I imagine her biggest single expense is malpractice...
The National Coalition of Healthcare has some interesting data here. I don't know their particular "angle" so you may want to take their data with a grain of salt. However one point in particular that gelled with info I have heard from practicing physicians is the impact of administrative costs. I don't have their source handy but in essence when comparing healthcare provider's (nurses, doctors, techs, etc...) cost to administrative ones, administrative costs have skyrocketed in the mid 90's -- not sure if it was after HIPAA or more HMO type events that it was correlated (although not necessary cuasated) with. At any rate - my point (and based on the data in the link above) is that administrative costs are a huge factor as well.
There have been many comments here about the "outrageous" salaries of doctors (and parent poster, this is not you, but something I have to rant about for a second). I wonder if they are referring to the 120-140k that a family physician gets for their 7 years of training, constant call schedule, and constant licensing requirements? How many software engineers would train that hard for that long for that kind of money? Software is necessary and helps people -- let's face it, without it the world as we know it would not go around. Software can (and constantly does) save peoples lives, relieves suffering, and in my (and many people's opinion) are a huge benefit to society (Windows comments, bugs, and such aside). But how many engineers would take cuts because this software is too expensive? I know plenty of software people who make close to or better than a family doc (and I was one of those people, even post-boom)
And yes, there are those specialties that make 250k, 350k, etc... after their 4+ years of med school and 5-9 years of training after that. Many of these are high stress, high stakes jobs with 80+ hour workweeks. I know that many of you have worked deathmarches before. How would you like to sign up for the 80-100 hour work weeks for an indefinite period of time? How much monetary incentive would that take? What would you be making at your current hourly rate if you worked those hours? This isn't a "poor doctors work too hard" jab, but perhaps something to think about what it would take for you to work under the stress/pressure/hours that doctors do.
If you think that the 200k a physician makes or the 80k a traveling nurse makes is too much, then what about the health care insurance company CEO? The health care insurance actuarial?
Ok - end rant. That's what a get for commenting after a bike crash.
Because of terroir, different regions are going to have different climates and different soil content to produce different tasting or different quality products.
Hmmm. But wouldn't that make them terroirists?
Thanks folks. I'm here every Wednesday. Try the veal
In general from what I have read, the number one cause of knee pain is bad shoes (I know, I know...[citation needed]...). As a sib post states, go to a running specific shoe store and have someone at least look at your gait. It won't be a hugely precise analysis, but if there are gross abnormalities (overpronation/supination, etc...) then it may help to narrow down the right shoe for you. Plus you should generally have more options available there than you would at your local general shoe chain. In general for shoes, once you are in a particular "class" of shoe (e.g. high arch support, neutral, etc...) the more expensive in the class just means you have more padding. E.g. the Nike Air Max Motos are basically the same shoe as the Nike Pegasus, but with more padding (and $20-$40 more depending on your location).
If properly fit shoes do not help then you may want to see a physical therapist. Some knee pain is due to weakness in muscles such as the hip stabilizers which do not get used in our usually sedentary jobs. They can set you up with exercises that can greatly help very quickly (yes...been there done that).
If one of those works out and things start feeling better, then the last thing to keep in mind is the 10% rule: don't increase your mileage by more than 10% total per week. This will decrease your chance of stress injuries and will help keep you running for more than just 6-7 weeks.
Good luck. Knee pain and such can be a bitch to figure out, but IMHO is well worth it.
Aren't modified flu viruses used to perform "gene therapy" with some rare genetic disorders
My understanding is that the transmission vector is usually an adenovirus or an adeno-associated virus. I would think that flu viruses (normal influenza -- orthomyxovirus) are not an ideal vector because it is a segmented virus, so odd recombination events (antigenic shift) can occur under the appropriate conditions.
I always wondered whether viruses were deliberately created by the cells in all sorts of creatures as a way of spreading beneficial modifications
Maybe not "deliberately" created by cells, but a decent chunk of the human genome is viral. Of course, the viruses to viruses are pretty conceptually interesting (e.g. Hepatitis D -- which can only exist with a Hepatitis B infection).
