User talk:Doc James/Archive 130

Stop templating regulars!

Don't template me, and revert changes without discussion please, as you did at Psyllium. You reinstated a stupid edit from a primary guideline study that says there may be a "potential" problem with vitamin absorption with psyllium, whereas there are solid studies, if you bothered to look, that prove the exact opposite (e.g. PMID 12209371 ). Moreover, there are 2 review studies and lots of primaries pointing to the information you deleted, which I had inserted, that bowel obstruction/bezoars can result from use of psyllium, namely PMID 12681118 PMID 8590522 as well as PMID 29085697 PMID 25771442 and more.

Really, James, I expected more from you than this. I notice you are shadowing many of my edits, and not in a nice way. Ratel (talk) 21:30, 1 March 2018 (UTC)

The request was to use secondary source User:Ratel

Please stop using case reports. The review articles you used this time around are good.

This is a primary source [1] Doc James (talk · contribs · email) 10:58, 2 March 2018 (UTC)

Additionally my first edits to psyllium were Dec 3 2016.[2] Your first edits were Feb 8 2018. Doc James (talk · contribs · email) 11:11, 2 March 2018 (UTC)

I see you've once again restored, without discussion, a speculative comment from an old (2002) review about fiber inhibiting nutrient absorption. You ignore more recent reviews that point in the exact opposite direction, namely: A large amount of research has reported an inverse relationship between fiber consumption and the risk for coronary heart disease and several types of cancer. For that reason, the FDA has adopted and published the claim that increased consumption of dietary fiber can reduce the prevalence of coronary heart diseases and cancer. The mechanisms behind these findings are still unclear. However, it is thought to be attributed to several factors including increasing bile acid excretion, decreased caloric intake, increased short chain fatty acid production, carcinogen binding effects, increased antioxidants, and increased vitamins and minerals. From this review study

More: dietary fiber enhances mineral bioavailability. Review, PMID 24876314

More: In addition, it is estimated that even with a doubling of current dietary fiber, there is unlikely to be an adverse effect on serum vitamin and mineral concentrations in healthy US children consuming a balanced diet containing adequate levels of nutrients Review study PMID 7494673

I could go on, but perhaps I've made my point. Please fix this or I shall. Ratel (talk) 12:23, 2 March 2018 (UTC)

Yes that last review says there may be a decrease but it is unlikely to be significant "A review of the scientific literature suggests that a small loss of energy, protein, and fat may occur with a high intake of dietary fiber. However, this small loss of energy is unlikely to be significant to children consuming adequate levels of major nutrients, especially at conservative fiber intakes as recommended by the American Health Foundation's age plus 5 formula."

Have added that. Doc James (talk · contribs · email) 12:31, 2 March 2018 (UTC)

But you miss the point. That quote refers to 'energy, protein and fat' not to vitamins and minerals. In fact, dietary fiber causes an increase in short chain fatty acids which in turn raises the microbiome levels of bifidus and acidophilus bacteria, which in turn produce a lot of vitamins and enhance the bioavailability of minerals. You don't already know this stuff? Please show me any credible source, even a primary source, that proves a loss of vitamins and/or minerals. Thanks Ratel (talk) 12:54, 2 March 2018 (UTC)

The ref by the statement in question says "Potential negative effects of dietary fiber include reduced absorption of vitamins, minerals, proteins, and calories."

This is a pubmed indexed guideline.[3] Doc James (talk · contribs · email) 12:57, 2 March 2018 (UTC)

But those same guidelines have been reissued twice more, most recently PMID 26514720 . Where is that "potential" negative effect mentioned again, or has it disappeared because it was wrong? Ratel (talk) 13:04, 2 March 2018 (UTC)

Thanks yes that is an excellent point. We should be using the most recent one.

It says "Mineral bioavailability is affected by dietary fiber content, as sources of dietary fiber often contain other compounds, such as phytate, oxalates, and tannins, which reduce mineral uptake in the intestines."

