GamingWe are Jennifer Hale (FemShep - Mass Effect), Ray Chase (Noctis - FFXV), Phil LaMarr (Hermes - Futurama) and Keythe Farley (Kellogg - Fallout 4) AMA!
Nov 21st 2016 by gameperfmatters • 32 Questions • 5260 Points
Hello from the Microsoft Excel team! We are the team that designs, implements, and tests Excel across each of our platforms; e.g. Windows desktop, Windows mobile, Mac, iOS, Android, and the Web. We have a great group of people from the Excel team with deep product experience ready to answer your questions. We did this a year ago and we are excited to be back. We'll focus on answering questions that pertain to Excel usage, its various platforms, and the Excel team. There may be questions that come up around bugs, feature requests, what’s new, training & resources. Here are some quick links that may be useful to you.
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We'll start answering questions at 9:00 AM PDT and continue until 11:00 AM PDT.
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After this AMA, you may have other help related questions that come up. You can still ask these normal Excel questions in the https://www.reddit.com/r/excel subreddit.
10:45 AM - The questions so far have been great. Please keep them coming. Our session ends in an about 15 minutes.
11:00 AM - We are wrapping up the Excel AMA. We'll stick around for a few more minutes to finish some answers. Thanks for all of the great questions.
Hey, guys! Some of my favorite people in this AMA.
Figured I'd ask a multi-part question that some of the other folks might not think to ask. The law firm representing the struck companies have responded to all three of the picket events (EA, WB, Insomniac) by repeating that SAG-AFTRA leadership has refused to bring their proposed contract to the actors for a vote.
- Do you have a response to their claim?
- Did you ALREADY respond to it, given that they've made this statement three times after each picket?
- If yes to #2, did they ever respond to your counterargument?
Why is it that hospitals can have incredible hardware like electron microscopes, yet pagers are still being used?
What is your favourite feature which the average Excel user wouldn't necessarily know about?
PL: Great question. The membership was very clear when they voted at more than 96% for a strike that they were interested in a secondary payment structure. That was not in the GameCorps proposed contract so it made no sense to go back to the membership.
JH: We'll go back to them, when we have something to go back to them with. We're dealing with the following mindset: the same mindset that's attacking much of middle class America, as an executive said to one of our people, "I'm not giving them a bonus, that comes out of my bonus."
Good question! I wonder this myself when I'm walking around the grocery store looking like a drug dealer. I think it is because we need a cheap device that doesn't lose contact in hospital basements and other locations lacking cell service. Sat phones are too expensive to give us, I guess. I do have all my pages go to my cell phone as well, though, so I don't have to carry that thing everywhere I go...
Ctrl-` switches to formula view and back. Love it! :-)
-- Alex [MSFT]
What do you think is the hardest part of voice acting in a video game? Is auditioning for a game any different from auditioning in a voice over role in a to commercial tv show, film etc?
Are you concerned about the long term effects of radiation exposure from fluoroscopy?
Graham and Kathleen: raising a young daughter into such publically visible setting as streaming and Desert Bus for Hope, how do you balance that?
As Penelope gets older will you allow her to get more involved in LRR/DB and streaming in general, or less and explicitly keep her away from internet publicity?
Additional question, do you ever plan to revisit making full length sketches should a fitting script arise?
I work in data analysis and use pivot tables every day. They are great, but for ONE feature; "Summarize Values By" cannot be applied to all values. So you have to right click, find the menu, and select "SUM" or "GROUP" or whatever for each column in Values.
There should be an option to set everything in "Values" to the same summarization. If there is already an option to do this then please, I will give you my money for it.
JH: It's acting on steroids and everything is cold reading.
RC: The lack of transparency. What the character's name is. What the tone of the game is. Who am I saying this to? It's the details that make a performance really land and give you a real enjoyment of the game. And right now, for monetary reasons, we're being kept in the dark.
I stand next to an X-ray beam almost every working day, so I am definitely concerned. Not so much about becoming sterile or anything, since that takes really high doses, but about small incremental risks of cancer, particularly leukemia or lymphoma. I'm hoping that instead, I will develop cool mutant powers like Spider Man, but I am told that is really really unlikely.
I wear a lead kilt and lead vest that make me look like a really slow Scottish warrior, and it protects from about 90% of the scatter radiation that I experience. I also wear a radiation badge that gets turned in every month, and radiation safety officers write me scary sounding emails about how many milliGray I was exposed to, but never really equate that to how much risk I'm exposed to. Fortunately I've done my own research, and it seems that the cancer risk from my occupational radiation exposure is fairly small in the grand scheme (cancer risk for the general population is 40%, but for me might be 40.5% or 41% after a lifetime of working in IR).
Interesting is that there are reports out there of cardiologists having tumors grow on the left side of their brain or face - this is more common because cardiologists typically stand with the radiation beam on their left side (same as me). I typically protect against this by hiring fat fellows (block a lot of X-rays) and standing behind them as much as possible.
