I was chatting with one of our staff surgeons a few months ago. He saw me looking up some headphone recommendations for a friend while I was on a break. He wondered if I even had a stereo at home. I told him I did, although he seemed surprised that my main source of music was a turntable. He reminisced about his early residency, sharing that it used to be a rite of passage to buy your “first real stereo” out of med school, once you started making a little bit of spending money. Now, he lamented, he’d be surprised if even one of the residents in their program owned an actual stereo.

87 Speaker by macattckI use the term stereo knowing full well that many of you do not really understand this concept. A few years ago, I didn’t either. On a real stereo, music is played from two speakers (left and right). When these speakers are placed in appropriate position relative to the listener’s ears, a three-dimensional “image” forms roughly between the speakers. With appropriate stereo recording and engineering, it’s not that the drums come from the left speaker and the guitar from the right. You can actually picture a stage in front of you. The drums come from 1 foot left of center, the guitar from 1 foot right of center, and the lead vocalist sounds like he is singing directly between the speakers. Better yet: the bass drum kicks dead center, the hi-hat two feet to the left of that and the snare hits between them. In other words, an entire concert takes place between the speakers. Or even beyond the sides of the speakers. Have you ever heard music in true stereo? Imagine standing in the front row at a concert. That’s what your music should sound like at home!

So why do we settle for anything less? I think a major reason is ignorance, especially among younger listeners. If you’ve never heard music you love on a proper stereo, you’re not only missing out, but you don’t even understand what you’re missing. Once you hear it, in my opinion, there’s no turning back. Convenience is also a factor. Today, there are so many devices for listening to your music: TV sound-bars, Bluetooth speakers, iPod/iPhone docks, headphones, car speakers, and even laptop speakers (shudder). Almost none of them actually sound good or give true stereo imaging, but the companies that make them have powerful marketing departments. They’re all sold as “ready to listen” devices. Plug in and press play. But if you only understood what you’re missing! And listening to music that sound this good doesn’t even have to be expensive!

Listening habits have changed, too, but it’s a more fundamental change than saying music is more portable. There are plenty of ways to listen and maintain portability. But stereos are from a different era. Forty or fifty years ago, both adults and kids sat down to listen to an album, although probably still not together and not the same artists. Think about that. When was the last time you sat down and just listened? No phone, computer, or tablet, and not cleaning the house, chatting with friends, exercising, or driving. Music has become, in most instances, background noise.

You notice things when you sit down and listen, especially to good, well-recorded and well-produced music. You notice inflections in people’s voices. You notice the sound of instruments. You realize there are different drums in a drum set. You notice the lyrics and consider what they mean. Music is an emotional art, and that emotion is ripe when you sit quietly and listen to it. Take it in and let it run through you. That’s music.

Turntable by David LenkerA few weeks ago, an old friend was in town. She is one of the few others I know who owns and uses a turntable. This was the first time she had been to our apartment since I have owned a decent stereo. We visited a local record shop, Bullseye Records, where she bought Illinois by Sufjan Stevens. We were both in for a treat the next morning when I put the record on. I, because I had never heard this album before. It’s fantastic. I bought it a few weeks later. She, because she had never heard it on vinyl in stereo. She mentioned afterwards that she should get some real stereo speakers for her ‘table instead of the built-in speakers. (n.b. This post actually has nothing to do with vinyl. Similar results can be obtained with CDs or music downloads. Don’t be discouraged!)

This got me excited because I love to spend other people’s money, but I also love to help them get a good deal and great value for their money. I’ve been reading a lot about home audio lately. I have a subscription to Stereophile magazine, and I read Steve Guttenburg’s blog The Audiophiliac over at CNET. Although Stereophile tends to focus on very high-end equipment, out of the price- and interest-range of 99% of the population, I do keep my radar up for components with particularly high price/performance ratios. Stephen Mejias’ column, The Entry Level, frequently reviews these high-value components. I mentioned to my friend that I had recently read Mejias’ review of a set of decent sounding bookshelf speakers selling for $50/pair, and she seemed interested. A few days ago I read another article from The Audiophiliac recommending pairing these speakers with an inexpensive but high-quality amp. All things considered, with these components you can own a very nice sounding stereo for $70-100.