If you cancel your account, all of your saved information will be permanently deleted. This means you'll lose access to your profile and account information.
Of course, they may not actually delete the information, and it certainly exists in backups, but short of nuking it from orbit, there's not much else you can do as a (former) monster.com user (AFAIK, at least).
... or give you an *alternate* key to an edited version purged of anything you don't want to show.
I think that is a good idea on the surface. The reality though is that you do not know what parts are OK to leave out. One key piece of medical information can radical change the differential diagnosis and problem solving approach. If you personally redact information, then you run the risk of removing key (pardon the pun) information for diagnosis.
That being said, however, it is very difficult to get a good history. So if I am faced with having 1/4 the information I want from the medical interview (due to time constraints, patient being a poor historian, etc...) or 1/2 of information from a personally edited electronic record, I know which one I would prefer...
Antibiotics will not help against the flu virus. However, it will help against the secondary bacterial pneumonias that can occur and are a cause of significant morbidity/mortality.
Additionally, there are flu specific pharmacotherapies available. For example M2 channel blockers (amantadine, ramantadine) and neuraminidase inhibitors (oseltamivir and zanamivir) can help with treating the flu.
This group used them to induce a specific mutation which now seems to be HIV resistant
As others have noted, the CCR5 mutation already exists in nature -- in general in those of western european descent. However CCR5 (chemokine receptor 5) is just one co-receptor that HIV can use. Generally the CCR5 variant is involved in early stage HIV infection. As the disease progresses, HIV can change to use just the CXCR4 receptor or both the CCR5 and CXCR4 receptor. One would presume that the gene mutation would not effect acquisition/progression of disease in the CXCR4 variants.
I am somewhat curious about the type of person that uses Firefox 3 but has a Hotmail (note not Passport) account that they actually check.
I do. I've used Hotmail since before MS bought them (I think they ran off BSD in those days...netcraft may have even confirmed it!) and I just never bothered to switch over to something else.
Well if you have gotten past the slurry of goatse references, random trolls, and at least one or two (hundred) Vista jabs, I laud your patience and thank you for reading my $0.02. I was in IT for about 10 years, worked hard, made great money, and never lacked for a job.
But I had to leave.
It wasn't just the continued feel of deja vu. I mean, if you switch jobs or do consulting/contracting, you get used to arguing for the benefits of process, unit testing, design, etc... But everything just was getting so boring. The options of tech people -- staying in the trenches and fighting the same battles year after year or going into management (yawn) weren't really appealing to me. And really at the heart of it was a nagging feeling of there being something that would be better for me to do (more complimentary to my strengths, more intellectually interesting, more personally satisfying).
I think you need to look at what you feel is missing with your job. Many people have suggested looking for a different job in the same field. That is good advice. If you do not think you can get what you need in the field, then consider a job switch. If you think you need a job switch, make sure you and your wife are in agreement on the course of action (well - since I do not have a wife, I would assume this is the best course of action:)
Even though you have a wife and kids, many things are possible. I switched from IT to medical school, and am almost 1/2 way done with my M.D. I have many classmates who are in the 40s (and some in their 50s) with wife and kids and manage to make things meet. I do not regret the switch one bit, and while the loss of income is difficult, it is only temporary.
Many will argue that you need to stay where you are for your kids. Perhaps that is true, although giving your kids an example of having strength/tenacity/etc... to make a positive change in your life might be good as well. You have been given a gift of having options in your life. That is not something that many people in this world have (even in the US). As an engineer you know that there are many ways to fix a problem - the trick is to find the right method for the given situation.
Not sure if this has helped out at all, but you know what they say about free advice...
The New England Journal of Medicine actually had an interesting article about direct-to-consumer genetic testing (Jan 10, 2008 -- sorry not a free link (unless you can get it through your institution)). Three main points it makes is that
1. There are questions regarding quality control and transparency. Due to the numbers involved, even small percentage mistakes in sequencing can add up and give wrong information.
2. What is the clinical validity of the sequence such that it can accurately predict the disease? Lack of a sequence may give a false sense of security, and presence of a sequence may cause unnecessary harm.
