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Tidying up an infectious diseases navboxEdit

Hi all, I'd like some help tidying up this navbox (I have cross posted at WP:COVID).

I have come across this navbox and find it particularly difficult / ugly - the sections are weighted weirdly, the structure makes me worry there are missing topics, and some sections such as "Transmission" seem to be a long list that could be structured in a more easy to understand way. Unfortunately I don't have a great broad understanding of this area enough to make some changes to this navbox, and thought editors here might be able to have a look. Thanks, I hope! --Tom (LT) (talk) 07:43, 25 October 2020 (UTC)

This may be just a spurt of morning pessimism but I'm having trouble imagining a more complete version of this navbox that doesn't become bloated and enormous. I'm not sure what the selection criteria were for the infectious agents, but clearly many many other common agents exist. If we must have a navbox, I might suggest splitting it three separate navboxes: a "Human infectious agents" box (perhaps there's a clearer way to phrase that; I mean bugs that infect humans), a "Concepts in infectious disease" box, and a third "People in infectious disease" box (which could be split either by time, occupation, or something else). Ajpolino (talk) 15:39, 25 October 2020 (UTC)
I don't know that we need to aim for completeness. Trimming it could also be an option. I wouldn't be opposed to simply reverting to this version and adding COVID-19. TompaDompa (talk) 17:03, 25 October 2020 (UTC)
Tom (LT), hello again. Primary thing I notice is that this navbox is titled as if it's an "overview" but then includes multiple examples of specific infections. I think the first step is going to be to remove examples of specific infections and limit it to the headings for types (bacteria, virus, etc). It actually may be a good idea to organize it at the top level by bacteria, virus, fungus, parasite - then you can have the next level separate into medications/associated people/etc. The alternative, as others have hinted at, is splitting - but I'd recommend splitting based on infectious organism types (ex: "Infectious bacteria" or "Bacterial infectious diseases" or similar). Regards -bɜ:ʳkənhɪmez (User/say hi!) 17:15, 25 October 2020 (UTC)
For better or worse, my opinion is we need a targeted navbox (eg as proposed above or below by myself and others) or none at all. A navbox that is simply "Infectious bacteria" will in a few years time end up being humongous. --Tom (LT) (talk) 04:35, 26 October 2020 (UTC)
I also think that splitting is a plausible approach to this navbox, or just cutting. Do we *need* to have biographies in a navbox at all? WhatamIdoing (talk) 00:16, 26 October 2020 (UTC)
I'm glad it's not just me scratching my head over this one! Thanks everyone for your comments. How does this sound, taking into account the views above:
A Concepts in infectious disease navbox (@Ajpolino I think this is a great idea)
A History of infectious diseases navbox with "people" and "historically significant infections" as well as some general links eg History of emerging infectious diseases (nb. renaming discussion in process). ("People in infectious diseases" is, to me, a weird title as essentially we are listing them because they are historically notable in the context of infectious diseases) --Tom (LT) (talk) 04:31, 26 October 2020 (UTC) ADDIT: alternatives might just be something like Significant infectious causes of disease or Infectious agents causing significant outbreaks - this would provide some useful links between Cholera, Tuberculosis, Malaria, Influenza because of their current and historically significant spread. --Tom (LT) (talk) 04:35, 26 October 2020 (UTC)
That seems like a good idea, especially combined with WhatamIdoing's suggestion of how to heavily trim this navbox, seen below. TompaDompa (talk) 11:07, 1 November 2020 (UTC)
I feel that we could remove the "people" section, which is better suited to articles about the history of medicine/infectology, and add some basic stuff that we're missing such as pneumonia and UTIs. I quite like the structure otherwise. I think the other thing that is missing is some kind of hint or visual cue to the unexperienced reader that the items we're listing are just some common examples of each thing and we're not being exhaustive. Dr. Vogel (talk) 08:44, 26 October 2020 (UTC)
We could maybe add links to the most common types of diseases, but I'm not sure that it should be in the same (large) navbox. WhatamIdoing (talk) 18:19, 26 October 2020 (UTC)
Adding things like pneumonia is a bad idea. It would necessitate starting over from scratch with the layout and contents. The diseases the navbox currently includes have a single causative agent, but pneumonia is a condition that can be caused by several different infectious agents. There is Bacterial pneumonia such as Pneumococcal pneumonia, Fungal pneumonia such as Pneumocystis pneumonia, Viral pneumonia, and Parasitic pneumonia. TompaDompa (talk) 06:00, 27 October 2020 (UTC)
I was thinking of linking to the pneumonia article. Dr. Vogel (talk) 06:23, 27 October 2020 (UTC)
Right, but there's nowhere to put that link with the current layout. It's not bacteriology, virology, mycology, or parasitology. We'd have to change the entire layout. TompaDompa (talk) 06:38, 27 October 2020 (UTC)
Yes, absolutely. How about we put just the 2 most common causes (bacterial and viral) in the corresponding boxes? We're not being exhaustive anyway, and I don't really want to leave pneumonia out of this just because it has more than one cause. Dr. Vogel (talk) 20:56, 27 October 2020 (UTC)
Your suggestion kind of changes the scope of the navbox. I think the suggestion below is better. We'll just end up with all possible clinical manifestations of infections otherwise. TompaDompa (talk) 21:06, 27 October 2020 (UTC)

I've been thinking about simplification this way:

Maybe we could do something similar for "Concepts", and remove the people. WhatamIdoing (talk) 16:32, 27 October 2020 (UTC)

That looks great to me. As far as a separate "Significant infectious agents" navbox that Tom (LT) mentioned above. I agree that "significant" was probably the intended inclusion criterion for the diseases listed above. If we do decide to have such a box going forward, perhaps we could have a brief discussion somewhere on which diseases fit that bill. It feels odd to apply the same label to Tuberculosis/AIDS as Tinea/Amoebic dissentary. Ajpolino (talk) 16:56, 27 October 2020 (UTC)
That looks good, especially if we also create a "Concepts in infectious disease" navbox and a "History of infectious diseases" navbox per Tom (LT) above. TompaDompa (talk) 11:07, 1 November 2020 (UTC)
I implemented the change. TompaDompa (talk) 23:41, 2 November 2020 (UTC)