Video Response: https://www.youtube.com/watch?v=UWbAZJtWAuI&feature=youtu.be
Thanks for the feedback. You can do this with Power Pivot ("Summarize By" in Advanced). For non-data model based pivot tables, do add an item to https://excel.uservoice.com, we look forward to having the community vote on this!
thanks, ash [MSFT]
As a Entrepreneur that's started an Indie Studio, and looking into future VO needs; what's the baseline incentive and payment structure for VO, and/or other items that we (new Indie Studios) should consider when hiring Voice Talent? We don't really have anyone to ask, so I'm hoping straight to the source might be the best place to start! Thanks for the AMA! (Major fan personally)
What is the most difficult procedure you have ever performed?
PL: Super happy you asked! One of the things that's huge is that you can currently get A-LEVEL UNION acting talent under the new Indie Budget Contract. And if you meet the budget criteria and agree to the secondary payment structure, it's really easy.
JH: And keep in mind that the secondary payment structure only kicks in if the game is a big hit. Which we are happy to help you do! And in kind with that, I have to leave to go work on one of those contracts right now!
RC: I'd just like to add that you are paying the same rate that you would for non-union performer, but you have access to the best of the best.
Wow tough question. One was a TIPS (which is basically a shunt placed through the liver under semi-blind X-ray guidance, used to relieve pressure in the portal system in patients with cirrhosis) that I was doing in a patient who was actively vomiting blood, bucking around on the table and generally trying to die. Another was a patient with a massive pulmonary pulmonary embolism who was 500 pounds and I was trying to navigate a catheter through the lung arteries to suck out the clot as their blood pressure was tanking and they were coughing blood and I had to decide whether to keep trying or call the surgeons to crack her chest. Both turned out OK, the TIPS patient survived and got a liver transplant a few days later, and the PE patient I was able to suck out enough clot to get them out of the woods, and the next day she was sitting up in the ICU eating french toast. Win.
Do you play the games that you voice?
What is your favorite game?
Any super duper secret lines that may never be heard?
Current med student who is very interested in a carrier in IR. What would you say would make a strong application for someone who is applying to an IR residency? Any suggestions about creating a strong application would be greatly appreciated.
RC: Yes, I play all of them, it's the best thing in the world. New Vegas is my fav. Noctis: I love listening to Afrojack!
KF: Yes, a little, I'm playing rise of the Tomb Raider and I can't wait to chase myself. Tomb Raider. Cursing as Thane was always fun.
JH: I suck at games. My fav game is the one I'm doing this afternoon, but if I told you, I'd have to kill you. If I told you I'd have to kill you
PL: Yes I play. MLB: The Show. Jen won't let me say a line.
Definitely start by not having any mis-spellings in your application or personal statement.
A strong application is the combination of a few things:
1) Good med school transcripts. Try to get some letters of distinction, or honors, or whatever your school offers. Work hard and be the first one there and last one to leave. It will be noticed.
2) High board scores. Especially step 1. It sucks to study for it but it is well worth it. A high score here can carry you a long way.
3) Good letters of recommendation. These get more important the farther along in training you get. If you are working hard and studying hard, and you aren't a total a-hole, then this should work itself out.
4) Research experience. Especially for academic institutions, they want to see one or more projects that you have carried through to the end. First author on a paper, or at least on a poster or conference presentation.
5) A really beautiful head-shot. Just kidding. Kind of.
Notice I didn't include a great personal statement. These all read basically the same to me, so I just skim them, looking for any signs that you are a mass murderer or serial rapist. Otherwise they don't make much difference, at least to me.
Phil LaMarr, I'm such a big fan of your work on Futurama. I loved every bit of that show.
What is your favourite line as Hermes? and How did you end up on futurama?
Hi Dr. McWilliams, just wanted to jump on with a very related question. I'm a current radiology resident planning to apply into IR prior to the switch in 2020, and I'm having a hard time gauging my competitiveness and how many programs/where to apply, since the more "objective" standards including grades and board scores are not as relevant to a fellowship application. I've heard great letters of recommendation and research become even more important (especially prior to the interview invitation), but wouldn't everyone have great letters and at least some research? How do you differentiate between candidates at that phase?
I guess from a practical standpoint that what I'm asking is, is there any way to gauge how competitive I am in order to figure out how broadly I should apply?
Might we ever get purchasable shame ticket pads? I would love them for personal use when watching DB at home
I'm late, but is there any plan to make it so a highlighted range would stay highlighted when switching between screen? For example, I highlight a column and then go to a screen where I need to enter data. My highlight no longer shows. It would be pretty nice for data entry and auditing.
PL: Fav line: I love the bureaucrat song. And I got in to Futurama by auditioning for Matt Groening. When I didn't wet myself, I got the job.
It takes some introspection. Look at the following things in yourself:
-How good is my board score? Yes we still look at that!
-Did I get AOA or lots of good grades in med school? We still look at that too!
-Is my radiology residency considered "top-tier"? That definitely helps your cause.
-Have I won any sort of awards or honors during residency?
-Did I do a lot of research, more than my peers?
-Has your own IR program told you you would be a shoo-in at their program?