This made me wonder whether others might be interested in such a set-up. An advantage of building this stereo from components is that you can modify what you buy based on what features you want. Here is the basic stereo I would recommend, including prices.

  • Dayton Audio B652 bookshelf speakers – $40-55 [PE] [Amazon]
  • Lepai LP-2020A+ amplifier (without power cable) – $20 [PE] [Amazon]
  • Recommended upgrade: Power cable (12VDC 5A, only if buying amp without cable) – $15 [PE]
  • Recommended upgrade: Speaker wire (16 AWG OFC) – $9-11 [PE] [Amazon] [Monoprice]
  • Total: $85 + $15 shipping
  • Optional upgrades: Bluetooth input ($20), improved DAC ($40)

People frequently spend this amount of money or much more on a TV sound-bar or Bluetooth speaker or iPod/iPhone speaker dock or even headphones. They’ll spend 4-5 times this much on a “Home Theater in a Box.”  So what about you? Would you ever consider spending $100 to make your music sound infinitely better?

Learning Ubuntu with Unity

Ubuntu 11.04 will be released on April 28th, 2011. It contains a significant visual redesign called Unity, which is a shell over the more traditional desktop environment found in previous Ubuntu releases (called GNOME). There will likely be a lot of critique of Unity over the next few days and weeks, but by most testing and user reviews, Unity is a significant step forward in usability for both computer novices and experts alike. I have compiled a set of links demonstrating some of Ubuntu’s new features in 11.04.

I am excited to make the switch. I’ve been trying Unity out at various points of development via “live cd,” and it’s really nice to work with. I’m looking forward to doing a complete reinstall this week to check out the new installation procedure as well. Let me know what you think in the comments!

Facebook and the Email Apocalypse

So in case you haven’t heard the rumors, supposedly Facebook will release “Project Titan” on Monday. As rumor has it, they will be introducing a web-based email system that’s built into Facebook. It will replace traditional “messaging” on Facebook with a full-fledged email system. It will likely include your own email address. Some are calling this a Gmail killer. I tend to agree with the other side, who find that assessment laughable. Of course, by “laughable” I don’t mean that it will be unsuccessful. On the contrary, I’m sure it will be quite popular as far as numbers go. It’s just that I remember email before Gmail and how much they changed the game. I am highly skeptical that Facebook would even be able match Gmail in terms of utility and ease-of-use, and I find it laughable that they would be able to innovate enough to draw me away from Gmail’s clutches.

No doubt there is a market for integrating email into Facebook. As a user of both Gmail and Facebook, I got to thinking about what might happen in the coming months given what I know about the past.

First, Facebook email will almost certainly create a rift among emailers. To me, the division will be between those who use email as a tool and those who use it as a toy. I could easily see some of my friends and family, young and old, who spend the majority of their time behind Facebook’s walled garden anyway, integrate Facebook’s inbox into their life and slowly forget about their prior email addresses. “Email that’s separate from my Facebook account? That’s so 2010.”

In fact, that’s kind of Facebook’s plan, right? The whole goal is to take over the Internet by making their own Internet inside of Facebook. Do you want to play a game? Why go to another site when you can play lots of them on Facebook? Do you want to share photos with your friends? Why go to another site when you can do it on Facebook? Their whole goal is that you never have to leave, and adding a way to communicate with the “outsiders” will take away another major reason to leave their site.

But as I alluded to earlier, those of us who actually use email to communicate with 10, 20, 50, or even 500 people a day, we want a system that is made specifically to make that process more pleasurable. That’s what Gmail is, and I find it nearly impossible that Facebook will be able to rival Gmail’s feature-set. Remember, that’s not even their goal. Their goal is to make it functional enough to keep you from leaving their site. Ever.