Concepts in infectious disease navboxEdit

Above, creating a "Concepts in infectious disease" navbox was suggested. Here's a rough first draft of how it could look. @Tom (LT), Ajpolino, Berchanhimez, WhatamIdoing, and DrVogel: What do you think? TompaDompa (talk) 19:23, 8 November 2020 (UTC)

TompaDompa, I think that's great start. I would recommend finding a way to shorten the phrase "emerging infectious disease" as it makes the entire "header column" wider because it's long. I'd also recommend adding a "types" - to include the types of pathogens (bacteria, virus, fungi, parasites, etc) - likely this would be best as the first one, followed by transmission, followed by medication. I can make the edits to your mockup if you'd like, or if you'd like to discuss/work on it yourself that's fine too. All in all I think this provides a basis for how we can move forward. I note that the "disciplines and pathogens" will now be separated.. I think they should be included in "concepts" - and the original template (Template:Infectious disease) turned into a sidebar such as is present on things like Donald Trump or similar. That way the disciplines are still present in the navbox but can also be featured more prominently towards the top of the article. -bɜ:ʳkənhɪmez (User/say hi!) 21:42, 8 November 2020 (UTC)
Hi TompaDompa, I think your concept for the concepts box is great. A couple of comments:
  • we should include agents (bacteria, virii, etc)
  • we may or may not want to combine the rows for agents and medications. Something like "bacteria (antibiotics), viruses (antivirals), ...". Or perhaps as 2 separate rows.
  • I think we may want to include all the elements from the chain of infection (agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host)
Dr. Vogel (talk) 22:13, 8 November 2020 (UTC)
I think that looks great! Since this is just a question of taste I'll share my quibbly opinions. Ignore all you wish. If you wish to shorten "Emerging infectious diseases" (per Berchanimez's suggestion), perhaps "Emerging infections" gets the point across? I'd lose the extra parentheses around "Reverse zoonosis" – it's still an example of cross-species transmission. If you choose to include the pathogen types (which I don't think completely necessary), I'd suggest just using the line from the {{Infectious disease}} template above. As far as adding things, I find navboxes' usefulness to be inversely proportional to the number of links in them (too many links, and it's a sea of blue words I don't bother reading). I think you've done an excellent job picking a fairly minimal set of "concepts"; I'd add more only with caution. Also I'll have to disagree with the suggestion above about turning {{Infectious disease}} into a sidebar. Sidebars are fairly prominent on articles, and I don't think its appropriate for articles like Bacteriology, Mycology, etc. that are much broader topics than just their role in infectious disease to have such a prominent sidebar. All that said, you've done the heavy lifting here. I don't think anyone will fault you for splitting disagreements to whatever your own preference is. Thanks for all the work on this! Ajpolino (talk) 22:28, 8 November 2020 (UTC)

Seeing as people seem to like this draft, I created Template:Concepts in infectious disease and implemented a few of the suggestions above. Feel free to edit that one. I might create a draft for a "History of infectious disease" navbox later. TompaDompa (talk) 22:49, 8 November 2020 (UTC)

History of infectious disease navboxEdit

Above, creating a "History of infectious disease" navbox was suggested. Here's a (very) rough first draft of how it could look. A few thoughts of my own:

  • I'm not sure what to call the first row. "History of individual diseases" would perhaps be a bit long, methinks. "History of..." is a potential solution, but feels a bit unprofessional. I welcome your suggestions.
  • With regards to the people, we have to decide how inclusive we want to be – the only two people I think have to be included here are Fleming and Jenner, all others could be debated. I personally think Credé, for instance, can be cut. Nightingale is also more associated with nursing in general than infectious disease, specifically. Especially when it comes to people who made microbiological contributions such as Pasteur, we could potentially include an enormous number of people—starting with Antonie van Leeuwenhoek, and including Alexander Ogston, George Miller Sternberg, Theodor Escherich, Barry Marshall, and so on—so we have to limit ourselves.
  • In the list of epidemics, I included the three deadliest ones and added COVID-19 (mostly because it would be such a conspicuous omission if I didn't). This means the epidemics that are listed here all have different causative agents. I'm not exactly opposed to adding the Plague of Justinian (which would be the fourth-deadliest one according to List of epidemics) or e.g. the Hong Kong flu and/or the 1957–1958 influenza pandemic, but then we would have multiple ones caused by the same(-ish) infectious agent, and I worry that that would result in an excessive number of epidemics being added over time. There's no point in duplicating Template:Epidemics.
  • I considered adding a "Timeline" row, for articles such as Timeline of peptic ulcer disease and Helicobacter pylori, Timeline of human vaccines, Timeline of antibiotics, Timeline of the COVID-19 pandemic, Timeline of HIV/AIDS, and so on. Those articles are kind of bad, however, so I'm not sure if that's a good idea.

@Tom (LT), Ajpolino, Berchanhimez, WhatamIdoing, and DrVogel: What do you think? TompaDompa (talk) 01:42, 19 November 2020 (UTC)

I personally think that looks fantastic. Like you say there are a lot of tricky elements to discuss but I think your approach and the contents here are really spot on. --Tom (LT) (talk) 05:15, 19 November 2020 (UTC)

I created Template:History of infectious disease with a reduced number of people included (that way, the "people" row isn't way wider than the rest). TompaDompa (talk) 12:27, 21 November 2020 (UTC)

Expert help needed: Gamal EsmatEdit

Hello everyone,

I am trying to de-orphan the page of Prof. Gamal Esmat which is supposed to be a famous hepatologist and a Board Member of the strategic and technical advisory committee for viral hepatitis (STAC-Hep) from WHO. Unfortunately I am not able to find any meaningful and reliable source in order to back up this (and other) statements, given that I mostly found researches about hepatology under his name.

Since my field of work is in the IT I do not feel qualified with carrying on looking for sources myself, but rather than nominating this article for deletion point blank I would like to hear a second (or third) opinion in this matter.

Would someone be so kind to help me in this task? I am also tagging this article as expert needed, fyi.

Thanks a lot in advance!!