3. What can you do clinically given the answers? There is little observational or clinical data for how the genetic information can be used effectively, especially for low penetrant conditions.
Clearly, there are disease where knowing ones gene status is very helpful (e.g. BRCA1/2, MEN1/2A/2B, etc...) but many disease we are just in the infancy of determining their genetic basis. The article sums things up like this:
So what advice should a physician offer patients? For the patient who appears with a genome map and printouts of risk estimates in hand, a general statement about the poor sensitivity and positive predictive value of such results is appropriate, but a detailed consumer report may be beyond most physicians' skill sets. For the patient asking whether these services provide information that is useful for disease avoidance, the prudent answer is "Not now -- ask again in a few years." More information is needed on the clinical utility of this information in the light of existing disease-specific opportunities for prevention or early detection and the potential value that genomic profiles can add to that of simpler tools, such as the family health history. Finally, given the risk of commercial exploitation, if patients are determined to proceed, perhaps because they are simply curious, are genetic hobbyists, or are "early adopters" of new technology, it would make sense to encourage them to enroll in formal scientific studies.
You are right -- for example, CHOP therapy for Hodgkin's disease. Wikipedia has a list of other chemo regimens. Combination therapy is usually much better for a number of reasons, among them being better outcomes.
Technically the TCA does not include the ETC. At least, not according to
Stryer's Biochemistry
From Stryer's:
The function of the citric acid cycle is the harvesting of high-energy electrons from carbon fuels. Note that the citric acid cycle itself neither generates a large amount of ATP nor includes oxygen as a reactant.
Again, nitpicky, but many points have been lost on tests on that technicality:)
Since this is/., I can be nitpicky and say that the TCA releases very little ATP. Most ATP is generated via oxidative phosphorylation using NADH and FADH2 created in the TCA.
Slashdot Mirror
...they would make the Any key bigger :(
I imagine her biggest single expense is malpractice...
The National Coalition of Healthcare has some interesting data here. I don't know their particular "angle" so you may want to take their data with a grain of salt. However one point in particular that gelled with info I have heard from practicing physicians is the impact of administrative costs. I don't have their source handy but in essence when comparing healthcare provider's (nurses, doctors, techs, etc...) cost to administrative ones, administrative costs have skyrocketed in the mid 90's -- not sure if it was after HIPAA or more HMO type events that it was correlated (although not necessary cuasated) with. At any rate - my point (and based on the data in the link above) is that administrative costs are a huge factor as well.
There have been many comments here about the "outrageous" salaries of doctors (and parent poster, this is not you, but something I have to rant about for a second). I wonder if they are referring to the 120-140k that a family physician gets for their 7 years of training, constant call schedule, and constant licensing requirements? How many software engineers would train that hard for that long for that kind of money? Software is necessary and helps people -- let's face it, without it the world as we know it would not go around. Software can (and constantly does) save peoples lives, relieves suffering, and in my (and many people's opinion) are a huge benefit to society (Windows comments, bugs, and such aside). But how many engineers would take cuts because this software is too expensive? I know plenty of software people who make close to or better than a family doc (and I was one of those people, even post-boom)
And yes, there are those specialties that make 250k, 350k, etc... after their 4+ years of med school and 5-9 years of training after that. Many of these are high stress, high stakes jobs with 80+ hour workweeks. I know that many of you have worked deathmarches before. How would you like to sign up for the 80-100 hour work weeks for an indefinite period of time? How much monetary incentive would that take? What would you be making at your current hourly rate if you worked those hours? This isn't a "poor doctors work too hard" jab, but perhaps something to think about what it would take for you to work under the stress/pressure/hours that doctors do.
If you think that the 200k a physician makes or the 80k a traveling nurse makes is too much, then what about the health care insurance company CEO? The health care insurance actuarial?
Ok - end rant. That's what a get for commenting after a bike crash.
Because of terroir, different regions are going to have different climates and different soil content to produce different tasting or different quality products.
Hmmm. But wouldn't that make them terroirists?
