Observed agreement, expected agreement, and chins

Imaginez qu’au lieu de bien zyeuter les crânes…

Screenshot 2017-08-29 06.26.00
Source: Yadav et al. (2017), Semantic relations in compound nouns: Perspectives from inter-annotator agreement

Question : Coucou, C’est quoi Cohen’s kappa ?

Réponse : Ce n’est pas moi, ce Cohen.  🙂  Cohen’s kappa est une façon de calculer l’accord entre deux personnes.  Par exemple : Diap. 11, les deux personnes sont d’accord l’une avec l’autre 4/5, donc 80% des fois.  Cohen’s kappa essaie de prendre en compte la possibilité d’être d’accord juste par hasard.  On peut dire que la probabilité d’être d’accord juste par hasard, c’est 50% en ce cas.  Imaginez qu’au lieu de bien zyeuter les crânes, chacun fait pile/face.  On a donc ces possibilités :

  • Kevin oui, Mayla oui : 0.25
  • Kevin oui, Mayla non : 0.25
  • Kevin non, Mayla oui : 0.25
  • Kevin non, Mayla non : 0.25
Voilà les deux cas où ils sont d’accord :
  • Kevin oui, Mayla oui : 0.25
  • Kevin non, Mayla non : 0.25
0.25 + 0.25, cela fait 0.50.  Donc, ils peuvent être d’accord 0.50 (50%) des fois… par hasard–rappelez-vous qu’ils ont fait pile/face.
Le calcul du kappa de Cohen, cela se fait comme ça :
  • Accord experimenté – Accord prévu par hasard = 0.80 – 0.50 = 0.3
…divisé par accord prévu par hasard, donc
  • 0.3 / 0.5 = 0.6
…donc on prévoit que le kappa de Cohen, c’est toujours moins que l’accord “cru.”  Vu que l’on ne veut pas surestimer la performance, on utilise le kappa de Cohen pour éviter cela.

Question :  C’est un genre de coefficient correcteur de réalité j’ai l’impression pour ne pas s’emballer sur des résultats in vivo qui parfois peuvent être faussés par le caractère très humains des annotateurs.  Enfin je crois comprendre ça 🙂

Réponse : Tu l’as dit mieux que moi !  🙂
Why would anyone want to label skull specimens as to whether or not they have chins?  See this post, and be sure to read MELewis‘s comment.


French notes

l’accord inter-annotateur : inter-annotator agreement.  See a nice set of slides on the topic, in French, here.
zyeuter : to scrutinize.  It seems like a soutenu word, but given the book where I ran across it, I would expect it to be familier.  (Comment from native speaker Phil dAnge: zyeuter is definitively not “soutenu”but completely “familier, limite argot ”)

Acquisition of edible invertebrates

As far as I know, no videos of Morning Dance Party exist.

Thelenota ananas, a species of sea cucumber. Credit: By Leonard Low from Australia – Flickr, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=1552175
I mostly relate to places through two things: food, and language.  (Presumably it would be better to be relating to people, rather than to places, but in the absence of a shared language, relating to people is difficult.)  Both of those–food, and language–get you pretty quickly into odd and difficult-to-resolve questions of what one might call “authenticity:” people never want to teach you slang, but it’s the thing that interests the typical linguist-on-the-road the most; we’re all always looking for that “real” svíčková na smetaně in Prague, but looking for “real” anything these days gets you into either fun conversations about cultural appropriation or fun conversations about post-modernity, both of which are fairly instant buzz-killers for anyone other than, say, me and the two other people in the universe who enjoy talking about cultural appropriation from the perspective of post-modernism without having slept very much the night before.  (Obviously, I’m not a very fun date–this may be related to my shitty divorce record.)

I think I cracked the “authenticity” nut on a recent evening in Hangzhou, though, where I had the funnest experience I’ve ever had in China that didn’t involve me, my niece and nephew, and Morning Dance Party.  (As far as I know, no videos of Morning Dance Party exist, and we should all be thankful for that.)  A colleague took me out for dinner to a buffet at a place that he described as typical and reasonably priced–the kind of place that any family could afford to go to.  Indeed, it was packed with families–imagine a very loud room filled with long tables, those long tables filled with big families talking, laughing, and passing an ever-growing assortment of plates back and forth while various and sundry foods hiss over a grill built into the table.

The way that the restaurant works: you wander around and pick things from an enormous selection, then take them back to your table, where you grill them.  When I say “enormous,” bear in mind that I’m talking about China here–“enormous” in China is really big.  Then think about this: I only recognized perhaps 10% of the available foods.  Some fruits; some vegetables; duck gizzards, certainly, and I guessed the avian liver correctly, too.  But, for the most part, I hadn’t the faintest clue what I was looking at.

Zipf’s Law describes an important characteristic of language: about 50% of the words in any large sample of words almost never occur–but, they do occur.  The word that came up in the Chinese restaurant: trepang.  As a verb, Wikipedia defines it like this:

Trepanging is the act of collection or harvesting of sea cucumbers…

“Not to be confused with trepanning,” it adds.  Indeed, indeed.

Zipf’s Law takes you into some pretty out-of-the-way corners of the lexicon.  As Wikipedia points out, to trepang is a member of a larger group of English verbs.  A trepang is a sea cucumber–a marine invertebrate animal related to starfish and crinoids.  To trepang is to harvest sea cucumbers, and in having that relation between the noun and the verb meaning to harvest things that are labelled by that noun, it resembles a number of more-familiar verbs.  From Wikipedia again:

Trepanging is comparable to clammingcrabbinglobsteringmusselingshrimping and other forms of “fishing” whose goal is acquisition of edible invertebrates rather than finfish.