Regards

I-Bin-A-Bibi (talk) 19:05, 20 November 2020 (UTC)


I just did a Google search for "Gamal Esmat" and restricted the search results to news stories. There were lots of them. So definitely don't delete this article. It should be straightforward to de-orphan the article using these news stories if someone wants to put in the effort. Jaredroach (talk) 19:23, 20 November 2020 (UTC)

Sometimes people make a list article (e.g., List of faculty members of the Courtauld Institute) or make a list of notable faculty as a ==Section== in the article about their current employer. I'd bet that David Eppstein could suggest a few other ideas.
Often, biographies are just left as orphans, and we don't worry too much about it. WhatamIdoing (talk) 22:17, 20 November 2020 (UTC)
My knowledge of both Egyptian and medical academia is weak. But his citation record on Google Scholar looks strong enough for WP:PROF#C1 and his distinguished professor title is probably enough for #C5, at least. He is cited in Schistosoma mansoni so linking him from the citation there should at least provide one incoming link. I'm not enthusiastic about lists of faculty at institutions; categories do that better. —David Eppstein (talk) 22:30, 20 November 2020 (UTC)

Hello again,


thanks a lot for everyone's help, the article is now de-orphaned!

Kind regards,

I-Bin-A-Bibi (talk) 06:24, 23 November 2020 (UTC)

Pandemrix: People probably have an opinion on this.Edit

Hey, I just read about the pandemrix case while reading about the association between narcolepsy and h1n1 vaccine when listening to a bbc program about vaccination. I wrote about this here: https://en.wikipedia.org/wiki/Vaccination#Side_effects.

I imagine this is something people might have opinions on.

Talpedia (talk) 23:10, 20 November 2020 (UTC)

Talpedia, I think it's in the wrong article. Why don't you split it out to its own page? There has never yet been a vaccine on the market that didn't meet the WP:GNG easily. WhatamIdoing (talk) 02:51, 21 November 2020 (UTC)
I think it deserves a mention in the vaccine safety section. The fact that vaccines have showed differential rates of adverse outcomes seems quite relevant to the question of vaccine safety in general - because it is quite suggestive that vaccines can have rare but real side effects - often those of the disease they protect against it seems. Obviously WP:DUE applies. How about something like "Different vaccines for the same disease can have different rates adverse events and this has resulted in legal action. An example of this was Pandemrix, a vaccine for H1N1.", and then moving this section into the Pandemrix article? Talpedia (talk) 03:59, 21 November 2020 (UTC)
Certainly adverse outcomes and their variability should be mentioned. However, there are vaccines with much more significant side effects than this one. Off hand, there was that disastrous flu vaccine in the 1970s that left some people paralyzed, and the dengue scandal in the Philippines, and the yellow fever vaccine whose side effects can be so bad that some travelers wonder whether the (usually small) chance of yellow fever might actually be a better alternative.
Also, completely apart from that, we should probably have an article on every vaccine that was ever marketed, or at least have a list of them all. This particular one probably has more to do with Influenza vaccine than with Vaccination in general, but I still think that you should start by splitting it into its own articlee. WhatamIdoing (talk) 06:20, 21 November 2020 (UTC)
Okay, that's a pretty compelling argument. I'll see if I can dig up the dengue fever case and add something high-level that links to a few cases. Talpedia (talk) 09:59, 21 November 2020 (UTC)
I've added a more general discussion of "post-trial adverse outcomes". Comments welcome! Talpedia (talk) 11:43, 21 November 2020 (UTC)

DANMASK-19Edit

Today's Guardian has an Opinion piece: "We need scientists to quiz Covid consensus, not act as agents of disinformation" by Sonia Sodha, which discusses reaction to the recently published DANMASK-19 trial. In particular, the author is critical of the response article in the Spectator magazine: "Landmark Danish study shows face masks have no significant effect" by Prof Carl Heneghan and Tom Jefferson. The Spectator claims "Carl Heneghan is professor of evidence-based medicine at the University of Oxford and director of the Centre for Evidence-Based Medicine Tom Jefferson is a senior associate tutor and honorary research fellow at the Centre for Evidence-Based Medicine, University of Oxford". The study appears to be deeply flawed, as well as not answering the question some claim it does. A good roundup of expert reaction can be found at "expert reaction to paper using an RCT to assess mask use as a public health measure to help control SARS-CoV-2 spread (DANMASK-19)". In particular, the excellent Prof Trish Greenhalgh's comments are damning.

I think it worth looking at the variety of expert comments there, because some clearly want to say positive and nice things about the paper before mentioning that it doesn't answer the more important questions. Why is it that some are saying "well-designed and carefully presented study" and "a good study" and "a well-run trial with enough participants to have high confidence in the results" and "This is a very valuable community study. The paper is very clear, the analysis correct and the interpretation appropriate" and yet Greenhalgh, author of the book "How to Read a Paper", tears it apart so thoroughly that one wonders how it got published. For example, it appears to fail the basic ethics requirements of the journal it got published in. One of the responses Greenhalgh links: "Letter of concern regarding »Reduction in COVID-19 infection using surgical facial masks outside the healthcare system«" notes "this study is uninformative regarding the benefits (or lack thereof) of wearing masks outside of the healthcare setting." and says the study "poses a serious risk of mistranslation".

Coming back to article in the Spectator (a right-wing British magazine), it claims "As a result, it seems that any effect masks have on preventing the spread of the disease in the community is small." which is not a claim the study could have produced, even if it was well designed and conducted. Those authors also make a comment about observational vs RCT studies that appears over-simplistic and perhaps that has consequences for us also when we assess the evidence. It seems the Oxford Centre for Evidence-Based Medicine is highly respected and does important work, yet this Spectator article appears scientifically incompetent and non-evidence-based. The Spectator have corrected the article title to no longer say "face masks have no significant effect to "no significant effect for facemask wearers".

The Guardian article concludes "The moral of this sorry tale? Trust science, not the scientists. They are only human, subject to the same cognitive biases, the same whims of ego, as the rest of us." -- Colin°Talk 12:32, 22 November 2020 (UTC)

