This has been an issue for years since the recognition of Creutzfeldt-Jakob Disease as a prion disease. Hospitals are more and more moving to disposable equipment, although this is not yet possible for neurosurgical instruments. Special cleaning procedures are already in place for surgeries having a high risk of contamination.
Put your money where your mouth is... how many RVUs will the physician earn doing this procedure? My guess is 2-3 at most, if he/she is there in person. At $70 per RVU, we're looking at about $200. This includes overhead of maintaining an office, nursing staff, clerical staff, etc, if he/she is one of the increasingly rare independent practice physicians
Most physicians I know spend a lot of time doing activities for which they earn nothing... especially email and phone calls,
Executing a prisoner is not difficult.
We have 4 commonly used drugs to cause unconsciousness: thiopental, propofol, etomidate, and ketamine. Any of those will do. Of the 4, ketamine also produces intense analgesia.
So, a reasonable drug combination would be midazolam, fentanyl, and ketamine, followed by potassium chloride.
A single drug that might also be adequate for execution is bupivacaine IV. It causes analgesia and, when given in large enough doses (2.5 mg/kg or more), causes seizures, unconsciouness, and ventricular fibrillation, leading quickly to death.
Of course, most executions add a paralytic agent, mainly so that the spectators aren't disturbed by the agonal movements of the dying prisoner.
Unfortunately, the American Society of Anesthesiologists prohibits it's members from participating in executions, even though anesthesiologists would be the persons most likely to be able to administer a pain-free execution. The ASA and ABA will in fact revoke a physicians board certification for participating in an execution.
I work in healthcare, actually for one of the organizations mentioned in the article.
Healthcare organizations have a big incentive to show "meaningful use" to the federal government. The federal government will reimburse healthcare organizations a substantial amount - up to $44,000 per physician under Medicare or up to $65,000 over six years, under Medicaid - if they adopt electronic medical records and show "meaningful use" of those EMRs to improve patient care. (Note: this money doesn't go to physicians, it goes to healthcare organizations.)
What we are seeing in this article are 2 healthcare organizations trying to show a tiny bit of "meaningful use" so that they can partake of the federal government's financial largesse. Nothing more.
The study described in the article would be an "observational" study. Observational studies are one of the weakest forms of medical evidence. A positive finding would indicate something that should be investigated further. What we are really interested in in medicine are randomized controlled trials showing an intervention results in a positive (good) outcome and, for big data in medicine, such studies aren't even on the horizon.
I think your math is incorrect.
If you wish each pair of offices to have a direct line between themselves, and every line to be secured by a pair of one-time pads, you would need n*(n-1)/2 pairs of one-time pads.
California's High Speed Rail is a boondoggle. I speak as a Californian. The problem is not simply traveling from SF to LA, it's how to get to where you are going once you are there. In each large city, the public transit system is not comprehensive enough to make travel easy. I don't take my family on BART to SFO because it costs $50 each way. These billions would be better spent enhancing BART or LAs subway system.
What no one has yet commented on is the impact self-driving cars will have on transportation. Driving from SF to LA will no longer be so onerous if you can do work on the way. We will see the birth of the working commute.
The article loses me almost immediately when it states that information is lost in a black hole. Anyone who's read Susskind's book knows that this implies all sorts of unpleasantness like the irreversibility of the the S-matrix, and so it is likely incorrect; ie, information is not lost when objects fall into a black hole. This makes sense, because to an outside observer, an object never falls into a black hole, it only approaches the event horizon without ever quite reaching it. Therefore, one would expect that information from objects falling into a black hole is written on the surface of the event horizon. This represents the highest information density possible. This is Susskind's thesis, and it was my understanding that it is becoming the accepted view.
Stephen Hawking was a proponent of black-hole information loss, and Palmer was a student of Hawking (20 years ago). Therefore, it is not surprising his theory is based on rejected premises.
