Author Archives: R.E. Buxbaum

About R.E. Buxbaum

Robert Buxbaum is a life-long engineer, a product of New York's Brooklyn Technical High School, New York's Cooper Union to Science and Art, and Princeton University where he got a PhD in Chemical Engineering. From 1981 to 1991 he was a professor of Chemical Engineering at Michigan State, and now runs an engineering shop in Oak Park, outside of Detroit, Michigan. REB Research manufactures and sells hydrogen generation and purification equipment. He's married with 3 wonderful children who, he's told, would prefer to not be mentioned except by way of complete, unadulterated compliments. As of 2016, he's running to be the drain commissioner/ water resources commissioner of Oakland county.

Curing my heart fibrillation with ablation.

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Two years ago, I was diagnosed with Atrial fibrillation, A-Fib in common parlance, a condition where my heart would sometimes speed up to double its normal speed. I was prescribed metopolol and then atenolol, common beta blockers, and a C-Pap for sleep apnea. None of this seemed to help, as best I could tell from occasional pulse measurements with watch and a finger pulse-oxometer. Besides, the C-Pap was giving me cough and the beta blockers made me dizzy. And the literature on C-Pap did not impress.

So, some moths ago, I bought an iWatch. The current versions allows you to take EKGs and provides a continuous record of your heart rate. This was very helpful, as I saw that my heart rate was transitioning to chaos. While it was normally predictable, it would zoom to 130 or so at some point virtually every day. Even more alarming, it would slow down to the mid 30s at some point during the night, bradycardia, and I could see it was getting worse. At that point, I agreed to go on eliquis, a blood thinner, and agreed to a catheter ablation. The doctor put a catheter into my heart by way of a leg vein, and zapped various nerve centers in the heart. The result is that my heart is back into normal behavior. See the heart-rate readout from my iWatch below; before and after are dramatically different.

My heart rate for the last month, very variable before the ablation treatment, 2 weeks ago; a far less variable range of heart rates in the two weeks following the treatment. Heart rate data is from my iPhone and iwatch — a good investment, IMHO.

The reason I chose ablation over drugs or no therapy was that I read health-studies on line. I’ve go a PhD, and that training helps me to understand the papers I’ve read, but you should read them too. They are not that hard to understand. Though ablation didn’t appear as a panacea, it was clearly better than the alternatives. Particularly relevant was the CABANA study on life expectancy. CABANA stands for “Catheter ABlation vs ANtiarrhythmic Drug Therapy for Atrial Fibrillation – CABANA”. https://www.acc.org/latest-in-cardiology/clinical-trials/2018/05/10/15/57/cabana.

2,204 individuals with persistent AF were followed for 5 years after treatment, 37% female, 63% male, average age 67.5. Prior hospitalization for AF: 39%. The results were as follows:

  • Death: 5.2% for ablation vs. 6.1% for drug therapy (p = 0.38)
  • Serious stroke: 0.3% for ablation vs. 0.6% for drug therapy (p = 0.19)
  • All-cause mortality: 4.4% for ablation vs. 7.5% for drug therapy (p = 0.005)
  • Death or CV hospitalization: 51.7% for ablation vs. 58.1% for drug therapy (p = 0.002)
  • Pericardial effusion with ablation: 3.0%; ablation-related events: 1.8%
  • First recurrent AF/atrial flutter/atrial tachycardia: 53.8% vs. 71.9% (p < 0.0001)

I found all of this significant, including the fact that 27.5% of those on the drug treatment crossed over to have ablation while only 9.2% on the ablation side crossed to have the drug treatment.

I must give a plug for doctor Ahmed at Beaumont Hospital who did the ablation. He does about 200 of these a year, and does them well. Do not go to an amateur. I was less-than impressed with him pushing the beta-blocker hard; I’ll write about that. Also, get an iWatch if you think you may have A-Fib or any other heart problem. You see a lot, just by watching, so to speak.

Robert Buxbaum, August 3, 2022.