See also Talk:COVID-19 pandemic/Archive 40#Effectiveness (or lack thereof) of face masks, where it has been considered and rejected. The actual result of the study, which does not align with the media descriptions, appears to be that recommending that adults wear masks (which is not quite the same as actually wearing them), in a community where most people don't use face coverings, probably has little or no effect on reducing the potential mask-wearer's chance of contracting COVID-19.
I gather that the upshot is what health authorities have been saying all along: masks primarily protect healthy people from the mask-wearers' potential germs, rather than primarily protecting the mask-wearers from non-mask-wearers. If we are feeling mean, then we could phrase this bluntly: People who refuse to wear masks when COVID-19 infection rates are up really are selfish jerks who don't care if they make other people sick. WhatamIdoing (talk) 21:10, 22 November 2020 (UTC)
It is worse than that. The analysis of the study's design and limitations reduce the conclusion from "probably has little or no effect on reducing the potential mask-wearer's chance of contracting COVID-19" to "did not find anything informative about the effect of participants chances of contracting COVID-19". Not being able to demonstrate an effect (and quite a strong effect of 50% protection, equivalent to what some hoped a vaccine might produce) is not the same as demonstrating no effect. There were compliance issues and fundamental problems with the testing that meant some positive cases were likely infected prior to the study and some negative cases were likely to become positive after testing stopped. The study was under powered for a realistic threshold: rather than 50%, a even 10% protective effect might well have been cost-beneficial at reducing the R number below 1, but would have required a much larger study and/or a country with much higher prevalence. It is almost like they wanted it to fail.
However, I'm less interested in this specific study than in the reaction where experts failed to pick up the flaws or even reported results that were pretty clearly not evidence based from this study. I know the Spectator is not a MEDRS source, but the authors are experts one might expect to publish a review or meta analysis in a journal. Would their mistakes be caught there? I hope so. -- Colin°Talk 14:37, 23 November 2020 (UTC)
Some thoughts. Obviously this stuff is contentious (everything can become about intent, and it's true that it can be about intent), so it becomes important to be technical about the analysis. I think the study itself is quite clear about what it does and doesn't do, and includes confidence intervals. I imagine the power analysis might have been driven more by the number of participants available than anything else. Yes, it would have been good to do the study on 60k people, but that requires you to do a study of 60k people. One point worth bearing in mind in that in the *observational* studies the effect of masks was upwards of 60% (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext) - I'm suspicious here. You could view the study more as a punt at the effect being large than anything else. I think the comments about ethical concerns aren't necessarily very relevant to the analysis itself - studies that violate ethical principles often give you useful results - they might be relevant to the people who took party in the studies. I suspect that the authors would not make mistakes in journals. The critique about the antibody tests not being effective within the time period o the study is perhaps more interesting.... though does not necessarily reflect upon the authors. Talpedia (talk) 23:16, 24 November 2020 (UTC)
@Talpedia: I don't agree with your analysis of the study, particularly the assertion "the study itself is quite clear about what it does and doesn't do". A lack of evidence of effect is not evidence of a lack of effect, and the conclusion "The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50% in a community with modest infection rates, some degree of social distancing, and uncommon general mask use." is not supported by the study. The study does not acknowledge its two largest flaws: (1) its duration (4 weeks for each cohort) is too short to sensitively measure differences in effects, particularly as the volunteers ("community-dwelling adults aged 18 years or older without current or prior symptoms or diagnosis of COVID-19") were not screened for existing asymptomatic or pre-symptomatic infection; (2) it makes no attempt to compensate for random variance resulting from the probability that most cases of infection would occur in the 19.5 hours when the subjects were indoors, rather than outdoors either wearing masks or not. Those two effects swamp the numbers reported (42/2392 and 53/2470) and invalidate the confidence intervals quoted. There are good analyses in the comments section of the study. Increasing the sample size of the study would have helped to a small extent, but running the study for a much longer period would have far more effect on reducing the contribution from pre-existing infections in the first two weeks of the study. --RexxS (talk) 18:20, 25 November 2020 (UTC)
"A lack of evidence of effect is not evidence of a lack of effect" Certainly. It provides covidence intervals that make it clear that a masks could still reduce the risk of infection, "it makes no attempt to compensate for random variance" a RCT compensates for other factors by randomizing group selection so that these factors just add variance, rather than changing the results - observational studies need to compensate for other factors, RCTs do not. "and invalidate the confidence intervals quoted" these increase the size of the confidence interval but as far as I can tell do not exactly "invalidate it" (if B > b and A - b < x < A + b then it is still True at A -B < x < A + B). The systematic bias is perhaps a different matter. I guess the quoted numbers for the difference in effect are potentially wrong due to the protocol. The rates will be of the form p * R_intervention + N_1 + a and p * R_no_intervention + N_2 + a, where the two N noises are identically distributed, it's legitimate to look at the difference. I guess by making the trial longer you can ensure a is small comparted to R and then you can calculate an *odds ratio* thereby eliminating p. Talpedia (talk) 20:08, 25 November 2020 (UTC)
"a RCT compensates for other factors by randomizing group selection so that these factors just add variance" – not really. Consider the possibility that three times as many infections occur indoors than outdoors when masks are not worn (a not unlikely scenario). Then we would expect around 40 of the 53 infections in the control group to be due to infection indoors, with the remaining 13 due to infection outdoors. In the masked group, if the masks had no effect, we would have expected 51 infections, 38 due to indoor infection and 13 due to outdoor infection. Since we found only 42 total infections in the masked group, that would mean wearing the masks outdoors reduced the number of outdoor infections from 13 to 4, which makes a nonsense of the techniques used in the study that ignored the effect of indoor infection. Hope that's clearer for you now. --RexxS (talk) 23:28, 25 November 2020 (UTC)
Yup, that's a systematic error the "a" term in "p * R_intervention + N_1 + a" (I guess you could think of it as biased error / noise as as well), if you look at the *difference* between infection rate (as the study does) you can remove this bias. You get p * (R_intervention - R_non_intervention) + N' , where N' is an error term and p is constant less than one. Taking a large number of cases gets rid of the N' term (but not the p ter), allowing you to calculate whether the study does or does not have effect. It does make the calculation odds ratios problematic though - but the paper doesn't calculate an odds ratio exactly, it does a power calculation - hopefully before the study began. If there had been a significant effect it would still have been significant despite `a`. By analogy, if you say, "putting seatbelts in cars cars reduces the road traffic death rate" but you include pedestrian deaths then your analysis is still correct. I guess when it tries to reference the power calculation in the conclusion it should take account of this. Hope that's clearer for you now. :P Talpedia (talk) 08:43, 26 November 2020 (UTC)
The maths here is a bit impressionistic (there's an edge case where *everyone* gets infected - so the experiment tells you nothing). To do this properly I should be playing with probabilities and binomial distribution. The edge case is going to be to do with P(not_infected)=P(not_infected_while_outside)*P(not_infected_while_inside), P(not_infected_while_outside) = P(not_infected) / P(not_infected_while_inside) which becomes impossible if P(not_infected_while_inside) = 0. Talpedia (talk) 08:43, 26 November 2020 (UTC)

