You're not wrong, but you're overlooking some practical matters.
My 86 year old grandmother could benefit from this device (and, in fact, uses a competing product purpose-built for fall detection that automatically places a 911 call when triggered.) My grandmother is statistically pretty likely to have need of this device at some point during the remaining years of her life. She's statistically pretty unlikely to be arrested, charged or convicted of a crime that police happened to notice/fabricate when they respond to her call for help. Its extremely unlikely that the police have any reason to look for an excuse to arrest my grandma. For her, the cost/benefit clearly supports having this kind of device.
I'm a young, healthy, mobile person who usually has my cell phone in my pocket. Statistically, I'm not likely to have any use for a fall detection device, hopefully for at least the next 30 years or so. I'd like to imagine the police wouldn't have any particular reason to want to find an excuse to arrest me, but I won't be giving them the opportunity. The cost/benefit doesn't support me using one of these devices.
That's life. I don't know if you've ever have had to respond to an elderly person who's fallen on the floor and remained there for several days before being found. I have, several times (I work as a paramedic.) Its gruesome. Beyond the medical consequences (broken bones, pressure sores, malnourishment), its degrading - likely lying in your own piss and shit, and then having your house fill with cops, firemen and paramedics to help you. And elderly people are rightly terrified of this scenario. I can't in good conscience recommend that they forego this kind of device because of the hypothetical conspiracy theory that the cops might dig up some arcane law just to throw them in jail.
Many of the scalpers will likely go to jail, BUT, this was a program being admined by Ticketmaster itself. Nearly all states have anti-scalping laws on the books. As such, Ticketmaster employees that KNEW about this should be going to prison (aiding/abetting or participating). BUT, I am guessing that not a ONE will see prison, esp the executives, even though they were almost certainly in on it.
Not everything that is illegal is punishable by prison time. And I would not expect scalping concert tickets to carry a penalty of prison time, nor would I want the tax payers to bear the costs associated with imprisoning someone convicted of scalping.
Ideally, this crime would be punished by levying a hefty fine against Ticketmaster, and investing that money into something which benefits society as a whole.
A lot of cynical responses here, and glib references to assumptions that the hospital chose to treat the guy so they could bill his insurance. As a paramedic, let me assure you that 1) cases of ambiguous DNR orders are among the most difficult decisions we have to make in our career, 2) no health care provider involved at the point of delivering emergency care has any idea how or if the patient can pay for treatment 3) most health care providers, especially emergency health care providers, are in fact huge advocates for DNR, hospice, and patient's right to determine the extent of health care they receive at the end of their lives. We don't get a kick out of resuscitating people for fun. A resuscitation is ugly, painful, and fails far more often than it succeeds. We know, as well as anyone, that resuscitation is so often futile, and that even a successful resuscitation rarely results in a return to a real quality of life.
Here's a few examples of real situations I've personally been in, to give you an idea of just how much of a gray area this can be, and how challenging it can be to do the moral and ethical thing.
A 40 year old man is diagnosed with terminal pancreatic cancer. While currently in good health, he is expected to have less than 4 months of good health left, and 6 months at most to live. He gets stung by a bee, to which he is severely allergic, and develops an anaphylactic reaction. His airway is swelling shut, his blood pressure is dropping, he is losing consciousness and can't talk nor follow directions. He needs an administration of Epinephrine, along with multiple other drugs and interventions, to reverse the allergic reaction. He has a valid DNR bracelet on his wrist, which he has not removed. What's his intent? Did he intend for the DNR to prevent you from treating a life threatening allergic reaction?
You are called for an 80 year old woman who is unconscious on the floor of her kitchen. She has a valid DNR order. Her husband tells you she choked on her soup, and needs the Heimlich. You don't see any food in her mouth or upper airway. Performing the Heimlich, chest compressions, or inserting an advanced airway would violate the DNR. What do you do?
An elderly man arrives in the ER with fresh bruises. He is unconscious with critically unstable vital signs and inability to maintain an airway. A woman identifying herself as his daughter says that she can't find a DNR, but she is certain he had said that the doesn't want anything heroic measures done at the end of his life. You suspect foul play given his apparent injuries, but then again, old people bruise easily. You have no ID on the man, and haven't yet been able to ID the alleged daughter. Do you begin resuscitation, at least long enough to verify the pretense or absence of a DNR?
You get called to do a welfare check on someone who hasn't been seen in several days. You force entry into his house, and find him unconscious on the floor, surrounded by blood. There's a scrap of paper next to him that says "Don't bring me back" with a signature. You can't tell whether this is the natural progression of some terminal illness, an accident, an attempted suicide, or an attempted murder. You also can't tell the extent of the patient's injuries and whether they're obviously incompatible with life. Do you begin resuscitating the patient?
The case of my own grandfather, who had terminal lung cancer and a valid DNR. His dying words were "Please save me." He specifically asked to be saved. Do we start performing resuscitation?