Other than the pure joy of having a verb that means “to collect or harvest sea cucumbers,” what’s interesting about this?  In science, “interesting” usually means “different from what you would expect based on what you already know.”  The interesting thing here, then, is that there are other verbs that come from a noun that refers to an animal–but, they don’t mean “acquisition of.”  Consider, for example, the verb to flea.  Don’t look for it in Merriam-Webster—it’s not there.  What it means is to remove fleas from.  It’s a transitive verb–here’s an example from a forum on pets:

Source: http://www.petforums.co.uk
The poster has a cat, the cat has fleas, and the poster would like to cause the cat to no longer have fleas, but is concerned about the fact that the cat has recently had kittens.  Thus: Can I flea my cat a week after she’s had kittens?

To foal is another verb that comes from a noun that refers to an animal.  A foal is a young horse, and to foal is to give birth to a foal.  It can be transitive or intransitive:

  • I would say she will foal in less than a week. (Intransitive.  Source: enTenTen corpus, from Sketch Engine.)
  • Animal science students have been involved with the entire process of preparing the horses to foal and bringing them to campus.  (Intransitive.  Source: enTenTen corpus, from Sketch Engine.)
  • Ada had just been up four hours helping to foal a horse and wasn’t prepared for the intrusion of the outside world.  (Transitive.  Source: enTenTen corpus, from Sketch Engine.)

To lamb is a similar verb–Merriam-Webster gives the example The ewes will lamb soon.

Getting into conversations like this over dinner is probably why I get divorced a lot, so I’ll point you to this YouTube video, One way to flea a cat, and get on with my day–I need to run a bunch of experiments on how to split up words in sentences in biomedical journal articles…

On being stared at

At some point in their life, everyone should spend some time in a place where they’ll be stared at

Picture source: me.

It’s 1981, and my ship has pulled into Istanbul for a week.  Being a stupid young sailor, I’m wandering around alone.  I pass some old men sitting on a stoop drinking tea (a common pastime for old men in Turkey).  One of the old men gets up, walks over to me, spits on a finger, and tries to rub one of my many tattoos off.  When he can’t, he shakes his head in disgust and sits down again.

It’s 1981, and my ship has pulled into Istanbul for a week.  Being a stupid young sailor, I’m wandering around alone.  Going down a busy street, I suddenly find myself surrounded by a crowd of young men.  One of the guys emerges from the crowd, and in broken English starts translating for the rest of the crowd, telling me everything that they have to say about how much they love my tattoos.

It’s 2016.  I’m waiting in line at an art show in China.  A guy walks up to me: excuse me, I can take picture of you with my children?  Sure, why not?  Smiles all around as pictures are snapped, and we all go back to waiting in line.

My job and my pastimes take me far and wide, and in some of the places that they take me, I look unlike anyone else.  Japan, Guatemala, China, Mexico, Turkey–in all of them, I am a “white guy,” a light-skinned, blue-eyed guy in a country where everyone else is brown-skinned, with black hair and brown eyes.  In some of those countries, I go places where I may be the only “white guy” that I see all day, and in those countries, I get stared at–a lot.  It’s not just me–it’s the experience of any Westerner in those places.

What I’ve learnt in those countries: how good it can feel to be smiled at.  This morning I took a walk along the riverfront in Hangzhou, China.  Men (and a couple women) did tai chi alone.  Women (and a couple men) did synchronized dancing to music.  Grandmothers pushed strollers, and grandfathers jogged–often in business casual–occasionally omitting a loud yell or two.  (I have no clue what the purpose of the yells is–native speakers, do you have any insight into this?)  For 45 minutes, I was the only “white guy” that I saw.

It was unusual for people not to stare at me.  Sometimes out of the corner of their eyes, and sometimes quite openly, but almost everyone stared.  Some of them, though–some of them smiled at me, too.  你好, they might say.  你好, I would answer.  I waved at little kids, and their grandmothers smiled–and made them wave back at me if they were too shy to do it on their own.  Not big-deal interactions–but, it always felt so good.  What it cost them: nothing.  What it gave me: a lot, actually.

I maintain that at some point in their life, everyone should spend some time in a place where they’ll be stared at.  It’ll teach you the value of a smile for someone who doesn’t seem to fit.  Lots of people get stared at in today’s America–Muslim women in hijab.  Black men in nice hotels/white neighborhoods/academic conferences.  Any woman at all in a computer science department.  A smile at someone else costs nothing–and can give a lot.

English notes

on being stared at: I include this one in the English notes because of the commonly-taught, commonly-believed old bullshit that there’s something wrong with ending a sentence with a preposition.  Is on being stared at English?  Absolutely.  Is there any other way to say it?  Not that I know of.

their life: This is a good example of the use of a third-person plural pronoun to refer to a singular person.  Since there is no reason to assume any particular gender here, some dialects of English use their gender-neutral pronoun, which looks like the plural pronoun, but in this context is not.  You can read more about this phenomenon here.

Picture source: http://media.philly.com

stoop: Besides being a verb with a number of different meanings, stoop can also be a noun.  Merriam-Webster defines it as  a porch, platform, entrance stairway, or small veranda at a house door.  How I used it in the post: I pass some old men sitting on a stoop drinking tea (a common pastime for old men in Turkey). 

Rackling against the breast bone

When I was a kid, I liked to do drugs as much as the next trailer trash, but I never, never understood how someone could stick a needle in their arm–until I had my wisdom teeth out. (Trailer trash explained in the English notes below.) The oral surgeon pushed the plunger on the syringe, I watched the medication travel down the IV line, and before I slipped off into unconsciousness, I heard the sound of the wind blowing in my ears and thought Ohhhhhhhh–THIS is why they do it.

