Mbioguy
Any substantial change to the pay structure for physicians needs to address the cost of education and training, and not screw over a large cohort of physicians saddled with debt who see a massive pay cut. They will significantly oppose any attempted changes that don't address these two things.
Doctors in Europe are paid a good bit less than here in the US, but their education is paid for (and then some) by the state.
Frankly, this comment just sounds like you have an axe to grind with PAs. (Hence conflating MAs with PAs.)
PA is a Master's degree. They diagnose, treat, and prescribe. Unlike MDs, who are board-certified independent practitioners, PAs are not trained to work independently but as part of a team. In some cases that means they function as physician extenders, freeing up physicians to focus on more complicated cases. In other areas they focus on tasks delegated to them, for example central lines or other procedures, wound care. Some are used as First Assists in surgery, others are used for pre and postsurgical care, which helps surgeons do more surgeries. In any case, while the roles for physicians and PAs are much more similar, the condescension remains in your comment.
Punching down on MAs is inconceivably poor form. Punching down on PAs is still bad. Conflating the two gives away your game. You suggest harm... have any evidence to back this up?
Hint: you won't find any. There aren't a ton of studies, and quality could be better, but mid-levels (NPs and PAs) who stay within their roles have comparable outcomes to physician colleagues. How can this be, given the difference in training time? Easy. The roles are different. The subset of pts managed by PAs/NPs is different than MDs, because professionals consult and transfer care when appropriate. It's no different than a family practitioner or hospitalist consulting specialists. Nobody does everything, healthcare is a team effort.
Trash talking other professions, especially without evidence, is unprofessional.
A student confesses to their religious leaders that they have done some sin. Fine, go through the religious repentance process. That's how things normally work in other religions too. A religious leader doesn't have authority to academically punish someone. What doesn't normally happen, is that this info gets shared with a school authority that does. And then the school authority shares info with campus police, from where it can also go into state or federal databases.
Or it goes the other way, where info given to city police ends up in the hands of academic or religious folks who use it abusively.
A student like Madi Barney is assaulted, she goes to city police. City police share detailed info with campus police, who share it with title ix and honor code office, who share it with religious authorities. She was not the assaulter, she was the victim. Yet, because a part of the police report includes a history of some breaking of the honor code, even though as in my original response predators manipulate folks into doing this, she ends up being investigated and punished academically and religiously. City PD ends up functionally an investigation and enforcement arm of academic and religious authorities. That is ABSOLUTELY institutional abuse of power.
I didn't share much of my personal experiences, just enough to rebut the claim that religious attendance is not mandatory, that was the purpose of paragraphs 1-2 so I don't know what you are going on about. The rest of the response was what detailed the abusive system.
I didn't even touch on how this is used against LGBT students.
If you attend BYU as an LDS member, you need to maintain an ecclesiastical endorsement. Part of this includes paying tithing and attending at least some services. If you do not maintain your ecclesiastical endorsement, you can have a hold put on your account to where you can't register for additional classes, graduate, and possibly can't even apply for a transcript. In short, they can keep you from transferring schools unless you are willing to start from scratch, in order to get you to comply. Yes, that is mandatory religious worship, just with extra steps between point a and c. I should know. I attended BYU within the last decade and stopped believing at that time. You are not free to cease being a practicing LDS member. As it is a private school, I would have been fine had they simply asked me to pay the non-member tuition, or requested that I transfer schools. Instead they held my transcript as punishment. I had to grovel and go through a family friend to get an ecclesiastical endorsement to get a transcript. What rubbish. Surely you would be upset if Notre Dame treated a student who converted from Catholicism to Mormonism similarly?
The Honor Code Office has a whole history rife with abuse. In 2015, student Madi Barney was raped. She reported this to Provo police. She was placed under investigation by the Honor Code Office and was barred for a time from enrolling in classes. Unlike previous victims of this institutional abuse, she fought back and went public, ultimately forcing the Title IX office to formally separate from the Honor Code office. Previously information had been shared freely between the two.
https://archive.sltrib.com/article.php?id=4732048&itype=CMSI...
And it's not just the Honor Code Office and the Title IX office. BYU's campus police department was and is complicit in the institutional abuse of authority wielded to keep students in line. Earlier this year the BYU police department was sanctioned in a move to decertify the entire police department. This happened because they failed to investigate misconduct where campus officers were accessing and sharing information using external police databases.
https://www.sltrib.com/news/politics/2019/02/26/utah-moves-d...