Three identical strangers, and the genetics of personality

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Inheritability of traits is one of the greatest of insights; it’s so significant and apparent, that one who does not accept it may safely be called a dullard. Personal variation exists, but most everyone accepts that if your parents are tall, you are likely to be tall; If they are dark, you too will likely be dark, etc., but when it comes to intelligence, or proclivities, or psychological leanings, it is more than a little impolite to acknowledge that genetics holds sway. This unwillingness is glaringly apparent in the voice-over narration of a popular movie about three identical triplets who were raised separately without knowing of one another. The movie is “Three identical strangers”, and it recounts their meeting, and their life afterwards.

Triplets, raised separately, came out near identical.

As one might expect, given my introduction, though raised separately, the three showed near identical intelligence, and near identical proclivities: two of them picked the same out-of-the way college. All of them liked the same sort of clothes and had the same taste in women. There were differences as well: one was a more outgoing, one was depressed, but in many ways, they were identical. Meanwhile, the voice-over kept saying things like, “isn’t it a shame that we never saw any results on nature/nurture from this study.” Let me clear this us: genetics applies to psychology too. It’s not all genetics, but it is at least as influential as upbringing/ nurture.

This movie also included pairs of identical twins, raised separately, they also showed strong personality similarities. It’s a finding that is well replicated in broader studies involving siblings raised separately, and unrelated adoptees raised together. Blood, it seems, is stronger than nurture. See for example the research survey paper, “Genetic Influence on Human Psychological Traits” Journal of the American Psychological Society 13-4, pp 148-151 (2004). A table from that paper appears below. Genetics plays a fairly strong role in all personal traits including intelligence, personality, self-control, mental illness, criminality, political views (even mobile phone use). The role is age-dependent, though so that intelligence (test determined) is strongly environment-dependent in 5 year olds, almost entirely genetic in 25-50 year olds. One area that is not strongly genetic, it seems, is religion.

In a sense, the only thing surprising about this result is that anyone is surprised. Genetics is accepted as crucial for all things physical, so why not mental and social. As an example of the genetic influence on sports, consider Jewish chess genius, Lazlo Polgar: he decided to prove that anyone could be great at chess, and decided to train his three daughters: he got two grand masters and an international master. By comparison, there are only 2 chess grand masters in all of Finland. Then consider that there are five all-star, baseball players named Alou, all from the same household, including the three brothers below. The household has seven pro baseball players in all.

Most people are uncomfortable with such evidence of genetic proclivity. The movie has been called “deeply disturbing” as any evidence of proclivity contradicts the promise of education: that all men are equal, blank slates at birth that can be fashioned into whatever you want through education. What we claim we want is leaders — lots of them, and we expect that education will produce equal ratios of woman and men, black and white and Hispanic, etc. and we expect to be able to get there without testing for skills, — especially without blind testing. I notice that the great universities have moved to have testing optional, instead relying on interviews and related measures of leadership. I think this is nonsense, but then I don’t run Harvard. As a professor, I’ve found that some kids have an aptitude and a burning interest, and others do not. You can tell a lot by testing, but the folks who run the universities disagree.

The All star Alou brothers share an outfield.

University heads claim that blind testing is racist. They find that some races score poorly on spacial sense, for example, or vocabulary suggesting that the tests are to blame. There is some truth to these concerns, but I find that the lack of blind testing is more racist. Once the test is eliminated, academia finds a way to elevate their friends, and the progeny of the powerful.

The variety of proclivities plays into an observation that you can be super intelligent in one area, and super stupid in others. That was the humor of some TV shows: “Big Bang Theory” and “Fraser”. That was also the tragedy of Bobby Fischer. He was brilliant in chess (and the child of brilliant parents), but was a blithering idiot in all other areas of life. Finland should not feel bad about their lack of great chess players. The country has produced two phone companies, two strong operating systems, and the all time top sniper.

Robert Buxbaum, May 15, 2022

Girls are doing better, Boys are doing far worse.