I was lucky–before anesthesia was invented in the mid-19th century, that would’ve been a horrible procedure. Here’s a woman’s description of her mastectomy in 1811. Her name is Fanny Burney, and her record of the operation has survived until today because she was both a popular novelist and a part of the court of George III. This extract from a letter to her big sister Esther is quite unusual, in that it is a rare record of pre-anesthesia surgery from the patient’s point of view, rather than from the surgeon’s point of view, which is much better documented. Just in case you don’t feel up to reading the whole dreadful thing, I’ve shortened it, and then I’ve bolded the most horrific sentence—the sentence that people cite the most.  You’ll find the whole thing at the bottom of the post, after the English notes.

…when the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves… I began a scream that lasted unintermittingly during the whole time of the incision—and I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, and the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp and forked poniards, that were tearing the edges of the wound—but when again I felt the instrument—describing a curve—cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose and tire the hand of the operator, who was forced to change from the right to the left—then, indeed, I thought I must have expired… The instrument this second time withdrawn, I concluded the operation over—Oh no! —Dr Larry rested but his own hand, and—Oh Heaven!—I then felt the Knife rackling against the breast bone—scraping it!—This performed, while I yet remained in utterly speechless torture…

Once a year I spend a week in Guatemala with a group of physicians, nurses, operating room techs, and therapists who do free surgeries for people for whom the almost-free national health care system is still too expensive.  When people think about groups like ours, they mostly think about the surgeons, and the stories that people want to hear are mostly about the surgeries that those surgeons do—the children who will be able to get married some day because a plastic surgeon repaired their cleft lip; the child who will be able to learn to write because the hand surgeon gave him functioning fingers; the woman who will be able to go to the market and sell corn again—thereby getting cash to pay for her kids’ school supplies—because the gynecological surgeons repaired her prolapsed uterus and urinary incontinence. There’s someone who usually gets left out of these stories, though–the anesthesiologists and nurse anesthetists who made it possible for those surgeries to happen.

Reasonable people could debate about what the most important inventions in the history of humankind have been. The wheel makes most lists; penicillin gets on a lot of them; stupid ones have “The Internet.” Here’s my hypothesis, in no particular order:

  1. The toothbrush
  2. Vaccines
  3. Corrective lenses
  4. Anesthesia

After that, the importance levels drop off pretty quickly–vaccines have killed some diseases forever (and may kill more if bad hombres with political motivations don’t prevent it–Boko Haram, Trump administration Cabinet member Ben Carson, and occasional presidential candidate Jill Stein come to mind here). Penicillin, on the other hand, is a once-great idea whose time will soon be past, leaving us with no good answers for XDR (extensively drug-resistant) tuberculosis or for people like my former Navy shipmate whose penchant for returning from port visits with gonococcal pharyngitis was legendary throughout the 6th Fleet. Few things will ever be as near and dear to our hearts as our toothbrushes, but the Internet will die as soon as the zombie apocalypse starts, leaving us poorer in idiotic Twitter feeds (see death of Internet) but immeasurably richer in our appreciation for the value of our ties to our fellow humans (see zombie apocalypse).

Anesthesia, though: let’s think about some things that would not have ever happened without anesthesia. Bear in mind that before anesthesia as we know it today was invented in the 1840s or so, surgery was something to be avoided at all costs and, in the case of non-emergencies like cancer, until the last possible minute; if unavoidable, it was to be done as quickly as possible. (The main criterion for the quality of an amputation, other than the patient surviving it, was how quickly it was done; as far as I know, amputation was the main surgical intervention of the American Civil War.) With anesthesia, though–with anesthesia, surgeons could be careful. They could do things that took time; they could do things that were complicated. As Dr. David Metro, our chief anesthesiologist, put it to me: “anesthesia is what has made every surgical advance since the mid-19th century possible. Organ transplantation–it saved over 33,000 lives last year–cochlear implants, cataract surgery, hip replacements, coronary artery bypass surgery–all of that is only possible because we can put patients to sleep, keep them there painlessly for as long as necessary, and then wake them up again afterwards.”

That’s what anesthesia has done for us–but, on some level, anesthesia is just a bunch of chemicals. You could give them to yourself, like folks once used ether for fun. (See John Irving’s novel The cider house rules for where playing with ether can lead–it’s nowhere good.)  But, anesthesiologists–they’re another thing altogether. I’m not talking here about their technical skills–about the nurse anesthetist who worked the night shift in a hospital where I worked in the late 1980s, and who saved the life of pretty much every single patient whose life got saved in our emergency room, or about the anesthesiology resident who picked up on a case of tuberculosis a couple years ago here in Guatemala. I’m talking about a display of honesty and intellectual rigor that has had effects not just in the surgical world, but in the engineering world in general and in flight safety in particular.

In the 1970s, four anesthesiologists at Massachusetts General Hospital undertook a study of errors by members of their profession. 47 of their colleagues discussed with them–on tape–the errors that they had made in their careers. They talked about 359 incidents in total, of which 82% were caused by human error. As one commentator on that paper put it, Anesthesiology is the one domain in which patient safety was identified as a problem long before the Institute of Medicine’s 1999 wake up call to the healthcare community. Not only was the problem identified in the late 1970s, but anesthesiologists faced the issues, taking actions to effect changes that would reduce errors, adverse outcomes, and injuries. While it is often difficult to trace the historical path of change, there is reason to believe that the anesthesia critical incident studies planted seeds of ideas for others, either directly or subliminally.