In each of these cases, you need to make an initial decision within seconds. You don't have time to do a lot of research, interview witnesses, search for evidence. And, if you guess wrong, the patient could die - which is kind of a lot for us to live with.
I'm not trying to defend or blame any particular party here. I'm just asking for a little sensitivity to the fact that, most of us in emergency health care are decent people doing the best we can to serv
Its possible that you might change your mind at a time and place inconvenient to a tattoo parlor. 99% of DNRs are in the form of paper, or bracelets. Which can be easily destroyed to signify your intent.
The ONLY thing necessary for a DNR order to be valid is for it to be a true reflection of person's informed wishes. Someone getting it tattooed on themselves and then fucking signing under the tattoo is all the proof anyone with a brain needs.
Paramedic here. This is technically not true (at least in any state I've ever worked in). Though, perhaps it should be.
Of the four states I've worked in, each one has required that a DNR order appear on a particular form, with particular legal-ese. Each state has required that the form be witnessed by at least one additional competent party, and three of the four have required that it be signed by the patient's primary care physician. Some states allow medic alert bracelets to signify a DNR order. The paperwork typically allows the patient to opt in or out of specific interventions (for instance, you can have a DNR, that would allow your ventilations to be assisted via rescue breathing, but would not allow a breathing tube to be inserted.)
A tatoo would not be considered a legal DNR in any state I've ever worked in.
Now, this has actually caused real problems in the past, that I've personally been involved with on several occasions. Some hospice services weren't great about getting the proper paperwork in place, or educating the patient's family on the necessity of having the paperwork present and producible. So when a terminally ill hospice patient dies, some family member panics and calls 911, we show up and find an obviously terminally ill hospice patient either in cardiac arrest or damn close to it, but no technically legal DNR present. Technically, we'd have to begin full resuscitation efforts. In practice, a quick call to our supervising physician is usually enough to get permission to withhold resuscitation efforts.
One state required a DNR bracelet be physically on the patient's wrist for the DNR to be valid. Thought being that the patient could remove the bracelet from their wrist, if they wished to signify their intent to rescind the DNR. Turns out, people sometimes fall or thrash around as they die, and these bracelets were coming off in what I'd presume to be an accident. Again, puts us as paramedics in a tough spot.
Long story short - I personally believe it should be easier for people to indicate their end of life preferences. Though, the current situation would render things like this tatoo to not be a valid DNR, in many states.
One of the more significant events in recent Slashdot history was the bungling (and ultimate dismissal) of the failed Beta redesign project. A topic which, understandably, gets little further mention from the/. staff - but I'd love to see something of a postmortem of that project. Seems like it could be a useful parable for our audience.
The fact that the operation is irreversible is clear enough. That fact that "all changes" is actually synonymous with "every file, regardless of whether or not you think you've actually CHANGED it" is not.
> Go to less developed countries and you don't see plastic bottles and plastic bags and food being thrown away like it worthless. You don't see 50 gallon garbage cans being emptied every week.
Have you actually ever traveled anywhere near a "less-developed" country?
Consider Rwanda, for example, which has such a problem with discarded plastic bags that they actually prohibit you from bringing them into the country. As in, the customs officials search your luggage and confiscate any that you might try to sneak in.
The specific drugs you're referring to here (Epi, Atropine, D50, etc) are known as "code drugs" or "ACLS drugs." The majority of these drugs are actually quite cheap, as far as pharmaceuticals go. In all honesty, it ends up being cheaper just to discard these drugs when they expire, rather than investing the effort in tracking expiration and rotating drugs across multiple sites and potentially across multiple organizations (like between unaffiliated doctor offices and ambulance services.) It doesn't have anything to do with "unlicensed re-sale" or whatever imaginary regulations you've come up with - its actually just less cost effective than budgeting to replace them every ~2 years or so.
That said, we have identified cost savings by coordinating purchasing across multiple EMS services, clinics, etc, just to be able to leverage volume discounts. But that requires far less manpower to manage than it would to coordinate a large scale drug rotation project in hopes of saving, maybe, a couple hundred dollars every few years.
A more interesting problem concerns the small number of expensive drugs, which treat rare conditions, but are carried by many ambulances and stocked by many hospitals. A few examples that come to mind off the top of my head - Dantrolene is a drug which is occasionally used in small quantities to treat muscle spasms. It's also the only treatment for an incredibly rare but quite deadly condition called malignant hyperthermia, where it needed in huge quantities. So you have hospitals which stock enormous quantities of this drug, knowing full well that it will almost certainly expire prior to being used. There's similar stories for drugs to reverse poisonings that are damn near statistically never going to occur - but, we have to have them, and have to have them readily available.
So you allude to a somewhat interesting problem... But the problem really isn't sugar water (D50) and cheap Epinephrine. Its these other, far more expensive and very rarely used drugs. I'm not sure there's a clear solution to the problem, though.
That's the problem - In your analogy, you've hired "production workers" when you actually need engineers.
