Are you trying to say that there's a phone that will do 3G data on both AT&T and T-Mobile in the US? Point me to it. I think you've mixed up triple/quad band GSM voice with the UMTS frequencies. (Example: Nexus One order page where you have to choose an operator.)
If you really want serious landline quality and great range, go track down an old 49 MHz phone. Those things might have been interceptable, but the cordless phone with the longest range and best reception I've ever had was one of those. I'd use it today if it had caller ID.
Also, kiddies of today: you have no idea how good phones used to sound. People quit caring somewhere along the way. Remember that the logo for Sprint is meant to make you think of the bounce of a pin off a hard surface - because their original ad campaign talked about how the call quality was so good that you could hear a pin drop from across the country.
There are four major network operators in the US: two use GSM (but with different 3G data frequencies) and two use CDMA (but while Verizon will supposedly activate a Sprint phone, Sprint will not activate a Verizon one). So smartphones are effectively locked to one carrier by hardware.
Yes, this is sub-optimal in a lot of ways. Still, it's not without its compensations: all four operators' plans allow calling from anywhere in the US, to anywhere in the US, without any charges beyond airtime - no roaming, no extra fees for calling a mobile on another network, nothing. Just because I was bored, I checked with WolframAlpha. The area of the contiguous 48 states is just over 8 million sq km. The combined area of Europe excluding Russia is just under 6 million sq km - only 3/4 of the area of the lower 48. So we pay more, and phones are tied to carriers, but I can travel 1000 miles and use my phone just like I'm at home - voice, data, text, no matter - without paying a cent more.
The ultimate problem to be solved is the same one that drove HD: sports. HD evening news is pointless. HD sitcoms, not much better. HD movies, well, those are nice. But sports drove HD, and they'll drive 3D as soon as someone comes up with technology that lets you have 20 people over to watch the Big Game. Until then, I'm pretty sure that 3D TV will be a gimmick that most people buy only because it's a basically free add-on.
I watched two guys install a 42" TV on a wall mount once. I'd gladly pay $150 to the store in return for their installing it and accepting all liability for its being dropped during the install process.
We use them for nurses dispensing meds; do you use them for physician charting? Maybe you're just in a much more technologically advanced area of the country.
Of course loopholes exist; politicians couldn't leave the tax reform act alone. Nonetheless, both 17% and 27% are a lower than 44% and a lot lower than 70-90% (yes, I know that was a marginal and not an overall rate).
It's rather rich for Buffett to complain. After all, he would be among the first to move his capital overseas if capital gains were taxed as income. This is the ultimate problem faced by taxing governments: capital is mobile and will move to avoid both taxes and regulation. Example: the US after Sarbanes-Oxley, where private equity firms sprang up out of the woodwork so as to avoid the painful paperwork occasioned by being a public company. We couldn't have given London a better gift.
Extreme? The middle class is about income, not wealth - i.e., we have a lot of the former and very little of the latter. Until your net worth is way up there, you're middle class in my book - you still have to work for a living.
The classic upper class - the feudal types - lived off rent payments that were resistant to inflation. They didn't have to work, EVER. Most people with incomes of $200k/yr work - and work very hard. They have to submit themselves to the FAFSA shakedown when they send kids to college - where private schools are $50k/year of AFTER-TAX income per student. A favorite figure these days is a 50% tax. So be it. If you make $300k per year as a couple, you will have (something very close to) $150k in take-home pay. If you have twins and want to send them to a top-name college, well, that's $100k of that $150k. Someone who is forced to live on 1/6 of their income is not doing the equivalent of snow angels with gold coins.
If the 1986 tax reform had not existed, this might well be a valid consideration. However, the tax simplification of 1986 eliminated a LOT of loopholes, deductions, etc., which were used to prevent people from paying those 70-90% income tax rates (which really only fell on poor suckers who won sweepstakes or lotteries and who thus had no way to hide the income).
When Bush Sr left office, the top marginal rate was 40%. In fact, Bush Sr raised that rate several times.
Yes, that 40% (which is less than 44%) tax rate was a significant contribution to his losing the presidency in 1992.
If you could read English, you'd notice that I didn't say a word about reimbursements. It does have to process those. But it doesn't collect FICA or send out bills; that's done by the IRS.
