We have a super-robust set of tools for this for fiction; I'm still chewing through the list generated by 'all Pulitzer prizes for fiction written during my lifetime' - and all of them have been quite good. ('the Orphan Master's Son' so far has been my least favorite, though it was still really quite good. And because these were chosen /at the time/ you get a glimpse into what people were thinking at the time. Mailer's "The Executioner's Song" was a wonderful book in it's own right, but I think was also a historical slice of 'the discourse' at the time.)
For Movies, I find that Ebert aligns a lot with my taste. If he says it's good, it's really good. I mean, that doesn't help with recent movies, but there's more than enough of the old good stuff. (There's a lot to be said for consuming old media; it gives it time for critical opinion to stabilize. )
I mean, of course, all of these methods will leave out a lot of really good stuff. But... that's kind of the point; there's way more media than I can consume. There are professional reviewers that can give you more really good media than you could consume in a reasonable lifetime. I'm not quite halfway through the 'Pulitzer prizes awarded in my lifetime' list, and I've started a few years back. (I mean, I was 40 or so by the time I started, and so I had read a few of the books just 'cause they were popular books that people recommend. McCarthy's "The Road" is exactly the sort of thing I like, so I read it before on another person's recommendation. But still, like, you see some really great work outside your genre; I'm not normally a romance novel kinda guy, but Lurie's "Foreign Affairs" was absolutely beautiful, and absolutely not a thing I would have read without this project.)
I haven't completely solved the problem for technical books, just 'cause people who have good up to date knowledge of an area have often built up that knowledge over time. they read some books but those books are long out of date, they've brought their skills up to date with mailing lists, which they then vet based on their knowledge of the reputation of the person posting.
I mean, I think it's pretty easy for the non-perishables, "The C Programming Language" is a thing you should read if you work with computers. But which tomb on docker is up to date enough and pretty good? that can be a difficult question to answer, and is often answered based on the author's reputation for other technical work they do, which usually tells me something about the accuracy of the book, but doesn't tell me if it's well written or if it's up to date enough. (On the other hand, if you are well known for writing a big part of the subsystem I wanna learn, eh, I don't feel too bad about giving you money for a book even if I later decide that the book is not written in a way I find engaging, like, you earned it and I'll buy another book.) And... I dunno. often you can get sample chapters, and that gets you a pretty good idea of how engaging the writing is.
I mean, one way to address it is to start at the base... "go read the gang of four design patterns books, and then use your knowledge of object orientedness to make sense of modern object-oriented configuration management systems" - which does make some sense. But still, I should spend the time to find the tech book awards that match up with my taste.
Eh, I don't really care about 'edgy' but it bothers me that so many projects, especially when those projects are computer commands, are hard to search on. Like, ss or ip. I mean, in those cases, they're central enough to my world (I'm a sysadmin) that it's worth just memorizing to the point where I rarely need to look it up, but looking up an 'ip' command is way harder than looking up an 'ifconfig' command. Not everyone writes "Iproute" before pasting their 'ip' command.
I mean, I think it's less of a problem for projects that are not commands... really my whole complaint is that a lot of the commands in my universe used to be super unique; you aren't going to get a lot of off the wall results for lsof or ifconfig; but ss and ip? yeah, even when you limit it to my work context, you get conflicts on those.
I'm not the best at this Linux foo, but wouldn't aliasing certain commands that you need be helpful?
I mean if your going to go through the hassle of looking up that certain command, might as well make it easier on future you to alias that foo while you have it fresh in you mind.
for me, devices of different sizes do different things; I carry a lot of specialized devices, from a small laptop to a giant e reader to a regular sized ereader to a cellphone to a watch, and for me? the thing that is currently missing is a thing I can input text on with one hand (while doing something with the other hand) the SE original filled that gap; the iphone 7 is slightly too large to comfortably input text with using one hand, it's a little cramped to input text with two, at least for my hands.)
I should try one of those pop-out deals and see if it makes using the iphone 7 with one hand practical.
> The continued gains in productivity we have seen since that time have come by way of mechanization/automation.
but that has been true since the first chimp figured out how to shove a stick into an anthill and get more tasty bugs than just picking off the ants on the surface. We use tools, better tools are how productivity advances.
Yes, yes, we have better tools than ever before, to the point where they don't look like tools. We can build a machine to do a thing and then leave, and only come back and tinker with it when it breaks.
Some time in the previous century basically everything switched over to assembly-line type production, where nobody built the whole widget themselves. the current switchover is to, uh, I guess you would call them robots. Tools that do the thing with one time input to guide them (and, of course, lots of ongoing maintenance)
But make no mistake, these "robots" we have are still just tools; tools that give massive leverage to the labor that programs those robots and that maintains those robots.