It also says " Although very high intakes of certain functional fibers can contribute to excessive flatulence, bloating, and diarrhea,72 there is little evidence that dietary fiber from a variety of sources causes significant adverse effects in healthy individuals."

Will adjust to reflect this. Doc James (talk · contribs · email) 13:11, 2 March 2018 (UTC)

[edit conflict] I was trying to add:

here is the full text of that guideline, but this time a recent version (2015). A quote: The bacterial production of SCFAs, in response to fermentable dietary fiber reaching the colon, results in a wide variety of physiological effects.61 Fermentable fibers, such as oligosaccharides, b-glucans, gums, some hemicelluloses, and some resistant starches yield SCFAs, primarily acetate, propionate, and butyrate. These compounds lower the pH in the colonic lumen, thus increasing bioavailability of some minerals and inhibiting the growth of pathogenic bacteria. Interestingly, that review still tries to cling to the idea that fiber may be bad for minerals, claiming (without giving any source!) that "Mineral bioavailability is affected by dietary fiber content, as sources of dietary fiber often contain other compounds, such as phytate, oxalates, and tannins, which reduce mineral uptake in the intestines. SCFAs have been suggested to enhance mineral uptake, but this mechanism cannot outcompete the effects of other bioactive compounds in the lumen". So claiming psyllium (which does not contain significant amounts of these antinutrients, especially in the small quantities typically consumed) affects mineral is simply WRONG.

You may want to look at the best review source I have found for clarity: Fiber and Prebiotics: Mechanisms and Health Benefits Ratel (talk) 13:20, 2 March 2018 (UTC)

Yes and not about psyllium directly so best not on that page. Have removed. Doc James (talk · contribs · email) 13:34, 2 March 2018 (UTC)

Thank you

...for your assistance in editing the prostate cancer screening article. You introduced an error when you changed the text to say that prostate cancer is the most common cancer in men. The American Cancer Society source does not agree with the text as it now appears. Please keep doing what you are doing to make the article better and I appreciate it very much. Best Regards, Barbara (WVS) ✐  ✉ 16:28, 2 March 2018 (UTC)

Per the World Cancer Report it is second after lung. Skin is not typically included in Cancer stats. Whether or not it is most common does not belong in the lead of that article so removed it. Doc James (talk · contribs · email) 00:29, 3 March 2018 (UTC)

Deletion pending for File:Pyloric-stenosisLocal.jpg

Hello, Doc James. Some time ago, a file you uploaded — File:Pyloric-stenosisLocal.jpg — was tagged with {{OTRS pending}}, indicating that you (or perhaps the copyright holder if you did not create this image) submitted a statement of permission to permissions-en@wikimedia.org. Though there is often a backlog processing messages received at this address, we should have received your message by now.

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Email sent Doc James (talk · contribs · email) 00:41, 3 March 2018 (UTC)

Air your thoughts?

Would you like to take a moment and describe your views on the topic of quality vs. quantity at User:Eddie891/sandbox/Quality v. Quantity for a Wikipedia Signpost Report? Eddie891 ^Talk _Work 18:28, 2 March 2018 (UTC)

User:Eddie891 I think the answer depends on the language of Wikipedia in question. Additionally it is not an either / or relationship.

For English Wikipedia IMO our priority should be on improving the quality of content. But this does not mean adding further articles on notable topics should be stopped.

As we are mostly a volunteer self directed and horizontal community my position on the question, while it can direct my own efforts, likely has little wider significance as volunteers are free to work on and how they wish :-) Doc James (talk · contribs · email) 01:06, 3 March 2018 (UTC)

Is Verywell an acceptable source?

