I've always assumed that the failure rate for handing off care to another person and the rate because of long hours must go in favor of long hours. I don't have anything to back this up except the MCAT being designed to check how you perform when tired. Now with electronic records I've been wondering if long hours are still be necessary, assuming I'm right about the failure rates.
Super intersting to see people discussing this! As someone that holds a pilots license and talks with a lot of commercial pilots about their jobs, sleep is often a hot topic of discussion. It would be illegal, not just irresponsible, for a pilot to try pull off a 120 hour work week. Why do we treat doctors differently? Their macho behaviour in my opinion is unacceptable, and likely reduces positive patient outcomes, yet it goes on?
Medicine has different concerns than piloting, though. Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks. Doubling the number of patient handoffs, on the other hand, significantly increases the risk of one of the more common sources of error.
But could the increase in errors from increased hand-offs be smaller than the increase in errors from sleep-deprived doctors, nurses and patients combined with the increase in disease spread and disease progression from the effect of sleep deprivation on the immune systems of doctors, nurses and patients? Additionally, could there be benefits from getting more eyes on a patient's condition?
I've always wondered if the problem might be in the handoff procedures. Those studies about mortality in the event of a handoff always make it sound like obviously handoffs are an inherently dangerous thing, but perhaps the modern way of doing them is just poorly implemented? It feels extremely unlikely to me that absurdly long hours are the only solution.
There's just no way efficient way to capture, log, and communicate every single little detail a doctor observes while diagnosing and setting treatment for a patient. First impressions are often wrong, and little details can become significant later. Early treatment might be designed not only to address symptoms but to exclude other diagnoses.
In a plane in level controlled flight, there is very little to hand off between two type-rated pilots. Both folks understand the machine, and the machine is working the way it is supposed to. Humans work the same way! Parents "hand off" their healthy kids to schools or babysitters or relatives every day.
But imagine a plane that is in the process of crashing; it's in a dive, controls are not responding as expected, one of the engines keeps turning off. A pilot is fighting to regain control... how comfy are you with THAT pilot handing off the aircraft to another pilot in the middle of that situation?
It's a little silly as an analogy, since plane crashes tend to be resolved pretty quickly one or the other. But conceptually, just imagine a plane that is in the process of maybe crashing for 12 hours. There's a good argument for a pilot to just see that through instead of "clocking out" at 8 hours.
I think this is a rational question to ask! Often people will jump to conclusions "handoffs cause errors", and while errors are a symptom of handoffs executed poorly, it seems uncommon for people to often ask for improvements to these processes.
> Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks.
Are you aware that on long haul international flights pilots do in fact rotate who is actively "flying" the plane? Flying is in quotes because most of the work is done by automation these days. I won't draw any analogies between the autopilot doing much of the work for pilots and nurses doing it for doctors because I can't actually support the statement with any data.
Yes, but that's the whole point: there's little risk in rotating pilots, whereas rotating members of the care team carries a substantial risk of key information falling by the wayside.
I see your point, but i'd love to see a peer reviewed study to back up the claim that "it's better to have over-worked doctors and nurses than to introduce more handoffs".
There's no error in hand offs. Attending doctors are detached and spend just a little time with a patient during their stay. Nurses and PAs do most of the work.
Flying a plane is way less complex than medicine. A pilot can hand off a flying plane way, way, way more easily than a doctor can hand off a patient with a complex set of symptoms and treatments.
I should also point out that the vast majority of doctors don't work 120 hours a week continuously, rather, they experience higher-than-usual clusters of working time vs. not working time. That is, they might be on rotation for 36 hours straight but then off for 36 hours or more. And some of their shifts might only be 8 hours. Residents work longer hours, but are supervised by doctors.
I know several ER docs and they all cite the dangers of patient hand-off as the main reason they continue to support long shifts.
This is the claim, but if you look at the experiments supporting it, they’re all bonkers. For example, care is no worse from doctors on 28 hr shifts vs 24. I would argue that both of these are so far from a well-rested baseline that they’re meaningless.
We know from lab experiments that performance craters way, way before that, which is why pilots, truck drivers, cops, and every other profession work shorter shifts.
All this talk is insane. I have like maybe 4 top-performing hours on my best days. The idea of working more than 8 in a life safety critical situation boggles the mind.
When I have used it, and I have to for a certain project, it is incredibly slow to resolve depenendcies. Enough so that I go for a walk or do something else for 15 minutes while it thinks about whatever it's doing.