My first thought when I saw this article a few days ago on news.google.com was... Why didn't this hospital have a neonatal dialysis machine, or transfer the child to a tertiary care center that did? Is this what it's like in the NHS, that they are willing to let a baby die for lack of renal replacement therapy? I can't help but think that in the US, no physician would have had to develop this piece of equipment in his garage, because many tertiary care centers have this equipment already.
First, Mary's and Jane's age do not need to be integers. The solution space includes all non-negative real numbers (this restriction derives from the meaning of age).
1. How old was Jane when Mary was Jane's age?
Mary was Jane's age (a-b) years ago, which is simply the difference in ages. Ie, if Mary is 16 and Jane is 12, then Mary was 12 (16-12)=4 years ago . Now, (a-b) years ago, Jane was (a-b) years younger, so Jane's age was b-(a-b), i.e., c=b-(a-b)
2. Now, Mary is twice that age:
a=2c
a=Mary's current age
b=Jane's current age
c=Jane's previous age
1. a=2c
2. c=b-(a-b)=2b-a
So a=4b-2a or a=4b/3.
Test the answer: if Mary is 8, then Jane is 6 and Jane was 4 previously.
If you want your kids to be smart, turn off the television and game console, make them do extra homework every night, and be involved in their education. It's not the public schools job to educate your children, it's your job.
Though the association between high BMI and workers comp claims might be obvious to you, medicine is replete with examples of the obvious being proven simply wrong.
Medicare guidelines generally call obesity morbid when the BMI>35 and 1 obesity-related complication exists. In my own practice, I also regard anyone with a BMI>=40 as being morbidly obese, even if they don't have a obesity-related complication. (I am told by bariatric surgeons that when they are trying to qualify patients for surgery, they order a sleep study, because almost all patients with BMI>35 have at least a mild degree of obstructive sleep apnea).
I am not aware of a correlation of BMI<25 and workers comp claims. I am aware of data indicating that, in terms of mortality rate in the elderly, the best weight is a BMI of 27. If you have a BMI<25, you have a slightly higher mortality rate than people with a BMI 25-30. These observations may not hold true for younger people.
Most correlations of outcomes with morbid obesity are not "all-or-none". If you drop your BMI from 35.1 to 34.9, one's likelihood of obesity-related complications does not fall to zero. However, they do likely decrease.
There are plenty of references in the literature. Here's one:
Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants.
Breeze E, Clarke R, Shipley MJ, Marmot MG, Fletcher AE.
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. e.breeze@ucl.ac.uk
BACKGROUND: The relevance of body mass index (BMI) to cause-specific mortality in old age is uncertain. OBJECTIVES: To examine cause-specific 5 year mortality in old age by BMI in old age and middle age (40-69 years). METHODS: Cox proportional hazards for mortality rates among 4862 former male civil servants in relation to quartiles of BMI measured when screened in 1968-70 and when resurveyed in 1997-98 (median age 76 years). RESULTS: The association between all-cause mortality after resurvey and BMI in old age was U-shaped with hazard ratios (HRs) of 1.3 (95% CI 1.1-1.5) for the lightest and heaviest categories relative to the middle two. Among 'healthy' men the lightest (<22.7 kg/m2) had greatest all-cause mortality. The heaviest men (>26.6 kg/m2) had increased risk of cardiovascular disease (CVD) mortality in the first two years or for the whole period if never-smokers. Respiratory mortality was inversely associated with BMI in old age [adjusted HR for trend per BMI category increase 0.6 (0.5-0.7)] but cancer mortality lacked a clear pattern. Net gain or loss of 10 kg or more between middle and old age was a strong predictor of all-cause and CVD mortality. CONCLUSIONS: The shape of the association between BMI in old age and mortality differs by cause of death. Major weight change over time is a warning signal for higher CVD mortality. Having BMI<22.7 kg/m2 in old age is associated with above-average mortality rates even if apparently healthy.