I also have a source about nonproblematic use of criminalized drugs, but I am not sure what it says about criminalized opioid use specifically because alas, I am but a poor lady who can't afford to read journals. CommuniqueNew2 (talk) 23:06, 4 March 2018 (UTC)

User:CommuniqueNew2 No would not be a suitable source per WP:MEDRS. Best Doc James (talk · contribs · email) 10:16, 5 March 2018 (UTC)

Thanks. Is there a way I can read the paywalled source? CommuniqueNew2 (talk) 18:34, 5 March 2018 (UTC)

Which paywalled source? Doc James (talk · contribs · email) 18:39, 5 March 2018 (UTC)

FYI

Hi James, just wanted to give you a heads up that there's some edit warring going on over at granulomatosis with polyangiitis. I've left them a notice but I don't want to keep reverting since otherwise I will be edit warring myself. P.S. it's also occurring over at Friedrich Wegener too. TylerDurden8823 (talk) 20:19, 3 March 2018 (UTC)

I am okay with this. The name is still used by many people even though some are trying to move away from eponymous names. Doc James (talk · contribs · email) 10:06, 4 March 2018 (UTC)

I strongly disagree. The term has fallen out of favor (see my comment on the talk page) and with good reason. It's an offensive and unhelpful eponym that doesn't describe the underlying pathophysiology. The rest of Wikipedia does not handle the terminology this way and we shouldn't on this page either. It was fine as it was written before as "formerly known as", which is accurate. It's shameful that clinicians continue to use the WG terminology. I'm appalled by the indifference. I recommend you have a look at this: [4]. TylerDurden8823 (talk) 11:30, 4 March 2018 (UTC)

User:TylerDurden8823 We have 100s of diseases named after people from Parkinson to Alzheimer. I assume your concern is that Wegener was a Nazi?

The ref says there are lots of groups who are trying to change the name. Than says "However, the use of the new name is far from ubiquitous. Why do physicians and students continue to use the name Wegener? I believe that it is simply much easier to pronounce and remember than granulomatosis with polyangiitis."

The pharmaceutical industry knows the importance of pronunciation, which is why they try to get complicated generic names and simple brandnames so people use their brand names.

When we say "also known as" we are reporting on common usage which the ref you provided says it still is. Even though it probably should not be. The question is should we report what is (common usage) or what we wish (that it was a former name rather than a current name)? Doc James (talk · contribs · email) 10:03, 5 March 2018 (UTC)

It's not necessarily that it's "my" concern. Personally, I strongly favor disease names which describe the actual disease (e.g., granulomatosis with polyangiitis) over unhelpful eponyms and I am concerned about Wegener's Nazi ties (as was the medical community) and it should concern you too. The use of the new name may not yet be ubiquitous (it may never be so that seems like a fallacious bar to set since there may always be a minority who insist on using WG and I would wager many are ignorant of Wegener's Nazi ties and would quickly start saying GPA if they knew), but the use of GPA is increasing dramatically and I've demonstrated that numerous sources address it as such.

The Chapel Hill criteria were passed by definitive authorities six years ago. That seems like plenty of time to me for a simple name change. If not now, then when exactly? How many people have to not use it and switch over to GPA for the phrase "formerly known as" to be justified exactly? What is your precise cutoff and if you have one, what do you base it on? It's a slippery slope. Furthermore, just because something is popular does not mean it's correct (or moral) though language is one area that sometimes (depending on one's philosophical bent on language) potentially allows room for that.

As I mentioned on the article's talk page though, this comes down to prescriptive vs descriptive grammar approaches. I favor saying "formerly known as". We already discuss its continued colloquial usage in the history section and that's adequate. You don't really know how "common" it is to use the old terminology. I doubt that's been formally studied. Anecdotally, sure, but definitive sources increasingly are doing away with the term and I've put forward strong evidence suggesting that "formerly known as" is absolutely appropriate. Many sources say "formerly known as" (as does the rest of Wikipedia I might add). I strongly recommend you read that Lubitz article (it addresses the pronunciation aspect you raise) if you haven't already. People abbreviate the name to GPA for simplicity so it's really not that difficult. If we're really at an impasse, then it may have to be opened to the Wikipedia community in an RfC. This was the language for quite a while and no one seemed to have any issue with it then and GPA has only become more commonly used since then. Also, I recommend you have a look at the whitewashing (AKA removal of sourced material) over at Friedrich Wegener as well. TylerDurden8823 (talk) 21:16, 5 March 2018 (UTC)

Yes I did not realize the Nazi ties until you raised the issue.