Along with later work on equipment problems in anesthesia that proceeded on the same methodology, this body of research set the standard for a broad field of research in engineering on how to understand problems with systems, and how to use your understanding of those problems to make those systems safer. Table 3 in that paper gives nice insight into how that works. It shows the distribution of frequent types of equipment-related errors; one thing that you notice there is how many of the frequent categories of problems are related to misconnections or disconnections of the various and sundry tubing systems involved. One of the responses to this finding was to make it mandatory to have connectors on medical gas systems that cannot be plugged into the wrong gas supply–today, it is mechanically impossible to plug your oxygen line into a “room air” supply, or your room air supply into a vacuum. Today’s anesthesia machines are one of the best-designed kinds of systems for supporting a human life on this planet, and the anesthesiologist’s approach to thinking about what he or she does is ubiquitous in fields as diverse as flight safety—and surgery. As Atul Gawande put it in his book The checklist manifesto, describing the ways that checklists are used to help a pilot and co-pilot work together to recover from a potentially fatal emergency: as integral to a successful flight as anesthesiologists are to a successful operation.  Step back for a second and think about where these advances came from: anesthesiologists admitting to other people what they did wrong, on the record.  I wish that I had that kind of courage.

Connectors for the hoses for four different kinds of gases.  It’s not physically possible to plug these hoses into the wrong source–a product of those studies by anesthesiologists.

I woke up when my surgery ended, poorer by four molars but with an increased appreciation for what anesthesia and anesthesiologists bring to the world.  When our patients wake up here in Guatemala, it’s usually with their lives changed–Monday’s reconstruction of a hand for a teenager who I’ve seen every one of the five years that I’ve been coming here, as it’s a complicated surgery that has to be done in stages; yesterday’s removal of a mass on the right wrist of a woman whose job involves writing with a pen all day, and who therefore was losing the ability to support herself in a country in which there is no such thing as unemployment insurance, or disability support for people who can’t work; Tuesday’s repair of a cleft lip for a kid who otherwise would have been unlikely to find a spouse, in a country in which your only social support net is your family…

Enjoying these posts from Guatemala?  Why not make a small donation to Surgicorps International, the group with which I come here?  You wouldn’t believe how much aspirin we can hand out for the cost of a large meal at McDonalds–click here to donate.  Us volunteers pay our own way–all of your donations go to covering the cost of surgical supplies, housing for patients’ families while their loved one is in the hospital, medications, and the like.

English notes

Trailer trash: Here’s Wikipedia’s definition of this very American term: Trailer trash (or trailer park trash) is a derogatory North American English term for poor people living in a trailer or a mobile home.[1][2] It is particularly used to denigrate white people living in such circumstances[3] and can be considered to fall within the category of racial slurs.[4] The term has increasingly replaced “white trash” in public and television usage.

How I used it in the post: When I was a kid, I liked to do drugs as much as the next trailer trash, but I never, never understood how someone could stick a needle in their arm–until I had my wisdom teeth out.

The full description of Fanny Burney’s surgery

Here are the two paragraphs of Fanny Burney’s letter to her sister describing her surgery.  There’s more to the letter, which also describes the whole process of the development and diagnosis of her breast cancer–there’s a link to it at the end of the post.

My dearest Esther,—and all my dears to whom she communicates this doleful ditty, will rejoice to hear that this resolution once taken, was firmly adhered to, in defiance of a terror that surpasses all description, and the most torturing pain. Yet—when the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision—and I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, and the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp and forked poniards, that were tearing the edges of the wound—but when again I felt the instrument—describing a curve—cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose and tire the hand of the operator, who was forced to change from the right to the left—then, indeed, I thought I must have expired.

I attempted no more to open my Eyes,—they felt as if hermetically shut, and so firmly closed, that the Eyelids seemed indented into the Cheeks. The instrument this second time withdrawn, I concluded the operation over—Oh no! presently the terrible cutting was renewed—and worse than ever, to separate the bottom, the foundation of this dreadful gland from the parts to which it adhered—Again all description would be baffled—yet again all was not over,—Dr Larry rested but his own hand, and—Oh Heaven!—I then felt the Knife rackling against the breast bone—scraping it!—This performed, while I yet remained in utterly speechless torture, I heard the Voice of Mr Larry,—(all others guarded a dead silence) in a tone nearly tragic, desire everyone present to pronounce if anything more remained to be done; The general voice was Yes,—but the finger of Mr Dubois—which I literally felt elevated over the wound, though I saw nothing, and though he touched nothing, so indescribably sensitive was the spot—pointed to some further requisition—and again began the scraping!—and, after this, Dr Moreau thought he discerned a peccant attom (fragments of diseased [peccant] breast tissue)—and still, and still, M. Dubois demanded attom after attom.

Web site with Fanny Burney’s letter http://newjacksonianblog.blogspot.com/2010/12/breast-cancer-in-1811-fanny-burneys.html

Blog about pre-anesthesia surgery https://thechirurgeonsapprentice.com/2014/07/16/the-horrors-of-pre-anaesthetic-surgery/


A letter to my colleagues

Dear colleagues,

It is well known that there are certain things that one doesn’t talk about in professional contexts, and since social media has pretty much become a professional context for many of us, that includes Facebook, Twitter, and the like.  One of the foremost of those things about which one is taught not to talk is politics.  Nevertheless: as some of you may have noticed—and as I hope that all of you will notice as you read this message—since the results of the last presidential election in the United States, I have not been quiet in my publicly visible postings on Facebook, Twitter, or this blog about my position regarding Trump.  I will state that position briefly here: I am opposed to him.  When I say “him,” I am referring to the policies that he has espoused; to the actions that he has taken; to his dishonesty; to his tolerance of white supremacists; to his attacks on the judiciary and the press; to his actions towards women, specific ethnic groups, and most of all, his actions against Muslims.  This list is not meant to be exhaustive—I mention here only the things that have gotten the most public attention.