If you have a lot of yeses to the questions above, you probably are sitting pretty, and applying to a dozen or so programs will do. If not, apply widely, since you can always turn down interviews after you are granted them.
Video Response: https://www.youtube.com/watch?v=o-4gskWwBqI&feature=youtu.be
Interesting idea. By highlight, do you mean the cells that you selected with your keyboard/mouse? Feel free to add your request to our uservoice site: https://excel.uservoice.com/ -Joe [MSFT]
So great of you all to do this! I'm certainly behind the #performancematters movement, and wish you all the best of luck there.
So the strike has caused a bit of a stir throughout the US as it is, since there hasn't been a strike since the writer's guild took a stand. Is the strike causing a lot more waves around the Los Angeles area where most of these larger games get made? And is there a way people can support their SAG-AFTRA chapter in this movement in other cities? I'm in Seattle for example, where there's also a ton of game voice work, though I think most of the companies have been working with their VO talent well.
I'd love to ask for VO advice as well as an upcoming VO actor, but that's a whole other can of worms!
During residency, be nice to nurses. You never know who they have the ear of.
PL: One, don't take struck work, two, login to SAGAFTA and gameperformancematters.com and signal boost the messages. KF: We're doing a virtual picket later on this week, keep an eye out JH: And go to iwanttobeavoiceactor.com and partake of the insane generosity of Dee Baker
This is 1000% true. Not just during residency, either. Nurses can make your life easy or very, very hard.
This question is for Mrs. Hale and Mr. Farley. How did it feel to work with each other?
What was your favorite class in college?
What is your favorite "ghetto gourmet" trick for dressing up cheap food?
How have things changed in the last 10 years in your field?
What do you consider to be the most exciting developments in cancer treatment in the last 5-10 years?
My stepmother has survived 5 years after a pancreatic cancer diagnosis, which would have been a death sentence not so long ago but for people like you, so thank you all for your hard work!
Hi Canada, this is your loud downstairs neighbors. Can you send us some Hope? We're a bit low at the moment.
The "Large Address Awareness" is great..... ...but what's the holdup on just getting rid of 32bit?
Both: we didn't. We work alone in games.
KF: Jen and I were at a meeting of actors talking about what we wanted to see in the video game contract. And after, I walked up to her and said, "you don't know me, but we made out in a video game."
JH: laughs hysterically
Any math class and logic. I actually got a perfect 100% for logic, for the whole semester. Didn't miss a point. I remind my girlfriend of this constantly.
I am king of ghetto gourmet. First, put blueberries on any cold cereal. Also, you can make pretty good quesadillas over the open flame of your gas range, just use tortillas and shredded cheese. And no one can convince me that there is a better mac and cheese than the classic Kraft box with the orange powder cheese. You can dress that up with hot dog slices, but I wouldn't say you need to.
The last 10 years in IR have seen an explosion of technologies. Our equipment keeps getting smaller, and new devices are coming out all the time, so the scope of what we can treat keeps getting bigger. Surgeons have seen the writing on the wall and have started to try to learn our techniques. It has created a competitive environment in health care, but overall patients are benefiting.
For cancer treatment, I'd say the advances of ablation technologies that allow us to cure (not just treat) small cancers have been big. Y90 radioembolization, which allows us to deliver massive doses of radiation through the blood vessels into very targeted locations, is very cool too. Also, the nascent field of personalized oncology, where biopsies are used to find what the cancer is susceptible to, and a custom cancer-fighting agent is personalized to the patient. As above, that one may be huge.
Thanks! Wish I could take credit for that one, but hopefully we keep getting better!!
On the technical side, marshalling between 32 and 64 bits to support the existing add-ins would introduce a significant performance cost. Which means we'll have to support 32 bits for the customers who need their add-ins to be as fast as in older versions. So, back to square one.
-- Alex [MSFT]
First of all, thank you so much for doing this! I've been following news of the discussions and strikes so it's great to hear directly from those on the front lines, so to speak.
So we know which companies you are striking against, but on a more positive flipside, which video game studios do you feel treat voice actors the best? I know this is something that might vary from project to project even within the same studio, but overall, which companies do you really enjoy working for? I'd love to know who is on the side of proving that #PerformanceMatters.
Can you speak to the turf wars between IR and vascular surgery? Do radiologists make better interventionalists because of the dedicated rads experience?
JH: There are SO MANY we love to work with, it's mind boggling. We really only have an issue with the culture of exploitation practiced by the corporate 11 we are striking against. The people we work with are great! It's their corporate overlords and their lawyer lackeys.
It's a pretty open war in many ways- we pioneered the procedures, but they adopted them and have gotten quite good at them in many cases. I do still believe that the imaging skills are what separate us from the other doctors who try to do our procedures. There is a power in my ability to have a patient come in, interpret their MRI scan, treat them, and interpret their imaging results, allowing me to determine what the best follow-up treatments will be.
TL;DR - yes, we are way better.