If you're hiring people dumb enough to copy and paste code into production, without understanding the ramifications, you deserve what you get.
Anaphylaxis is a acute state where a few Very Bad Things are happening all at once, and very very quickly (over the course of a few minutes.) The key ideas are:
The air passages in your throat and lungs swell shut so severely that you cannot physically force air in and out. Within a matter of minutes, you will loose the ability to breathe. Period.
At the same time, your blood vessels are rapidly dilating, causing a dangerous drop in blood pressure. This is why its commonly called anaphylactic shock, because your blood pressure has dropped to the point that the blood cannot adequately perfuse vital organs, namely your brain and your heart.
So between the fact that you can't get oxygen into your lungs, and the fact that your blood can't deliver oxygen to your brain, and the fact that you feel like shit, and know very well that you're in the middle of a life-threatening emergency... you don't really have the capability to perform tasks requiring concentration and fine motor skills, such as would be required to manually draw up a precise dose of medication into a syringe and inject it into yourself.
An EpiPen or similar device is "necessary" because it is an incredibly simple mechanical device that you can operate even while in extremis. You pop a cap off both ends, and push it against your butt check. Its something that anyone, even children, can be trained to do, and to practice (obviously with a dummy device with no needle or medication). And practice until using it practically becomes a reflex, and not something that requires concentration to perform. Its easy enough to do that, even when overcome with anxiety and decrease oxygenation, people can usually manage to work an EpiPen.
I suspect you probably haven't actually experienced anaphylaxis, if people had time to talk to you and for you to convince them that everything was fine. Anaphylaxis requires rapid administration of epinephrine. So you may have had an allergic reaction, maybe even a bad one, but unless you actually experienced the sensation of being unable to force air in and out of your lungs, even when trying with all your might, you haven't truly experienced anaphylaxis. I'd also take issue with your assumption that administering an EpiPen is a "high risk emergency procedure." I suppose there is some risk of local infection, but I'm not aware of any documented cases of infection, at least anything requiring treatment, as a result of an EpiPen. (There are other risks associated with Epi administration, but infection is effectively not one of them.)
So some sort of autoinjector device, be it an EpiPen or a similar competitor, is effectively required to be able to safely manage anaphylaxis.
There are many cases where the patient has no perceptible breathing or heart rhythm, but wakes up at a later time - in some cases living years longer.
Many cases? There's a small handful of anomalies whose stories get retold because they are so bizarre... but that's just statistical noise compared to the billions of humans who have died, and stayed that way.
Death is something that happens with a great deal of regularity, there's actually quite a bit of research done to correlate various medical interventions with survival rates... Obviously assessment techniques and record keeping have both improved considerably since the Civil War days. I don't think what you're citing here is a substitute for actual evidence-based research.
There's also a growing body of research, conducting much more recently than the Civil War, which does indicate clear signs that a patient is in fact dead and damn near 100% unlikely to "wake up."
Well, one reason is a concern that doctors and hospitals might be less interested in saving you if that means potentially damaging donatable organs
While I'm sure this is a concern for some people, I'm questioning whether its a realistic concern. I have some experience in the health care field (as a paramedic), and infrequently but regularly find myself working on people close-to-death, where organ procurement is a concern. I can't say that I've ever witnessed, or even heard, of any inkling of an idea that we wouldn't put forth our full efforts to save the patient in front of us in favor of potentially harvesting organs.
I'm also not sure that there's any difference in care that would be rendered even if, hypothetically, we were trying to preserve donatable organs without trying to resuscitate the actual patient.
Furthermore, my understanding is that there's a great deal of opaque bureaucracy between an organ donor, and the eventual recipient. It's not like an ER doc can just think, "gee, there's a guy in the bed upstairs who can really use a new kidney, might as well swap out this one while I'm here." Rather, there's a rather involved (though efficient) process by which an independent organization is notified of available organs, and matches them to a recipient, who will likely be in a different hospital quite a distance away. I don't think there's usually much contact between personnel at the "donor site" and the "recipient site."
Maps present information by region, not be age/generation. So of course the electoral college results map will appear to show support based on geography rather than by other factors.
In the USA, at least, tax-payer funded municipal services cover the overwhelming majority of the country, for both fire and ambulance service. However, most tax-payer funded ambulance services will still bill people for individual ambulance calls, even though they are tax payer funded. The reason is at least partly because the tax income simply does not cover the cost of running these services. As a paramedic, I can tell you that on any one call, we may go through a few hundred dollars of disposable equipment - most of that money is in medications, but also EKG and defibrillation supplies, IV supplies, airway management supplies, etc. The tax income simply does not cover that, so we bill separately.
You may disagree that this is an appropriate thing to do - but these services do take money to run. The money has to come from somewhere. So we can either raise taxes, or bill for actual services rendered, or both. Most of the country does both right now, seeing it as the best compromise.