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When I began college in 1972, the majority of engineering students and business students were male. They from the top of their high school classes, and from stable homes mostly; they went on to high paying jobs. Boys also dominated at the bottom of society. They were the majority of the criminals, drug addicts, and high-school dropouts. Many went off to Vietnam. Some, those who were handy, went to trade schools and a reasonable life, productive life. Society did not seem bothered by the destruction of boys in prison, or Vietnam, or by drugs, but there was an outcry that so few women achieved high academic levels. A famous presentation of the problem was called “for every 100 girls.” An updated version appears below showing the status as of October, 2021. A more detailed version appears further down.

From the table above, you can see that women are now the majority of those in college, the majority of those with a bachelors degree or higher, and a majority of those with advanced degrees. Colleges added special tutoring, special grants, and special programs. Each college had a Society of Women Engineers office, and similar programs in law and math. All of these explicitly excluded men or highly discouraged their presence. The curriculum was changed too; made more female-friendly. Dirty, and physical experiments were removed, replaced with group analysis of the social interactions — important aspects of engineers that boys were far-less adept at doing well. Perhaps society and engineering is better off now, but boys (men) are far worse off. This is particularly seem by the following chart, looking at the bottom. Boys/men provide the vast majority of the prison population, of those diagnosed as learning disabled, of those expelled, or overdosed, and among the war dead.

I’ve previously noted that a majority of boys in school are considered disruptive, and that these boys are routinely diagnosed as ADHD and drugged. It is not at all clear that this is a good thing, or that the drugs help anyone but the teacher. I’ve also noted that artwork and attitudes that were considered normal for boys are now considered disturbing and criminal like saying I wish the school was blown up. The cure here, perhaps is worse than the disease. I’m not saying that we should encourage boys to say such things, but that we should acknowledge a difference between an active and a passive wish. And we should find a way to educate boys/men so they don’t end up unemployed, addicted, or dead. Currently boy, particularly those at the bottom are on the scrap-heap of society.

Here is some source material for the above:

Robert Buxbaum, May 28, 2022

Induction

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Most of science is induction. Scientists measure correlation, for example that fat people don’t run as much as thin people. They then use logic to differentiate cause from effect that is do they not run because they are fat, or are they fat because they don’t run, or is everything base on some third factor, like genetics. At every step this is all inductive logic, but that’s how science is done.

The lack of certainty shows up especially commonly in health work. Many of our cancer cures are found to not work when studied under slightly different conditions. Similarly with weight los, or heart health. I’d mentioned previously that CPAPs reduce heart fibrillation, and heart filtration is correlated with shortened life, but then we find that CPAP use does not lengthen life, but seems to shorten it. (see a reason here). That’s the problem with induction; correlation isn’t typically predictive in a useful way.

Despite these problems, this is how science works. You look for patterns, use induction, find an explanation, and try to check your results. I have an essay on the scientific methods, with quotes from Sherlock Holmes. His mysteries are a wonderful guide, and his inductive leaps are almost always true. Meanwhile, the inductive leaps of Watson and Lastrade are almost always false.

Robert Buxbaum, May 9, 2022

Biden stops fracking and gas prices go up 300% — Surprise!

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Natural gas prices for June 2022 as of May 6, 2022.

Natural gas prices have quadrupled in the last 17 months. It’s gone from $2.07 per million BTU in mid January 2021 when Joe Biden took office, to nearly $9 today. It’s a huge increase in the cost to heat your home, and adds to the cost of any manufactured product you buy. Gasoline prices have risen too, going from $2/gallon when Biden took office to about $4.40 today. Biden blames the war with Russia, but the rise began almost as soon as he took office, and it far outstrips the rise in the price of wheat shown below (wheat is grown in Ukraine — it’s their major export). The likely cause is Biden’s moratorium on fracking, including his decision to stop permitting oil exploration and drilling on federal land. In recent weeks Biden has walked back some of this, to the consternation of the environmentalists. On April 15, 2022, the Interior Department announced this significant change including its first onshore lease sale since the moratorium.