In my own personal experience, I and friends disclosed information to religious leaders, which was subsequently disclosed to the honor code office and used to justify academic probation and punishment. Yes, this was absolutely a blatant violation of priest-penitent confidentiality.
Think about that for a minute. Think about the sharing of information between religious authorities, school's honor code office, title IX office, campus police, and external law enforcement. All in a direct line. Institutional abuse of power and crossing lines that should not be crossed.
The social implications of student body awareness that the Honor Code can be used against you as a student, has been taken advantage of by predators. During my time on campus, talking with victims of sexual assault, the following was explained to me. Would-be predators would attempt to target individuals, like women or closeted gay men, and manipulate them into breaking the honor code in some manner. And have a recording of this. And then assault them or attempt to coerce them. If the victim then went to the police, the campus would become aware that they had previously broken the Honor Code and would have action taken against them. This was used to try to silence victims and prevent them from turning to the authorities for help. And you know what? It worked in a number of cases I personally knew of, allowing predators to victimize multiple individuals before being stopped.
I'm no longer a believer, but reading this comment, I assume you are. Is this how you believe Jesus would want his church, and a school supposedly run in his name, behaving?
Proudhon early on imagined a world without capitalist ownership, but with a free market. He expounded the idea of Mutualism, building from earlier writers like John Gray. This libertarian-socialist vision has little in common with either the state socialism of the USSR, or the internationally-corporate world we live in today. Socialism as social ownership of the means of production, either by workers (agricultural or factory coops), communities (in our time, municipal fiber), or users/consumers (credit unions are a descendant of mutualist credit systems).
Later socialists argued over the recompense owed to individual labor vs the community as a whole (Bakunin v Marx), over the methods to reach their aims (through socialist parties, or revolution and establishment of a proletarian state, or through direct expropriation as the syndicalists and anarchocommunists did in Spain).
Later writers and revolutionists fought against imperialism, against racism and apartheid, for feminism and LGBT rights, and now for the rights of animals and the environment.
We have always allowed some few to take the lion's share of our collective efforts. To run our mutual efforts like their private fiefdoms. We tolerate in privately-held companies what we never would in public democracy.
And now, now that the world has been globalized and new markets exhausted, they look to privatize our public lands, our schools, prisons, thoroughfares, and every other system held in common.
Programmers are waking up to their exploitation. There is more talk of forming coops and unionizing than I have ever heard. However, I hope you all (and we) keep in mind that our affluence, now or future, also rests on the inherited exploitation of others in our past and around the world. Let's not be like the white American socialists who were exclusionary towards others' struggles (and whose efforts were broken when the capitalists brought in those they excluded as scabs). Let's not repeat the mistakes of the past. But to do that, we need to know them.
As other responders have pointed out, brains are just one possible substrate for intelligence. We can't account for other systems (biological or otherwise) that could lead to the development of intelligence, so of necessity any probability estimate based on us has to be a lower bound of possibility.
One bit of our earth history that is worth noting is that the conditions when life presumably arose are hostile to multicellular life as we know it. Earth's early oceans were hot, anoxic and reducing, and under heavy pressure from far thicker atmospheres. The great oxidation event essentially turned earth's atmosphere into a bacterial waste dump, the waste being oxygen produced by early cyanobacteria. Life had to evolve ways to cope with oxygen or learn to hide. This is still true of our own cells. While we need oxygen to survive, it is still and will always be toxic. Free radical damage such as from reactive oxygen species is a constant threat, and is the ultimate form of irrecoverable information death when we die.
Might it be that the conditions under which life can arise, and under which intelligent life can arise, are different? We got lucky that earth traversed from the first to the second. Add this to the list of a million things that had to go right for us to exist at all. The same might well be true of any other intelligences out there. And the odds of two arising close enough in time and space to contact each other would be far less common than lonely civilizations looking out into the dark.
This is disgusting to see at the top of the comment thread. Anyone who upvoted that comment needs to engage in some serious introspection.
This tactic, of identifying a problem that may have some real validity, but then making logical leaps into absurdity, is typical of postmodern types like Bannon. How exactly does war solve the problem identified? Who are we to watch against?
It's not always about the words that are said. There's a subtext or more than one. The given justification isn't always the real justification, it just has to be plausible enough to get the real message out, seen in that last line. The overton window opens, and those on the sidelines who might have kept similar thoughts to themselves can now be drawn in and engaged. And that last sentence creeps closer to becoming real.