Phil: When playing Vamp, who survives a bullet to the head, did you find yourself thinking back to your part in Pulp Fiction? Every time I see the scene where Marvin gets shot, since MGS2, I picture him getting up and saying "I can't die twice."
is your girlfriend also a Doctor, if so what kind?
What do you do with all the hats used on Feed Dump? Do you still have them all, and if not, when was the last time you purged your collection?
and they look like a spreadsheet.
I will never look at spreadsheets the same way again.
PL: laughs That's funny. Actually, no, because it's my policy to never be there when my characters are shot in the head.
KF: We do so many deaths in a session and head shot is always one of them. We almost never know how we die. Kellogg got shot around 95 times right?
/u/maddking: I shot you with a missile.
No she works in finance. I had dated doctors in the past, but sometimes it's nice to leave work at work and not "talk shop" all the time. I don't talk too much about my procedures and she doesn't tell me too much about her Excel spreadsheets, and instead we cuddle on the couch and watch Westworld
Basically we collect all the hats we get for feed dump and hang onto them for a while. From time to time we perform a cull and keep the very best hats. The rest are sent to a farm upstate to charity. If we hung onto them all we'd have rooms that were floor to ceiling with hats, and it would just be untenable, but most of your favorite LRR hats are FeedDump Hats.
Why choose? -Jen [MSFT]
I read that you have a separate contract with Blizzard for voicing their games that makes them not part of the strike. What are they doing right that needs to be emulated by the industry at large?
What is the most disgusting case you've had? Funniest case?
Why the switch from 8 hour shifts to 12 this year? Will there be more codrivers next year? (Kate Stark needs a shift with Kathleen or Jamie.)
I think I speak on behalf of all accountants everywhere when I say, thank you for Excel.
Where do you see Excel going from here? Are there any "game-changing" new features on the horizon, or is the focus going to instead be to continue to polish the existing product?
PL: Blizzard used to be non-union, but ever since they went union they have played by the union rules and they recognize that they are part of the entertainment industry. And the union has a good relationship with them.
I think I have been showered with every bodily fluid at some point, which has prompted me to come up with a definite ranking of bodily fluids, in terms of which ones I don't want splattered on me... in order from most to least disgusting: -Feces -Vomit -Saliva -Urine -Ascites -Blood
At this point I'd say the last 3 don't bother me at all. Urine for example is sterile and really is just filtered blood, so it doesn't seem disgusting to me at all any more.
But I digress. I did have a patient who was having heavy GI bleeding from the stomach. When that happens, the blood passes through the digestive tract and gets semi-digested into a nasty semi-solid blood/feces cocktail called "melena". The patient came down for me to stop the bleeding, and proceeded to "melena" all over my shoes as I was helping transfer the patient to the table... and I wasn't wearing shoe covers. This prompted a stat trip to Sports Authority for new sneakers.
Funniest case- I had a patient come in for treatment of varicocele, which is like a "bag of worms" in the scrotum composed of blood vessels due to incompetent venous valves in the abdomen. Usually patients come for treatment because the varicocele hurts, or is causing a decrease in sperm counts... but he wanted it treated because he didn't like how it looked on camera. Turned out he was a male porn star. I happily treated him (but never looked for my handiwork on the internet)
WE've done 12 in the past, we've done 24 in the past, shift durations have never been locked, it's always something we're willing to play with. We didn't think that 8 hours quite gave the drivers time to make the shift their own. 12 feels like a better duration for the drivers, without pushing them so hard that they spend the rest of the event recovering.
What "game changing" new feature would you like to see?
Thanks so much for all you do!
What would you say to people who constantly opine that unions are the worst thing since sliced bread?
Do you think in general, our country is headed for a place with fewer unions and fewer workers' rights?
Also for Phil: are you reprising your role for the conclusion to Samurai Jack that's coming out? How do you feel about that?
Have you ever had fluoro stop working midway through a procedure? What do you do in that situation?
If I switch my computers region from "English (US)" to "German (Germany)" (where I'm located), it takes 5,3x the time for calculating. Even worse when choosing Hindi: It needs app. 33x the time for calculating (here is the full report: http://professor-excel.com/performance-excel-study/) What is the reason? Are you going to solve this?
PL: Yes, we are working on the new eps of Samurai Jack and they look amazing...
JH: The issue is not unions, the issue is parity, equity and opportunity. When we focus on ideologies, we lose sight of the human beings involved. The question is not is are the labels working? (ie - Union, non-Union), the question are the PEOPLE involved looking at the resources we have, and distributing them between workers and executives in a way that is equitable and SUSTAINABLE? The current model has most corporations honestly, and their executives sucking the life out of the people they hire, and as a consequence out of the very consumers they need.
KF: Sliced bread is awesome.
Yea, a few times. Usually a re-boot gets it going again, just like my PC and iPhone. If it doesn't, I wish I could say I get out a scalpel and just dive in there the old-fashioned way, but in reality we just move the patient to another fluoro suite (we have 4 IR suites here at RRH).
Video Response: https://www.youtube.com/watch?v=C-3-ucpnCoU&feature=youtu.be
A better way of looking at this performance difference is that lookups in English are faster :-) The reason is that we can short-circuit English to byte comparison. More complex scripts require involving more heavy Unicode machinery.
