the HomePod from Apple Inc. 

Over time, Amazon wants to get better at handling complex customer needs through Alexa, be they home security, shopping or companionship. 

“Many of our AI dreams are inspired by science fiction,” said Rohit Prasad, Amazon’s vice president and head scientist of Alexa Artificial Intelligence (AI), during a talk last month in Las Vegas. 

To make that happen, the company in 2016 launched the annual Alexa Prize, enlisting computer science students to improve the assistant’s conversation skills. Teams vie for the $500,000 first prize by creating talking computer systems known as chatbots that allow Alexa to attempt more sophisticated discussions with people. 

Amazon customers can participate by saying “let’s chat” to their devices. Alexa then tells users that one of the bots will take over, unshackling the voice aide’s normal constraints. From August to November alone, three bots that made it to this year’s finals had 1.7 million conversations, Amazon said. 

The project has been important to Amazon CEO Jeff Bezos, who signed off on using the company’s customers as guinea pigs, one of the people said. Amazon has been willing to accept the risk of public blunders to stress-test the technology in real life and move Alexa faster up the learning curve, the person said. 

The experiment is already bearing fruit. The university teams are helping Alexa have a wider range of conversations. Amazon customers have also given the bots better ratings this year than last, the company said. 

But Alexa’s gaffes are alienating others, and Bezos on occasion has ordered staff to shut down a bot, three people familiar with the matter said. The user who was told to whack his foster parents wrote a harsh review on Amazon’s website, calling the situation “a whole new level of creepy”. A probe into the incident found the bot had quoted a post without context from Reddit, the social news aggregation site, according to the people. 

The privacy implications may be even messier. Consumers might not realise that some of their most sensitive conversations are being recorded by Amazon’s devices, information that could be highly prized by criminals, law enforcement, marketers and others. On Thursday, Amazon said a “human error” let an Alexa customer in Germany access another user’s voice recordings accidentally. 

“The potential uses for the Amazon datasets are off the charts,” said Marc Groman, an expert on privacy and technology policy who teaches at Georgetown Law. “How are they going to ensure that, as they share their data, it is being used responsibly” and will not lead to a “data-driven catastrophe” like the recent woes at Facebook? 

In July, Amazon discovered one of the student-designed bots had been hit by a hacker in China, people familiar with the incident said. This compromised a digital key that could have unlocked transcripts of the bot’s conversations, stripped of users’ names. 

Amazon quickly disabled the bot and made the students rebuild it for extra security. It was unclear what entity in China was responsible, according to the people. 

The company acknowledged the event in a statement. “At no time were any internal Amazon systems or customer identifiable data impacted,” it said. 

 “By controlling that gateway, you can build a super profitable business,” said Kartik Hosanagar, a Wharton professor studying the digital economy. 

Amazon’s business strategy for Alexa has meant tackling a massive research problem: How do you teach the art of conversation to a computer? 

Alexa relies on machine learning, the most popular form of AI, to work. These computer programs transcribe human speech and then respond to that input with an educated guess based on what they have observed before. Alexa “learns” from new interactions, gradually improving over time. 

In this way, Alexa can execute simple orders: “Play the Rolling Stones.” And she knows 

This year’s Alexa Prize winner, a 12-person team from the University of California, Davis, used more than 300,000 movie quotes to train computer models to recognise distinct sentences. Next, their bot determined which ones merited responses, categorising social cues far more granularly than technology Amazon shared with contestants. For instance, the UC Davis bot recognises the difference between a user expressing admiration (“that’s cool”) and a user expressing gratitude (“thank you”). 

The next challenge for social bots is figuring out how to respond appropriately to their human chat buddies. For the most part, teams programmed their bots to search the Internet for material. They could retrieve news articles found in The Washington Post, the newspaper that Bezos privately owns, through a licensing deal that gave them access. They could pull facts from Wikipedia, a film database or the book recommendation site Goodreads. Or they could find a popular post on social media that seemed relevant to what a user last said. 

That opened a Pandora’s box for Amazon. 

During last year’s contest, a team from Scotland’s Heriot-Watt University found that its Alexa bot developed a nasty personality when they trained her to chat using comments from Reddit, whose members are known for their trolling and abuse. 

For years, researchers have been studying medical conditions using huge swaths of patient data with identifying information removed to protect people’s privacy. But a new study suggests hackers may be able to match “de-identified” health information to patient identities. 

In a test case described in JAMA Network Open, researchers used artificial intelligence to link health data with a medical record number. While the data in the test case was fairly innocuous — just the output of movement trackers like Fitbit — it suggests that de-identified data may not be so anonymous after all. 