We still have lots of medical articles published in the last couple of years that use the name in their titles.[5]

I have adjusted the Wegener article.

Doc James (talk · contribs · email) 11:01, 6 March 2018 (UTC)

Scientifically outdated and sexist image you put at the top of the mental disorder page and insisting on keeping there

Please clarify your justifications rather than using brute force due to your authority on Wikipedia. Jingoizle (talk) 12:06, 6 March 2018 (UTC)

Ah? Yes I realize that images in mental health are controversial. And historical ones are often not politically correct.

But no I do not support efforts to rewrite history or the effects to remove images generally. This is a historically notable image.

We are NOT just a medical textbook, even though that image is frequently used in medical textbooks. We cover the history of medicine which is an integral part of medicine. Doc James (talk · contribs · email) 12:13, 6 March 2018 (UTC)

regarding self harm

hello,

im not an english native: is moved out of lead meaning something like unproportional length? (just making sure, since Ive not been able to find a translation for this saying).

I have personally deemed it important to note that research and research results - that the article itself specifically relies on - partially is not about self-harm in line with the definition given at the beginning of the page, but as I stated refers to several different definitions. E.g. some include self-poisioning, hair tearing and so on, others do not; some include suicidal intent, others exclude it; some solely research about the matter of suicide attempt solely refering to this behavior as self-harm.

To give an example from the reference list: reference 8 is a research study that included self-poisoning and suicide attempts, but excluded self-cutting for deeming it habitual behavior and therefore not deliberate self-harm in terms of the definition for this particular study. The reference is used for the connection of suicide risk, but later repeatedly used for referencing about treatment of self-injury.

So in my opinion it is a) important to make a notion about this matter (that wouldnt necessarily have to be in the introduction) and b) contradictory to have those references mixed up in this article (which I plan to clean up little by little).

kind regards, -- Shendoah (talk) 18:14, 2 March 2018 (UTC)

Self harm generally does not include suicide intent. How the terminology has historically been used belongs in the body IMO.

Also User:Shendoah with respect to referencing please read WP:MEDRS. A number of the sources you have used are primary sources rather than secondary sources. Doc James (talk · contribs · email) 00:42, 3 March 2018 (UTC)

I must have overlooked the fact that you had merely moved the added paragraph. I also agree with the current article version. Thank you for mentioning MEDRS, I will read into those guidelines. -- Shendoah (talk) 21:57, 4 March 2018 (UTC)

Just to make sure: Do I understand you correctly, that you agree with the fact that references regarding suicide attempts and those references who do not differentiate regarding suicidal intent should not be used in the self harm article? Because there are a lot in there used as reference for self-harm. My plan would be to identify those, substitute them with the citation needed template (or a reference, if I have one at hand or can use adequate one from the reference list) and when I went through the full reference list to find new citation to add in and remove all citation needed templates. -- Shendoah (talk) 19:00, 7 March 2018 (UTC)

Such as which reference / content? Doc James (talk · contribs · email) 02:38, 8 March 2018 (UTC)

Wikipedia:WikiProject Medicine/Priority maintenance

Can you think of any other categories of medical articles that people might use in detail before seeing a doctor. Had got OTC drugs and screening so far...Cas Liber (talk · contribs) 02:02, 8 March 2018 (UTC)

Not sure we have a clear idea regarding how Wikipedia is used by the general public. I think many may look stuff up after seeing a physician. Not sure how many looks stuff up before. Doc James (talk · contribs · email) 02:36, 8 March 2018 (UTC)

"After" is not such a problem as they will have had medical advice from at least one doctor. It's when they've had no input at all I am thinking about Cas Liber (talk · contribs) 06:51, 8 March 2018 (UTC)

Might be worth looking at pageviews for some articles as a comparison actually Cas Liber (talk · contribs) 06:51, 8 March 2018 (UTC)

Courses Modules are being deprecated

Hello,

Your account is currently configured with an education program flag. This system (the Courses system) is being deprecated. As such, your account will soon be updated to remove these no longer supported flags. For details on the changes, and how to migrate to using the replacement system (the Programs and Events Dashboard) please see Wikipedia:Education noticeboard/Archive 18#NOTICE: EducationProgram extension is being deprecated.