It’s one thing when Facebook adds a feature I won’t use, but I’m not sure their integrated email system won’t actually be detrimental to their platform as a whole. I mean, do you remember email in 2001? (or even 2007?) In addition to loads of emails offering me all sorts of adult content and attachments that would infect my computer with viruses, there were links to sites that would steal my banking credentials and hijack my Paypal account. Oh, and that’s not to mention the deluge of weekly email forwards pleading with any and every excuse to have me forward this chain letter to my entire address book. Gmail has largely hidden spam from me.

Does Facebook have a plan in place for when the spamming masses come down on their email system with phishing links and social engineered trojan horses? Because I hear about enough people now whose Facebook account and email accounts get hacked. Wait until their email is their Facebook. It sounds like a recipe for disaster. I shudder thinking about this, but imagine the eventual hacks that start messaging all 600 of your “friends” and writing spam ads on their walls. Won’t that be fun for your girlfriend from 6th grade who you haven’t talked to since junior high and your boss at work, both of whom are your “friends” on Facebook.

My solace lies in my apocalyptic hope that this venture shows Facebook for the house of cards that it is. Facebook has been largely preserved because of their ability to keep spam out, aside from user-selected spam. By opening up their floodgates to the world of spammers, the site will become much less navigable by average folks, which could cause a sizable exodus. I wonder how people will react when they realize that so much of their lives that they have poured into Facebook over the past months and years is lost in that walled garden? And where will these users go when they are left alone in this largely unexplored Internet.

So what do you think? What have I missed? What good or bad will come from Facebook’s integration of an email system?

Everyone should program

Here’s a quote I enjoyed from the book I’m currently reading:

“If you’ve never programmed a computer, you should. There’s nothing like it in the whole world. When you program a computer, it does exactly what you tell it to do. It’s like designing a machine — any machine, like a car, like a faucet, like a gas-hinge for a door — using math and instructions. It’s awesome in the truest sense: it can fill you with awe.

A computer is the most complicated machine you’ll ever use. It’s made of billions of micro-miniaturized transistors that can be configured to run any program you can imagine. But when you sit down at the keyboard and write a line of code, those transistors do what you tell them to.

Most of us will never build a car. Pretty much none of us will ever create an aviation system. Design a building. Lay out a city.

Those are complicated machines, those things, and they’re off-limits to the likes of you and me. But a computer is like, ten times more complicated, and it will dance to any tune you play. You can learn to write simple code in an afternoon. Start with a language like Python, which was written to give non-programmers an easier way to make the machine dance to their tune. Even if you only write code for one day, one afternoon, you have to do it. Computers can control you or they can lighten your work — if you want to be in charge of your machines, you have to learn to write code.”

Little Brother by Cory Doctorow

Sansa Clip Plus

My aunts gave me a gift certificate to for Christmas. I like to spend gift certificates on something I want rather than something I need (like a text book) because I don’t always get a chance to do that. I had been thinking about buying a portable music player to use in my car for a while now, and this was the perfect excuse. I knew that I didn’t want an iPod, so I did some research at Anything But iPod. I was very impressed by their review of the Sansa Clip Plus (or Clip+), and I noted that it took home their #1 player of 2009. I won’t go into too much detail about why I chose the Clip+, but the ability to play OGG and FLAC formats in addition to mp3, the cost, the expandable memory slot, and the reportedly great sound quality were all key factors. I must say that ABi didn’t misrepresent the Clip+ at all. It’s fantastic!

Sansa Clip PlusI bought the 8 GB model from Amazon. Since the Clip+ has an expandable microSDHC slot, I also recently grabbed an 8 GB card for $12 from Fry’s, giving me a total of 16 GB. My main reason for buying a portable music player was to replace the (literally) 50+ CDs strewn over the back seat of my car. I have a lot of music on my computer, but I get sick of listening to the same album all the time, and I usually get very frustrated with the radio. Since my car’s radio unfortunately doesn’t have a line-in jack, I also picked up an iriver AFT 100 FM Transmitter, which works surprisingly well. I was a little skeptical of the FM transmitters at first, but with this one the sound is usually pretty clear and without static.