“The study shows that machine learning can successfully re-identify the de-identified physical activity data of a large percentage of individuals, and this indicates that our current practices for de-identifying physical activity data are insufficient for privacy,” said study coauthor Anil Aswani of the University of California, Berkeley. “More broadly it suggests that other types of health data that have been thought to be non-identifying could potentially be matched to individuals by using machine learning and other artificial intelligence technologies.” 

Aswani and colleagues used one of the largest publicly available patient databases, the National Health and Nutrition Examination Survey, or NHANES. Included in the database were recordings from physical activity monitors, during both a training run and an actual study mode, for 4,720 adults and 2,427 children. 

The researchers showed their computer the data from the training runs for each person and included six demographic characteristics: Age, gender, educational level, annual household income, race/ethnicity and country of birth. The training data for each person was given a made-up record number. 

Then Aswani and his colleagues fed the computer the second set of activity data, including the six demographic factors. For 95 per cent of the adults and 86 per cent of the children, the computer successfully matched the two sets. 

What are the practical implications of that matchup? 

Aswani offers a hypothetical situation. “Say your employer is giving a discount for participation in a wellness programme and will be collecting demographic information as well as physical activity data,” he said. “At the same time, your health insurance company might have a programme to try to get insurees to lose weight. They also collect demographic information and physical activity data, but remove identifying information.” 

Theoretically, your employer could link the two data sets and “then they will accurately be able to link to the rest of your medical record,” Aswani said. 

Another scenario, Aswani said, is that your smart phone is collecting your movement data as part of a health app. If your insurer also has movement data, the app maker might be able to link your name to your medical record and then sell the information to others. 

Doctor Elliott Haut worries that studies like this one will spark fears in the public, which might call for cessation of research using de-identified data. That would be a mistake, said Haut, vice chair of quality, safety in the department of surgery at the Johns Hopkins School of Medicine and an associate professor of health policy and management at the Johns Hopkins University Bloomberg School of Public Health. 

While Haut acknowledges the risk that patient data could be relinked to patient identities, the benefits of research with this kind of data far outweigh those risks and can change medical practices for the better, he said. 

For example, he said, as a trauma surgeon, he wondered if the common practice of spine immobilisation — putting a neck collar on and buckling a patient to a back board — is helpful or harmful for gunshot victims. The goal is to prevent movement and thus possibly paralysis. 

“We looked at the data and not only is this not beneficial, but it also could be harmful because the first responder takes five to 10 minutes doing this procedure instead of going directly to the hospital where we can start fixing them,” Haut said. “If you are critically injured, that five minutes makes a huge difference.” 

LONDON — Scientists exploring what may trigger a complex disorder known as chronic fatigue syndrome (CFS) have found clues in the way some people’s immune systems respond more actively to a health attack.

A severe illness characterised by long-term physical and mental fatigue, CFS is thought to affect up to 17 million people worldwide and around 250,000 people in Britain.

Sufferers are often bed-bound and unable to carry out basic daily activities like washing and feeding themselves.

The researchers used a drug known as interferon alpha to create a model of the syndrome and found that patients, whose immune response to treatment was hyperactive or exaggerated were more likely to then develop severe fatigue.

“For the first time, we have shown that people who are prone to develop a CFS-like illness have an overactive immune system, both before and during a challenge to the immune system,” said Alice Russell of King’s College London’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN), who led the work.

The condition, as well as research into it, is highly contentious, in part because its possible causes and range of debilitating symptoms are poorly understood.

Interferon alpha is used as a treatment for hepatitis C infection, and activates the immune system in the same way as a powerful infection. Many patients who receive interferon alpha experience extreme fatigue during treatment, and some continue to feel chronic fatigue for many months after the drug course is completed.

Russell’s team used this knowledge and measured fatigue and immune system markers in 55 patients before, during and after treatment with interferon alpha.

They found that the 18 of those 55 who went on to develop a CFS-like illness had a hyperactive immune system before treatment, and an highly overactive response during treatment.

“[This suggests] people who have an exaggerated immune response to a trigger may be more at risk of developing CFS,” Russell told reporters at a briefing about the findings.

IoPPN professor Carmine Pariante stressed that while the study’s main finding is a useful addition to scant scientific knowledge about CFS — also known as myalgic encephalopathy (ME) — it offers few clues on how to treat, cure or prevent it.

“It’s a light in the fog,” he told reporters. 

“But a better understanding of the biology underlying the development of CFS is needed to help patients.”