On the fire side - $900/year isn't too outrageous, necessarily. If you had a taxpayer funded department, your taxes would increase somewhere in the neighborhood of $900/year. Again, the money has to come from somewhere. Municipalities basically have 3 options:
1. Hire full-time, career firefighters.
2. Rely on a volunteer fire department
3. Contract to a private service
Most of the country does either 1 or 2 (or a combination career-volunteer department). In both cases, they need to still buy all the fire trucks, equipment, training, insurance, etc. None of that is cheap, and there is absolutely on-going maintenance costs that are quite steep. The difference between 1 and 2 is that 2 saves you the cost of salary and benefits for employees. The downside is you're going to have much less reliable response times, experience levels of responders, etc. You get what you pay for.
Not to diminish the usefulness of the feature, but wouldn't it have made more sense to call an ambulance?
Yes, and no.
Actually, just yes. Speaking as a paramedic, a PE (or really anything which causes difficulty breathing lasting longer than a few seconds) is a completely legitimate reason to ask for an ambulance. That clot could move at any time, making it impossible to breath. And especially in the case described in this story, where the patient was suffering enough that he couldn't maintain full control of a vehicle without assistance - choosing to drive yourself is just silly. Just go ahead and give us a call, we don't mind. Or, at a minimum, get someone else to drive you.
But arriving in an ambulance will get you looked at sooner when you get there
Actually, no. Now, it sounds like you ended up in a shitty hospital that was poorly staffed or something - but in reality, the hospital staff triages and sees patients in order of severity, regardless of whether you arrived by ambulance or walked in. In fact, a lot of ne'er-do-wells seem to share your belief that an ambulance will get you seen faster, and thus call us for silly reasons that do not need an ambulance. And while we are more than happy to give you a ride to the hospital (non-emergent, without using the lights and sirens) - we'll drop you off in the waiting room, where you'll get triaged along with everyone else.
If the coder struggled but the result turned out great then the method will still flag the code to be likely to be bad.
The method will also completely miss buggy code caused by the programmer not realizing that the problem is tricky and going for a way too simple solution.
I agree that these factors mean that the test cannot be reliably used to just identify potentially dangerous parts of code. But I think the results could reveal some interesting information about the programmer.
As you said - if we have data showing that a developer struggled with a particular area of code, but that area ends up being of high quality - then we can see that the developer likely has a great attention to detail, and is being thorough with his design and testing. That's good information to know about a developer.
Another possibility is that the developer moved quickly through the area of code without stressing. But the code quality ends up being crap. This tells us that the developer is likely sloppy, lazy or just not very good. This may help identify an opportunity to coach a newer developer - or just to identify developers who we can't trust.
Now, I'd agree that in terms of yielding actionable data - this isn't as valuable or useful as if we were able to simply get a reliable indication of code quality. But its still something interesting to consider.
Paramedic here. We still use VHF pagers. They are simple, but reliable and rock solid. They work pretty much everywhere, and a charge will last for days. We have a complementary iPhone/Android app that will receive info when we get dispatched, but that requires an internet connection, and a series of interfaced software products to all work correctly. The pagers are maintained as a fail safe - all they require is a radio and a means of generating the tones required to signal the pager to open the squelch. In a disaster scenario, the necessary equipment can be run reliably off batteries and generators. That's just not the case with smartphone apps right now.
On the occasions when Linus has responded to criticism that he's an... asshole? It basically seems like he says, "1) This is my sandbox and I can do what I want. 2) This communication style solves more problems than it causes."
Linus may be correct on both these points. Linus is certainly an important enough person on an important enough project to probably be able to get away with some stuff that others might not. And its often pointed out that the people on the receiving end of these kinds of rants "had it coming" for one reason or another. That may be true as well.
On the other side of the coin, though - I see participating in an open source project as a kind of volunteer work. What you stand to get out of it are mainly intangible rewards. And, if you reach a point where the stress and BS you have to put up with as a volunteer outweighs the intangible rewards, then by all means, step away and do something else with your time.
In my own life, I was formerly a volunteer for a certain project (not software-related). Some parallels could be drawn between our head honcho, and Linus. Our guy had years of experience. To be fair and objective, the guy was smart, a hard worker, and his heart was in the right place. A lot of stuff got done, that wouldn't have otherwise gotten done if not for him.
The guy, however, was simply an asshole. Just rude, arrogant, insensitive. I worked with/for/near/around this guy for a few years, because I believed in what we were doing, and was trying to find some admirable or redeeming qualities about this person. But, after a few years, it just got to the point where I grew tired of trying to deal with this guy, on top of my actual responsibilities, which were difficult and time consuming in and of themselves. So I walked away from this organization, which was a painful and frustrating decision because there were certainly things about it that I did enjoy and get a lot out of. But, it just wasn't worth being treated poorly by an asshole.
Now its entirely possible that I should have grown a thicker skin, or that the asshole was smarter/better/righter than me and I somehow "deserved what I got" or whatever. But, fuck it, eventually I realized, 99% of my interactions with my fellow human beings were more pleasant than dealing with this guy. So, I walked away, and sunk my efforts into something similarly rewarding but without a bunch of intolerable BS.
