If you are reading popular books on social science (which many business books are), it is very likely that the author is pushing research they are personally invested in succeeding. They are often not trying to convey a nuanced understanding of a phenomenon. Furthermore, popular books are often not peer-reviewed to the same extant or at all as regular research literature.
A better alternative is to read review articles in journals. They are shorter than books and will also give a more reasonable estimate of the certainty experts have in a certain field of results. For example, in psychology there is the Annual Review of Psychology, which generally publishes ~50pg readable summaries of literature by experts in the field. For the love of social science, please stop reading popular books on the brain/mind.
As a psychologist/cognitive scientist (my identity depends on my mood/day), I was equally disappointed with the sections on psychology and neuroscience. Some of the questions have been answered (at least partially, such as the importance of domain knowledge versus "processing power").
Overall, it was a very odd look into a discipline that I am familiar with, which leads me to think that the ideas are not very promising for any of the fields I don't have expertise in.
This is hubris. Ventilators are not iPhones circa 2010. It's irresponsible for non-medical researchers to not only pursue, but also disseminate, these jailbreaks. A significant portion of medical device RnD is related to creating technology that is hard to misuse and won't result in accidental death, and I just don't see that here.
> it's irresponsible for non-medical researchers to not only pursue, but also disseminate, these jailbreaks. A good portion of medical device RnD is related to creating technology that is hard to misuse and result in accidental death, and I just don't see that here.
This is simply wrong, both from a user perspective and a general research perspective.
Positioning a jailbreak like this as a solution to general vent shortage may be irresponsible if it leads to people trying to treat others instead of relying on doctors, but going beyond that is ignoring the good that's come from work like this.
There's also a history of people unlocking and altering settings in CPAP/BiPAP devices in response to data (many providers treat them as set and forget devices and don't bother reviewing logs except for initial patient compliance).
Perhaps this is aimed at non-American healthcare systems, but I have not seen a single report of American hospitals running out of ventilators, let alone BiPaP machines. In order for this to be a responsible hack — used under the guidance of medical professionals — we would need to have run out of both.
If anything, at least in the American context, I'm more worried about running out of the sedative necessary for ventilation.[1]
I have nothing against hardware hacking in non-pandemics. If you want to hack your own insulin pump or create epi-pens on your own (non-crisis) time, that's fine by me.
But I think the cost-benefit-risk analysis changes in pandemics, because people are too hungry for easy fixes and make ill-advised decisions under pressure. For example, even doctors (ostensibly medically-literate professionals) are prescribing themselves hydrochloroquine [2], which does not seem to be a miracle cure and sometimes, itself, dangerous (and also leaves lupus sufferers at risk of a disrupted supply chain).
> but I have not seen a single report of American hospitals running out of ventilators
Are you really not going to just google "USA ventilator shortage"?
Also BiPaP machines require the same hack as CPAP machines. And of course a further hack for invasive intubation (which ventilators can do out of the box), though you aren't going to do that to your nightstand CPAP machine either.
Anyways, rest assured that the few people who can be bothered to jailbreak their CPAP machine are not the same kind of people who drink their koi pond cleaner. I think this kind of fear about people hacking their gadgets is misplaced.
It also reeks of what I can only register as this weird "doc knows best" subservience to the medical system. This is probably the weirdest meme I see on HN. And, as people upstream point out, nobody out there is paying attention to your insulin pump or CPAP machine settings. They just leave it on whatever default setting. It's all entirely on you to do the research to improve things for you.
The search you propose doesn't rebut their comment. We're all aware of the concern about shortages. Their claim was different.
There are stories about NYT hospitals doubling up patients on ventilators, but those stories are explicit about the fact that those hospitals have not run out of vents, and are instead working out the protocols for sharing them when/if it becomes necessary.
To be clear, your position is that we should eschew self care so that we can bankrupt ourselves by only getting care from doctors, who as you note are either hoarding critical medicines for themselves or using wrong medicine for treatment?
I think it's irresponsible to not be donating our full talents as engineers to assisting those medical researchers in getting a head start on such developments. We have the ability to offload trivialities from those researchers like developing a firmware flashing process, so that they can focus on ensuring the reliable operation of such hacks.
The problem is that those talents are being used to solve totally wrong problems because of engineers going gung-ho and starting to "engineer" before they understand the subject. The problem is not lack of designs or ideas for ventilators.
This sort of hack still requires that someone makes those things at scale. That's a supply chain issue, same as taking an existing, proven and actually certified design and manufacturing it at scale. Hacking up a few CPAP machines really doesn't solve the problem when the hospitals need tens of thousands ...
Even if we ignore the legal and medical bits (only in an extreme emergency with no other options and where the alternative is an inevitable death would anyone even contemplate using something like this on a patient), this machine isn't really a ventilator suitable for people with failing lungs. Patients that have to be intubated and the machine actually breathes for them, filters, humidifies and warms the air, allows sucking of phlegm without spewing virus everywhere ... And those are the machines that are in short supply. This hack doesn't do anything from that.