And I'm glad to see that you agree that there's no actuarial process at work with Medicare. Would you like to take the next step and admit that those are things that are necessary components of any private insurance system, and any single-payer system? The fact that individual contributions are not determined by sickness doesn't mean that the British NHS (e.g.) doesn't have to determine which treatments it will or will not pay for.
Medicare doesn't have a billing or collections department; it has the IRS. It doesn't have an actuarial process; it pays a percentage of what private insurers pay. These things help
As for schools, private schools have lower costs than public schools - in general. Private schools are generally better places to work, so they can get away with not paying as much money. (Indeed, sometimes teachers work there just to get the tuition discount for their children.)
UpToDate is a brilliant piece of work, but it won't make a dignosis for you. Neither will checklists - they are, as you describe, decision support tools. They will make sure that you don't miss important things, but they won't do your job for you.
tl;dr: Evidence-Based Medicine depends on good evidence, which is often lacking. And while sometimes the guy who's standing out in the cold being ignored is really a genius who needs to be taken seriously, he's usually a crank.
If a machine could do a better job than me, I'd be no better than Mengele for preventing it from doing so.
Now, when it comes to evidence-based medicine (EBM), there's a whole separate controversy. The ultimate problem in medicine is that very few studies are actually of good quality. This is partly limited by ethics, and partly limited by the sheer difficulty of enrolling patients. Classic example? There is a simple device called a pulse oximeter that measures the degree to which your hemoglobin is saturated with oxygen. However, it has never - EVER - been shown in a study to improve outcomes during general anesthesia versus not using one at all. It is, by a purely scientific standard, voodoo. Of course, the reason that it has never been tested is that it does work, and it would be unethical not to use it. A lot of medicine works like this. Studies that are released always have flaws, and sometimes they outweigh any possible benefit. In short, while physicians are not scientists, we are not anti-science - but we also will not lightly jump into something just because a study supports it. Sometimes, like with H. pylori, this approach is wrong. Other times, like with thalidomide and the FDA, a wait-and-see approach is correct. Since physicians are the ones on the hook, their judgment - for good or ill - makes the difference.
SSO improves the sign-on process, but doesn't do anything about having to sign on (paper never makes me sign on) or the time that it takes to do so (getting and opening a chart takes about 10 seconds).
So much of the medical diagnosis could be automated. Everything from image analysis to the various charts they read off.
I am aware that I may be pissing up a rope here. However.
I'm a physician, and I'd be happy to let every drug (except antibiotics) be over-the-counter. Kill yourself, make yourself better, get high - it's really no skin off my back. But good diagnosis is hard, and it's definitely not automatable except in the most trivial of situations. After all, if it were automated, you'd have a great product to sell to physicians who could then hire a vast cadre of nurses to do the patient interviews and generate the diagnoses, which they could then swoop in and bill for.
Physicians are not (necessarily) technophobes. Allow me to explain.
One of the many oddities of medicine in the US is the payment model. There are two ways in which physicians can earn money: by doing procedures, or by applying their learning. Now, procedures are fairly straightforward; if you do it, you can bill for it. But how do you get paid to think? You prove how much thinking went into the process by your documentation. On a paper chart, this is straightforward: you see a patient, talk to them, formulate a plan, and scribble out a note. The paper is easy to pull out and read, or copy, or whatever. You can take it with you on a clipboard into the room. Unless you get laptops with carts, you can't do that with EMR.
When you're in a hospital with EMR, you have to remember your username and password (and every password system has a different expiry cycle). In the one hospital in which I work, I have SIX systems with different usernames and passwords - the general EMR system (which has labs and dictations), the radiology system, the pharmacy dispensing system, the OR EMR system, the OR scheduling system, and email. Those who admit patients to two or three hospitals have this problem at each and every one.
In other words, physicians have two jobs - one as a physician, and one as a data-entry clerk. Not surprisingly, we are incredibly averse to spending time and effort on the second of these jobs, and anything that causes that data entry to take more time is costing us money. Not only that - the electronic records are often inferior to the paper ones they replace. In particular, many branches of medicine use drawings or diagrams. It's nice not to have to deal with handwriting, but a heart diagram with coronary blockages marked by location and percentage blocked is superior to a verbal description of those blockages.
On the random chance this is not a troll, cat is the command in Unix to display the contents of one or more files. It can be redirected to output to anywhere you like, e.g. a serial port.
Slashdot Mirror
Are you trying to say that there's a phone that will do 3G data on both AT&T and T-Mobile in the US? Point me to it. I think you've mixed up triple/quad band GSM voice with the UMTS frequencies. (Example: Nexus One order page where you have to choose an operator.)