I don’t have much else to say except: I love this thing! My assortment of music on the road is huge now, which is something I’ve been wanting for a long time. I did a lot of driving during the months of February and March, and this little guy was a perfect companion. Plus, I’m thrilled that this thing has an expandable microSDHC slot. Recently companies have started making 32 GB microSDHC cards, and in a year or two when the price drops, I’ll have a 40 GB mp3 player that’s about the size of a box of matches for very cheap. Plus I love that I have an excuse to expand my music collection. I bought a couple of new albums recently, so look forward to some new music reviews. Sansa also impressed me by having standard protocols for syncing, so I can choose either MSC or MTP mode. To make a long explanation short, it works well on Ubuntu (and Linux in general).

All-in-all, this Sansa Clip+ gets an A+ from me. It comes with a very high recommendation.

Rush Proxy Bookmarklet

Graham Walker, a tech-savvy ER Resident who blogs over at The Central Line, recently posted a really nifty little solution to a problem that plagues higher education. Many academic journals require subscriptions to view their contents, and although most school libraries offer proxy accounts to facilitate student access from home, these accounts are often cumbersome to use. His solution was to create a bookmarklet to streamline the process of accessing these materials via proxy account. His video demonstrates how this works really well.

I went ahead and created a Rush University version using his awesome proxy bookmarklet generator. You can create one too by going to the generator and entering: “” (without quotes) and clicking “Make the Bookmarklet!” You can save the new link as one of your favorites or simply drag it into your “bookmarks tool bar” if you use Firefox. Then, the next time you’re browsing your favorite academic journal, hit your bookmarklet to easily access the material via your proxy account. Obviously if you’re at a different institution, substitute your school’s proxy account.

If you’re interested, this is the code:

I’d like to reiterate that I did nothing to write this code, and it’s all thanks to Graham Walker. If you like this code, you may also want to check out Dr. Walker’s incredibly useful

Dad’s Computer

My dad built a computer a few months ago. He has been talking about building a new one for a few years now, so it was about time he got around to it. He had always talked about building a computer that he use to record some of his music on and he wanted something that was more cutting-edge than his current desktop. I think he succeeded quite nicely and although I would tweak a few things if this was a machine for me, I think it fits the bill.

Total: $2200

That’s pretty expensive for a desktop these days. I was really surprised by the expensive sound card, although it does allow him to record multiple inputs, which he plans to use to plug his guitar into the computer. When I built my mom’s budget desktop back in 2008, I was able to do it for about $300 (without a monitor). She was just going for a bare bones system though. Of course this thing is a beast compared to that thing. I’d be interested to see how the Core i7 is working. Apparently, up until a few days ago, he was having trouble with the machine randomly freezing, but it looks like that problem has sorted itself out. He also grabbed a fancy webcam, so we’re able to chat on Skype.

All-in-all, it’s a very nice machine that makes me quite jealous. I had fun giving him my thoughts as he was picking everything out. Too bad I don’t have some spare money lying around because I’ve been brainstorming for an HTPC recently. Oh well, some day!

Amazon MP3 on Ubuntu 9.10 64-bit

I recently reinstalled Ubuntu 9.10 (Karmic) on both my desktop and laptop. When I went to buy an album on Amazon MP3, I remembered that Amazon only offers a 32-bit version of their MP3 downloader. Unfortunately, there’s not a very intuitive way to install the Amazon downloader on a 64-bit system, and you need it to have this application installed in order to buy more than a single MP3 from Amazon. If you want, you can try out the command-line tool Clamz. Otherwise, I’ll walk you through the moderately painful steps to installing the real program on your 64-bit version of Ubuntu. Note that this guide pertains to the Amazon MP3 downloader version for Ubuntu 9.04. I’m installing it on Ubuntu 9.10 (although this should work for any version of Ubuntu 9.04 and above). Adapted from Cappy.