Yeah, this is becoming a real problem. This didn't use to happen, but now conda is slow to the point of being unusable if you need to create environments a lot (like during testing)
The problem with the entertainment system hack is that the can bus used in vehicles uses a priority system that is designed so that higher priority device can always claim the bus. If I remember correctly the entertainment system hack moved up the priority of the entertainment system on the bus so that it was higher priority than whatever nominally controls the car. A can bus isn't robust against bad actors and should have been air gapped to any external connection.
Priority doubles as ID in most CAN systems, so changing the priority means you're no longer sending the message to the same endpoint. As you say, though, CAN isn't secure against someone with physical access to the bus.
IMO "the problem" isn't the CAN priority system, it's that a remotely programmable device (the CAN gateway) was connected to both the control network and the internet (via the entertainment center). For something so security critical, it should have been kept as dumb as a box of rocks, and certainly never made network-updatable.
I learned and was fluent with Mathematica early and learned python later. I still run to Mathematica for doing symbolic analysis because there is basically no impedement between my ideas and the keyboard when I am solving that type of problem. I've moved all my numerical analysis to the scipy system since it is a more natural language for those types of problems.
There is no "right" thing. There may be an optimal thing from the development perspective and an optimal thing from the business perspective. Since the two pieces cannot exist without each other, both parties have to communicate effectively and trust each other to find the optimal decision for the combined problem space which may be sub-optimal when considered separately.
In my opinion, environmental regulation exemptions are the real cost to the state[1]. Not to mention its kind of weird to give out an exemption, if the standards are being lowered why is it just for this one entity?
I've never heard of anything like this. Is this common?
(1) Let Foxconn discharge dredged materials or fill wetlands without a permit. The provision would apply not only to wetlands Foxconn fills when it's constructing its 1.6 square mile complex, but also to wetlands it fills once its new facility is fully operational. (2) Exempt the company from another state law that requires businesses to create new wetlands when they get permits to fill existing ones. (3) Allow Foxconn to change the course of a stream, or straighten a stream without a permit. (4) Let Foxconn build on a lake or stream bed without a permit. (5) Sidestep a state law that requires environmental impact statements before businesses can begin construction. (6)Let public utility projects begin for the Foxconn complex without approval by the Public Service Commission.
Also, Foxconn gets "refundable tax credits" -- does this mean state could end up paying FoxConn cash (not merely a break on taxes)? is this also common? I wish every small business could be paid to create jobs.
Interesting. What stops foxconn from inserting itself (and "selling" services) to buy a bit of land, fill in wetlands, change stream courses, build a lake, etc., then sell the "improved" land to another company? Maybe even begin construction of buildings to then be sold to someone else?
Nothing. Scott Walker is one of the most openly corrupt politicians to ever stay in office. He probably has a back end deal with a"family friend" to make this happen.
I can't wait to vote for the challengers of any one on my ballot that supported this foxconn bs. Also, the WEDC is a fucking joke. Talk about privatizing profits and socializing losses. The Republicans in this state are the biggest hypocrites, picking winners and losers. Free markets my ass. Makes my blood boil (and I tended to vote just right of aisle).
or a gazillion dollar job with a company once he retires from the state job. Maybe not with Foxconn but with a supplier or client of theirs. Wink + nod=
> I wish every small business could be paid to create jobs.
I always thought tax credits for businesses were more related to numbers rackets than to actual economic gain.
Here's a thought experiment:
I take one person from my company, fire him, and split the job into two people. Both get paid less than half of the original guy I fired. Yet one of the keeps the old title. Did I create a job? Yes. Did I grow the economy? Doubtful.
While splitting one job into two seems far fetched, it's not that far fetched to split 8 jobs into 10, say.
Actually, you arguably shrank it if the new lower salaries both render the receivers eligible for a greater share of public benefits while subjecting them to lower marginal tax rates.
> Did I create a job? Yes. Did I grow the economy? Doubtful.
Probably depends on the salary range(s) involved and how deep into "mostly discretionary income" the original employee was (and, I guess, how much they spent v stashed that discretionary income).
Living around the great lakes, and knowing what China's like due to lax enforcement of environmental regulations, this kind of stuff terrifies me. Michigan didn't do this kind of kowtowing trying to get Foxconn (to be honest I don't think it would be possible to after the whole Flint water issue), but who knows what kinds of problems will be introduced throughout the watershed when Foxconn exercises any of these allowances.