From Wikipedia "Obesity": A study examining Duke University employees found that those with a BMI>40 filed twice as many workers compensation claims as workers whose BMI was 18.5-24.9, and had more than 12 times as many lost work days. The most common injuries were due to falls and lifting, and affected the lower extremities, wrists or hands, and backs.[97]
Ostbye T, Dement JM, Krause KM (2007). "Obesity and workers' compensation: results from the Duke Health and Safety Surveillance System". Arch. Intern. Med. 167 (8): 766-73
In our OR, sponges come in packs of 10. They are counted by the surgical scrub (a graduate of a 12 to 18 month technical program) and an RN (usually a college graduate) together. I have seen cases where there could absolutely be no lost sponge (i.e., small incision on an arm or leg), yet the sponge count is incorrect. This can result from either incorrectly counting the sponge at the beginning of surgery, or someone careless throwing out a sponge with a surgical towel or gown. Although I have seen surgeons go back into patients when a sponge count is incorrect at the end of surgery, more often it is the result of a miscount or throw-away.
The bar-code technique mentioned above will only work if all codes are scanned at the beginning of surgery. Unfortunately, I don't see this a practical, as it would take many minutes to scan all sponges and instruments, and at $600/hour per operating room (hospital staff and equipment), it will raise costs too much. RFID tags are an interesting solution, as long as none of the tags stop functioning, and current counting methods are retained.
I understood that food manufacturers started using high-fructose corn syrup as a substitue for cane sugar because of a run-up in cane sugar prices, and corn syrup was a cheaper alternative, not because they sold more product.
This talk about the correlation between high-fructose corn syrup and obesity has been around for awhile. There are also cultural reasons for obesity, especially the difficulty some cultures have with denying their children sweets, and the ideal of a corpulent baby. Although he points out the significant amount of exercise to work off the calories of just one chocolate chip cookie, the amount of exercise among schoolchildren in the U.S. has also decreased dramatically, and the benefits of exercise exceed simply the number of calories burned during the activity.
My experience with health care in the U.S. is both as a patient and a health-care provider. Since graduating college 20 years ago, there has not been a single year that I have not been covered with some type of health insurance, even though I was a poor graduate student for 4 of those years.
Regarding elasticity of healthcare pricing, I guess Simon suggests that healthcare pricing does not reflect the balance between supply and demand. I don't think you can make this statement. Demand for healthcare is very high. I see patients constantly escalating the severity of their relatively minor problems so that they can obtain coverage via their HMOs. I can say that regarding physician charges, when there are an excess of physicians, their charges drop. I see it daily where I live - the least in demand surgeons take the poorest reimbursing insurances. I believe the same is true of hospitals.
I have met a nurse who previously worked in the NHS, and a patient previously treated in the NHS. Both agreed that healthcare in the U.S. is much better. It is clear in talking to them that healthcare in the U.S. is more highly regulated than in GB. Objectively, I don't think we have good metrics for evaluating the performance of health care systems - life expectancy and infant mortality are plagued by confounding variables.
A fact that has been overlooked by the media and most commentators is that few linux users actually use RCU, JFS, NUMA. Most linux users are running uniprocessor machines, and if a journaling FS is being used it is likely ext3.
So, it seems that SCO *is* misrepresenting the need for licensing, as most linux users (and probably a lot of companies) are not actually using *any* SCO copyrighted technology.
Slashdot Mirror
This has been an issue for years since the recognition of Creutzfeldt-Jakob Disease as a prion disease. Hospitals are more and more moving to disposable equipment, although this is not yet possible for neurosurgical instruments. Special cleaning procedures are already in place for surgeries having a high risk of contamination.
I only wished to establish an upper bound, based on CPT coding guidelines published by pacemaker/AICD companies.
As my Google and Facebook neighbors buy million dollar homes, I grow tired of insinuations that physicians are over-compensated.