As I pointed out above, talking about politics in a professional setting is something that we are taught not to do—in most of our cases, from the beginning of our careers.  There is a reason for this: one does not want to alienate colleagues in an intellectual context over issues that don’t relate directly to one’s position on professionally relevant topic.  Consequently, my twofold purpose in writing this message to you will probably strike you as counter-intuitive, and therefore, I’d like to explain it to you, my colleagues—and to persuade you to act on it.

My first purpose in writing this letter is to make my position known, as widely as possible, and specifically, as widely as possible within my professional world.  My second purpose is to encourage my professional colleagues to do the same.  I’ll argue that making my position known is a responsibility, and a moral responsibility at that; then I’ll present data that suggests that specifically in your position as a scientist, you have a responsibility here as well; a responsibility, and a stake, and a unique platform from which you have the capacity to act—or not.

As a scientist, you like data—so, I’ll give you some.  In the late 19th and early 20th centuries, Germany was one of the scientific powerhouses of the world.  Even after a boycott of German scientists in the post-WWI period, German science—and German-language scientific publishing—continued to be dominant in some fields (chemistry in particular), and strong in many others.

On April 7th, 1933, the Reichstag passed the Law for the Restoration of the Professional Civil Service.  It made three categories of people ineligible for employment in academia: (1) non-Aryans, (2) members of the Socialist and Communist parties, and (3) political appointees of the preceding (non-Nazi) government.  According to Michael Gordin’s excellent Scientific Babel: How science was done before and after global English, as many as 25% of all German physicists were let go; “at certain centers, most prominently Göttingen, almost the entire department of physics and mathematics was gutted…about one in five, or 20%, of scientists had been driven from their jobs by 1935, followed by another wave when Austria was annexed in 1938…” Travel into and out of Germany became difficult, and to some extent less desirable, since many of the best scientists could no longer be worked with, whether because they had fled Germany or because they no longer had academic posts.

The consequences for German science were pretty devastating.  As Gordin tells it:

…the most immediate and perhaps the one with the longest-lasting consequences [was] the rupture of the graduate student and postdoctoral exchange networks….One of the most salient indications of the importance of German science [before the war] was the centrality of German universities as the destination of choice for foreign students….

What happened next?  Gordin again:

These networks [of collaboration and exchange of graduate students and post-doctoral fellows] did not reassemble until after the war, and they reassembled with the United States as the hub.

We have responsibilities here.  They are of three kinds: our responsibilities as human beings, as Americans, and as scientists.  Our responsibilities as human beings have been discussed extensively by far better writers than me since pretty much as soon as the ashes of WWII started cooling, and I will take them as a given.  Our responsibilities as Americans are related to Trump’s profoundly un-American actions; I have written about those, from my specific perspective as a veteran of the American armed forces, elsewhere (https://goo.gl/XvmuV7).  Instead, I will emphasize here your responsibilities as a scientist.  Your responsibilities as a scientist are of two kinds: your responsibility towards others in your capacity as a scientist, and your responsibility towards science itself.

As the philosopher Alan Chalmers has pointed out, we lay claim to science, and to being a scientist, for a reason: being a scientist confers a certain kind of credibility that people who do things similar to science do not have.  That means that you can speak out against Trump from a position that is founded on data and supported by logic; that at least tries (hopefully better than this letter) to eschew emotion in favor of evidence and reason; that takes advantage of the intellectual capital that our predecessors have been building up for us since Aristotle.  You can speak out over beers with your colleagues.  And, yes: you can speak out in your classrooms—all that it takes is not avoiding the many times that the actions of the current administration are relevant to questions of ethics, of the role of science in society—and its suppression with respect to topics like climate change and vaccinations.  (For those of us who work on language processing and social media data, it’s difficult NOT to talk about Trump.)  You can speak out in your faculty meetings.  Are you skeptical about this?  I suggest to you this thought experiment: pick your favorite social-political horror of the past century, and ask yourself this: would scientists, professors, government employees have been justified in speaking out against it in their professional capacities?  I think that you’ll arrive at a “yes” on this.

Those responsibilities towards other people, as a scientist, are the most important.  But, you have another responsibility, too: toward science.  I began my argumentation in this letter with data on what happened to German science in and after 1933.  The time is ripe for the same thing to happen to American science today—and while American science does not constitute the entirety of science, it constitutes a hell of a lot of it.  There’s some sense in which protecting science is everyone’s duty.  But, not everyone is really qualified to do so.  You, however, are.  And if you want to do that, the most effective way to do it is not to argue with your friends about the causal factors involved in climate change (although I certainly don’t want to discourage you from doing so)—the most effective way to do this is by getting at the root of the problem.  Speak out about Trump and his administration, and do it as a professional.

There is a potential counter-argument to my point in this letter.  It is commonly held that science should not be politicized.  Certainly we can point to cases in which the overt politicization of science has had bad consequences both for science, and for society—consider the effects of Lysenko on Soviet biology, and Nicholas Marr’s on linguistics.  (Lysenko is probably familiar to most of my colleagues, but Marr less so.  You can find a marvelous discussion of his work, of how Stalin used it to justify Russification, and of the consequences that it had for non-Russian speakers in Marina Yaguello’s book, whose unfortunately poorly titled translation was published in English as “Lunatic lovers of language.”)

To this potential counter-argument, I respond: it’s too late—science has already been politicized.  Science has been getting politicized in the US since at least 1975 and the Proxmire Golden Fleece Awards.  (I’ll point out here that Proxmire was a Democrat, not a Republican.)  Khan et al. describe politically-motivated attempts to stop vaccination in Nigeria and in Pakistan.   In 2016, three major candidates for the Republican nomination (Trump, Cruz, and Rubio) all used environmental science as a target.  Science has been politicized—by the bad guys.  Staying out of the fight over science means letting those bad guys win.