-- Alex [MSFT]
Miss Hale, I love your work! What was your favorite part of voicing Rosalind Lutece? And how does voicing a game character differ from voicing an animated character (as I'm aware you're also the current voice of Cinderella in Disney)?
How many years of training does it take to become an Interventional Radiologist?
JH: My fav part of voicing Rosalind was EVERYTHING. In an animated session you share the workload with several other people throughout the session. A game session is a four hour-1 person show. And you have 10 to 20 times more lines. I've had up to 600 lines in a game session and we usually work out of sequence. Nothing follows a particular storyline. Everything is out of sequence.
PL: I find it challenging because so much of the acting is out of context. In an animated show, you know the entire story and what your character is doing every step of the way (and you have drawings). In video games, you will have hours of lines where you have to completely create an emotional context for what you are saying out of whole cloth so that each response line sounds different.
4 years university + 4 years med school + 1 year internship + 4 years diagnostic radiology + 1 year IR = 14 years after high school. Sounds bad but to be honest those years were some of the best of my life, and the training and learning were really fun. Now that I'm out on my own I have real responsibility and spend a lot more of my time waking up at 4 am worrying about patients.
Is there a character or franchise you would love to voice?
I recently watched "In a World...". Have you seen it? What are your thoughts on the film, it's accuracy, and how it portrayed the voice over/acting profession?
Also, Jennifer Hale, I adored your work on Mass Effect. FemShep is the best Shep!!!
Can you explain how the field of interventional oncology will grow? Like radonc will it also be put on the back burner to personalized onc chemo in the future?
In line with that do you think interventional radiology will be the big field of the future with its own residency?
KF: In a world is pretty great. It's decently accurate. With a lot of great VO cameos in there.
IO is definitely growing. Cancer is really common (about 40% of us will be diagnosed with cancer during our lifetimes) and people are looking for minimally invasive treatments and cures, such as those that we offer in IR. So I expect that will really grow. I do agree that personalized onc chemo has great potential, but it has quite a ways to go... and maybe like flying cars, it may not reach the potential we expect as quickly as we hope it will.
Regarding IR residency, it's already a reality! Medical students can now apply directly to IR residency, which is a 5 year training program after internship. So 4 years med school, 1 year internship, and 5 years of diagnostic and interventional radiology (essentially 3 years diagnostic and 2 years interventional)
My question might be just paranoia but UbiSoft just announced they were going to have "less narrative" in a game series that is nothing but narrative do you think that's them trying to a spin on the Voice actors' strike? #performancematters
Med Rad tech here.
I've heard chatter about changes that would allow nurses to order, perform and report their own imaging work. What do you feel of this suggestion? I myself am very concerned about this as I completed years of schooling in order to take appropriate diagnostic images while you've undergone even further education to ensure those images are appropriately interpreted. I don't feel these jobs could be accurately done by an RN.
While it's probably less of a concern with high level IR procedures, what do you think about the possibility of rads and their image reading being replaced with computers? We already see this being done on a limited scale in mammography with CAD being used as a "second read", but it hasn't seen much penetration beyond that.
Beyond poor quality imaging (low quality images, sloppy pos'n), what is something that drives you nuts about us imaging techs?
Least favourite type of case to do/read? I've heard many complaints about the GI tract (swallows and enemas) from my doctors here. And then bitching about bone age studies.
"1-2" should be prioritized to a string of "1-2" and not "JAN-02"
JH: I doubt it. They're known for pushing creative boundaries and they're an awesome group of people.
I haven't heard this change myself, but I agree that it is a bad idea. There is a reason why we have to spend 14 years in training- there really is a lot to learn
Regarding CAD, this is definitely already here in some areas (like mammo), and for the rest of radiology, it is coming. I think it is a matter of time before you do a scan, and a computer auto-compares that to a library of millions of normal and abnormal scans, using pattern recognition. Then it spits out a report. Probably will still have a radiologist to double check it, but someday the humans will be the quality control rather than the other way around.
We have amazing techs at UCLA IR. The best thing a tech can do is anticipate what the doctor might want next. Sometimes you know the equipment so well you can suggest what tool might be right for the job. That's the sign of a great tech... along with staying in/near the room within shouting distance.
Least favorite case is definitely the dialysis graft de-clot. You spend an hour hugging the X-ray beam trying to pull and remove clot out of the graft, and when you finally do the angio run at the end to check your work, it is already clotted again. So discouraging sometimes.
The addition of the chat monitor was a recommendation of the survey. We were surprised that we hand't thought of it ourselves. It was an obvious add, and a huge improvement.
Not a solution, but a workaround: prepend ' to force Excel treat "1-2" as text.
-- Alex [MSFT]
I am a big fan of all of you and your work and I'm happy to see that the Union is striking to speak out for voice over actors. Have you felt like you have been getting significant support from Union members who don't primarily do voice over?
As for a more light-hearted question, besides Dee Baker and Frank Welker, which LA voice actor can make the best sound effects with their voice?