I think a lot of it is politics and labor leverage and education. after the new deal and the second world war and the GI bill, a lot of our workers had free education. We had a serious safety net for the time and a very progressive tax system with very high top marginal rates to pay for it. and lots of unions. All things that give workers more negotiation power.
dunno, I kinda think that the right actions at the right time can [could have] make a huge difference. I think that if the rest of the country shut down the way CA and NY did... we'd have a real chance at this thing being a month-long crisis. (Of course, the real test here is how bad it ends up getting in CA; California shut down earlier in it's spread than NY. If I'm right, that means the peak won't be as bad here... but that is yet to be seen.)
I also think the cuts to the county health department are... normally mitigated by an ample federal response.
What makes you think this could ever be a one month thing? A Belgian hospital did an experiment and tested everyone coming in with no COVID-19 symptoms (broken legs etc.). They found 8% of those were carrying and spreading the virus and were completely unaware of it.
Why are people praising NY when the city is totally fucked and they've already run out of beds? Chicago seems to be doing better than SF, LA, or NYC right now...
Yeah, I'm personally not too concerned with the "stuff" end of things. This is America; in spite of rhetoric to the contrary, we remain a manufacturing powerhouse. Apply enough money and we'll get whatever "stuff" we need on pretty short order.
I think the big problem is medical technicians and doctors. My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at. Perhaps the military could provide medical technicians the fastest? lots of healthy young people who are trained in the use of serious PPE? (I wonder how the procedures differ between nuclear, chemical and biological threats like these?)
People talk about beds... but the problem isn't physical beds. I could make you a physical bed. the problem is doctor and medical technician labor to make the bed useful.
The problem is threefold. We need: 1. ventilators 2. PPE 3. healthcare personnel (respiratory therapists). In the short term we should train existing doctors, physician assistants, and nurse practitioners in respiratory therapy ASAP. But without PPE they put themselves at risk, and without ventilators the patient may die anyway.
We need all three, and there's a worldwide shortage. That is the bottleneck.
I'm not questioning the need. I'm just saying that it seems to me a lot more realistic that we'll be able to short-term ramp-up production of 1 and 2 than it is to think we'll be able to adequately ramp up 3.
The stories I hear from medical people I know (and this is just anecdotal) is that they are only given serious PPE when they know there is an infection, but it's less clear if that's just standard policy or if that is due to limited supply.
I do agree that if PPE isn't used early and often here, we're going to be short medical personnel, and I think getting those back online is probably going to take longer than throwing money at manufacturers to build more PAPRs.
It’s not that we’re bad at training medical personnel. It’s that the AMA acts as a cartel to limit the number of physicians train to keep income high. We just need to allow more people into medical schools and make more residencies available.
Certificates of Need were something _hospitals_ themselves lobbied for. It's a case of "this is awesome when it protects me, and an aberration when I'm on the losing end".
Certainly politicians enacted such things, but I'm not losing sleep over the hospitals. Only us mortals, stuck with the cost of the system.
Yeah, remove the limiter, and how long does it take to make a doctor? I mean, sure, some people are saying that this thing is still gonna be here in four years (I am not a medical person, but that's what some of them say. something about the type of virus this is that will make a vaccine difficult) so that might not be a bad idea, but... I think we probably need to be focusing on how we can increase medical capacity four weeks from now more than four years from now.
the disrespect for sleep the medical profession has is insane.
If someone is gonna be cutting on me, I want them to have a good night's rest. They tell me to sleep consistently and well quite often. seems like if it's good for me it would be good for them, too.
We should cut about $50-100B out of the military budget and make it for training medical personnel without raising tuition because it doesn't matter if there's no population to defend or recruit from.
It's easy if we are willing to cut red tape and willing to prioritize people over pets. Veterinarians need almost no training to do the job. Test runs done for emergency preparation have proven that veterinarians do a better job than all medical professionals who aren't already specialized in respiratory care.
>Test runs done for emergency preparation have proven that veterinarians do a better job than all medical professionals who aren't already specialized in respiratory care.
> Yeah, remove the limiter, and how long does it take to make a doctor?
Undergraduate entry medical degrees in Ireland are either five or six years with summers off and ample other holidays. Post graduate is four years like the US but pre-med doesn’t exist. You have to learn the necessary content yourself ahead of time and if you fail the exams that’s your problem. You can get in with a degree with no science content whatsoever as long as you have high enough grades in your Bachelor’s. I believe during WWII the US ran some schools at three semesters a year so people were done in two years, eight months. A newly graduated doctor then has residency, a year of 60-100 hour weeks of on the job training. If some of the generalist training was cut you might be able to get someone able to do routine medical care in their specialty, like a nurse practitioner in three years.