So if that's all that's going on here... then godspeed.
I was going to mention something along these lines - this concept really isn't that unusual. I worked in the public safety sector (EMS, though, not law enforcement) in the Cleveland, Ohio area for a few years. I was amazed at the number of distinct law enforcement agencies that had overlapping jurisdictions. In addition to the individual municipal departments, county sheriff, and state agencies, here's a set of a few I remember, just in the Cleveland area:
University Circle Police - a private department funded by the businesses they serve. University Circle is a neighborhood housing many significant educational, medical, cultural and historical facilities, which is bordered on all sides by very high-crime neighborhoods
The Transit Police, which I believe may be the largest department in Ohio - polices the public transit buses, trains and terminals
CMHA Police - serves the public housing projects in the county
CMSD Police - serves Cleveland's public school district
Cleveland's three largest hospitals, Cleveland Clinic, University Hospitals, and MetroHealth, each have their own police forces (though apparently not web sites)
That's obviously in addition to all the private security services that lack full law enforcement authority. And I'm probably leaving a few out in my list above - it's been a few years since I've lived there or payed real close attention. But the point is, it's by no means unusual for a private organization to form it's own full-fledged police force.
He died doing what I would think could be a several hundred foot free fall abruptly terminated by contact with a concrete surface. That is probably not something he loved.
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My 86 year old grandmother could benefit from this device (and, in fact, uses a competing product purpose-built for fall detection that automatically places a 911 call when triggered.) My grandmother is statistically pretty likely to have need of this device at some point during the remaining years of her life. She's statistically pretty unlikely to be arrested, charged or convicted of a crime that police happened to notice/fabricate when they respond to her call for help. Its extremely unlikely that the police have any reason to look for an excuse to arrest my grandma. For her, the cost/benefit clearly supports having this kind of device.
I'm a young, healthy, mobile person who usually has my cell phone in my pocket. Statistically, I'm not likely to have any use for a fall detection device, hopefully for at least the next 30 years or so. I'd like to imagine the police wouldn't have any particular reason to want to find an excuse to arrest me, but I won't be giving them the opportunity. The cost/benefit doesn't support me using one of these devices.
That's life. I don't know if you've ever have had to respond to an elderly person who's fallen on the floor and remained there for several days before being found. I have, several times (I work as a paramedic.) Its gruesome. Beyond the medical consequences (broken bones, pressure sores, malnourishment), its degrading - likely lying in your own piss and shit, and then having your house fill with cops, firemen and paramedics to help you. And elderly people are rightly terrified of this scenario. I can't in good conscience recommend that they forego this kind of device because of the hypothetical conspiracy theory that the cops might dig up some arcane law just to throw them in jail.
Many of the scalpers will likely go to jail, BUT, this was a program being admined by Ticketmaster itself. Nearly all states have anti-scalping laws on the books. As such, Ticketmaster employees that KNEW about this should be going to prison (aiding/abetting or participating). BUT, I am guessing that not a ONE will see prison, esp the executives, even though they were almost certainly in on it.
Not everything that is illegal is punishable by prison time. And I would not expect scalping concert tickets to carry a penalty of prison time, nor would I want the tax payers to bear the costs associated with imprisoning someone convicted of scalping.
Ideally, this crime would be punished by levying a hefty fine against Ticketmaster, and investing that money into something which benefits society as a whole.
Here's a few examples of real situations I've personally been in, to give you an idea of just how much of a gray area this can be, and how challenging it can be to do the moral and ethical thing.
A 40 year old man is diagnosed with terminal pancreatic cancer. While currently in good health, he is expected to have less than 4 months of good health left, and 6 months at most to live. He gets stung by a bee, to which he is severely allergic, and develops an anaphylactic reaction. His airway is swelling shut, his blood pressure is dropping, he is losing consciousness and can't talk nor follow directions. He needs an administration of Epinephrine, along with multiple other drugs and interventions, to reverse the allergic reaction. He has a valid DNR bracelet on his wrist, which he has not removed. What's his intent? Did he intend for the DNR to prevent you from treating a life threatening allergic reaction?
You are called for an 80 year old woman who is unconscious on the floor of her kitchen. She has a valid DNR order. Her husband tells you she choked on her soup, and needs the Heimlich. You don't see any food in her mouth or upper airway. Performing the Heimlich, chest compressions, or inserting an advanced airway would violate the DNR. What do you do?
An elderly man arrives in the ER with fresh bruises. He is unconscious with critically unstable vital signs and inability to maintain an airway. A woman identifying herself as his daughter says that she can't find a DNR, but she is certain he had said that the doesn't want anything heroic measures done at the end of his life. You suspect foul play given his apparent injuries, but then again, old people bruise easily. You have no ID on the man, and haven't yet been able to ID the alleged daughter. Do you begin resuscitation, at least long enough to verify the pretense or absence of a DNR?