Thanks for taking the time to raise discussion about important issues in VO and doing this AMA!
Hi Dr. McWilliams, with new applicants being corralled into the esir or integrated pathways and the vir fellowship disappearing what are your tips for evaluating all the new programs as an interviewee?
PL: Yes, just this week Brandon Routh tweeted us out, Clancy Brown was on the strike line, and Jason George from Grey's Anatomy showed up to march around and yell.
JH: Fred Tatasciore is another super secret weapon when it comes to making sounds
Tough time to be an applicant, since IR is a popular field right now- I think we had 220 applicants for our 3 integrated IR spots. But just realize you will be able to get into IR even if you "only" match diagnostic radiology. So look for DR programs that have a strong associated IR program (and offer ESIR) and also apply to integrated IR programs, which would be even better. As far as evaluating programs, it helps to talk to the current or past fellows, they will be brutally honest- or come shadow in the department or do away rotations to see for yourself. There are lots of good programs but you have to find one where you feel like you fit in. For example I thought of going to Miami Vascular for fellowship (which is an amazing place) but I was single at the time and the thought of being in beautiful South Beach and never doing anything fun because I was spending 18 hours a day at the hospital just crushed my soul too much. So I stayed at UCLA and never regretted it.
So excited to see all of you in one AMA! Ms Hale, you should know that FemShep/Mass Effect helped me through a really rough time in my life and your performance of FemShep continues to be one of my favorite performances I've ever had the pleasure of seeing.
I was relatively unaware of the SAG-AFTRA contract issues/strike until a few months ago. Since then I've tried to pay as good attention as I can. I was wondering, since you guys have experience in games and TV/Film voice acting, how Hollywood treats voice actors. Are the contracts there something that video games should follow? If not, how would they differ? And finally, what can I do as a fan of video games to help you guys get your fair deals? I want to see great games continue to be made and I want the actors to be as excited about them as I am!
Thanks a lot, y'all, and keep up the awesome work.
PGY-1 here who's been accepted into a DR program with ESIR. I'm concerned that software will soon enable computers to interpret imaging in the near future, reducing the need for DR physicians, perhaps relegating them to just double-checking the computer's work. Is my fear justified?
JH: First of all, thank you. That moves me so much. To support us, think about where your game dollars go when you're out this holiday season, and support the other awesome game companies out there. Feel free to call the corporate 11 and tell them what you think!
Yea see above- it's a ways off though. In the same way, wouldn't you have some concern that an inpatient medicine doctor could be replaced by a robot that takes in all the lab values, vitals, X-ray reports, and synthesizes a diagnosis and best treatment based on its internal library of best practice literature? I've seen Terminator 2. I know what's going to happen. But overall I think robots are going to help us rather than replace us, at least for a long while.
Thank you for taking the time to do this. I have a question for you:
I am currently in the process of trying to gather as much information about the strike as possible -- what both sides have said about it, etc., as I've decided to write the game companies a letter and tell them that I think performance matters (Ms. Hale, our paths crossed on Twitter, and you inspired me to do this).
Do you have any recommendations in particular as to where to look, and also, if possible, what key points I should pay particular attention to? I'm a gamer from Europe whose first language is not English, and I have to admit, it's starting to become difficult to keep up with all the details.
Thank you very much in advance, and good luck!
Corindus makes a robotic angioplasty system for interventional cardiologists that allows the physician to step away from the table and control stent placement from a computer, away from the radiation source. Has UCLA begun adopting a similar device for IR procedures and/or does a similar device for IR procedures exist?
RC: you can check out all of the links to the gameperformancematters.com site up top. Thanks so much!
Yes there is a similar robot system for IR, that allows remote control from the control room outside the angio suite, or even from across the world, theoretically. The technology though is still in its infancy. A lot of our procedures are performed by guiding shaped wires and catheters through the blood vessels or other parts of the body, and there is a certain "feel" - like a tactile feedback - that you get when you are holding/advancing/spinning the wire and catheter that can't really be replicated when you're just holding the controls of a robot. So as much as I like the idea of sitting on my sailboat in the Caribbean and curing cancer via robot, I think it is a ways off from reality. Plus I don't have a sailboat. And, I've never been to the Caribbean. Academic medicine doesn't pay that well...
Subscription: we wanted to offer a new model of buying Office that wasn't about buying new software when you bought a new computer so that we could deliver functionality outside of the old "box software" model, get new features out to folks quicker than traditional/slow upgrade cycles, and help users with service-based offerings such as Office365 and even things like the new Designer feature in PowerPoint (that helps you make beautiful looking slides using cloud services).
Meeting Bill Gates: Yup! I've met Bill a couple of times. The first, and most memorable, was at his house when I was an intern. They stopped doing that years ago, but he was a very gracious and patient guy with all the ridiculous questions that us interns were throwing at him.
Bill's "orders": Oh yeah, over the years Bill has weighed in on what we should and shouldn't do for every single version. I still remember contributing to my first BillG review. Me and Dan (one of the other folks commenting here) built this crazy prototype and Bill (rightly) ripped it apart. Good times.