Immune thrombocytopenic purpuraEdit

This article is a bit of a mess. For a long time, the I in ITP stood for idiopathic. But now, it is no longer idiopathic, but instead an autoimmune illness (the I now being immune). The article, even the lede, swings back and forth on if it is idiopathic ("...absence of other causes of low platelets") or not. It really could use some love. I'm not at all confident that I could fix it without causing more harm than good. So I thought I'd come here and hope someone has the time, interest, and ability to clean this up. Thanks. Hobit (talk) 23:05, 22 November 2020 (UTC)

We usually move disease-related articles when the ICD changes its official name. WhatamIdoing (talk) 21:14, 23 November 2020 (UTC)
It's not the name. The problem is that at one point ITP had an unknown cause. Now it is known. But the article still indicates, in places, that it is unknown. Such as the quote I gave that's in the lede. I'm fairly sure that quote is now wrong (and has been for years). Hobit (talk) 13:17, 24 November 2020 (UTC)
"It's an autoimmune disease" is not always what people (especially patients) think is "the cause". What makes the autoimmune reaction start? WhatamIdoing (talk) 16:37, 24 November 2020 (UTC)
Any of a variety of infections, drugs, ... things that stimulate the immune system. — soupvector (talk) 20:06, 24 November 2020 (UTC)
Presumably genetic susceptibility is a factor, too.
In my experience, when people want to know what the cause is, they usually want to hear something like "that drug you were taking" or "the nasty chemicals you use in the garden" or "smoking tobacco". They don't want to hear "it's caused by your immune system attacking your body". That's true, but what exactly made this immune system attack this body? WhatamIdoing (talk) 20:17, 24 November 2020 (UTC)
Agreed. Maybe that's what the article is trying to say? Not sure. I know a fair bit about ITP, but I don't know enough (either about ITP or how we write medical articles) to feel qualified to do a large rewrite here. Hobit (talk) 22:30, 24 November 2020 (UTC)
  • Given immunological memory (e.g. that the immune systems of monozygotic twins rapidly diverge during life - reflecting the accumulated divergence of a lifetime of immunological experiences), ascribing cause is often an exercise in the availability heuristic rather than true or deep causal analysis. — soupvector (talk) 22:46, 24 November 2020 (UTC)

Medical student editing initiativeEdit

Hello, I am supervising a group of medical students from Queen's University while they improve 17 Wikipedia medical articles. We are using the following project page which is also linked to an events dashboard. I will be moderating all the edits as they are made and we have the following series of steps to verify that what the students add is of high-quality, is accurately paraphrased, and is supported by WP:MEDRS sources. step 1: Faculty member "tutor" chooses a Wikipedia article in their field of expertise that they feel needs improving (most are B or C level articles). 2) Students share proposed article improvements with faculty members and health librarians via a series of course assignments including a lesson on MEDRS. 3) Students share a brief summary of their individual proposed change on the article talk page including the exact citation they propose to include. I will be moderating the 17 talk pages in case they need cleaning/citation tweaking, etc 4) Students practice editing, adding citations in their sandboxes. 5) Students edit their article based on feedback from talk pages. Each student aiming to add a paraphrased sentence or two along with its high-quality secondary source. 6) I will be moderating all the edits that the students make to the actual article to ensure the "final" improvement is of high-quality and meets Wikipedia guidelines. I do not need additional volunteers for the aforementioned steps, but if any of these articles interest you, encouraging and positively expressed feedback for the students would be great. It would be wonderful if we could show them how fun and interesting it can be to improve medical articles on Wikipedia and maybe a few of them will stick around to help us here at WP:MED! This is our fourth year running this short course following this similar work flow.JenOttawa (talk) 22:21, 23 November 2020 (UTC)

Great! Best of luck. One question, I see Cirrhosis is on this list. If I understand correctly, that means it is one of the pages chosen for student work? It's also currently a Collaboration of the Month nominee so if you're planning to improve it with your students, let me know and I'll pull it from the COTM nominations page for now. Ajpolino (talk) 00:38, 24 November 2020 (UTC)
Good catch @Ajpolino: Thanks for noting this! Yes, one of the faculty identified Cirrhosis as needing work and chose it for their students. Sorry that I missed this. The students will not be completely overhauling the whole article, just improving different sections. They will be finished in 2 weeks. Thank you again, JenOttawa (talk) 02:57, 24 November 2020 (UTC)
Got it, thanks. We just won't pick it this month then. To your original point, I'll keep an eye on Amyloidosis and help out (or just interact positively) with folks there. I'm glad to see all the work on this! Ajpolino (talk) 03:10, 24 November 2020 (UTC)

Non-pharmaceutical interventionEdit

Hello -- I notice when I linked it that a redlinked editor has recently rewritten this article, and much of it now does not seem neutral/balanced/readable. I wonder if someone here could take a look? If nothing else, readers will be predominantly looking for coronavirus mitigation measures, which have been rather drowned out. Cheers, Espresso Addict (talk) 06:28, 24 November 2020 (UTC)