If you really want serious landline quality and great range, go track down an old 49 MHz phone. Those things might have been interceptable, but the cordless phone with the longest range and best reception I've ever had was one of those. I'd use it today if it had caller ID.
Also, kiddies of today: you have no idea how good phones used to sound. People quit caring somewhere along the way. Remember that the logo for Sprint is meant to make you think of the bounce of a pin off a hard surface - because their original ad campaign talked about how the call quality was so good that you could hear a pin drop from across the country.
There are four major network operators in the US: two use GSM (but with different 3G data frequencies) and two use CDMA (but while Verizon will supposedly activate a Sprint phone, Sprint will not activate a Verizon one). So smartphones are effectively locked to one carrier by hardware.
Yes, this is sub-optimal in a lot of ways. Still, it's not without its compensations: all four operators' plans allow calling from anywhere in the US, to anywhere in the US, without any charges beyond airtime - no roaming, no extra fees for calling a mobile on another network, nothing. Just because I was bored, I checked with WolframAlpha. The area of the contiguous 48 states is just over 8 million sq km. The combined area of Europe excluding Russia is just under 6 million sq km - only 3/4 of the area of the lower 48. So we pay more, and phones are tied to carriers, but I can travel 1000 miles and use my phone just like I'm at home - voice, data, text, no matter - without paying a cent more.
The ultimate problem to be solved is the same one that drove HD: sports. HD evening news is pointless. HD sitcoms, not much better. HD movies, well, those are nice. But sports drove HD, and they'll drive 3D as soon as someone comes up with technology that lets you have 20 people over to watch the Big Game. Until then, I'm pretty sure that 3D TV will be a gimmick that most people buy only because it's a basically free add-on.
I watched two guys install a 42" TV on a wall mount once. I'd gladly pay $150 to the store in return for their installing it and accepting all liability for its being dropped during the install process.
Whoever modded me flamebait, why? you can't make hippie/pot jokes?
We use them for nurses dispensing meds; do you use them for physician charting? Maybe you're just in a much more technologically advanced area of the country.
But he's not a Senator anymore, and he can't vote unless it's a tie.
Didn't you know that general aviation exists to subsidize the airlines?
Of course loopholes exist; politicians couldn't leave the tax reform act alone. Nonetheless, both 17% and 27% are a lower than 44% and a lot lower than 70-90% (yes, I know that was a marginal and not an overall rate).
It's rather rich for Buffett to complain. After all, he would be among the first to move his capital overseas if capital gains were taxed as income. This is the ultimate problem faced by taxing governments: capital is mobile and will move to avoid both taxes and regulation. Example: the US after Sarbanes-Oxley, where private equity firms sprang up out of the woodwork so as to avoid the painful paperwork occasioned by being a public company. We couldn't have given London a better gift.
Extreme? The middle class is about income, not wealth - i.e., we have a lot of the former and very little of the latter. Until your net worth is way up there, you're middle class in my book - you still have to work for a living.
The classic upper class - the feudal types - lived off rent payments that were resistant to inflation. They didn't have to work, EVER. Most people with incomes of $200k/yr work - and work very hard. They have to submit themselves to the FAFSA shakedown when they send kids to college - where private schools are $50k/year of AFTER-TAX income per student. A favorite figure these days is a 50% tax. So be it. If you make $300k per year as a couple, you will have (something very close to) $150k in take-home pay. If you have twins and want to send them to a top-name college, well, that's $100k of that $150k. Someone who is forced to live on 1/6 of their income is not doing the equivalent of snow angels with gold coins.
If you make $250k you're wealthy.
No, you have a large income. There is a difference between wealth and income.
When Bush Sr left office, the top marginal rate was 40%. In fact, Bush Sr raised that rate several times.
Yes, that 40% (which is less than 44%) tax rate was a significant contribution to his losing the presidency in 1992.
Well, if you could get the temperature hot enough to vaporise them, you could get high off the smoke...
If you could read English, you'd notice that I didn't say a word about reimbursements. It does have to process those. But it doesn't collect FICA or send out bills; that's done by the IRS.
And I'm glad to see that you agree that there's no actuarial process at work with Medicare. Would you like to take the next step and admit that those are things that are necessary components of any private insurance system, and any single-payer system? The fact that individual contributions are not determined by sickness doesn't mean that the British NHS (e.g.) doesn't have to determine which treatments it will or will not pay for.