Biden also cancelled the Keystone XL oil pipeline that would have brought tar-sands oil from Canada and North Dakota to Texas for refining. Blocking the pipeline helped increase gas prices here and helped cause a recession in Alberta and North Dakota. The protesters who claimed to speak for the natives are not affected.

Another issue fueling price increases is that Biden is printing money. Bidenflation is running at 8%/year. It’s not hyperinflation, but it’s getting close. It’s money taken from your pocket and from your savings. Much of the money is given to friends: to groups that Biden thinks will use it virtuously, but inflation is money taken from us, from our pockets and savings. Another beneficiary are those who are rich enough to take no salary, but live by borrowing against their real estate and corporate equity. The richest people in the US do this, earning $1 per year or less, (here’s a list compiled by Bloomberg, it’s basically every rich person). They pay no taxes, as they have no income. The only way to tax them is by tariffs, taxing what they import, but the government is against tariffs.

What you can do, personally about energy-cost inflation is not much. I would recommend insulating your home. I plan to repaint the roof white, and put in a layer of roof insulation. I also have fruit trees: an apple tree and a peach tree, grapes and a juneberry. They provide summer shade, and you get a lot of fruit with minimal work. Curtains are a good investment. Another thought is to buy solar cells. A vegetable garden is fun too, but it’s unlikely to pay you back.

Winter wheat prices are up by about 40%, likely due to the loss of supply from Ukraine and Russia

Speaking of wheat prices, they are up. They increased 40% when Russian troops invaded Ukraine, and have held steady at that level since. This is far less increase than for natural gas. Corn and rice prices are up too, but nowhere near as much. Fertilizer prices are up 300%, though, and Biden has indicated he’d like to push for a sustainable alternative; is that poop? There is a baby formula shortage too. We can handle it, I think, unless Biden get involved, or starts a hot war with Russia.

Robert Buxbaum May 10, 2022. As a fun sidelight, here is Biden answering questions about Pakistan when someone in a Bunny costume grabs him and walks him away from the reporters. Who is that masked handler? What’s going on in Pakistan?

A clever range extender for EVs

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Electric vehicles work well for short trips between places where you can charge with cheap electricity. Typically that’s trips from home to a nearby place of work, and to local shopping malls and theaters with low-cost charge spots. If you drive this way, you’ll pay about 3.2¢/mile for home electricity, instead of about 17¢/mile for gasoline transport (e.g. 24 mpg with $4/gallon gas). Using an EV also saves on oil changes, transmission, air filters, belts, etc., and a lot of general complexity. Battery prices are still high, but much lower than they were even a few years ago.

The 10 kW Aquarius Engine is remarkably small and light, about 10kg (22 lb).

EVs are less attractive for long trips, especially in the cold. Your battery must provide the heat, as there is no waste heat from the engine. Expect to have to recharge every 200 -250 miles, or perhaps twice in the middle of a long trip. Each charge will take a half-hour or more, and fast charging on the road isn’t low cost. Expect to pay about 15¢/mile, nearly as much as for gasoline. See my full comparison of the economics here.

One obvious solution is to have two cars: a short commuter and an EV. Another solution is a hybrid. The Toyota’s Prius and the Chevy Volt were cutting edge in their day, but people don’t seem to want them. These older hybrids provided quick fill-ups, essentially infinite range, and about double the gas milage of a standard automobile, 30-45 mpg. The problem is you have even more complexity and maintenance than with even a gas automobile.

Aquarius liner engine as a range extender

I recently saw a small, simple, super-efficient (they say) gas engine called Aquarius. It provides 9.5 kW electric output and weighs only 22 lbs (10 kg), see picture above. A Tesla S uses about 16 kW during highway driving, implying that this engine will more than double the highway range of a Tesla S at minimal extra weight and complexity. It also removes the fear of being stranded on the highway, far from the nearest charge-station.