>I've never heard of anything like this. Is this common?
With the scope creep of what is a "wetland" (1)(2) is basically an approval to construct a facility. Wetland regulations are so broad that you basically can't build a large building and a parking lot for the people who will work in it without 9000+ hours of back and fourth with the EPA and local agencies.
Last I heard (2017) many man-made drainage ditches would be considered wetlands.
(6) is basically an authorization to run power lines to the facility. (3) and(4) are basically an authorization to pave driveways to connect to existing infrastructure
Basically all but five are the state saying "we're not gonna bait and switch by bogging you down in red tape once you select a location and get the ball rolling"
(5) is the one where they're going out of their way to sweetening the deal and depending on the site selected I really don't see a big issue with it because Foxconn is still subject to federal rules so they're not gonna build a factory somewhere that the risk of environmental impact is large.
My problem here is that Foxconn can get quick and easy approval for a facility but Noname Joe's Lumber Supply has to tailor their plans skirt around the laws if they want to build a facility.
At $150k/yr, your marginal tax rate is close to 40%, but your overall tax rate is more like 31%. I'm in Saskatchewan, and every time I've played with different income levels, taking into account the exchange rate, we end up paying very similar amounts of all-in income tax, with ours including (most) health care. (Comparing with California)
Once you consider the typical US co-payments to actually use health care, it's cheaper in Canada. Getting an MRI in California cost me close to $1K out of pocket, despite fancy insurance that paid most of it. In Canada it's pre-paid in taxes.
Also when you consider that we don't have to pay anything for insurance to cover that. The MRI costs $0 out of pocket, covered by the healthcare that is already factored into our equal-cost taxes.
There's still a benefit to having health insurance for covering stuff not covered by the gov't plan: vision, dental, some fraction of prescription drugs, etc. I do have a health plan through work, but I think it costs somewhere around $50-75/month to cover all of that stuff for my family.
Absolutely. If you add decent insurance to income taxes as a basic cost of living, it's cheaper in Canada. I moved to Canada from California and even before becoming a permanent resident I needed to use the health service as a family member was sick. I will be forever grateful for the excellent service and zero cost at point of use even for my family as (tax paying) temporary workers. I'm now raising Canadian kids to do their part to pay back the system that saved their mother's life.
It's pretty wild. At one point, I forgot to renew my health card and had a bit of a fall that tweaked my wrist. I went to the clinic by my house and they warned me that I'd have to pay out-of-pocket for the services, but I could submit the receipt after renewing my health card and get reimbursed.
Doc felt my wrist, asked me to go to the radiology clinic next door for a digital X-Ray, and to come back to discuss what he saw on it. Doctor visit: $30, X-Ray: $30.
When the two options are: use your provincial health card or pay cash, costs can stay relatively low.
I wish no business could be paid simply to create jobs. This is just distorting the economy. Arguably, the pressure to spend less on humans where possible drives technological advancement.
So... Foxconn can get tax breaks, and environmental regulation exemptions, good for them, but what about other businesses?
Say I have a business (does not have to be in Wisconsin... say, Texas) doing something similar to Foxconn. So I have to pay taxes - no tax breaks as for Foxconn, and no environmental regulation exemptions.
So now, how can my business compete with Foxconn? They get all the breaks and I get none. Basically, that will shut my business down. Employees will be fired, shareholders will lose their money, etc.
That should be added to the tally when we are looking at the overall impact of such sweetheart (for the Foxconn) deals on the economy.
No states are allowed to favor FC because it might risk an incumbent. FC takes business to Canada. Canadian economy is now slightly stronger than the US, USD drops slightly. Zero US jobs were created.
>> Canadian economy is now slightly stronger than the US
But... is it? That was kind of my point. It is not clear at all.
So in Canada in particular, I remember big issues with the likes of GM and Ford. Here is what happens:
1/ Government attracts GM with tax breaks, will finance infrastructure, provide loans etc, etc.
2/ GM says "great". Builds the plant, employs people. This is the good part.
3/ Once the tax breaks expire, GM declares that the plant is not profitable anymore and shuts it down.
4/ So... was the plant beneficial to Canada? Depends who you ask. Some pundits add the numbers and say that Canada lost money in the deal, some say Canada gained.
What is obvious is that government spent a boatload of money to provide a job to like 3,000 people for three years.
Some argue that it would have been much cheaper to just give that money to random 3,000 people.