Not in a hospital, it's not. Maybe at your clinic. But in either place, it's a pain.
Medicare doesn't have a billing or collections department; it has the IRS. It doesn't have an actuarial process; it pays a percentage of what private insurers pay. These things help
As for schools, private schools have lower costs than public schools - in general. Private schools are generally better places to work, so they can get away with not paying as much money. (Indeed, sometimes teachers work there just to get the tuition discount for their children.)
UpToDate is a brilliant piece of work, but it won't make a dignosis for you. Neither will checklists - they are, as you describe, decision support tools. They will make sure that you don't miss important things, but they won't do your job for you.
tl;dr: Evidence-Based Medicine depends on good evidence, which is often lacking. And while sometimes the guy who's standing out in the cold being ignored is really a genius who needs to be taken seriously, he's usually a crank.
If a machine could do a better job than me, I'd be no better than Mengele for preventing it from doing so.
Now, when it comes to evidence-based medicine (EBM), there's a whole separate controversy. The ultimate problem in medicine is that very few studies are actually of good quality. This is partly limited by ethics, and partly limited by the sheer difficulty of enrolling patients. Classic example? There is a simple device called a pulse oximeter that measures the degree to which your hemoglobin is saturated with oxygen. However, it has never - EVER - been shown in a study to improve outcomes during general anesthesia versus not using one at all. It is, by a purely scientific standard, voodoo. Of course, the reason that it has never been tested is that it does work, and it would be unethical not to use it. A lot of medicine works like this. Studies that are released always have flaws, and sometimes they outweigh any possible benefit. In short, while physicians are not scientists, we are not anti-science - but we also will not lightly jump into something just because a study supports it. Sometimes, like with H. pylori, this approach is wrong. Other times, like with thalidomide and the FDA, a wait-and-see approach is correct. Since physicians are the ones on the hook, their judgment - for good or ill - makes the difference.
SSO improves the sign-on process, but doesn't do anything about having to sign on (paper never makes me sign on) or the time that it takes to do so (getting and opening a chart takes about 10 seconds).
So much of the medical diagnosis could be automated. Everything from image analysis to the various charts they read off.
I am aware that I may be pissing up a rope here. However.
I'm a physician, and I'd be happy to let every drug (except antibiotics) be over-the-counter. Kill yourself, make yourself better, get high - it's really no skin off my back. But good diagnosis is hard, and it's definitely not automatable except in the most trivial of situations. After all, if it were automated, you'd have a great product to sell to physicians who could then hire a vast cadre of nurses to do the patient interviews and generate the diagnoses, which they could then swoop in and bill for.
Physicians are not (necessarily) technophobes. Allow me to explain.
One of the many oddities of medicine in the US is the payment model. There are two ways in which physicians can earn money: by doing procedures, or by applying their learning. Now, procedures are fairly straightforward; if you do it, you can bill for it. But how do you get paid to think? You prove how much thinking went into the process by your documentation. On a paper chart, this is straightforward: you see a patient, talk to them, formulate a plan, and scribble out a note. The paper is easy to pull out and read, or copy, or whatever. You can take it with you on a clipboard into the room. Unless you get laptops with carts, you can't do that with EMR.
When you're in a hospital with EMR, you have to remember your username and password (and every password system has a different expiry cycle). In the one hospital in which I work, I have SIX systems with different usernames and passwords - the general EMR system (which has labs and dictations), the radiology system, the pharmacy dispensing system, the OR EMR system, the OR scheduling system, and email. Those who admit patients to two or three hospitals have this problem at each and every one.
In other words, physicians have two jobs - one as a physician, and one as a data-entry clerk. Not surprisingly, we are incredibly averse to spending time and effort on the second of these jobs, and anything that causes that data entry to take more time is costing us money. Not only that - the electronic records are often inferior to the paper ones they replace. In particular, many branches of medicine use drawings or diagrams. It's nice not to have to deal with handwriting, but a heart diagram with coronary blockages marked by location and percentage blocked is superior to a verbal description of those blockages.
I had a 70 MB IDE drive in a 386 around 1990, FWIW. But I think anything under 40 is going to be MFM/RLL.
On the random chance this is not a troll, cat is the command in Unix to display the contents of one or more files. It can be redirected to output to anywhere you like, e.g. a serial port.