  1. Save the 32-bit AmazonMP3 installer for Ubuntu 9.04 to your computer (Don’t attempt to ‘Open’ it). By default on Ubuntu 9.10, it’s saved in your Downloads folder. I will assume that’s where the file is from now on.
  2. Install getlibs. (You can just ‘Open’ this one. If that link doesn’t work, look here.)
  3. Open Terminal (Applications -> Accessories -> Terminal) and run the following (one bullet point at a time, pressing Enter after each blurb of code) [Tip: press Ctrl+Shift+V to paste in Terminal]:
    • sudo apt-get install libboost-signals1.34.1 libboost-date-time1.34.1 libglademm-2.4-1c2a libboost-iostreams1.34.1 libboost-thread1.34.1 libboost-regex1.34.1 libboost-filesystem1.34.1
    • [Type your password and hit enter when prompted]
    • sudo dpkg --force-architecture -i ~/Downloads/amazonmp3.deb
    • getlibs /usr/bin/amazonmp3
    • [Press 'y' and hit enter when prompted by getlibs]

  4. Close the terminal when it’s finished.
  5. Open AmazonMP3 via Applications -> Internet -> Amazon MP3 Downloader. This should open the program and the Amazon MP3 website in Firefox. Follow the directions on to finish the installation and download your free song.

Too bad Amazon won’t release a 64-bit version of their program or open source it. These hoops are a huge pain to jump through, and it makes our system appear overly complex to new users. If I’ve made this guide more complicated than it needs to be, feel free to let me know.

Smoke and Mirrors

Apparently Lenovo has put a lot of work in making Windows 7 boot “unbelievably fast.” When you go on to read the article, you see that you’ll get a boot time possibly as “quickly” as 30 seconds, which is a significant improvement for Windows. Of course to explain how they get that, you get a bunch of vague double-speak. They push back loading drivers and various Windows services until after booting “finishes.” They also make some claims about preventing “Windows rot” by doing some work with drivers. Not quite sure what they’re doing there. Sounds like they need to take some tips from the pros: 10 seconds on a mid-level machine to a logged in idle computer without delaying any background services. Your computer is ready to use in 10 seconds. That’s the goal for Ubuntu 10.04, due out in April 2010. Ubuntu 9.10, due out in a few weeks, already has Lenovo’s Windows 7 numbers beat, so 10.04 will just be some sweet icing on the cake. And then of course, there’s reason to believe boot speed will actually be closer to 5 seconds when it’s all said and done… Maybe some day Windows will catch Ubuntu.

Medicine in an electronic age

The following is the fifth (and probably final) post in a series entitled, “Securing your Email.” I’ve spent the majority of the series talking about logistical things like why secure email is important and how to get started with public-key cryptography. If you look back at my first post, you’ll see that the reason I went out and learned all of this (and wrote about it ad nauseum) is because I feel like it’s an incredibly interesting and important topic where medicine meets technology.

Communication throughout the world is becoming more and more electronic, and things are changing rapidly. In the field of medicine five years ago, most institutions (including very large hospitals) were still using paper records. In fact, even today a number of institutions still do. Doctors communicated by telephones and pagers, and records from other facilities were carried in by hand or faxed. With the technological advances in the last 10 years, today a physician could easily be consulted halfway around the world with a simple email, and a copy of an X-ray or CT-scan could be sent electronically. These changes in the way health care is administered presents a new set of problems to the industry.

This electronic age spawned a strong concern about health care privacy in the United States, which was addressed by HIPAA. The health care industry spends an incredible amount of time and resources dedicated to preserving people’s privacy. They spend millions and millions of dollars on “enterprise level solutions” to make sure that they can work online safely. These are not always dollars well-spent, but that’s the topic for another day. Unfortunately these solutions end up restricting health care professionals in such a way as to reduce the utility of the system. As an example, I’m going to talk about email (as you might have guessed).