The energy efficiency is 34%, far higher than that for normal automobile engines, but fairly typical of floating piston linear engines. The high efficiency of these engines is partly due to the lack of tapper valves, risers, crank-shaft, and partially due to the fact that the engine always runs at its maximum power. This is very close to the maximum efficiency point. Most car engines are over sized (200 hp or so) and thus must run at a small fraction of their maximum power. This hurts the efficiency, as I discuss here. The Aquarius Engine makes electricity by the back-forth motion of its aligner rods moving past magnetic stator coils. Slots in the piston rod and in the side of the cylinder operate as sliding valves, like in a steam engine. First versions of the Aquarius Engine ran on hydrogen, but the inventors claim it can also run on gasoline, and presumably hythane, my favorite fuel, a mix of hydrogen and natural gas.

At the moment shown, slit valves in the piston rod are open to both cylinder chambers. The explosion at left will vent to the exhaust at left and out the manifold at top. The sliding valve is currently sending fresh air into the cylinder at right, but will soon send it into both cylinders to help scavenge exhaust and provide for the next cycle; engine speed and impression are determined by the mass of the piston.

A video is available to show the basic operation (see it here). The drawing at right is from that video, modified by me. Air is drawn into the engine through a sliding valve at the middle of the cylinder. The valve opens and closes depending on where the piston is. At the instant shown in the picture, the valve is open to the right. Air enters that chambered is likely exiting through slits in the hollow piston rod. It leaves through the manifold t the top, pushing exhaust along with it. When the piston will have moved enough, both the slits and the intake will close. The continued piston motion (inertially driven) will compress the air for firing. After firing, the piston will move left, generating electricity, and eventually opening the slit-valve in the piston to allow the exhaust to leave. When it moves a little further the intake will open.

The use of side-opening exhaust valves is a novelty of the “Skinner UniFlow” double-acting, piston steam engines, seen on the Badger steamship on Lake Michigan. It’s one of my favorite steam engine designs. Normally you want a piston that is much thicker than the one in the drawing. This option is mentioned in the patent, but not shown in the drawing.

Aquarius is not the only company with a free-piston range extender. Toyota built a free-piston extender of similar power and weight; it was more complex but got higher efficiency. It has variable compression though, and looks like a polluter. (the same problems might affect the Aquarius) They dropped the project in 2014. Deutsch Aerospace has a two headed version that’s more powerful, but long and heavier: 56kg and 35kW. Lotus has a crank-piston engine, also 56kg, 35kW; it’s more complex and may have service life issues, but it’s compact and relatively light, and it probably won’t pollute. Finally, Mazda is thinking of bringing back its Wankel rotary engine as a range extender. Any of these might win in the marketplace, but I like the Aquarius engine for its combination of light weight, compact size, and simplicity.

This is not to say that Aquarius motors is a good investment. Aquarius automotive went public on the Toronto exchange in December, 2021, AQUA.TA. The company has no profits to date, and the only chance of them making a profit resides in them getting a good licensing deal from an established company. The major car companies have shown no interest so far, though they clearly need something like this. Their plug in hybrids currently use standard-size, 4 stroke engines: 110-150 kW, 100-150 kg, complex, and low efficiency. Consumers have not been impressed. Tesla autos could benefit from this engine, but Musk shows no interest either.

Robert Buxbaum May 5, 2022. I have no stock in Aquarius motors, nor have I received any benefits from them, or any auto company.

A more accurate permeation tester

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There are two ASTM-approved methods for measuring the gas permeability of a material. The equipment is very similar, and REB Research makes equipment for either. In one of these methods (described in detail here) you measure the rate of pressure rise in a small volume.This method is ideal for high permeation rate materials. It’s fast, reliable, and as a bonus, allows you to infer diffusivity and solubility as well, based on the permeation and breakthrough time.

Exploded view of the permeation cell.

For slower permeation materials, I’ve found you are better off with the other method: using a flow of sampling gas (helium typically, though argon can be used as well) and a gas-sampling gas chromatograph. We sell the cells for this, though not the gas chromatograph. For my own work, I use helium as the carrier gas and sampling gas, along with a GC with a 1 cc sampling loop (a coil of stainless steel tube), and an automatic, gas-operated valve, called a sampling valve. I use a VECO ionization detector since it provides the greatest sensitivity differentiating hydrogen from helium.