There’s an implicit assumption in my encouraging you to speak up about your take on the current situation: an assumption that you share my position.  I actually do, in fact, assume that. I also assume that there is some small number of my colleagues that are Trump supporters—it doesn’t seem very probable that a scientist would support Trump, but variability is a fact of being human, and it’s certainly possible.  If that describes you: I do want you to express your opinion, and I will guarantee you one thing, and ask the corresponding of you.  I guarantee you that I will listen respectfully to what you have to say, and that I will think about it before I respond.  I will then ask you to do the same—to listen to what I have to say, and to think about it before you respond.  I encourage this precisely because I am a scientist: being a scientist (or at least being a good one) requires being open to the possibility that you are wrong, and if you are, in fact, wrong, wanting to find out about it sooner rather than later.  I would be pretty surprised if you, as a scientist, didn’t come to see things my way, and I’m pretty sure that if you didn’t, it would not be because of the facts or your inability to interpret them, but rather because of a failure on my part to present them cogently.  But: as a scientist, I remain open to the possibility that I’m wrong, and if you disagree with me on things Trumpian, I will listen to you—respectfully, and giving due consideration to your reasoning.

I’m writing you this letter with the purpose of speaking out, as loudly and as clearly as I can; and I’m writing you this letter to ask that you do the same.  If my appeal to your conscience is not enough to convince you: let me appeal to your grandchildren.  Personally, I have enormous faith in America’s ability to right itself; we have never, ever been a perfect country, but we have always striven to improve our country.  Someday, we will end the current surreal situation.  What happens then?  As Jonathan Safran Foer put it in his novel Everything is illuminated (incidentally the most compelling illustration of the importance of collocations and of statistical language modelling that I’ve ever seen), in Europe the question that everyone asks themselves today is: what did Grandpa do during the war?  Someday your grandchildren will ask what you did during the Trump administration.  You can choose for the answer to be “I kept my head down and hoped that they wouldn’t come for me;” you can choose for the answer to be “I figured out what I could do, and I did it.”


Kevin Bretonnel Cohen

Khan et al. on vaccination: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635542/


Remember: the only way that people will expect you to know everything is if you pretend that you do.

Once a year I spend a week in Antigua, Guatemala, with a group that does free surgeries for people for whom even the almost-free national health care system is too expensive.  My part is to do Spanish-English interpreting.  You can read about some of the mechanics of a surgical mission at this link.  To give you a feel for what the interpreting part of it is like, here is the introduction to a manual for our interpreters.


Congratulations on being selected as an interpreter for Surgicorps!  If you went through the work of applying to go on a mission, I don’t have to convince you what a rewarding experience this will be. As Dr. David Kim, our medical director, put it: “Interpreters play an integral part in the Surgicorps mission, assuring nervous patients and their families—at a very frightening point in their lives—that they will be heard and understood if they are in pain, and that they will be able to understand pre- and post-operative instructions—it is a big comfort to them.”

The purpose of this manual is not to teach you medical Spanish.  Rather, its purpose is to give you some suggestions about how to prepare for your Surgicorps mission.  The manual will cover some aspects of medical interpretation in general, medical interpretation for Surgicorps in Guatemala in particular, and some of the vocabulary that is specific to the hospital in which we operate that you are likely to need.  In addition, some Central American Spanish grammar and vocabulary will be discussed, as well as general advice on how to comport yourself in a surgical setting.

If you’re not insanely hubris-ridden, you are already starting to worry about whether or not you are up to the task.  You can more productively spend your time preparing, rather than worrying, and the more prepared you are, the less anxious you get to feel when you arrive in Guatemala.

What to expect when you’re expecting a mission in Guatemala

Where expectations are concerned, the most important thing to be aware of is not your expectations, but the practitioners’ expectations of you.  The practitioners will expect you to be proficient in Spanish, but they will not expect you to be proficient in medical Spanish.  You are probably not proficient in medical English, and you will not be expected to be proficient in medical Spanish, either.  You should, however, be quite familiar with anatomical terms.  This book will cover some medical vocabulary in Spanish; it will be much easier for you to learn it if you know what it means in English, and you should consult a good book on English medical terminology if you are not familiar with it.  .  Remember, though: the only way that the practitioners will expect you to be familiar with medical vocabulary is if you pretend that you are.

An important expectation is that you will be honest and forthcoming when you are not sure what is being said.  This applies equally if you are not sure how to interpret what a patient is saying to the practitioner, and if you are not sure how to interpret what the practitioner is saying to the patient.  I guarantee you that the practitioners will trust and respect you more if they know that you will make clear when you do not understand, and will ask for clarification, than if they think that you are trying to bluff your way through something.

General advice for behavior in the hospital

There are a number of principles that should guide your behavior in the hospital.  The ones that are listed here come from general principles for safe and ethical behavior in health care settings, as well as experience on Surgicorps missions.  I’ll list them briefly here, and then expand on them below:

  • Do not run, ever.
  • Be familiar with principles of confidentiality.  Think hard before you post something about the mission on social media.
  • Be familiar with proper dress and behavior in the operating suite and associated spaces.  (The OR staff will help you with this.)
  • Be familiar with proper dress and behavior around sterile fields.  (See above about the OR staff.)
  • In case of doubt, follow the most recent instruction.
  • Develop a highly refined sense of smell.
  • Know your limits in interpretation situations.\item Know your limits in clinical situations.
  • Never answer a patient’s or family member’s question with anything other than some version of “I’m not a doctor, I don’t know—I’ll go find out.”
  • Clarify, clarify, clarify.
  • Nothing is ever about you.  Everything is always about the patient.