Thank you! Sent by: xaosflux 20:28, 8 March 2018 (UTC)

Okay thanks. Doc James (talk · contribs · email) 22:02, 8 March 2018 (UTC)

Am I methylated or not?

If you have time, please glance at Talk:Epigenetic clock#Getting_old where I rant about another missing basic fact in a specialized topic. The inability to relate basics to readers is amazing to me. This article is the equivalent of saying "the frequency of that neutron star is changing, so now we know the age of the universe!" Changing how? 'Age' derived by using which interpretation? Gaah! Shenme (talk) 17:33, 9 March 2018 (UTC)

Yup much of Wikipedia needs work. Doc James (talk · contribs · email) 17:47, 9 March 2018 (UTC)

Sucralose revert

Please have a look at the sucralose talk page. It's regarding a revert of a big chunk of text I added some time ago. I feel that it was in error but perhaps I'm missing something. Would you reconsider or give me a more details so I can understand your objection?

The reason I commented on that article was that the title of the review and the interpretation seemed unlikely, from a scientific point-of-view. Although possible, the idea that fewer calories leads to weight gain should make us think twice. The more unexpected the result, to more data should support it.

Sure enough, when I read the article, it's more complex than the wikipedia article implies. There may be some small increase in weight but this is suspect because association-type studies were included. Also, the 6-month minimum trial length is rather short compared to the slow weight gain that is associated with the gains made in middle age and older adults. There may be an effect CAUSED by non-nutritive sweeteners but the small effect observed, in practice, indicates that better observations are in order. Too much hype on a small-ish effect is a real problem in scientific research. I think we should be cautious about how we use this review in the article.

The gist of the article seems to be that non-nutritive sweeteners are not a magic bullet for weight management. That is an interesting and important result that is evident and appropriate for the methods and analysis used by the researchers.

https://en.wikipedia.org/wiki/Talk:Sucralose

Please have a look at my contribution and let me know what you think.

neffk (talk)

We reply on the topic page. Doc James (talk · contribs · email) 15:47, 12 March 2018 (UTC)

A barnstar for you!

	The Tireless Contributor Barnstar
	Hi Doc James,I'd just like to thank you for your input regarding the edits I made to the Suicide prevention article. It's been a great learning experience. Cooks2 (talk) 18:07, 13 March 2018 (UTC)

User:Cooks2 thanks for taking it on :-) Doc James (talk · contribs · email) 18:56, 13 March 2018 (UTC)

Removal of details

Hi, I see you reverted my change without discussing it on the talk page, thanks for keeping wikipedia filled with stale references and misinformation — Preceding unsigned comment added by 92.11.237.146 (talk) 03:02, 14 March 2018 (UTC)

Have responded on the talk page. Doc James (talk · contribs · email) 03:08, 14 March 2018 (UTC)

Metronidazole

Hi, I saw your reversion of my two edits to this page. I think you looked at the explanation for only the more recent and minor edit, but not at the explanation that accompanied my first edit. Metronidazole is no longer the drug of choice for Clostridium difficile colitis. The reference that I removed is a set of recommendations by the Infectious Diseases Society of America issued in 2010 that is no longer considered current and has been replaced by a new set of recommendations which state that vancomycin is the treatment of choice in almost all situations.

Please reconsider storing both my edits, as the page as it currently appears has old and outdated information, and MNZ is not a standard abbreviation and adds no useful information to the content.

Ira

Ira Leviton (talk) 18:00, 14 March 2018 (UTC)

User:Ira Leviton For mild to moderate it is still the drug of choice.