Put your money where your mouth is... how many RVUs will the physician earn doing this procedure? My guess is 2-3 at most, if he/she is there in person. At $70 per RVU, we're looking at about $200. This includes overhead of maintaining an office, nursing staff, clerical staff, etc, if he/she is one of the increasingly rare independent practice physicians
Most physicians I know spend a lot of time doing activities for which they earn nothing... especially email and phone calls,
My bazel BUILD file:
,
cc_binary(
name = "HttpEchoServer",
srcs = ["src/HttpEchoServer.cpp"]
+glob(["src/common/**/*.cpp"])
includes = [],
copts = ["-g","-std=c++1z","-I/usr/include/mysql++","-I/usr/include/mysql","-Isrc","-Isrc/common"],
linkopts = ["-L/usr/local/lib",
"-lcairo","-lcryptopp","-lpq",
"-lPocoCrypto","-lPocoFoundation","-lPocoJSON","-lPocoNet","-lPocoNetSSL","-lPocoUtil",
"-lboost_date_time","-lboost_unit_test_framework","-lboost_random","-lboost_system","-lgtest",
"-lproxygenhttpserver","-lfolly","-lglog","-lgflags","-lpthread"],
)
Julian Assange Could Be Time's 'Person Of The Year', And Is Also Still Not Dead
Perhaps Time know something we don't...
Executing a prisoner is not difficult. We have 4 commonly used drugs to cause unconsciousness: thiopental, propofol, etomidate, and ketamine. Any of those will do. Of the 4, ketamine also produces intense analgesia. So, a reasonable drug combination would be midazolam, fentanyl, and ketamine, followed by potassium chloride. A single drug that might also be adequate for execution is bupivacaine IV. It causes analgesia and, when given in large enough doses (2.5 mg/kg or more), causes seizures, unconsciouness, and ventricular fibrillation, leading quickly to death. Of course, most executions add a paralytic agent, mainly so that the spectators aren't disturbed by the agonal movements of the dying prisoner. Unfortunately, the American Society of Anesthesiologists prohibits it's members from participating in executions, even though anesthesiologists would be the persons most likely to be able to administer a pain-free execution. The ASA and ABA will in fact revoke a physicians board certification for participating in an execution.
I work in healthcare, actually for one of the organizations mentioned in the article.
Healthcare organizations have a big incentive to show "meaningful use" to the federal government. The federal government will reimburse healthcare organizations a substantial amount - up to $44,000 per physician under Medicare or up to $65,000 over six years, under Medicaid - if they adopt electronic medical records and show "meaningful use" of those EMRs to improve patient care. (Note: this money doesn't go to physicians, it goes to healthcare organizations.)
What we are seeing in this article are 2 healthcare organizations trying to show a tiny bit of "meaningful use" so that they can partake of the federal government's financial largesse. Nothing more.
The study described in the article would be an "observational" study. Observational studies are one of the weakest forms of medical evidence. A positive finding would indicate something that should be investigated further. What we are really interested in in medicine are randomized controlled trials showing an intervention results in a positive (good) outcome and, for big data in medicine, such studies aren't even on the horizon.
I think your math is incorrect. If you wish each pair of offices to have a direct line between themselves, and every line to be secured by a pair of one-time pads, you would need n*(n-1)/2 pairs of one-time pads.
California's High Speed Rail is a boondoggle. I speak as a Californian. The problem is not simply traveling from SF to LA, it's how to get to where you are going once you are there. In each large city, the public transit system is not comprehensive enough to make travel easy. I don't take my family on BART to SFO because it costs $50 each way. These billions would be better spent enhancing BART or LAs subway system. What no one has yet commented on is the impact self-driving cars will have on transportation. Driving from SF to LA will no longer be so onerous if you can do work on the way. We will see the birth of the working commute.