Thanks folks. I'm here every Wednesday. Try the veal
In general from what I have read, the number one cause of knee pain is bad shoes (I know, I know...[citation needed]...). As a sib post states, go to a running specific shoe store and have someone at least look at your gait. It won't be a hugely precise analysis, but if there are gross abnormalities (overpronation/supination, etc...) then it may help to narrow down the right shoe for you. Plus you should generally have more options available there than you would at your local general shoe chain. In general for shoes, once you are in a particular "class" of shoe (e.g. high arch support, neutral, etc...) the more expensive in the class just means you have more padding. E.g. the Nike Air Max Motos are basically the same shoe as the Nike Pegasus, but with more padding (and $20-$40 more depending on your location).
If properly fit shoes do not help then you may want to see a physical therapist. Some knee pain is due to weakness in muscles such as the hip stabilizers which do not get used in our usually sedentary jobs. They can set you up with exercises that can greatly help very quickly (yes...been there done that).
If one of those works out and things start feeling better, then the last thing to keep in mind is the 10% rule: don't increase your mileage by more than 10% total per week. This will decrease your chance of stress injuries and will help keep you running for more than just 6-7 weeks.
Good luck. Knee pain and such can be a bitch to figure out, but IMHO is well worth it.
Aren't modified flu viruses used to perform "gene therapy" with some rare genetic disorders
My understanding is that the transmission vector is usually an adenovirus or an adeno-associated virus. I would think that flu viruses (normal influenza -- orthomyxovirus) are not an ideal vector because it is a segmented virus, so odd recombination events (antigenic shift) can occur under the appropriate conditions.
I always wondered whether viruses were deliberately created by the cells in all sorts of creatures as a way of spreading beneficial modifications
Maybe not "deliberately" created by cells, but a decent chunk of the human genome is viral. Of course, the viruses to viruses are pretty conceptually interesting (e.g. Hepatitis D -- which can only exist with a Hepatitis B infection).
-1, 0, 1?
And of course, FILE_NOT_FOUND.
This is what they say when you cancel it:
Of course, they may not actually delete the information, and it certainly exists in backups, but short of nuking it from orbit, there's not much else you can do as a (former) monster.com user (AFAIK, at least).
I think that is a good idea on the surface. The reality though is that you do not know what parts are OK to leave out. One key piece of medical information can radical change the differential diagnosis and problem solving approach. If you personally redact information, then you run the risk of removing key (pardon the pun) information for diagnosis.
That being said, however, it is very difficult to get a good history. So if I am faced with having 1/4 the information I want from the medical interview (due to time constraints, patient being a poor historian, etc...) or 1/2 of information from a personally edited electronic record, I know which one I would prefer...
Yes. There's a gene called APOE-1.
It's actually APOE-e4 (according to the abstract of TFA).
Antibiotics will not help against the flu virus. However, it will help against the secondary bacterial pneumonias that can occur and are a cause of significant morbidity/mortality.
Additionally, there are flu specific pharmacotherapies available. For example M2 channel blockers (amantadine, ramantadine) and neuraminidase inhibitors (oseltamivir and zanamivir) can help with treating the flu.
And last but not least -- chicken soup :)
This group used them to induce a specific mutation which now seems to be HIV resistant
As others have noted, the CCR5 mutation already exists in nature -- in general in those of western european descent. However CCR5 (chemokine receptor 5) is just one co-receptor that HIV can use. Generally the CCR5 variant is involved in early stage HIV infection. As the disease progresses, HIV can change to use just the CXCR4 receptor or both the CCR5 and CXCR4 receptor. One would presume that the gene mutation would not effect acquisition/progression of disease in the CXCR4 variants.
I am somewhat curious about the type of person that uses Firefox 3 but has a Hotmail (note not Passport) account that they actually check.
I do. I've used Hotmail since before MS bought them (I think they ran off BSD in those days...netcraft may have even confirmed it!) and I just never bothered to switch over to something else.
Pleaz sends teh codez.
I think I saw that phrase on a bumper sticker....
I program in FORTRAN, you insensitive clod!
Short answer: Yes
Long answer: Yyyyyyyyyyyeeeeeeeeeeeeesssssssss
Well if you have gotten past the slurry of goatse references, random trolls, and at least one or two (hundred) Vista jabs, I laud your patience and thank you for reading my $0.02. I was in IT for about 10 years, worked hard, made great money, and never lacked for a job.