Ref says "Drugs of choice are metronidazole and vancomycin; 100 312 313 314 315 316 'metronidazole generally preferred and vancomycin reserved for those with severe or potentially life-threatening colitis, patients in whom metronidazole-resistant C. difficileis suspected, patients in whom metronidazole is contraindicated or not tolerated, or those who do not respond to metronidazole." [6] Doc James (talk · contribs · email) 18:03, 14 March 2018 (UTC)

But drugs.com is not the cited reference for the statement on the metronidazole page that "it is the drug of choice for a first episode of mild-to-moderate Clostridium difficile colitis" - the outdated Infectious Diseases Society of America is. The updated I.D.S.A. recommendations, which replaced metronidazole with other antibiotics in nearly all situations, were released just last month - my point is that the reference to the old recommendations should be removed because they are no longer valid, and the statement in quotes is not accurate. (I know you're a physician, so am I. But c'mon - do you know any doctors who make their recommendations based on websites like drugs.com? Like Wikipedia, it gets all its information from other sources.)

Going to a meeting now, won't be able to respond until this evening.

Ira

Ira Leviton (talk) 18:51, 14 March 2018 (UTC)

User:Ira Leviton the ref is not from Drugs.com but the American Society of Health-System Pharmacists which IMO is a perfectly fine source.

Will look for the new IDSA guidelines to add as I agree we should definitely be using it. Doc James (talk · contribs · email) 18:57, 14 March 2018 (UTC)

Spores and endospores

Hi, I see you changed my edit of the anthrax article to revert my use of the term "endospores" back to the use of "spores" and citing the CDC to do so. Yes, the CDC does use the term "spores"... And a hundred other sources use either both terms, or use "endospores." Had I made some kind of mistake by using "endospores" consistently throughout this article? Because if I had not, then why did you insist on reverting what I had done unless you wanted to make some kind of point here? Did you consider the act vandalism? Does the CDC determine the use of biological and medical terms on Wikipedia? If "endospore" is the more-correct term, regardless of what the CDC happens to say on its web page and even though a number of published sources seem to go back and forth in their usage, shouldn't we be using that term here? Please justify this to me, because a reversion back to "spores" feels like a reactionary and needless "correction" of what was not a mistake. Thanks. A million reasons (talk) 07:01, 16 March 2018 (UTC)

User:A million reasons IMO "spores" is the more commonly used and better understood term. Thus my restoring it. Doc James (talk · contribs · email) 15:29, 16 March 2018 (UTC)

Regarding Self-harm Article Revision

Dear James, As you might remember, I had added some revisions and explanatory model for self-harm article. It was based on my article which was published by Journal of Trauma and Dissociation which is published under International Society for the Study of Trauma and Dissociation. The journal is a high-quality one and the article has been reviewed by three experts from this field. I understand that it is a primary sources, not a literature review, but since the journal is very prestigious and reliable source in this field, I thought that it might be considered as an exemption. So, I would like to ask you to reconsider your decision regarding my recent revision and re-evaluate it again.

Please let me know your conclusion about it. Bests, Habib — Preceding unsigned comment added by HabibNobakht (talk • contribs) 14:41, 15 March 2018 (UTC)

We tend to stick with review articles. Additionally it is best not to use primary sources you have written yourself. Doc James (talk · contribs · email) 15:27, 15 March 2018 (UTC)

Wait, you are telling me that an author of a highly-respected journal article on a relevant topic has had his edits undone because you don't like the fact that he cited himself? This is absurd. He knows his material, and Wikipedia may "prefer" reviews and secondary sources, but there is no prohibition against primary ones. Shouldn't experts be allowed to share their expertise here? A million reasons (talk) 07:06, 16 March 2018 (UTC)

That is only part of what I am saying. That author needs to use review articles per WP:MEDRS just like everyone else. In fact I said it twice before mentioning the COI issues.