You get called to do a welfare check on someone who hasn't been seen in several days. You force entry into his house, and find him unconscious on the floor, surrounded by blood. There's a scrap of paper next to him that says "Don't bring me back" with a signature. You can't tell whether this is the natural progression of some terminal illness, an accident, an attempted suicide, or an attempted murder. You also can't tell the extent of the patient's injuries and whether they're obviously incompatible with life. Do you begin resuscitating the patient?
The case of my own grandfather, who had terminal lung cancer and a valid DNR. His dying words were "Please save me." He specifically asked to be saved. Do we start performing resuscitation?
In each of these cases, you need to make an initial decision within seconds. You don't have time to do a lot of research, interview witnesses, search for evidence. And, if you guess wrong, the patient could die - which is kind of a lot for us to live with.
I'm not trying to defend or blame any particular party here. I'm just asking for a little sensitivity to the fact that, most of us in emergency health care are decent people doing the best we can to serv
Its possible that you might change your mind at a time and place inconvenient to a tattoo parlor. 99% of DNRs are in the form of paper, or bracelets. Which can be easily destroyed to signify your intent.
The ONLY thing necessary for a DNR order to be valid is for it to be a true reflection of person's informed wishes. Someone getting it tattooed on themselves and then fucking signing under the tattoo is all the proof anyone with a brain needs.
Paramedic here. This is technically not true (at least in any state I've ever worked in). Though, perhaps it should be. Of the four states I've worked in, each one has required that a DNR order appear on a particular form, with particular legal-ese. Each state has required that the form be witnessed by at least one additional competent party, and three of the four have required that it be signed by the patient's primary care physician. Some states allow medic alert bracelets to signify a DNR order. The paperwork typically allows the patient to opt in or out of specific interventions (for instance, you can have a DNR, that would allow your ventilations to be assisted via rescue breathing, but would not allow a breathing tube to be inserted.) A tatoo would not be considered a legal DNR in any state I've ever worked in. Now, this has actually caused real problems in the past, that I've personally been involved with on several occasions. Some hospice services weren't great about getting the proper paperwork in place, or educating the patient's family on the necessity of having the paperwork present and producible. So when a terminally ill hospice patient dies, some family member panics and calls 911, we show up and find an obviously terminally ill hospice patient either in cardiac arrest or damn close to it, but no technically legal DNR present. Technically, we'd have to begin full resuscitation efforts. In practice, a quick call to our supervising physician is usually enough to get permission to withhold resuscitation efforts. One state required a DNR bracelet be physically on the patient's wrist for the DNR to be valid. Thought being that the patient could remove the bracelet from their wrist, if they wished to signify their intent to rescind the DNR. Turns out, people sometimes fall or thrash around as they die, and these bracelets were coming off in what I'd presume to be an accident. Again, puts us as paramedics in a tough spot. Long story short - I personally believe it should be easier for people to indicate their end of life preferences. Though, the current situation would render things like this tatoo to not be a valid DNR, in many states.
One of the more significant events in recent Slashdot history was the bungling (and ultimate dismissal) of the failed Beta redesign project. A topic which, understandably, gets little further mention from the /. staff - but I'd love to see something of a postmortem of that project. Seems like it could be a useful parable for our audience.
The fact that the operation is irreversible is clear enough. That fact that "all changes" is actually synonymous with "every file, regardless of whether or not you think you've actually CHANGED it" is not.
Have you actually ever traveled anywhere near a "less-developed" country?
Consider Rwanda, for example, which has such a problem with discarded plastic bags that they actually prohibit you from bringing them into the country. As in, the customs officials search your luggage and confiscate any that you might try to sneak in.
Paramedic here.
The specific drugs you're referring to here (Epi, Atropine, D50, etc) are known as "code drugs" or "ACLS drugs." The majority of these drugs are actually quite cheap, as far as pharmaceuticals go. In all honesty, it ends up being cheaper just to discard these drugs when they expire, rather than investing the effort in tracking expiration and rotating drugs across multiple sites and potentially across multiple organizations (like between unaffiliated doctor offices and ambulance services.) It doesn't have anything to do with "unlicensed re-sale" or whatever imaginary regulations you've come up with - its actually just less cost effective than budgeting to replace them every ~2 years or so.
That said, we have identified cost savings by coordinating purchasing across multiple EMS services, clinics, etc, just to be able to leverage volume discounts. But that requires far less manpower to manage than it would to coordinate a large scale drug rotation project in hopes of saving, maybe, a couple hundred dollars every few years.
A more interesting problem concerns the small number of expensive drugs, which treat rare conditions, but are carried by many ambulances and stocked by many hospitals. A few examples that come to mind off the top of my head - Dantrolene is a drug which is occasionally used in small quantities to treat muscle spasms. It's also the only treatment for an incredibly rare but quite deadly condition called malignant hyperthermia, where it needed in huge quantities. So you have hospitals which stock enormous quantities of this drug, knowing full well that it will almost certainly expire prior to being used. There's similar stories for drugs to reverse poisonings that are damn near statistically never going to occur - but, we have to have them, and have to have them readily available.