Well... it certainly needs some cosmetic clean-up work, and some basic wiki-editing (e.g., to add links). The previous version was about three sentences long, so this is an improvement in some ways.
It's not clear to me whether NPIs are specifically non-drug ways of reducing your risk of getting infected by a pandemic virus, or if they're what it says on the tin, i.e., all non-drug treatments, including surgery, self-care, etc. WhatamIdoing (talk) 07:05, 24 November 2020 (UTC)
I've done some clean-up work. It needs a lot more. Alexbrn, if you've got 10 minutes to spare, I think the middle of it would especially benefit from your kind of help. WhatamIdoing (talk) 07:16, 24 November 2020 (UTC)
(edit conflict) The latter (or at least not just the former). See PubMed: cancer-related fatigue, diabetes mellitus type 2, multiple sclerosis, occupational noise-induced hearing loss. TompaDompa (talk) 07:22, 24 November 2020 (UTC)
Thanks, everyone. I've never seen it used to refer to surgical interventions. Espresso Addict (talk) 07:32, 24 November 2020 (UTC)
I split it: Non-pharmaceutical intervention for the term in general and Non-pharmaceutical intervention (epidemiology) for the specific use in epidemiology. TompaDompa (talk) 08:29, 24 November 2020 (UTC)
Espresso Addict, in your experience, is this usually more like a "doesn't require direct assistance from healthcare professionals" concept than a (narrowly) non-drug concept? ::::::WhatamIdoing (talk) 20:20, 24 November 2020 (UTC)
WhatamIdoing: My personal understanding is that it refers to prescribed specific interventions or, in the current case, specific public-health guidelines that do not involve pharmaceuticals (or afaik surgical intervention). I wouldn't use it for general wellness-type advice of the sort that could safely be given by anyone to anyone. Espresso Addict (talk) 20:32, 24 November 2020 (UTC)
Hum (ping:Alexbrn), would WP:Dictionary perhaps be pertinent here? (as in, "what it says on the tin"). Entering non-pharmaceutical intervention epidemiology into GoogleScholar currently retrieves a lot of (recent) publications directly related to the COVID-19 pandemic. But on PubMed, it's a somewhat different story (cf [1]). Fwiw, as a former medical writer I would have understood/used the phrase in relation to any non-pharmaceutical preventive or therapeutic intervention, whether in the context of clinical medicine or public/occupational health, etc. In other words, anything you could trial in an intervention study of efficacy/effectiveness; cf PICO process, etc.
Of note, in the Non-pharmaceutical intervention (epidemiology) page (started April 2020), I don't see why the term should necessarily be restricted to epidemics and prevention of spread of a contagious disease (permalink). 86.186.155.162 (talk) 17:30, 26 November 2020 (UTC)
It looks to me like an area which is not neatly partitioned in the real world, so Wikipedia will need to decide how to manage the topic space. This can be done with careful use of definitions in the opening sentence, hat notes, etc. Alexbrn (talk) 19:18, 26 November 2020 (UTC)
Yes, if done carefully, with circumspection, as you're suggesting, I think it has the potential to become a useful page(-s?) highlighting the range and relevance for human health around the world of interventions which don't actually rely on drugs etc. (A broad topic though.) 86.186.155.162 (talk) 20:41, 26 November 2020 (UTC)
  • WhatamIdoing Thanks for the ping, I've made a brief start on some clean up of the split article, but am now going for a bike ride while the weather's good. More later ... Alexbrn (talk) 09:05, 24 November 2020 (UTC)

Bye-bye baby, hello toddlerEdit

Although it requires some work, I don't think the current changes to the Toddler article are an improvement, more eyes needed please. CV9933 (talk) 10:47, 24 November 2020 (UTC)

This looks like a simple edit war over what age a toddler is/isn't. Adding some sources, such as this one, might help. WhatamIdoing (talk) 16:48, 24 November 2020 (UTC)

WoodruffEdit

Is anyone able to fill in any of the red-linked conditions at FA Michael Woodruff? Some of them may have articles, SandyGeorgia (Talk) 18:11, 25 November 2020 (UTC)

Also, as part of WP:URFA/2020, could anyone glance at that article to see if there are any issues? I don't see any, but am concerned that the original author is multiple-blocked for socking, and want someone else to lay eyes on the article before I mark it as "Satisfactory" at URFA. SandyGeorgia (Talk) 18:16, 25 November 2020 (UTC)
I made a redirect for the easy one. I'm not sure what to do about Antilymphocyte serum. It's a thing (MeSH), but I'm not sure if we have any obviously related articles. In practice, it's sort of like antivenin, except that instead of the non-human antibodies attacking venom in a human, they're supposed to kill human lymphocytes to produce an immunosuppressive effect. WhatamIdoing (talk) 21:09, 26 November 2020 (UTC)
Antilymphocyte serum is linked to Anti-lymphocyte globulin later in the article, but I'm not entirely sure it's the right link, as the ALG article claims "Its use was first reported by Thomas Starzl in 1966" while the Woodruff article claims he was studying it in the 1940s-50s. Not enough time to investigate this right now.... Spicy (talk) 02:37, 27 November 2020 (UTC)
Anti-lymphocyte globulin (specifically and more conventionally now, anti-thymocyte globulin, ATG) as a concept in suppressing immune responses has been around for more than a century - it's a fairly obvious concept once one has awareness of (1) antivenom (as WAID noted above), (2) lymphocyte infiltration of tissue/organ grafts during rejection, and (3) the tolerizing effects of thymectomy. That someone "worked on" something isn't very notable, unless they materially advanced that field or if that work specifically informed other notable work. — soupvector (talk) 12:06, 27 November 2020 (UTC)
It sounds like I should not be marking the article as “Satisfactory” until we have time for a deeper look ??? SandyGeorgia (Talk) 12:58, 27 November 2020 (UTC)

The Oxford vaccine and other storiesEdit

I suppose we'll end up with an article for every COVID vaccine candidate. I note (with approval) there has been push back on relaying the claims about the Russian "Sputnik" vaccine, until verified by WP:MEDRS. I have removed claims about the Oxford vaccine on the same principle, especially in the light of questions[2] about the research. Alexbrn (talk) 08:20, 26 November 2020 (UTC)

We should probably have an article for every vaccine that was marketed (for any disease, ever). I'm not sure that we need an article for every candidate. I think that candidates would be better handled in a list. WhatamIdoing (talk) 21:10, 26 November 2020 (UTC)
Quoting from what I wrote at Wikipedia talk:WikiProject COVID-19 #Oxford/AstraZeneca vaccine:
Here's a ringing endorsement of our policies from the NYT article:

Menelas Pangalos, the AstraZeneca executive in charge of much of the company's research and development ... responded, "I think the best way of reflecting the results is in a peer-reviewed scientific journal, not in a newspaper."