-Charlie [MSFT Excel Team]
What's one thing you wish nurses knew regarding recovery of IR patients?
Why is Beej ?
Bonus, why is glass shark ?
Call my fellow before you call me. Especially if it's after 9 pm.
A workbook that made creative use of circular references to solve the shortest route out of an arbitrary maze. Not particular useful but fun to build :)
-- JoeMcD [MSFT]
Why can't we still not open two workbooks with the same name at the same time?
That refers to cryoablation. Liquid gases like CO2 or liquid nitrogen can be circulated from a tank into a specialized needle, where the cold energy is concentrated around the needle tip, producing a zone of freezing encompassing the targeted tumor. It's a cool (ha) treatment because it is almost painless in many cases, and can effectively kill tumor cells by causing the water-rich cells to crystallize and shatter their cell membranes. At the end of the procedure the cancer is dead and the patient just has a few needle-sized holes about the size of an IV that heal in a day or two. Patients don't need anesthesia and go home the same day.
Every year, about halfway through planning that year's desert bus.
Allowing two workbooks with the same name would make entering formulas that reference them quite confusing:
Which one did the user mean?
-- Alex [MSFT]
Why did you name it Excel? Or did you guys name it at all? I mean, it is a spreadsheet program...
Correct, not enough tumor being killed at one time for that. You can get "cryoshock", which sounds like a new PS4 game but is actually where you freeze too much tissue (like in the liver) and your cytokines go bananas and you end up in DIC and organ failure and overall a world of hurt. But it's super rare, never had it happen.
BioMed engineering grad student. Just learned about CT and MRI this week, truly fascinating stuff. What future do you see for medical imaging in the world of big data? I would imagine that using a person's genetics, medical history, and scans of other patients with similar backgrounds could paint a better picture for treating various problems. How has big data affected your field?
Also I'm a USC alum. I hope you're prepared to get your butt kicked this weekend.
Typo or nefarious reason why MomoCon doesn't appear on the LRR wiki for DB9 Prize Sponsors? ;P
Here we use "XL", which is handy, since it's easier to fit on a license plate than "WORD" or "PPT" :-D
-- Alex [MSFT]
P.S.: Mine is "XLRULEZ", naturally.
Is there anything that you thought would be a cool feature to add then it turns out to be the most used and important one?
Almost never, it is kind of a pride thing. I tend to carry through almost to a fault, which sometimes means tough procedures last for hours and the back table looks like a garage sale with piles of catheters and wires. But if it truly looks like I can't do it, or if I run to more than 60 minutes of fluoro time, or if any point it is becoming unsafe to the patient, then I would definitely just stop and try again another day (or sometimes refer to surgery, if it can't be handled by minimally invasive means). Luckily I have really excellent IR colleagues, so I can always have them try as well- sometimes you just need a different set of eyes and a different pair of hands.
1) As a radiologist, what up and coming imaging technologies are you most excited about? I hear a lot about optogenetics making huge headway in the field of neuroscience, do you see something similar for hepatology?
2) With so much new research and publications printed daily and worldwide, how do you and your fellow radiologists keep up to date to give your patients the best care?
To be fair, Desert Bus is like one really extended Loading Ready Live
Hey Excel team!! As a Business major and stats minor, I use Excel daily and have a few questions.
1) What would you say is the most underutilized tool/data pack? (specifically that could be useful in business or stats)
2) How many functions can you "string" together in a single cell before excel crashes, I've written some pretty long strings but excel has spit out the answer every time
3) How come when Im working with the same data pack and functions/spreadsheets as my professors I can never get my sheets to work nearly as well as them?
I think Trump already took that title
Thanks for being so generous with your time!
- What's your favorite kind of procedure to do? What was the most rewarding time you did that? When did you first do it?
- What's your least favorite part of your job? What gets in the way of your being productive? What could make those things better?
- What kind of follow up do you do on patient outcomes? Do you get any feedback as to how well both a given procedure is working and how well you/your team are doing them?
- How do you decide which procedures you'll do vs. the fellow vs. the resident?
- What's the nicest thing a patient has done to thank you? What about someone you trained?
- What's your favorite paper you've authored? What's your favorite paper you've read?
Hey LRR! Big fan. Today you auctioned off a tour of Wizards of the Coast. Have you ever considered donating a tour of The Moonbase? Seems like it'd be fun!
I really love treating liver cancer. Most people are given the diagnosis as a death sentence, because most of them have cirrhosis and would go into liver failure if they underwent a curative surgical resection. So they get referred to me with little hope. Sometimes, the cancer is too advanced, and there is little I can do- but in most cases, I can stop or even cure the cancer using minimally invasive techniques. I also love the liver cancer population, they often have a history of harmful behaviors like alcohol or drug use, have reformed themselves, and are really appreciative that a doctor wants to help them. Just a great feeling to go into clinic after the procedure and tell the patient their tumor is cured. I will never get tired of that.