When doing an experiment, the permeate gas is put into the upper chamber. That’s typically hydrogen for my experiments. The sampling gas (helium in my setup) is made to flow past the lower chamber at a fixed, flow rate, 20 sccm or less. The sampling gas then flows to the sampling loop of the GC, and from there up the hood. Every 20 minutes or so, the sampling valve switches, sending the sampling gas directly out the hood. When the valve switches, the carrier gas (helium) now passes through the sampling loop on its way to the column. This sends the 1 cc of sample directly to the GC column as a single “injection”. The GC column separates the various gases in the sample and determines the components and the concentration of each. From the helium flow rate, and the argon concentration in it, I determine the permeation rate and, from that, the permeability of the material.

As an example, let’s assume that the sample gas flow is 20 sccm, as in the diagram above, and that the GC determines the H2 concentration to be 1 ppm. The permeation rate is thus 20 x 10-6 std cc/minute, or 3.33 x 10-7 std cc/s. The permeability is now calculated from the permeation area (12.56 cm2 for the cells I make), from the material thickness, and from the upstream pressure. Typically, one measures the thickness in cm, and the pressure in cm of Hg so that 1 atm is 76cm Hg. The result is that permeability is determined in a unit called barrer. Continuing the example above, if the upstream hydrogen is 15 psig, that’s 2 atmospheres absolute or or 152 cm Hg. Lets say that the material is a polymer of thickness is 0.3 cm; we thus conclude that the permeability is 0.524 x 10-10 scc/cm/s/cm2/cmHg = 0.524 barrer.

This method is capable of measuring permeabilities lower than the previous method, easily lower than 1 barrer, because the results are not fogged by small air leaks or degassing from the membrane material. Leaks of oxygen, and nitrogen show up on the GC output as peaks that are distinct from the permeate peak, hydrogen or whatever you’re studying as a permeate gas. Another plus of this method is that you can measure the permeability of multiple gas species simultaneously, a useful feature when evaluating gas separation polymers. If this type of approach seems attractive, you can build a cell like this yourself, or buy one from us. Send us an email to reb@rebresearch.com, or give us a call at 248-545-0155.

Robert Buxbaum, April 27, 2022.

Hypochondriacs anonymous: the first step is admitting you don’t have a disease.

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I’m writing a book about reverse psychology; please don’t buy it.

This one’s not by Rappaport

The judge said I had to keep 6 feet away from my ex-wife. So I buried her under the patio.

Robert Buxbaum: the above 3 jokes are from Jack Rappaport — He sometimes sells jokes. April 13, 2022. The ones below are from Gahan Wilson, and the one at right, I don’t know.

These last two are from Gahan Wilson

Ukraine looks like Vietnam or the beginnings of WWI

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The press and our Russian experts claim we’re helping in Ukraine, protecting it from a Russian invasion. I suspect they are wrong, and that our help and protection will prove to be as deadly to all as in the Vietnam war. I’m also uncomfortable with their presentation their framing of Putin as an out of touch autocrat. Putin has popular support, and acts with a strong sense of history, as I see it, just not our version of history. In the Russian version, it was Russia that stopped the Nazis — of Germany and Ukraine. We are not the heroes of WWII in their telling; I doubt we’ll be the heroes of this conflict either.

We have a habit of seeing ourselves as saving heroes as we enter other people’s conflicts. It is how we got into Vietnam, to save the South from the North. It’s also how Europe got into WWI: Russia was saving Serbia, Germany was saving Austria, etc (see cartoon below). We meddle our way, and leave much later than we planned. The result, as in Vietnam and Afghanistan is far more death and destruction than if we’d minded our own business. And US war-dead too. In Vietnam 58,000 US deaths. In Afghanistan 2,400 US dead. and no obvious accomplishment. As Henry Kissinger famously commented: “It’s dangerous to be America’s enemy, but deadly to be America’s friend.”

European aggression in WWII started with the good intention of preventing aggression. It got out of hand, as I fear our good intentions will in Ukraine.