The article loses me almost immediately when it states that information is lost in a black hole. Anyone who's read Susskind's book knows that this implies all sorts of unpleasantness like the irreversibility of the the S-matrix, and so it is likely incorrect; ie, information is not lost when objects fall into a black hole. This makes sense, because to an outside observer, an object never falls into a black hole, it only approaches the event horizon without ever quite reaching it. Therefore, one would expect that information from objects falling into a black hole is written on the surface of the event horizon. This represents the highest information density possible. This is Susskind's thesis, and it was my understanding that it is becoming the accepted view. Stephen Hawking was a proponent of black-hole information loss, and Palmer was a student of Hawking (20 years ago). Therefore, it is not surprising his theory is based on rejected premises.
My first thought when I saw this article a few days ago on news.google.com was... Why didn't this hospital have a neonatal dialysis machine, or transfer the child to a tertiary care center that did? Is this what it's like in the NHS, that they are willing to let a baby die for lack of renal replacement therapy? I can't help but think that in the US, no physician would have had to develop this piece of equipment in his garage, because many tertiary care centers have this equipment already.
First, Mary's and Jane's age do not need to be integers. The solution space includes all non-negative real numbers (this restriction derives from the meaning of age).
1. How old was Jane when Mary was Jane's age?
Mary was Jane's age (a-b) years ago, which is simply the difference in ages. Ie, if Mary is 16 and Jane is 12, then Mary was 12 (16-12)=4 years ago . Now, (a-b) years ago, Jane was (a-b) years younger, so Jane's age was b-(a-b), i.e., c=b-(a-b)
2. Now, Mary is twice that age:
a=2c
a=Mary's current age
b=Jane's current age
c=Jane's previous age
1. a=2c
2. c=b-(a-b)=2b-a
So a=4b-2a or a=4b/3.
Test the answer: if Mary is 8, then Jane is 6 and Jane was 4 previously.
If you want your kids to be smart, turn off the television and game console, make them do extra homework every night, and be involved in their education. It's not the public schools job to educate your children, it's your job.
Medicare guidelines generally call obesity morbid when the BMI>35 and 1 obesity-related complication exists. In my own practice, I also regard anyone with a BMI>=40 as being morbidly obese, even if they don't have a obesity-related complication. (I am told by bariatric surgeons that when they are trying to qualify patients for surgery, they order a sleep study, because almost all patients with BMI>35 have at least a mild degree of obstructive sleep apnea).
I am not aware of a correlation of BMI<25 and workers comp claims. I am aware of data indicating that, in terms of mortality rate in the elderly, the best weight is a BMI of 27. If you have a BMI<25, you have a slightly higher mortality rate than people with a BMI 25-30. These observations may not hold true for younger people.
Most correlations of outcomes with morbid obesity are not "all-or-none". If you drop your BMI from 35.1 to 34.9, one's likelihood of obesity-related complications does not fall to zero. However, they do likely decrease.
There are plenty of references in the literature. Here's one:
Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants. Breeze E, Clarke R, Shipley MJ, Marmot MG, Fletcher AE.
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. e.breeze@ucl.ac.uk
BACKGROUND: The relevance of body mass index (BMI) to cause-specific mortality in old age is uncertain. OBJECTIVES: To examine cause-specific 5 year mortality in old age by BMI in old age and middle age (40-69 years). METHODS: Cox proportional hazards for mortality rates among 4862 former male civil servants in relation to quartiles of BMI measured when screened in 1968-70 and when resurveyed in 1997-98 (median age 76 years). RESULTS: The association between all-cause mortality after resurvey and BMI in old age was U-shaped with hazard ratios (HRs) of 1.3 (95% CI 1.1-1.5) for the lightest and heaviest categories relative to the middle two. Among 'healthy' men the lightest (<22.7 kg/m2) had greatest all-cause mortality. The heaviest men (>26.6 kg/m2) had increased risk of cardiovascular disease (CVD) mortality in the first two years or for the whole period if never-smokers. Respiratory mortality was inversely associated with BMI in old age [adjusted HR for trend per BMI category increase 0.6 (0.5-0.7)] but cancer mortality lacked a clear pattern. Net gain or loss of 10 kg or more between middle and old age was a strong predictor of all-cause and CVD mortality. CONCLUSIONS: The shape of the association between BMI in old age and mortality differs by cause of death. Major weight change over time is a warning signal for higher CVD mortality. Having BMI<22.7 kg/m2 in old age is associated with above-average mortality rates even if apparently healthy.