So you allude to a somewhat interesting problem... But the problem really isn't sugar water (D50) and cheap Epinephrine. Its these other, far more expensive and very rarely used drugs. I'm not sure there's a clear solution to the problem, though.
That's the problem - In your analogy, you've hired "production workers" when you actually need engineers.
If you're hiring people dumb enough to copy and paste code into production, without understanding the ramifications, you deserve what you get.
So between the fact that you can't get oxygen into your lungs, and the fact that your blood can't deliver oxygen to your brain, and the fact that you feel like shit, and know very well that you're in the middle of a life-threatening emergency... you don't really have the capability to perform tasks requiring concentration and fine motor skills, such as would be required to manually draw up a precise dose of medication into a syringe and inject it into yourself.
An EpiPen or similar device is "necessary" because it is an incredibly simple mechanical device that you can operate even while in extremis. You pop a cap off both ends, and push it against your butt check. Its something that anyone, even children, can be trained to do, and to practice (obviously with a dummy device with no needle or medication). And practice until using it practically becomes a reflex, and not something that requires concentration to perform. Its easy enough to do that, even when overcome with anxiety and decrease oxygenation, people can usually manage to work an EpiPen.
I suspect you probably haven't actually experienced anaphylaxis, if people had time to talk to you and for you to convince them that everything was fine. Anaphylaxis requires rapid administration of epinephrine. So you may have had an allergic reaction, maybe even a bad one, but unless you actually experienced the sensation of being unable to force air in and out of your lungs, even when trying with all your might, you haven't truly experienced anaphylaxis. I'd also take issue with your assumption that administering an EpiPen is a "high risk emergency procedure." I suppose there is some risk of local infection, but I'm not aware of any documented cases of infection, at least anything requiring treatment, as a result of an EpiPen. (There are other risks associated with Epi administration, but infection is effectively not one of them.)
So some sort of autoinjector device, be it an EpiPen or a similar competitor, is effectively required to be able to safely manage anaphylaxis.
You don't understand, because you were not BORN MOBILE!
There are many cases where the patient has no perceptible breathing or heart rhythm, but wakes up at a later time - in some cases living years longer.
Many cases? There's a small handful of anomalies whose stories get retold because they are so bizarre... but that's just statistical noise compared to the billions of humans who have died, and stayed that way.
Death is something that happens with a great deal of regularity, there's actually quite a bit of research done to correlate various medical interventions with survival rates... Obviously assessment techniques and record keeping have both improved considerably since the Civil War days. I don't think what you're citing here is a substitute for actual evidence-based research.
There's also a growing body of research, conducting much more recently than the Civil War, which does indicate clear signs that a patient is in fact dead and damn near 100% unlikely to "wake up."
Well, one reason is a concern that doctors and hospitals might be less interested in saving you if that means potentially damaging donatable organs
While I'm sure this is a concern for some people, I'm questioning whether its a realistic concern. I have some experience in the health care field (as a paramedic), and infrequently but regularly find myself working on people close-to-death, where organ procurement is a concern. I can't say that I've ever witnessed, or even heard, of any inkling of an idea that we wouldn't put forth our full efforts to save the patient in front of us in favor of potentially harvesting organs. I'm also not sure that there's any difference in care that would be rendered even if, hypothetically, we were trying to preserve donatable organs without trying to resuscitate the actual patient. Furthermore, my understanding is that there's a great deal of opaque bureaucracy between an organ donor, and the eventual recipient. It's not like an ER doc can just think, "gee, there's a guy in the bed upstairs who can really use a new kidney, might as well swap out this one while I'm here." Rather, there's a rather involved (though efficient) process by which an independent organization is notified of available organs, and matches them to a recipient, who will likely be in a different hospital quite a distance away. I don't think there's usually much contact between personnel at the "donor site" and the "recipient site."
Maps present information by region, not be age/generation. So of course the electoral college results map will appear to show support based on geography rather than by other factors.
You may disagree that this is an appropriate thing to do - but these services do take money to run. The money has to come from somewhere. So we can either raise taxes, or bill for actual services rendered, or both. Most of the country does both right now, seeing it as the best compromise.
On the fire side - $900/year isn't too outrageous, necessarily. If you had a taxpayer funded department, your taxes would increase somewhere in the neighborhood of $900/year. Again, the money has to come from somewhere. Municipalities basically have 3 options:
Most of the country does either 1 or 2 (or a combination career-volunteer department). In both cases, they need to still buy all the fire trucks, equipment, training, insurance, etc. None of that is cheap, and there is absolutely on-going maintenance costs that are quite steep. The difference between 1 and 2 is that 2 saves you the cost of salary and benefits for employees. The downside is you're going to have much less reliable response times, experience levels of responders, etc. You get what you pay for.