Do not run, ever

If you’re a health care professional, the first thing that you learn is probably not first aid, but rather this: never run in a hospital.  It just freaks everyone out and creates a commotion that will probably hurt the situation more than it will help it.  Plus, if you trip, go flying headlong, and crack your head open, you are not going to be any help whatsoever, and your coworkers are now going to have two patients in crisis, not just one.  In case of emergency: just walk quickly.

In case of doubt, follow the most recent instruction

In the unlikely event of a serious situation where your help is needed, sometimes someone will tell you to do one thing, and then someone else will tell you to do something else.  The rule of thumb in this situation is: follow the most recent instruction.  The person who gave you the second instruction sees that you’re doing something—if they tell you to do something else, you should operate on the belief that they know that what they’re asking you to do is more important.  Someone tells you to do something, and someone else tells you to do the opposite?  It’s likely that something about the situation has changed, and the needs are different now.

Develop a highly refined sense of smell

Think not just about what is allowed, but about what things look like, what they sound like.  Could that tweet be misinterpreted?  You probably shouldn’t send it.  Not sure if it would be a good idea to…  Don’t.

Nothing is about you.  Everything is about the patient.

It can be really easy to suspect that someone doesn’t think that your Spanish is good enough, or that they’re upset with you, or whatever.  Maybe a nurse will walk right by you and ask another interpreter to help them, or you’ll be interpreting for a surgeon, and they’ll ask for another interpreter.  That can be hurtful, obviously.  The thing to keep in mind: don’t take anything personally.  Nothing here is about you, ever.  What the providers want is the best possible care for their patients, and that should be the only thing that you want, too.  Besides, you’re making some assumptions here—with no evidence whatsover.  You’re interpreting this as that nurse doesn’t like me, that surgeon thinks that I don’t speak Spanish well—but, it’s actually a lot more likely that the nurse was thinking about something else and didn’t see you standing there, or that the surgeon was about to ask the patient a question that she knows the patient would be more comfortable answering in front of an interpreter who is older/younger/skinnier/fatter/taller/shorter/maler/femaler than you—you really don’t know until you ask, and if it’s important to you to know, then ask you should.  But, ultimately, the point is that this is not about you—it’s about what the patient needs in that moment, and that is all and everything that matters.

Clarify, clarify, clarify

No one expects you to know what cholelithiasis means.  You’re not sure?  Ask.  No one expects you to know what every single word of Spanish means—you don’t know what every word of English means, right?  So, you’re not sure what a person just said?  Clarify.  People will be glad to know that if you don’t understand something, you’ll ask.  It bears repeating: people will only expect you to know everything if you pretend that you do.

Never answer a patient’s or family member’s question with anything other than…

Never answer a patient’s or family member’s question with anything other than some version of “I’m not a doctor, I don’t know—I’ll go find out.” You can bet that the first time that you think that you know the answer because you have chased down someone to answer the question five times already that day and so you decide to answer it so that you do not bother the doctor or nurse again, this will turn out to be some sort of special case, and you will have made a completely unnecessary mistake—one that could be harmful.

Know your limits in interpretation situations

You will not feel equally comfortable in every clinical area or communicating every kind of message.  If you are much more comfortable with gynecology vocabulary than with anesthesia screening vocabulary: say so.  If you don’t think that you can translate and stay calm when translating for a physician who is going to tell someone that we can’t help their child: say so.  The Surgicorps medical personnel will respect you far more for communicating your limits than they will for trying to take on something that you’re not sure you can do in a way that will be safe for everyone.  Also, if people know that you need help with something, then they can try to give it to you—if they don’t know that you need help, then they won’t try to give it to you.  In general, people like to be helpful.

Know your limits in clinical situations

You may occasionally be asked to help out in an operating room in a pinch.  If you don’t feel competent to help, do not hesitate to say so .  It is far, far less of a problem to say “no” than it is to screw something up.  Peope will forget the one, but you will never forget the other.

Working with your fellow interpreters

Surgicorps brings a finite number of interpreters to Guatemala, and while it sometimes seems as if you are all standing around with nothing to do, it is more often the case that there are not quite enough of us.  Consequently, it is important to try to work together to make sure that all  of the needs of the medical and administrative personnel are covered, and that none of your fellow interpreters is overwhelmed—or starving to death while the rest of us are hanging out in the lunchroom. So, coordinate lunch breaks and the like.  Tell someone if you are leaving for the day—if you disappear and no one knows about it, we not only run short on interpreters sometimes, but someone will be taken out of the game to go look for you and make sure that you are not lying in a bloody heap somewhere.

Another way to help all of us do a better job is to share information about which patients do not speak Spanish well—not all of our patients, or their parents, are fluent in Spanish, and it is important to pass along the word to such patients to the other interpreters.

Surviving the Zombie Apocalypse: The dreaded back door

One of the most helpful things that you can do in Guatemala is to handle the knocks at the back door.  This might sound trivial, but it is also one of the most difficult things to do in Guatemala, and if you find yourself having zombie nightmares while you are here, that back door is probably the reason why.   People show up at the back door for a lot of reasons, ranging from looking for a family member, to dropping off receipts and results of laboratory tests, to showing up for non-surgical treatments like steroid injections or to have a brace made.
You will also go to the back door to call for family members after a surgery, and then translate for the surgeon while they explain how things went.
When people bring forms to the back door, smile, take the form, and give it to one of the local nurses in the pre-op area.

As always, do not answer questions—tell the family members that you are not a doctor, and will go find out whatever it is that they are asking about.
When in doubt about what to do in these situations, remember: you cannot be most helpful by getting tied up trying to solve the problems that appear there.  You can be most helpful by finding, or asking someone free to find, the appropriate person who knows how to deal with the issue, and then making yourself available to interpret.  Most of the time, this will be one of the local nurses.