Additionally one cannot simple share their experience here on Wikipedia. Our goal is to paraphrase high quality sources. Primarily sources are typically prohibited yes. Doc James (talk · contribs · email) 15:32, 16 March 2018 (UTC)

Deleted Page

Hi Dr. James, hope you're well. I understand the concern around Penuma, but can you help me understand why Dr. James Elist's page was deleted? The content was consistent with Biography guidelines from Wikipedia. Perhaps edits could be made rather than a full deletion of a biography-oriented article? Thank you! — Preceding unsigned comment added by Specialist1981 (talk • contribs) 23:38, 16 March 2018 (UTC)

Probably because it was paid for and promotional. Doc James (talk · contribs · email) 00:01, 17 March 2018 (UTC)

Thanks for the invite! and a question on sourcing

Thanks for posting on my talk page. That information will surely be helpful along the way of making me a better editor in Wikipedia Medicine!

Also had question on sourcing. I skimmed the medical sourcing guideline article. In my recent edit to the Shigellosis article (https://en.wikipedia.org/wiki/Shigellosis), I wrote:

Shigella can also exist in natural water sources. Characteristics such as temperature, pH, and salinity can affect the ability of the bacteria to survive in the water.[9] Also, in the water it may exist in a viable but nonculturable (VBNC) state and then become culturable again upon ingestion by a human.[10] Futhermore, different strains of the bacteria in a common water souce can transfer genes, some of which may contribute to the virulence of the bacteria, between one another through horizontal gene transfer, thereby increasing the virulence of any specific strain.[11]

[9], [10], and [11] are all primary sources. Therefore, it sounds like from the sourcing guidelines I should revise the paragraph to the following (right?):

Shigella can also exist in natural water sources.

I do not have a secondary source citation for that, but would that be considered common knowledge? I could add .

I am going to look back at my other edits too. I know I have a few other fixes to make for sourcing.

Thanks again, Ylok (talk) 17:53, 17 March 2018 (UTC)

User:Ylok This textbook discusses it [7] Doc James (talk · contribs · email) 18:03, 17 March 2018 (UTC)

Thank you User:Doc James. I was more going for "Shigella can also exist in natural water sources, without recent prior contamination with fecal matter" as I think 'fecal-oral route' summarizes recent fecal contamination of a water source, but I should have been more specific. That textbook, from what I understand, is talking about water contaminated recently through the fecal-oral route; the use of the word 'indirect' is vague to me what it means. But I am open to hear your thoughts. Ylok (talk) 18:29, 17 March 2018 (UTC)

Yes with respect to uncontaminated water sources would be good to find a better source.

This source looks useful https://www.cdc.gov/healthywater/drinking/private/wells/disease/shigella.html

Doc James (talk · contribs · email) 18:32, 17 March 2018 (UTC)

Thanks. I moved the topic to the talk section of the article for now. Ylok (talk) 19:24, 17 March 2018 (UTC)

Down syndrome

why [8] per Wikipedia:Manual of Style/Medicine-related articles#Diseases or disorders or syndromes 'screening' and/or 'prevention' go after 'diagnosis' section?--Ozzie10aaaa (talk) 00:38, 18 March 2018 (UTC)

Good point User:Ozzie10aaaa. I have reverted myself. Doc James (talk · contribs · email) 00:40, 18 March 2018 (UTC)

Recent COPD edit Comment

I think that you keep a pretty close eye on this article, but would you mind reviewing my recent edit? https://en.wikipedia.org/w/index.php?title=Chronic_obstructive_pulmonary_disease&type=revision&diff=831534907&oldid=830912734

Thanks!

JenOttawa (talk) 02:09, 21 March 2018 (UTC)

Looks good. Doc James (talk · contribs · email) 04:00, 21 March 2018 (UTC)

WHO Cancer update

The WHO cancer fact sheet from 2009 has been updated to its newest, 2018 version. Best Regards, Barbara ✐  ✉ 11:36, 21 March 2018 (UTC)

To which Wikipedia page do you refer? Doc James (talk · contribs · email) 15:13, 21 March 2018 (UTC)

WP:Wikitext syntax highlighting colors and style matching wikEd's color and style as much as possible

WikEd

WikiText

I've installed your new common.css. Try it out using the Wikitext syntax highlighting beta feature, and let me know if you see anything I missed. Then I'll either fix that or let you know why I can't. When you're happy with it, let me know and then I'll email you. Thanks, wbm1058 (talk) 14:29, 18 March 2018 (UTC)

Wonderful User:Wbm1058. Testing now. Doc James (talk · contribs · email) 20:51, 18 March 2018 (UTC)

User:Wbm1058 looking good. Can you make a few adjustements?