Oppose these ideas and these tactics, HN.
/s
Proof by contradiction, mate. It's not impossible, just hard. There's plenty of things that once we're said to be impossible, and the data agreed... until they happened. Everything had to have had a first time.
Hacker News, come on. You're better than this.
Taking it from the top: The obvious take is that the new tools this is referring to is EMR and things like Watson. Will return to this in a moment.
Subjective and objective data both a play a role in medicine. The eye of an experienced person can often see in a blink what would be missed by someone looking only at numbers in a chart. Gestalt, or the fast system of Kahneman, is invaluable when time is a serious concern. But noone starts out that way. The slower, methodical plod of consciously using bayesian thinking is how the art is learned. Hear hoofbeats, think horses, not zebras... trying to weigh all available data and attempting to chart a course that gives patients the best outcomes at the most reasonable costs. Nowadays additional hoops must be jumped through: laws constrain, institutions have policies that must be followed, and most of all care is dictated by what is allowed by the insurance company. Rather than an invisible hand, this is an invisible supervisor robbing much autonomy and initiative from a sense of worthwhile work. Furthermore the ever-present fear of litigation pushes towards a course with more testing than might be suggested by treatment and diagnosis alone: how would this course be defended if things go wrong, as they will for a certain number? All of these things individually stood to reason, but we as a society must keep in mind the cumulative weight of it all. Emergent phenomena isn't just a thing of programs and physics, it's a thing of human systems like healthcare.
Back to the article. A happy picture is painted of modern CT scans, yet it neglects the downsides. In 1980 the average per capita dose of radiation was 3.0 mSv, with 0.5 coming from medical imaging. It is now 5.5 mSv and rising, with medical imaging alone exceeding 3.0 mSv. Medical imaging is now a larger source of ionizing radiation than all other sources combined, with particularly high risks for those in utero or pediatrics. Like any other test or treatment, there is a risk/reward ratio. As technology improves, it is more likely to be adopted, not because earlier physicians were anti-technology Luddites, but because the improved technology changed that risk/reward ratio. We are more likely to use imaging with less exposure, or better yet use a modality without that risk.
Back to the Bayesian part of thinking... testing isn't perfect. I'd love to see a test that is 100% sensitive and 100% specific. But there are inevitably false positives and false negatives. Tools and tests need to be used in an appropriate situation. For example: I have a test that is 99% sensitive. Great! It'll catch someone with the disease, 99% of the time. So I can thoughtlessly order tests and thoughtlessly obey the results, right? Wrong. What happens if you use it to test for a rare disease that only 0.1% of the population will have? It depends on how specific the test is. How many false positives does it let in? If I test it on 1,000 folks indiscriminately, I'll end up with a basket of folks, only one of which actually has the disease. How many false positives got treated (and possibly harmed by that treatment)? Mammograms work this way (which have fallen a little out of favor in younger demographics without risk factors like the BRCAs), necessitating imaging and invasive biopsies that, upon further collection of data and review, seem not worthwhile for those under 40 and of questionable value under 50.
Tools are great! They need to be used appropriately though. Things have a cost, not just financial but physical and temporal. Indiscriminate use of tests and tools is the last thing anyone should want.
Nothing to add in a world of advancing technology? Bah. Most would love for its promises to come to fruition. EMR for example. We were promised time savings, with cross-talk between systems for better availability of data and improved patient safety. Mostly what has happened is administrators now have data used to push docs to see more and more patients (and spend less and less time with any one of them), all the while the paperwork stacks up. Somehow the paperwork never quite seemed to go away.
Maybe doctors don't reject tools that make their jobs easier. The article is full of tools that were eventually adopted, after all. I can point to many in development that have their ardent advocates, like point-of-care ultrasound among many others. Maybe they don't like tools that were sold as making their jobs easier but mostly don't, and instead benefit insurance companies and conglomerate administrators.
https://old.reddit.com/r/askscience/comments/7kq5r4/what_det...
Whatever counting method you are using and whatever reporting method you are using, it needs to be verifiable. I still can't believe we had ballots from 2016 that were destroyed after brin subpoenaed, without any consequence for those who had charge of their possession and safety.
Media is hyping the fear of 'election hacking' to the point where people I know personally want everything to be done manually, no machine or computer involvement at all.