Some things to think about when you find yourself crying in the bathroom

I presume that you are not a medical professional and do not have much experience with professional-grade compartmentalizing.  Even if you are a professional, if you are human, you are probably going to find yourself crawling off somewhere to cry at some point in your mission.  I can’t deny that life sucks and is unfair, but here are some things that you might think about at these times:

      • We cannot fix everything for everyone, but we can fix a hell of a lot for someone.
      • There are a lot of people who we are not going to be able to help, but every single person that we can help is going to benefit enormously from what Surgicorps does—probably for the rest of their life.
      • As bad as life looks for some of the people that you are going to see, it is infinitely better for a kid with a handicap to be in a place like Obras (the facility where we do our surgeries) than to be lying in the corner of a dirt-floor hut in the jungle somewhere.

No English notes this time, sorry!  Enjoying these posts from Guatemala?  Why not make a small donation to Surgicorps International, the group with which I come here?  You wouldn t believe how much aspirin we can hand out for the cost of a large meal at McDonalds–click here to donate.  Us volunteers pay our own way–all of your donations go to covering the cost of surgical supplies, housing for patients’ families while their loved one is in the hospital, medications, and the like.


Once a year I spend a week in Antigua, Guatemala, where I interpret for a group that does free surgeries for people for whom even the almost-free national health care system is too expensive.  I spend a lot of time in the recovery room. It’s a challenge–you’re interpreting for people who are half-asleep, and often wearing an oxygen mask–and I do like a challenge. (This use of do explained in the English notes below.)  Sometimes the challenges are unexpected ones, though.

One day last year a recovery room nurse asked me to tell a little boy to cough. That’s not unusual in a recovery room–sometimes post-operative secretions in your lungs cause a minor drop in the amount of oxygen that you’re getting, and a cough or two will clear them right up.

Tosa, I said. The kid looked at me uncomprehendingly.  Hmmm, I thought to myself–does the kid not speak Spanish?  That’s not uncommon in Guatemala, where 70% of the population is indigenous and over 20 Mayan languages are spoken.

The father looked at me and smiled. Tosá, he said. The kid coughed. So: no cough when I said tosa, but tosá elicited the desired response.

The father was using a verbal form that’s used in Guatemala and a few other places in Central and South America. Indeed, it’s probably the most distinctive thing about Guatemalan Spanish. However, although I know a few local regional nouns and usually get a happy laugh when I use them, I had never learnt this particular verbal form–Americans would rarely have an occasion to use or to hear it, as it’s used only in the context of particular social relationships, and it wouldn’t be at all typical for a foreigner to have one of those.

My “voseo” lesson at Maximo Nivel, a Spanish language school in Antigua, Guatemala. Picture source: me.

The verbal form in question is called voseo. It’s used in very close relationships–between friends of long duration is the typical one.  In Guatemala, the tu form of verbs is used in many situations in which the usted form would be used anywhere else in the Spanish-speaking world–for example, waiters in restaurants and the ubiquitous vendedores ambulantes (people who stroll constantly through the tourist areas selling stuff, primarily Mayan women of a variety of ethnicities from the surrounding pueblos) will typically address you with the formal terms señor or señora (sir or ma’am)–and then use the tu form of verbs with you, which even on my fifth time in-country sounds weird.

So, you’re wondering: how does one form this mysterious conjugation?  For starters, let’s go over the present indicative.  It’s almost entirely regular, and very easy to relate to the three classes of Spanish verbs.

Spanish verbs end with either -ar, -er, or -ir, with the -ar verbs mostly being homologous with the French -er verbs.  (Sorry–I havent even thought about the others!)  To form the voseo present indicative of almost all verbs, you keep the vowel of the infinitive, add the -s that you would expect in the tu form of the verb, and put the stress on the final syllable.  So:

  • escribir – escribís
  • decir – decís
  • venir – venís
  • tener – tenés
  • comer – comés
  • volver – volvés
  • tomar – tomás
  • buscar – buscás
  • caminar – caminás

Of course, just because Ive learnt the voseo forms doesnt mean that I have anyone with whom to use them–as I said, there are only some relationships in which its OK.  I did use them with the dog at my host familys apartment.  I listened carefully, and they use the formal usted form with him,  but he didnt seem to mind my voseo–although I was sneaking him treats, so who knows…

Enjoying these posts from Guatemala?  Why not make a small donation to Surgicorps International, the group with which I come here?  You wouldn t believe how much aspirin we can hand out for the cost of a large meal at McDonalds–click here to donate.  Us volunteers pay our own way–all of your donations go to covering the cost of surgical supplies, housing for patients’ families while their loved one is in the hospital, medications, and the like.  Scroll down for the English notes, per usual.

English notes

I do like…  This use of do emphasizes something.  As far as I can tell, the primary use, although not the only one, is to emphasize something that is contrary to expectations.  For example, in this Dashiell Hammett quote

I do like a man that tells you right out he’s looking out for himself. Don’t we all? I don’t trust a man that says he’s not. And the man that’s telling the truth when he says he’s not I distrust most of all, because he’s an ass and ass that’s going contrary to the laws of nature.

…you wouldnt expect anyone to like a person who is looking out for himself (a very Trumpian behavior, particularly if youre only looking out for yourself)–hence the do.  How I used it in the post:

It’s a challenge–you’re interpreting for people who are half-asleep, and often wearing an oxygen mask–and I do like a challenge.   Liking a challenge is presumably at least somewhat contrary to expectations–hence, the do.  

In-country: being or taking place in a country that is the focus of activity (such as military operations or scientific research) by the government or citizens of another country (Merriam-Webster)