He might as well have added "... nor in our press release".
Cheers --RexxS (talk) 02:25, 27 November 2020 (UTC)

Dyskeratosis congenitaEdit

A request edit template has been on the talk page of Dyskeratosis congenita since August. I tried evaluating the request but I do not feel comfortable adding medical information to an article, especially if there might be a WP:COI. Can an editor from this project look at the request and give an opinion on if this information should be added to the article? I am more than happy to "clerk" the request, or you can follow the instructions at Template:Request edit/Instructions to do it yourself. Thanks for your help, and ping or post on my talk page if you have any questions. Z1720 (talk) 16:32, 27 November 2020 (UTC)

Disinfection at CryptosporidiosisEdit

Could someone please look at Cryptosporidiosis and see if the answer/clarification requested here is simple and obvious? It's about how to kill the pathogen. WhatamIdoing (talk) 20:29, 27 November 2020 (UTC)

I commented there. — soupvector (talk) 01:41, 29 November 2020 (UTC)

Perioral reflexEdit

Bonjour ladies and gentlemen, I come to you with another stubby orphan. Should it be merged? Left standalone? Deleted, even? As usual I'm prepared to do legwork if pointed in the right direction. ♠PMC(talk) 00:50, 28 November 2020 (UTC)

Could be merged into reflex in the cranial reflexes section. Your thoughts? Spyder212 (talk) 02:18, 28 November 2020 (UTC)
Agree that it belongs in that list. Each reflex could, with suitable detail (images, pathways, clinical uses, perhaps comparative neurology...) warrant its own page - each is notable. That said, the page linked in this section header doesn't warrant retention. — soupvector (talk) 01:44, 29 November 2020 (UTC)
Brilliant. I merged it to List of reflexes, although that list seems a bit redundant to Reflex and/or {{Reflexes}}. I'll let y'all hash that out. Thanks guys! ♠PMC(talk) 03:25, 29 November 2020 (UTC)

RfC on how to define "suicidal ideation" and compose the lead paragraphEdit

WP:MED is one of the WikiProjects listed as having interest in the article, Suicidal ideation. A request for comments (RfC) is currently underway at: RfC on how to define "suicidal ideation" and compose the lead paragraph. Your input would be very helpful. Thank you - Mark D Worthen PsyD (talk) [he/his/him] 16:09, 28 November 2020 (UTC)

That is unfortunate timing since WhatamIdoing and I have been formulating a broader RFC with Masem ... to hopefully deal with the number of inconclusive RFCs on the topic everywhere. This seems, though, to be focused on a a narrow aspect of one part of that lead, so probably a different thing. SandyGeorgia (Talk) 16:14, 28 November 2020 (UTC)

Medical items on WikidataEdit

Hi All,

For those editing Wikidata, I've made a Mix'n'match query where it is easy to connect external medical databases about illnesses, conditions, etc. to Wikidata items. Feel free to use it.

Best, --Adam Harangozó (talk) 17:15, 28 November 2020 (UTC)

thank you for post--Ozzie10aaaa (talk) 22:59, 28 November 2020 (UTC)

the science academy of turkey - should be removed from WikiProject MedicineEdit

Hello, I just edited "The Science Academy Society of Turkey" article in tr and en. In en.wiki it was somehow considered to be within the scope of WikiProject Medicine, but that's a mistake. this is not about medicine and it's not a medical academy, it's a scientific academy in general. I believe it should be removed from the medicine portal, but could not do so myself. please have a look. thanks! Danende (talk) 20:25, 28 November 2020 (UTC)danende

According to the article, The Science Academy Society of Turkey appears to have 31 of its 180 members from the life sciences, which would suggest to me that it is probably in the scope of WP:MED. More specifically, the project banner was added on 28 October 2014 by Cirt (who had just nominated it for deletion). At that time, it contained the statement "The Science Academy has presently a total of 144 full members (86 from the fields of natural sciences, mathematics and engineering, 35 from social sciences and humanities, 23 from medical sciences)", so it seems quite reasonable that Cirt placed it in the scope of WP:MED. --RexxS (talk) 00:24, 29 November 2020 (UTC)
Danende, thanks for this note. At the English Wikipedia, any group of editors (called a "WikiProject") can support any article they want. Tagging articles is only meant to to make it easy for a group to keep track of the articles. In this case, it might be appropriate to add a tag for Wikipedia:WikiProject Science as well. WhatamIdoing (talk) 01:49, 29 November 2020 (UTC)

Vorlage:Navigationsleiste Tumore des NervensystemsEdit

Is it acceptable to copy "Vorlage:Navigationsleiste Tumore des Nervensystems" (German) to the (English) "Template:Nervous system tumors"? It means that the English version will be removed and the German side will be used in English. The German side has more informations about Nervous system tumors.

Before here on the Wikipedia talk:WikiProject Medicine I was on the Teahouse: Welcome to the Teahouse, Wname1. I think that would be a very bad and confusing idea, but expanding the English template to include more links to a wider range of articles in English seems a more logical approach. I note you also asked the same question at Template talk:Nervous system tumors, so one hopes you might receive a reply there. However, that page has very few watchers, so I suggest you ask a question at Wikipedia talk:WikiProject Medicine, linking to the template talk page discussion so that you don't get answers spread around different discussion pages. Hope this helps, Nick Moyes (talk) 19:27, 28 November 2020 (UTC). Wname1 (talk) 21:43, 28 November 2020 (UTC)

de:Vorlage:Navigationsleiste Tumore des Nervensystems is in German (obviously) so it would not be appropriate to replace Template:Nervous system tumors with it.
On the English Wikipedia, these sort of navigation templates contain lists of English article titles that are related to the topic. It would not be appropriate to direct English readers to articles on the German Wikipedia, even if you translated the German titles to English.
If your point is that there are more potential articles on the topic of "nervous system tumours" than exist on the English Wikipedia, and that the German Wikipedia template displays them, then you may well be right. However, unlike the German Wikipedia, navigation templates on the English Wikipedia are designed for navigation for readers (not for editors), so only contain the titles of articles that exist. it would not be appropriate the add titles of articles that don't exist on the English Wikipedia to the template.
You might want to make a list of nervous system tumour articles missing from enwiki in your user sandbox, and then perhaps enlist help here in creating and developing them. --RexxS (talk) 00:43, 29 November 2020 (UTC)
@Wname1: - for notification. --RexxS (talk) 00:44, 29 November 2020 (UTC)
@Tom (LT) was looking at that navbox a few months ago, and might be interested in the idea of expanding it. WhatamIdoing (talk) 01:50, 29 November 2020 (UTC)
Thanks for the ping. I completely agree with what RexxS states. Our navboxes have evolved over the last 15 years or so to reflect the contents of articles, what is useful for readers, and have been divided according to navboxes in our namespace. We definitely have an appropriate template. Unfortunately a wholesale replacement would be inappropriate; the nom can consider individually going through articles to add them if they are missing when appropriate. --Tom (LT) (talk) 04:08, 29 November 2020 (UTC)
PS I am taking a short wikibreak so won't be able to respond for another two weeks :). Feel free to proceed in any direction without me :) --Tom (LT) (talk) 04:14, 29 November 2020 (UTC)