The problem is that an individual ballot in RCV if counted manually, needs to be counted several times if the vote ends up switching to the 2nd, 3rd, or fourth choice etc. As the number of total votes increases from the thousands to hundreds of thousands (or even millions), this can cause a pseudo-exponential growth in the amount of counting labor performed. Large municipalities that have trialed RCV have forged ahead with manual counts and succeeded despite the increased effort, but it has sometimes taken days to report results. That's only after massive amounts of labor from volunteers.
Going statewide with manual-only counts of paper ballots (no optical scanning or other machine-assisted counting) makes RCV or other methods of determining winner much more difficult because of the labor or cost involved.
It should be clear that I quite like RCV, but this is a factor to consider.
I am all for having a paper trail, mandatory audits, and secure infrastructure. I agree with those who thing the current private sector systems for voting have huge issues. What I don't understand is what I see as media pushing a false choice between paper or digital.
Estonia has been using e-voting alongside paper ballots for years without serious issues. (Of course, they have national ID and have digitized a lot of their gov't functions, so maybe this is a special case.)
https://www.newyorker.com/magazine/2017/12/18/estonia-the-di...
There are a lot of ways to improve our elections, from social engineering (France's media blackout a few days before elections, moving voting day to the weekend, making it multiple days, or just using the mail system) to improved systems like Scantegrity or increased use of optical scanning.
https://en.wikipedia.org/wiki/Scantegrity
The cynic in me fears this is a push designed to make it harder for us to use things like RCV and entrench FPTP.
https://www.youtube.com/watch?v=c-4xOe79epU&list=PL3MozITKTz...
https://www.youtube.com/watch?v=QzBoDe3PgAc&list=PL3MozITKTz...
Glutanimate has taken Anki to a whole new level. He created a painless UI for occluding any part of an image and making Anki flashcards out of it (Image Occlusion Enhanced). I used it to efficiently create and memorize thousands of anatomy flashcards. Ordered lists can be a real pain to memorize, but when not missing steps is crucial (as it is for medical OSCEs), Cloze Overlapper has worked very well.
Anki lets you share your decks with others, and medical students have collaboratively created very high quality study decks for studying for the various STEP exams.
To be honest, I was always a fairly mediocre student. Big-picture concepts and figuring things out on the fly, no prob. But I've always struggled to nail down bits of information long-term or learn sequential information, meaning calc and ochem required inordinate amounts of time. No longer the case. Spaced repetition plus visual/text/auditory learning is a recipe for success.
The possibilities here should not be underestimated. Folks on Hacker News have talked about the value of information commons, and this right here is the next best example behind Wikipedia I have ever encountered. While quality collaborative decks exist for things like medical school, learning languages, and more, none exist specifically for the program I am in (PA school). I am currently creating my own with the goal of it being the core of a quality collaborative deck. I am using Gephi to spatially organize concept maps for diagnoses complete with incidence and strength of associations, when such information is available. I then export these maps to Anki, use Visual Occlusion Enhanced to block out the information I want to recall, and voila: time-efficient first-time learning and long-term retention.
https://www.sciencedirect.com/science/article/pii/S016953470...
https://www.politico.com/agenda/story/2017/09/13/food-nutrie...
2. I'm very interested to know the answer to your second point myself. As displayed in figure 2, it looks like it wasn't exactly simultaneous or equal in magnitude everywhere. It does look like most geographic clusters did see something of a drop, at some point. Eyeballing it, it appears that the near-East and the Caucasus had the relatively most-significant drop. The African cluster appears to have had a more modest drop and at a later date. However, I wouldn't rely too heavily on trying to read more into the figures than the authors did (and as I just tried to do).
I suspect the resolving power their data sample gave them was insufficient to resolve your question. While it was enough to demonstrate the existence of such a drop, I would be skeptical of its power to demonstrate the relative severity or timing between each geographical cluster. (If I was the author, this finding would be begging for more grant money to do exactly that: gather more data and nail down exactly how much, when, and where the Y diversity was lost.)
Final point: it's not necessary to assume everyday life was brutal or violent. I'm not an anthropologist, so take my reference to Napoleon Chagnon with a grain of salt. The Amazonian Yanomamo people he lived among had high rates of violent death compared to other causes of death, yet everyday life was peaceful. Most of the bloodshed and conflict he documented occurred over very few days in quick moments. When a population is low, it doesn't take much to move the % up a lot.
Whatever caused the drop in Y diversity, if it happened over several thousand years, the yearly attrition rate could have been very low also.