As I pointed out in my first post, I’ve been thinking about this for a while. How in the world can health care institutions, who are so concerned about privacy and protection of their patient’s data, not be doing more to provide secure email solutions? I think I’m in an appropriate position to answer that question. I’m part of a committee that has been charged with selecting a new email provider for the hospital. We’re currently looking into a number of different vendors, and a question that consistently comes up is about “email security.” We’ve got a number of people on our committee including people from IS, the legal department, and human resources staff as well as physicians, nurses and students. Their “email security” questions have the best intentions. They want to make sure that the solution we choose is going to keep our patients’ data safe.

At the same time, however, I feel like there is a knowledge gap as to what they know about email security. I feel like most (if not all) of the people involved just want someone to say “your email is super-duper secure with our system.” One vendor took it a step further and started talking specifics of cool stuff that their system can do to prevent, for example, someone from emailing Protected Healthcare Information, or PHI, to someone outside of Rush. The problem I (and some members of the legal department) have is that sometimes this information needs to be sent out, for example to a lawyer’s office. From a patient’s perspective, if I request that my physician contact me via email with my lab results as opposed to over the phone, should that be discouraged? But it is, and that’s because some of the people in the IS departments across the land realize how insecure email is. So we need to make it more secure, and in order to do that, we have to understand where its security flaws lie.

The problem is that most institutions don’t look at the problem like that. They don’t get an unbiased assessment of email security. Instead they get a vendor to sell them an “email security solution” in which the vendor defines what secure email is and how their solution fits the bill. I’m not saying that all companies are giving a false sense of security, but it’s definitely a concern. It’s exactly why you have to understand the problem before you go looking for an answer. Things would be significantly different if a group of people like the “free software community” assessed a health care institution’s email security needs. In fact, the purpose of my post is to propose the following: the health care community should embrace the free software community’s model of email security.

Health care institutions have all the right resources already in place. They simply need to implement it. It would be fairly easy the create a public key server for your health care institution. When Housestaff and Physicians begin their tenure, they could easily be required to create a key pair during new employee orientation. Key pairs could be distributed on cheap flash drives for safe keeping and stored on a private server for easy access while on campus. Alternatively, keys could be distributed on smart cards. Since an institution has verified who an employee is, their internal web-of-trust will form easily. As long as someone’s public key has been signed by the company’s IS department, it can be trusted. These key servers could be made to exchange keys with those of other institutions or even external key servers, such as one set up by the NIH or the Department of Health and Human Services. Physicians also often travel to conferences, and “key signing parties” or booths could be set up to create a more full-fledged web of trust.

Having public keys freely available would make it easy for physicians to communicate more securely with one another. They’d be able to trust an email from a colleague. Plus, they’d be able to encrypt emails and attachments containing PHI. Physicians would also be able to communicate with their patients via email more freely. Patients could be given instructions how to acquire the physician’s public key and how to use it. It would be even better to set up a way to simplify the process by just emailing the patient a link so that an encrypted email could be viewed directly on the institution’s website. They wouldn’t need to worry about having the proper GPG client software installed, since they’d just have to click a link and the web page would decrypt the email for them.

Unfortunately, there are many in the health care IS industry that would rather none of this communication go on via email. They are probably smart to have a firm stance that no PHI should be communicated via email at this point since their email system is probably very insecure. The problem with their plan is that both now and in the future PHI is being sent via email and it’s probably not going to stop unless some serious consequences are put into place at individual institutions.

I have to wonder though. If the email system was actually set up securely and properly, why couldn’t PHI be sent via email? Why shouldn’t I be able to request my test results in electronic format from my doctor? These aren’t questions that are going to be addressed by any single institution, unfortunately, and this presents a very big problem in the near future. A number of other industries are currently caught in a downward spiral because they chose not to adapt to the Internet era. Does a similar fate await a health care industry that wants to deny physicians and consumers access to the PHI electronically under the guise of HIPAA and “we know what’s best” for protecting patients rights? Doing so is just going to drive the process more underground, giving them less control over the situation in the future. They’d be better off embracing the idea now and preparing for the future of medicine in an electronic age.