Question on phrasingEdit

Hi all! this says Acute respiratory disease of recruits (ARD), a major cause of morbidity in all military training camps, during and after World War II, and as defined clinically and epidemiologically at Fort Bragg, is a specific etiologic entity caused by several adenovirus types.. I'm having some trouble actually figuring out what that means, so I was hoping someone could advise me. Would a simple way to describe it be Acute respiratory disease of recruits is a condition caused by several adenovirus types? Does that make sense, or am a totally incorrect here? Sorry if this isn't the right place to ask. Cheers, Eddie891 Talk Work 23:45, 28 November 2020 (UTC)

Hi @Eddie891:, I hope you'll forgive our field's poor writing. Your description is correct. I'm not sure how much of the sentence you do(n't) understand so apologies if I'm telling you something you already know, but the long sentence you quoted is saying several things at once: (1) There's a disease they call ARD, (2) it causes substantial illness in all training camps, (3) it was originally described in a study of recruits at Fort Bragg, (4) that study was in 1944, so the disease has been tracked in the U.S. military since WWII, and lastly (5) it can be caused by several different adenoviruses. I hadn't heard of the condition until this evening, so if you have other questions feel free to point me in the direction of other sources and I'll do my best to help. Ajpolino (talk) 23:58, 28 November 2020 (UTC)

COVID-19 related RfCEdit

This RfC may be of interest to WPMED members: Talk:Sucharit Bhakdi#RfC about the article opening. Alexbrn (talk) 10:33, 29 November 2020 (UTC)

Looking for people who've done a physical examEdit

Talk:Heights of presidents and presidential candidates of the United States#rfc 9228113 is about whether to prefer sources that place Trump's height just high enough that he's very overweight, or just short enough that he's slightly obese. There seems to be a disagreement about whether authorized public statements from a politician's personal physicians should be treated as infallible. WhatamIdoing (talk) 02:08, 30 November 2020 (UTC)

I've commented. Ultimately, this looks more like a WP policy than medical question, but I agree some input from medical experts can help shed light on the data. — soupvector (talk) 03:43, 30 November 2020 (UTC)

Wikipedia, The Free Online Medical Encyclopedia Anyone Can PlagiarizeEdit

I checked the archives, and I couldn't find a notice about this, so I apologize if it's a duplicate. The September issue of Publishing Research Quarterly contains the article, Wikipedia, The Free Online Medical Encyclopedia Anyone Can Plagiarize: Time to Address Wiki-Plagiarism. It is about plagiarism from Wikipedia to medical journals.[1] I was able to locate the abstract and citation online via my local public library's access to EBSCOHost, and the notice there said that full text "may be held at another location, check with your librarian", and "Full text delay due to publisher restrictions ('embargo')" and mentioned a 12-month delay. Mathglot (talk) 09:22, 30 November 2020 (UTC)

References

  1. ^ Laurent, Michaël R. (September 2020). "Wikipedia, The Free Online Medical Encyclopedia Anyone Can Plagiarize: Time to Address Wiki-Plagiarism". Publishing Research Quarterly. Germany: Springer Nature. 36 (3): 399–402. doi:10.1007/s12109-020-09750-0. ISSN 1053-8801. Retrieved 29 November 2020 – via EBSCOhost. Abstract: Plagiarism and self-plagiarism are widespread in biomedical publications, although journals are increasingly implementing plagiarism detection software as part of their editorial processes. Wikipedia, a free online encyclopedia written by its users, has global public health importance as a source of online health information. However, plagiarism of Wikipedia in peer-reviewed publications has received little attention. Here, I present five cases of PubMed-indexed articles containing Wiki-plagiarism, i.e. copying of Wikipedia content into medical publications without proper citation of the source. The true incidence of this phenomenon remains unknown and requires systematic study. The potential scope and implications of Wiki-plagiarism are discussed.
The irony of an article about Wikipedia being paywalled... Roger (Dodger67) (talk) 10:14, 30 November 2020 (UTC)
I have access to this article and can email it to you if you'd like. The examples given are Catamenial pneumothorax (plagiarized by [1]), Cocaine ([2]), Exome sequencing ([3]), Hospital-acquired infection ([4]) and Infant colic ([5]). The articles were found by searching for transclusions of the reverse copyvio template. Spicy (talk) 10:51, 30 November 2020 (UTC)
But no mention of Diabetic neuropathy, which made the Wikipedia:List of hoaxes on Wikipedia, with the hoax content copied by an allegedly peer-reviewed medical journal? WhatamIdoing (talk) 05:45, 1 December 2020 (UTC)

References

  1. ^ Visouli AN, Zarogoulidis K, Kougioumtzi I, Huang H, Li Q, Dryllis G, et al. Catamenial pneumothorax. J Thorac Dis. 2014;6(Suppl 4):S448–60.
  2. ^ Pomara C, Cassano T, D’Errico S, Bello S, Romano AD, Riezzo I, et al. Data available on the extent of cocaine use and dependence: biochemistry, pharmacologic effects and global burden of disease of cocaine abusers. Curr Med Chem. 2012;19(33):5647–57
  3. ^ Pussegoda KA. Exome sequencing: locating causative genes in rare disorders. Clin Genet. 2010;78(1):32–3.
  4. ^ Lai YY, Li Y, Lang J, Tong X, Zhang L, Fang J, et al. Metagenomic human repiratory air in a hospital environment. PLoS ONE. 2015;10(10):e0139044, retracted
  5. ^ Kheir AE. Infantile colic, facts and fiction. Ital J Pediatr. 2012;38:34, retracted

Here is a case study: Talk:Dementia with Lewy bodies/Alain L. Fymat. The publisher has returned/rejected letters from my attorney. If you want to know more about how to proceed legally, you will have to email me. SandyGeorgia (Talk) 15:26, 30 November 2020 (UTC)

Just wow - so illuminating and exhausting - thank you for linking here! — soupvector (talk) 18:04, 30 November 2020 (UTC)
I suppose it is less than surprising. The publisher is on Beall's List of Predatory Publishers. They are located in a residential apartment park. Their journals are not PubMed indexed. The article is "authored" by the Fymat AL, who is also listed as Editor-in-Chief of the journal. Fymat's PubMed-indexed articles were in the range 1970-1998. To be fair, most of his articles were in Applied Optics, so perhaps some later publications were in legitimate journals that are outside of PubMed's scope. LeadSongDog come howl! 18:09, 30 November 2020 (UTC)
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