From Wikipedia "Obesity": A study examining Duke University employees found that those with a BMI>40 filed twice as many workers compensation claims as workers whose BMI was 18.5-24.9, and had more than 12 times as many lost work days. The most common injuries were due to falls and lifting, and affected the lower extremities, wrists or hands, and backs.[97] Ostbye T, Dement JM, Krause KM (2007). "Obesity and workers' compensation: results from the Duke Health and Safety Surveillance System". Arch. Intern. Med. 167 (8): 766-73
In our OR, sponges come in packs of 10. They are counted by the surgical scrub (a graduate of a 12 to 18 month technical program) and an RN (usually a college graduate) together. I have seen cases where there could absolutely be no lost sponge (i.e., small incision on an arm or leg), yet the sponge count is incorrect. This can result from either incorrectly counting the sponge at the beginning of surgery, or someone careless throwing out a sponge with a surgical towel or gown. Although I have seen surgeons go back into patients when a sponge count is incorrect at the end of surgery, more often it is the result of a miscount or throw-away. The bar-code technique mentioned above will only work if all codes are scanned at the beginning of surgery. Unfortunately, I don't see this a practical, as it would take many minutes to scan all sponges and instruments, and at $600/hour per operating room (hospital staff and equipment), it will raise costs too much. RFID tags are an interesting solution, as long as none of the tags stop functioning, and current counting methods are retained.
I understood that food manufacturers started using high-fructose corn syrup as a substitue for cane sugar because of a run-up in cane sugar prices, and corn syrup was a cheaper alternative, not because they sold more product. This talk about the correlation between high-fructose corn syrup and obesity has been around for awhile. There are also cultural reasons for obesity, especially the difficulty some cultures have with denying their children sweets, and the ideal of a corpulent baby. Although he points out the significant amount of exercise to work off the calories of just one chocolate chip cookie, the amount of exercise among schoolchildren in the U.S. has also decreased dramatically, and the benefits of exercise exceed simply the number of calories burned during the activity.
My experience with health care in the U.S. is both as a patient and a health-care provider. Since graduating college 20 years ago, there has not been a single year that I have not been covered with some type of health insurance, even though I was a poor graduate student for 4 of those years.
t ory.jhtml for an alternative viewpoint on Universal Coverage and Single-Payer Healthcare systems.
Regarding elasticity of healthcare pricing, I guess Simon suggests that healthcare pricing does not reflect the balance between supply and demand. I don't think you can make this statement. Demand for healthcare is very high. I see patients constantly escalating the severity of their relatively minor problems so that they can obtain coverage via their HMOs. I can say that regarding physician charges, when there are an excess of physicians, their charges drop. I see it daily where I live - the least in demand surgeons take the poorest reimbursing insurances. I believe the same is true of hospitals.
I have met a nurse who previously worked in the NHS, and a patient previously treated in the NHS. Both agreed that healthcare in the U.S. is much better. It is clear in talking to them that healthcare in the U.S. is more highly regulated than in GB. Objectively, I don't think we have good metrics for evaluating the performance of health care systems - life expectancy and infant mortality are plagued by confounding variables.
You may wish to check out the editorial at MTV: http://www.mtv.com/movies/news/articles/1563758/s
A fact that has been overlooked by the media and most commentators is that few linux users actually use RCU, JFS, NUMA. Most linux users are running uniprocessor machines, and if a journaling FS is being used it is likely ext3. So, it seems that SCO *is* misrepresenting the need for licensing, as most linux users (and probably a lot of companies) are not actually using *any* SCO copyrighted technology.