Here's the original article that caused such a stir in 2015. Figure 2 shows the sudden drop in the reproducing Y-population globally (meaning it cannot be explained by genes or migration).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381518/
The paper cited in the article alters the date of the event, but really there's a lot of uncertainty remaining.
https://www.nature.com/articles/s41467-018-04375-6
The best current hypothesis to explain this drop (and that no similar one occurred for the reproducing X-population) is the conflict between predominantly agricultural societies versus predominantly hunter-gatherer societies. Until sufficient evidence has been found to rule out this or alternatives, take any explanation with a grain of salt.
Look at Figure 2, and you'll notice the Y-axis are different. Between 50-10kya, the effective reproductive population was 3-4 times larger for women than men, globally. This fits with modern anthropological evidence of polygyny in early hunter-gatherer cultures (loose polygyny with on average 3-4 wives per successful male over a lifetime, but with limited ability to enforce fidelity). Y chromosome diversity tends to accumulate, albeit at a lower rate than the X.
An agricultural community is likely to be much more homogenous in terms of Y-chromosomes, than a hunter-gatherer one. Power is much more effectively concentrated in these communities, allowing leaders to amass more wives and enforce fidelity much more strictly than in hunter-gatherer societies. Stories of King Solomon's wives, or Sultan Moulay Ismail of Morocco (who reportedly sired hundreds of children) are an easy way to visualize this.
While man-for-man, a hunter-gatherer may be healthier and stronger, a hunter-gatherer society may find themselves vastly outnumbered by an agricultural community. Over time, hunter-gatherers would find themselves pushed off of prime land onto marginal land. The newer article mentions a founder effect. Where are these Neolithic pioneers coming from and where are they going to? From agricultural communities, expanding into territory previously held by hunter-gatherers. While certainly many deaths occurred due to combat, Y-chromosomal diversity loss also would have occurred to disease and famine. The agricultural population would continue to rise, while the hunter-gatherers would struggle to maintain on more marginal land. History is replete with stories of taking women, so if this scenario is the best explanation, it is unsurprising that there was not a corresponding drop in X-diversity.
This sort of scenario occurred globally. Agriculture independently arose in many places: the near-east, sub-saharan Africa, China, Mexico, the Andes, and possibly others. We've seen what happened to the Americas after Columbus. Similar mechanisms help explain the population-level Y-cide on smaller scales that probably occurred during each of the agricultural expansions above.
This hypothesis, while probably the most widely-accepted at present, is challenged by some of the evidence in the newer paper. It will be interesting to see how it falls out once the original authors have a chance to respond or additional voices join the conversation.
Compare to slavery. Obviously Southern slaveowners bear responsibility. But were non-slaveowners, Northerners, etc free of the taint? No. Ulysses S. Grant married into a slaveowning family and for years was supported by them. Northern factory owners turned profits off the products of slavery. Regular northerners purchased products produced by the system of slavery. Sure, some are more responsible than others, but the whole country from North to South bore the taint of slavery. Individuals giving up slaves didn't end slavery. Raising awareness of slavery's evil to the point where it hit critical mass, and then using power to force slaveholders to cease, that's how it ended.
This article is a member of the 9.9% speaking to others of the 9.9%, telling them they cannot absolve themselves; that they cannot expect to escape without consequence if the world turns again, as it has in the past.
In my mind the only question left to be addressed is how the power will be wielded. Will it be a politicolegal revolution or a violent one?
Consider brown bears and polar bears. We consider them 2 species yet they can successfully interbreed. The main reason they don't is that their ranges haven't historically overlapped. Geography, not biology, was the separator. You could view them as one species with a bivariate distribution, in the late stages of diverging into two.
Canids likewise viewed as one species with significant ecological clustering, but divided this time by behavior.
Think of Ethereum as a very slow decentralized computer. People make mistakes building applications all the time, but this doesn't necessarily mean the underlying language, or for a better comparison, the compiler is at fault. Problems with the underlying language can cause problems with applications, obviously. Programmer error =/= language/compiler error, while both can occur.
People have been talking about the Parity hack like it's Ethereum's fault. Imo that's as absurd as blaming C for your program crashing to your coding error.
Your post, while you are confusing two types of errors, isn't completely off. Solidity does need improving. Any language has to pick tradeoffs, and evolves over time as it becomes apparent what the system's needs are. But Ethereum and Solidity aren't to blame for most of the ETH-based apps that rushed to market without an appropriate level of QA and review, cut corners, made mistakes, and caused catastrophic problems for their users like the Parity bug... this should be ringing bells, folks.