1) darken up on the blue for the linked terms? Possible to make the shown linked term slightly bluer than the piped link?

2) add green background for files

3) Make "cite journal" and "cite web" slightly lighter purple

4) Can we make the normal text darker? The headings seem to have darker black text than the body text.

5) The spaces between the lines of text are greater with Wiki Text than WikEd. Anyway to decrease line spacing width?

6) Can we make the urls within the references slightly blue on a grey background?

Best Doc James (talk · contribs · email) 21:11, 18 March 2018 (UTC)

Taking them one at a time...

1) I believe there is a difference in the way Wikitext syntax highlighting and wikEd specify color and fonts for piped links.

• wikEd: one color/font combo is used for what the reader sees and another may be used for the internal link that they don't see, e.g.

  [[Vancouver]], [[Vancouver|Vancouver, BC]]

• Wikitext syntax highlighting: one color/font combo is used for the page that's linked to and another color/font for what the reader sees, if that's different, e.g.

  [[Vancouver]], [[Vancouver|Vancouver, BC]]

You may choose any color from the palettes at web colors or shades of blue, for each of the two colors used in piped links.

2) Per m:Community Tech/Wikitext editor syntax highlighting § Color and style customization, at the bottom of that table note the "Non-CodeMirror" wikitext elements. Categories are "treated as (an) internal link", and I believe the same for files. So can't do without a product enhancement.

3) Please choose one of the colors at web colors or shades of purple.

4) Headings are color: #000; (the darkest possible) and font-weight: bold. I'm not sure whether there is a CSS class for specifying the color and font for "normal" text. We can ask product support. It is possible to make the headings more grey or less bold.

5) Not that I'm aware of. Another question for product support.

6) The color for external links (URLs) may be specified but it will be the same regardless of where the URL is (either inside or outside of a reference). The grey background is because the URLs are inside a template (typically a {{cite}} template). Choose any color from the palettes at web colors or shades of blue. – wbm1058 (talk) 16:59, 21 March 2018 (UTC)

Okay so 1, 3, and 6 I will look at colors. For 2, 4, and 5 we need support from those who build the WikiText highlighter than? Has you made a request yet? Am travelling for the next week so will not come up with colors until after my return. Doc James (talk · contribs · email) 17:31, 21 March 2018 (UTC)

No, I haven't made any requests for changes to the Wikitext syntax highlighter that's in beta. While testing it to develop your custom CSS I found that the cursor jumps to the front of the line whenever I use the toolbar to enter an en dash or to sign an edit. That would be the first thing I'd want them to fix but I haven't reported it. I did ask one question that, depending on the answer, might offer more options for piped links; still waiting for an answer. Enjoy your trip. wbm1058 (talk) 18:03, 21 March 2018 (UTC)

Is PTSD a "disease"?

Would it be a good idea to correct a description of PTSD from "disease" to "disorder"? ☆ Bri (talk) 23:28, 20 March 2018 (UTC)

Is it a disease versus disorder? IMO better to call it a disorder but both terms are often used interchangeably User:Bri. Doc James (talk · contribs · email) 03:57, 21 March 2018 (UTC)

(talk page watcher) I would argue that it should be described as a disorder, because the D in PTSD is normally understood that way. --Tryptofish (talk) 17:55, 21 March 2018 (UTC)

When defining a term they recommend you not use the items in the term in the definition. But I still think disorder is better.

Were do you see it called a disease? Doc James (talk · contribs · email) 18:18, 21 March 2018 (UTC)

It was at Hell and Back Again, a war documentary. I rewrote the passage here. ☆ Bri (talk) 18:24, 21 March 2018 (UTC)