And finally, it doesn't address the issue of having enough trained staff that will operate and supervise the ventilators - these things have to be supervised 24/7, sometimes for weeks. One ICU nurse is commonly supposed to handle up to 6 patients, tops. You can't just add ventilators without adding nurses, because if anything goes wrong, people will die - and where do you get those nurses from? Especially if they have to deal with a gizmo that isn't as failsafe as a real ventilator (because it wasn't meant to be)? If you need more staff to run fewer ventilators/beds, then you haven't really solved anything, have you?
And the lack of trained staff is not something a jailbreak or an Arduino can solve.
People should stop messing with building "ventilators" and focus on things where they can actually make a difference - e.g. the production of face masks, face shields and similar gear, which are in extremely short supply and don't require much sophistication to build. That would make a much bigger difference than pretending that we are somehow solving the lack of ventilators with hacked CPAP machines ...
In a scenario where people are certain to die if there is a lack of ventilators, I’m willing to take a lot of risk that they instead might die from an alternative course of treatment that doesn’t meet a normal standard of care.
If that means taking already made CPAP machines and modifying them, that’s in bounds as far as I can judge.
I actually have yet to hear any reports of improvised ventilators being used outside of ventilating multiple patients from a single ventilator. A big reason is that doctors and nurses simply aren't trained to use improvised devices in a way they can trust to be safe.
They describe such usages in the first sentence of the article. Mt. Sinai researchers are actively working on converting BiPAP machines into ventilators.
I mean, it's also irresponsible for societies to have fewer respiratory therapists and ventilators than are needed to support their patients, but here we are.
>It's irresponsible for non-medical researchers to not only pursue, but also disseminate, these jailbreaks.
The reason for the underbelly trend of certain types of people to not trust doctors and scientists is a lack of trust in the system (medical system, science system, etc). The root of this for some people can be tied to this exact condescending attitude towards people.
Nobody responds to being told something is a bad idea, they only respond to understanding why it could be a bad idea and being allowed to decide for themselves, and your attempt at preventing them from deciding in a way you don't like how they treat their own body only furthers the rift that powers essential oil huns.
Me personally, If my local hospitals are out of ventilators and i'm showing signs of URD i'm gonna hack my autoset with this firmware to get the higher pressures needed for peep therapy and not bother going in. There isn't anything you can do to stop me. I might even do it even if they aren't out, as i would be able to start therapy sooner and potentially heed off snowball effects from a lower blood oxygen level on my immune system.
Attitudes like yours create, feed, and recruit anti-vaxxers and essential oil huns, and harm that does, is far greater than somebody hacking their own cpap machine for whatever ends.
> A good portion of medical device RnD is related to creating technology that is hard to misuse and result in accidental death, and I just don't see that here.
The people relying on these hacks would be definitely dead without the hacks, that is the point. Even if the chances of this working successfully are only 10%, you just saved 10% of the patients compared to 0%.
From personal experience as a cognitive psychologist, I have found it prohibitively complicated (albeit possible) to implement randomly counterbalanced experiments in Qualtrics. Stimuli sampling and reaction time measurement are particularly hard to implement (unless they've added more functionality recently).
All three of these pieces of functionality are required for many common paradigms in experimental psychology.
Although the time to completion seems quite disparate between Europe and US, the difference isn't nearly as stark as it appears.
Nearly all Europeans enter PhD programs with a Master's degree in hand. At least in psychology (my discipline), US PhD programs will admit candidates directly from undergraduate. The overall time from bachelor's to PhD is similar when you account for these differences.
It also seems that Dropbox Plus somewhat recently gained "smart sync" capabilities, allowing for the storage of selected folders/files in the cloud only.
As a meta-recommendation, I suggest checking out Five Books [1]. It's a website dedicated to bringing in experts and having them suggest five books that best represent their given fields. The archive of interviews on Five Books covers all the topics listed above and more.
Once you start looking for positive and negative feedback loops in the world around you, it's hard to stop. In particular, Meadow's book is great because it also goes beyond +/- loops in isolation, and shows more complicated patterns, such as eroding goal patterns and traps that often cause public policy interventions to fail.
+1 from me. Can't stop either :) But I came to the same idea while reading "Feedback systems: an introduction for scientists and engineers" by Karl Johan Åström and Richard M. Murray.
+1 on Donella Meadows. I've recommended her work here a few times. I've always had an affinity for perceiving systems, but was pretty bad at expressing my thoughts. Donella's work was fantastic for providing definition to my thought patterns and improving the way I articulate and express myself.
+1 I just recently read this book and i was met with gem after gem. Also made me start looking at the world in terms of feedback loops, is it a balancing, goal-seeking or reinforcing feedback loop? How tight are these feedback loops? etc. Definitely a must read!
In my experience, it's generally the budget-strapped universities that choose to replace tenure-track professors with adjuncts.
On the other hand, private universities with very large endowments tend to be prestigious and part of maintaining this prestige means hiring tenure-track professors to teach undergraduates, mentor graduate students, and to do research.
A better alternative is to read review articles in journals. They are shorter than books and will also give a more reasonable estimate of the certainty experts have in a certain field of results. For example, in psychology there is the Annual Review of Psychology, which generally publishes ~50pg readable summaries of literature by experts in the field. For the love of social science, please stop reading popular books on the brain/mind.