But I had to leave.
It wasn't just the continued feel of deja vu. I mean, if you switch jobs or do consulting/contracting, you get used to arguing for the benefits of process, unit testing, design, etc... But everything just was getting so boring. The options of tech people -- staying in the trenches and fighting the same battles year after year or going into management (yawn) weren't really appealing to me. And really at the heart of it was a nagging feeling of there being something that would be better for me to do (more complimentary to my strengths, more intellectually interesting, more personally satisfying).
I think you need to look at what you feel is missing with your job. Many people have suggested looking for a different job in the same field. That is good advice. If you do not think you can get what you need in the field, then consider a job switch. If you think you need a job switch, make sure you and your wife are in agreement on the course of action (well - since I do not have a wife, I would assume this is the best course of action :)
Even though you have a wife and kids, many things are possible. I switched from IT to medical school, and am almost 1/2 way done with my M.D. I have many classmates who are in the 40s (and some in their 50s) with wife and kids and manage to make things meet. I do not regret the switch one bit, and while the loss of income is difficult, it is only temporary.
Many will argue that you need to stay where you are for your kids. Perhaps that is true, although giving your kids an example of having strength/tenacity/etc... to make a positive change in your life might be good as well. You have been given a gift of having options in your life. That is not something that many people in this world have (even in the US). As an engineer you know that there are many ways to fix a problem - the trick is to find the right method for the given situation.
Not sure if this has helped out at all, but you know what they say about free advice...
The New England Journal of Medicine actually had an interesting article about direct-to-consumer genetic testing (Jan 10, 2008 -- sorry not a free link (unless you can get it through your institution)). Three main points it makes is that
1. There are questions regarding quality control and transparency. Due to the numbers involved, even small percentage mistakes in sequencing can add up and give wrong information.
2. What is the clinical validity of the sequence such that it can accurately predict the disease? Lack of a sequence may give a false sense of security, and presence of a sequence may cause unnecessary harm.
3. What can you do clinically given the answers? There is little observational or clinical data for how the genetic information can be used effectively, especially for low penetrant conditions.
Clearly, there are disease where knowing ones gene status is very helpful (e.g. BRCA1/2, MEN1/2A/2B, etc...) but many disease we are just in the infancy of determining their genetic basis. The article sums things up like this:
So what advice should a physician offer patients? For the patient who appears with a genome map and printouts of risk estimates in hand, a general statement about the poor sensitivity and positive predictive value of such results is appropriate, but a detailed consumer report may be beyond most physicians' skill sets. For the patient asking whether these services provide information that is useful for disease avoidance, the prudent answer is "Not now -- ask again in a few years." More information is needed on the clinical utility of this information in the light of existing disease-specific opportunities for prevention or early detection and the potential value that genomic profiles can add to that of simpler tools, such as the family health history. Finally, given the risk of commercial exploitation, if patients are determined to proceed, perhaps because they are simply curious, are genetic hobbyists, or are "early adopters" of new technology, it would make sense to encourage them to enroll in formal scientific studies.1. Don't talk about the hacker code.
2. Don't talk about the hacker code.
3. ????????
4. PROFIT.
You are right -- for example, CHOP therapy for Hodgkin's disease. Wikipedia has a list of other chemo regimens. Combination therapy is usually much better for a number of reasons, among them being better outcomes.
Technically the TCA does not include the ETC. At least, not according to Stryer's Biochemistry
From Stryer's:
The function of the citric acid cycle is the harvesting of high-energy electrons from carbon fuels. Note that the citric acid cycle itself neither generates a large amount of ATP nor includes oxygen as a reactant.
Again, nitpicky, but many points have been lost on tests on that technicality :)
A clean room and antibiotics? Somebody has been watching a little bit too much House lately... :)
Since this is /., I can be nitpicky and say that the TCA releases very little ATP. Most ATP is generated via oxidative phosphorylation using NADH and FADH2 created in the TCA.
...now!
The key thing to remember on the 30th birthday is...DON'T PANIC :)