Let's say there are no nationwide standards. Texas attracts a California company with no minimum wage, no taxes, very little regulations. In this imaginary situation, Texas "created" jobs. But we are all worse off.
It seems like we cannot leave anything we consider important to the states or local government or we risk a race to the bottom.
Or maybe we should leave everything possible to the states, so that we collectively get the most competitive system versus the world.
I don't think that we should toss out all federal standards, but I do worry about the pretense that we can operate our states as a giant cartel/union who collectively agree to not sharpen their pencils "against" each other, rather than seeking to be genuinely competitive in a world market.
> I do worry about the pretense that we can operate our states as a giant cartel/union who collectively agree to not sharpen their pencils "against" each other
Of course, no sane person will disagree with what you said. This is why we need international diplomacy (carrots and sticks) to force the world to follow suit. I think there are several problems and we can't please everyone. In my example, it is little consolation to tell someone in California that their jobs aren't going overseas. "Don't worry. It is just going to Texas. Nothing to see here. Move along." What good does it do to them? Should they just move to Texas following the jobs? What will happen is standards will lower everywhere.
Here is an outrageous idea (don't actually do this): disband these united states and all states individually join the European Union. We will quickly see how important the federal government has been for each and every one of us in the world stage.
I suspect I'd agree with you over beers more than is apparent on HN text, as we naturally focus on and discuss the differences much more than the agreement.
In your hypothetical, should we tell the person in Texas who doesn't get the new/moved job, "Don't worry; you are going to stay unemployed because someone in California is doing that job, not someone overseas."?
> "Don't worry; you are going to stay unemployed because someone in California is doing that job, not someone overseas."
I think I'd agree with you a lot as well but the problem with "moving" the job from California to Texas is that it is a net loss for us as a nation. No company will choose change if all else are the same. They picked Texas because they can get more for less. So, the Texan worker will get less than what the Californian was getting. I mean look at non-compete clauses. I think if you enforce a non-compete clause it is only fair that you have to pay them a certain amount of money (I think fair amount is market rate but I don't know how to calculate it) for NOT working. This to me is common sense and yet this is not the law in all fifty states.
Worse is when we are talking about negotiated tax "discounts" or regulation "waivers" to companies. These do not hurt anybody directly so nobody feels the pain in the short term. However, we are all worse off because of it.
To someone who thinks CA has an insane regulatory environment then TX getting the carrot part of the deal and CA getting the stick part of the deal is a net gain.
So be it. Ensuring CA jobs stay in CA is something the 49 other state governments should give exactly zero shits about.
Their responsibility is to their constituents not some other state. If CA doesn't like it that's exactly the kind of thing the federal government exists to mediate.
The usual scam is for your Texas company, if it is large enough, to start a public search for a new place of business, and encourage other cities to submit open bids. As they race to the bottom, your own city and state will feel like they should offer you tax breaks to stay. So you accept those, and you get free money. Or, if your intention as CEO was to move closer to your kids in Denver, then you accept their offer.
A lot of pollution is stuff where a little bit of it is more or less harmless, but it gets bad when lots of people do it. It can make sense to grant special case exemptions rather than lowering standards as a whole.
For example, it's common for old cars to be exempt from emissions regulations, and small aircraft are still allowed to use leaded gasoline. (Arguably the leaded gas use by small aircraft is still big enough that it should be stopped, but regulators don't seem willing to actually do it.)
Of course, granting it to one company just because they're building a factory you want is naked favoritism, not the sort of at least vaguely sense-based decisions we'd want to have.
My thoughts exactly. Or host semi-exclusive parties at larger public venues such as bowling centers, where employees have chance to mingle with outsiders, likely with better gender ratio (most such venues have split sections and people can walk across them. Thirsty Bear in SF is a good one). Not to even mention implication on gender issues, hiring models to interact with employees does not really help them improve their social skills.
I almost always buy textbooks through alibris. Thier prices are typically much lower than Amazon for used books. Sometimes I have to purchase an international or the next newest edition, but I almost always get out for less than $30. I actually just bought "the dragon book" 2nd edition for $25 shipped.
> Supposedly ~17 qubit devices are on the way. None has demonstrated quantum supremacy, practical or not.
That's exactly what I mean. I haven't seen any evidence of quantum computing being demonstrated. All I know is it's hypothetically possible. I'm not sure what people were downvoting when I said this, I'm just stating a fact. It's not like I wished it wouldn't happen or something.