Yes, and no.
Actually, just yes. Speaking as a paramedic, a PE (or really anything which causes difficulty breathing lasting longer than a few seconds) is a completely legitimate reason to ask for an ambulance. That clot could move at any time, making it impossible to breath. And especially in the case described in this story, where the patient was suffering enough that he couldn't maintain full control of a vehicle without assistance - choosing to drive yourself is just silly. Just go ahead and give us a call, we don't mind. Or, at a minimum, get someone else to drive you.
But arriving in an ambulance will get you looked at sooner when you get there
Actually, no. Now, it sounds like you ended up in a shitty hospital that was poorly staffed or something - but in reality, the hospital staff triages and sees patients in order of severity, regardless of whether you arrived by ambulance or walked in. In fact, a lot of ne'er-do-wells seem to share your belief that an ambulance will get you seen faster, and thus call us for silly reasons that do not need an ambulance. And while we are more than happy to give you a ride to the hospital (non-emergent, without using the lights and sirens) - we'll drop you off in the waiting room, where you'll get triaged along with everyone else.
If the coder struggled but the result turned out great then the method will still flag the code to be likely to be bad. The method will also completely miss buggy code caused by the programmer not realizing that the problem is tricky and going for a way too simple solution.
I agree that these factors mean that the test cannot be reliably used to just identify potentially dangerous parts of code. But I think the results could reveal some interesting information about the programmer.
As you said - if we have data showing that a developer struggled with a particular area of code, but that area ends up being of high quality - then we can see that the developer likely has a great attention to detail, and is being thorough with his design and testing. That's good information to know about a developer.
Another possibility is that the developer moved quickly through the area of code without stressing. But the code quality ends up being crap. This tells us that the developer is likely sloppy, lazy or just not very good. This may help identify an opportunity to coach a newer developer - or just to identify developers who we can't trust.
Now, I'd agree that in terms of yielding actionable data - this isn't as valuable or useful as if we were able to simply get a reliable indication of code quality. But its still something interesting to consider.
Paramedic here. We still use VHF pagers. They are simple, but reliable and rock solid. They work pretty much everywhere, and a charge will last for days. We have a complementary iPhone/Android app that will receive info when we get dispatched, but that requires an internet connection, and a series of interfaced software products to all work correctly. The pagers are maintained as a fail safe - all they require is a radio and a means of generating the tones required to signal the pager to open the squelch. In a disaster scenario, the necessary equipment can be run reliably off batteries and generators. That's just not the case with smartphone apps right now.
Hopefully Bennett Hasselton will add his insight and clarification promptly.
I post to Slashdot maybe one every few years... and it still can't convert line breaks to
's?
On the occasions when Linus has responded to criticism that he's an... asshole? It basically seems like he says, "1) This is my sandbox and I can do what I want. 2) This communication style solves more problems than it causes." Linus may be correct on both these points. Linus is certainly an important enough person on an important enough project to probably be able to get away with some stuff that others might not. And its often pointed out that the people on the receiving end of these kinds of rants "had it coming" for one reason or another. That may be true as well. On the other side of the coin, though - I see participating in an open source project as a kind of volunteer work. What you stand to get out of it are mainly intangible rewards. And, if you reach a point where the stress and BS you have to put up with as a volunteer outweighs the intangible rewards, then by all means, step away and do something else with your time. In my own life, I was formerly a volunteer for a certain project (not software-related). Some parallels could be drawn between our head honcho, and Linus. Our guy had years of experience. To be fair and objective, the guy was smart, a hard worker, and his heart was in the right place. A lot of stuff got done, that wouldn't have otherwise gotten done if not for him. The guy, however, was simply an asshole. Just rude, arrogant, insensitive. I worked with/for/near/around this guy for a few years, because I believed in what we were doing, and was trying to find some admirable or redeeming qualities about this person. But, after a few years, it just got to the point where I grew tired of trying to deal with this guy, on top of my actual responsibilities, which were difficult and time consuming in and of themselves. So I walked away from this organization, which was a painful and frustrating decision because there were certainly things about it that I did enjoy and get a lot out of. But, it just wasn't worth being treated poorly by an asshole. Now its entirely possible that I should have grown a thicker skin, or that the asshole was smarter/better/righter than me and I somehow "deserved what I got" or whatever. But, fuck it, eventually I realized, 99% of my interactions with my fellow human beings were more pleasant than dealing with this guy. So, I walked away, and sunk my efforts into something similarly rewarding but without a bunch of intolerable BS. So if that's all that's going on here... then godspeed.
That's obviously in addition to all the private security services that lack full law enforcement authority. And I'm probably leaving a few out in my list above - it's been a few years since I've lived there or payed real close attention. But the point is, it's by no means unusual for a private organization to form it's own full-fledged police force.
He died doing what I would think could be a several hundred foot free fall abruptly terminated by contact with a concrete surface. That is probably not something he loved.