The US troops we’ve sent to Ukraine are not called soldiers. They are “fighting advisors” sent to help the Ukrainians use our weapons. In WWI and Vietnam, fighting advisors are called invaders; it’s how we got drawn into Vietnam. The Russians claimed to send advisors when they entered the Crimea and later the Dundas. We called it an invasion. We can’t be that blind to our own words. Sooner or later, the advisors will start killing each other– something we’ll call an unprovoked attack. Our high tech aid including anti-tank missiles are reported to have killed some 10,000 Russians so far. We don’t seem to think the Russians will mind, or that they’ll give up as the body count mounts. In Vietnam, the more we killed with our high-tech weapons, the more the Vietnamese on both sides called us the villains, and the more Vietnamese joined the fight against us. That’s the future I fear for Ukraine, or worse. The conflict in WWI spiraled quickly beyond the borders of Serbia to include the whole world, and continued through WWII.

Our approach to diplomacy is counterproductive too, in my opinion, and similar to Vietnam too. We call Putin a terrorist, a madman and a narcissist, and then we begin talks with him to end the war. Biden has asked to have Putin removed by assassination.Does he think this will help, or if Putin is removed his successor will be a friend of the US? We demonized Ho Chi Minh, and propped up our favored, corrupt leaders. Minh was popular, as is Putin, and both have valid reasons for opposing us. Putin worries about the expansion of NATO. It’s not an illegitimate worry given Russian history of repeated invasions from the west.

Our desire to remove Russian leadership is a long-standing mistake. It does not lead to peace, or good negotiation, nor even peaceful co-existence.

Russia has been invaded many times. US schools mention Napoleon’s invasion in 1812 and the German’s in 1941, but there are more. They were invaded by the Germans in WWI too, and by the Ukrainian Cossacks in the days of Khmelnytsky, 1646-57. Before that the Polish Lithuanians, 1609-1618, the Swedes, 1701-1709, and in the early days, it was Tartars, Mongols, who invaded and ruled Russia from about 1225 til they joined with the Russian Tzars about 1650. Add to that, our help in the war of the Whites vs the Reds (1917-23) that produced Ukrainian independence — I talk about the relevance here. With a history like that, Russia has every reason to worry about NATO expansion. We should be cognizant of this and stop calling Putin a madman. Let’s accept the Russian version of history, and the sitting ruler of Russia.

Some cite the Budapest memorandum that lead to the removal of “Ukrainian” nuclear weapons –– read it here. It’s short, only 1 page, and deliberately vague. it was signed by Putin’s predecessor, Boris Yeltsin, for the Russian Federation, along with representatives for Ukraine, The US, and The UK. The missiles were not Ukrainian, they were Soviet, and pointed at us. As a result of that agreement, they were dismantled and moved into Russia. There is no sense that this is an invitation for us to protect Ukraine against Russia. The co-signers sort-of agree to protect Ukraine from outsiders (Germany, Turkey,..?), but that’s not clear. We commit ourselves to peace in the region, and can claim that Russia violated the peace first, but there’s no invitation for us to violate it second. Until recently, the UK provided no military aid. China and most of the EU still trades with Russia; if they see a villainy, it’s not enough to stop trade.

Robert McNamara was Secretary of Defense under Kennedy and Johnson, and a key “Whiz Kid” pushing for war in Vietnam. Years later, he decided Vietnam was a mistake. A sad cartoon: the veterans are walking past the grave monument for the 58,000 US dead. I worry we’ll have a similar cartoon after this war.

In my opinion, our best course is to reduce our military aid to providing only basics: bullets, blankets, food… We should reopen discussions with Putin, not demonize him, or try to remove him. Ukraine will likely fight on even without our high-tech weapons. Perhaps they’ll buy from Europe, or from independent dealers. The death rate on both sides will be lower and peace will come quicker without us. Crimea might remain Ukrainian or Russian, but that will not be our decision. We’ve done enough damage for now. It took many years after the end of the Vietnam war for the instigators admit is was a mistake.