Meetings. I have so many meetings, where precious little usually gets done. I try to follow the 4 hour work-week advice: avoid all meetings, and if you have to go, show up 15 minutes late and leave 15 minutes early. That way all the small talk is already out of the way, you can get something out of it and get out of there before you waste your entire day looking at some admin's Powerpoint.
We do. A lot of our research consists of retrospective studies where we review patient outcomes and use that in reverse to figure out how we should best do procedures and who we should best do them on. It's a big part of what I do, and thankfully I have lots of good medical students and residents who are keen to jump through all the IRB hoops and spend lots of hours sifting through patient charts to collect this.
I'm always supervising, but I try to let the trainee do as much as they safely can. Exceptions would be really critically dying patients, really high-risk procedures, and the occasional time when I get bored watching and decide I just want to "show them how it's done". IR really is fun, but kind of like video games, it is more fun to play than to watch.
I had an absolutely adorable elderly patient who had kept a medical text from the 1800s- it had belonged to her grandmother. It was called "The Cottage Physician" and it had awesome chapters on how to make salves and ointments and potions for any ailment (this was well before antibiotics and the like). I had been treating her for cancer for a few years, and one clinic visit she brought it down and gave it to me. I took it to a professional book restorer who re-did the cover and it now sits on my shelf in my office at home. Gives me a smile every time I look at.
I can't say any of my papers have been New England Journal-worthy. I'm more of a clinician than a researcher, so although I do have a number of publications, I'm not going to say any were world-changers. Favorite paper I've read? There was a terrific paper on how to correlate hepatic arterial anatomy with angiograms, that I think about every time I do a chemoembolization procedure. Totally nerding out right now.
The moonbase is... not actually very big. It'd be a short tour.
Any plans to build some of the features that ThinkCell offers?
BTW, I love O365 and Office 2016.
Oh man. All I know about Mars I know from Total Recall, the original Schwarzenegger one, not that crappy re-boot. I assume there will be lots of strippers with 3 boobs, which I would not be in favor of treating, but probably there will also be frostbite, radiation sickness, bone density problems from lower gravity, seasonal affective disorder, and all kinds of infectious disease coming from a concentration of people in a small station. Probably we won't need many interventional radiologists, but if they ask me, I'll definitely go.
I really doubt we would decide to put the X-ray or ultrasound machines outside on Mars, as that would be really really cold for patients, who already have to wear those embarrassing ass-less gowns. So since the machines will be inside in normal temperatures, I expect they will work fine.
Could you suggest the best programming that helps to automate tasks/ report for the online version of Excel ?
I think the new IR residency will make better IR physicians. 1 year of fellowship just isn't enough any more. The extra time in IR, the ICU month, the clinic experience, all will produce IR doctors who are better equipped to treat patients rather than just do procedures.
Competitiveness seems higher than DR, significantly so, because the number of slots is quite low. This will expand in the next few years, but IR is a hot field right now (for good reason!)
Remember that there will be an independent residency (which is much like a fellowship, you apply for it during DR residency) so if you don't get into an IR integrated residency, you can still do the DR pathway and get into IR later. I don't think there is any secret meeting of the minds saying we want to limit slots, it is just a matter of funding and the fact it is a whole new training program.
Schwannomas in difficult places like tied up in the cauda equina or under the sciatic nerve under the buttock/ back upper leg. Would these treatments you mention apply?
Would you rather 500 duck sized busses or 1 bus sized duck?
There have defiinitely been one-off, hand knit LRR touques or hats. whether those will ever become an official thing? Who knows.
Great to hear that you love the product. We continue to improve the product in terms of reliability and performance. We have millions and millions users worldwide and it is important to keep Excel as a reliable experience for all of them. See this blog post on some of the themes around Intelligent Cloud Services and Collaboration which we will working towards.. https://blogs.office.com/2016/09/26/office-365-news-in-september-at-ignite-intelligence-security-collaboration-and-more/ -Sangeeta [MSFT}
Hi Dr. McWilliams. Care extender at Ronald Reagan MC here! There's a chance I might have seen you around. Thanks for taking the time to do this AMA.
I am currently in year 3 of undergrad planning to apply to med school the upcoming cycle. I got interested in IR ever since my grandfather's cancer metastasized to his liver, and he underwent TACE treatment. Could you explain the TACE procedure, and maybe why TACE would be better than other approaches in certain scenarios for treating liver cancer? Since my grandfather only stayed one night post-op, I am assuming that TACE's upsides are that its highly localized and minimally demanding on the patient. Other than that, my understanding of the hows and whys behind TACE is pretty limited.
Also could you expand on the differences between IR and vascular surgery? (interest in both!) Are there instances where IR docs will work closely with vascular surgeons, or do the two specialties tend to operate autonomously? They seem similar in certain regards, but I can imagine they are significantly different in terms of approaching treatment and practice.
Finally, what are your thoughts on AI in medicine, and its possible applications (or implications) for IR?
Just wanted to say that its doctors like you who have allowed me to spend more valuable time with my grandfather, so thank you for all that you do!
Just page or email me! Happy to talk more, running out of time here.