Robert Buxbaum April 3, 2022. Much of my thinking about Vietnam comes from Francis Fitzgerald’s wonderful book “Fire in the Lake”. I see it all happening again here. Also worth reading is this 2014 letter by Henry Kissinger about how to negotiate a peace: “Damning Putin is not a foreign policy; it’s an alibi for the lack of one.” It’s a nice insight. He seems to understand diplomacy about as well as anyone.

C-PAPs do not help A-Fib, and seem to make heart health worse.

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In this blog-post, I’d like to report on the first random study of patients with Atrial fabulation, A-Fib, and sleep apnea, comparing the health outcome of those who use a C-PAP, a “Continuous Positive Airway Pressure” device, to the outcome those who do not. The original study was published in May, 2021 (read it here) in the American Journal of Respiratory and Critical Care Medicine. The American Journal, Pulmonary Advisor published a more-popular version here.

As a background, if you are over 65 and overweight, there is a 25% chance or so that your heart rate will begin to surge semi-randomly, and that it will flutter. This is Atrial fabulation, A-Fib. It tends to get worse and tends to lead to heart attacks and strokes. People with A-fib tend to be treated with drugs, aspirin, warfarin, beta blockers, and anti arrhythmics. They also tend to be prescribed a C-PAP because overweight, older folks tend to snore and wake up a lot during the night (several times per hour: apnea).

A C-PAP definitely stops the snoring and the Apnea, and the assumption was that it would help your heart as well, if only by giving you a better night’s sleep. As it turns out, the C-PAP seems to decrease heart health — significantly.

For this study, adult patients between 18 and 75 years old diagnosed with paroxysmal A-Fib (that’s occasional AF) were screened for moderate to severe sleep apnea. Those who agreed to participate were randomly assigned to either a treatment of C-PAP plus usual care (drugs mostly) or just usual care for the next 5 months. Of the 109 who enrolled in the study, 55 got the C-PAP plus usual care, 54 got usual care alone. The outcome was that there were 9 serious, adverse heart events (strokes and heart attacks); 7 were in the C-PAP group.

The CPAP pressure was, on average, 6.8 cm H2O; mean time of use was 4.4±1.9 hours per night. The C-PAPs did their jobs on the apnea too, reducing residual apnea-hypopnea to 2.3±1.9 events per hour for those in the C-PAP group.

There was a non-statistically significant reduction is AF among the C-PAP group. They reduced their time in AF by 0.6 percentage points compared to the control group  (95% CI, -2.55 to 1.30; P =.52). That not a statistically significant difference, and is most likely random.

There was a statistically significant decrease in heart health, though. A total of 7 serious adverse events occurred in the C-PAP group and only 2 in the control group. A total of 9 is a relatively small number of events, but there is a strong statistical difference between 7 and 2.

The authors conclude: “CPAP treatment does not seem to reduce or prevent paroxysmal AF.” They should also have concluded that it reduced heart health with a statistical confidence of ~82%: (1-2(36+10)/512) =82%. See more on this type of statistics.

A possible explanation of why a C-PAP would would make heart health worse is an outcome of the this recent sleep study (link here). It appears that the C-PAP helps restore breathing, but by doing so, it interferes with a mechanism the body uses to deal with A-fib. It seems that, for people with A-Fib, their bodies use breathing stoppages to get their heart back into rhythm. For these people, many of their breathing stoppage are not obstructive, but a bio-pathway to raise the CO2 level in the blood and thus regulate heart rate. The use of a C-PAP prevents this restorative mechanism and this seem to be the reason it is destructive to the heart-health of patients with A-fib. On the other hand, a C-PAP does improve the sleep those patients whose apnea is obstructive. It seems to me that sleep studies should do a better job distinguishing the two causes of apnea. C-PAPs seem counter-indicated for patients with A-fib.

Robert Buxbaum, March 30, 2022. I was diagnosed with apnea and A-Fib some years ago. The sleep doctor prescribed a C-PAP and was adamant that I had to use it to keep my heart healthy. There were no random studies backing him up or contradicting him until now.