The problem with this is that until we have better means to train people without exposing them to real situations, increasing the number without lowering the overall skill level is an incredibly hard problem.
No, but there is a sufficiently large number of problems that relatively few people suffer from that even with people specialising there are plenty of problems where getting people to a point where they are competent enough to participate in operations on real people, and then get them enough experience to be able to do it unsupervised is a challenge.
We can specialize more, but that has its own problems in terms of e.g. availability to deal with urgent cases. And ultimately we do not get away from the fact that giving enough people enough experience even with relatively rare situations is a big challenge.
Eventually we will be able to simulate the situations well enough, and this problem will go away, but it simply is not as simple as throwing more bodies at it.
Training people to respond to this one situation so that they can respond to this one situation is fine. After covid19 is resolved they wont be needed anyway.
You do your 4 year undergrad and at your first job, no one trusts you. Your supervisor/senior engineer checks Everything you do. You are reserved for paperwork and unskilled manual labor which is also checked. After a few years (4) you get some Freedom, but still checked by your seniors. Anything important, even when you are a senior engineer goes through your Managers and directors.
I don't see why this system wouldn't work in medical. We build airbags and bridges. Both safety critical.
I would even say having 1 physician is more dangerous than having a team of Engineers with less Schooling.
When choosing a primary physician at one of the San Francisco Kaiser Permanente campuses, I noticed that a substantial number of doctors had overseas medical training. Which was fine by me--I'm an enthusiastic Kaiser member and support their cost management strategies--but I found it interesting.
> So they're now using a mixed strategy of both out-sourcing and in-sourcing medical training to address high costs.
Not as much as they could though - there are still federal caps on the number of fellowship seats available as well as pretty strong restrictions for physicians coming from overseas (although if I recall correctly, California has less stringent restrictions than most)
We discuss insurance as a big part of the cost problem, but regulatory capture on the supply end is another huge (and unnecessary) factor.
You don't need full MDs for respiratory therapy, or for many medical treatments. PAs and RNs can do a lot, and it's far easier and less expensive to attain those certifications than full MD.
Doctors wouldn't let either of those things happen because it would lower their salary. The AMA is a powerful lobbying association, no way any law that lowers doctor salary would pass.
Lobbying power can be confronted by other considerable lobbying interests. Large healthcare conglomerates would seem to have considerable interest in reducing labor costs.
A crisis like this would be the perfect opportunity to fix some of these supply side issues. Lobbying is less effective when voters are paying attention and the government is in crisis-response mode.
There are two extra years of classes for med students, at which point they begin doing rotations through all the different specialties. During rotations, they are essentially “reserved for paperwork and unskilled labor which is also checked.”
This process continues in intern year and residency, during which time they gradually build competency and trust.
Much of medicine in the US is delivered by nurses, who have a training regime even more similar to what you suggest.
Categorically false for modern medical school. My daughter started rotations almost immediately, alternating with classes every couple of months throughout. She rarely did 'paperwork' (computers), had close patient contact immediately and was doing procedures almost from the start, under close supervision. Her final rotations had her in the operating room, handling her own patients from triage to discharge, doing night shifts etc along with a resident.
Things have changed rapidly in medical education. At least some places.
More medical personel would be great. Another option would be to train contact tracers, much easier to train than medical personel. That is one of the reasons for Singapore's success, I belive. https://www.bbc.com/news/world-asia-51866102
My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at
Or just lock down nationally now, including full lockdown in major cities, and none of this will be necessary. The only reason this is going to get out of control in the US is the lack of testing and the lack of controls being imposed.
By the time they are imposed, it will be too late and more people are going to die because of that.
I wish this was true, but from all appearances the medical infrastructure is not scaling up at a reasonable pace... i.e.
> The Trump administration has not yet formally asked GM to use its network of plants and suppliers to make any medical equipment, the person said. (From the Article)
> Tesla makes cars with sophisticated hvac systems. SpaceX makes spacecraft with life support systems. Ventilators are not difficult, but cannot be produced instantly. Which hospitals have these shortages you speak of right now? (From twitter 9 hours ago https://twitter.com/elonmusk/status/1240492347835604992)
We cannot just lockdown and “none of this is necessary.” There is no scenario short of locking down for 10 years that would be able to manage with the number of critical beds we actually have. We need to dramatically upscale capacity (which means training new doctors) and quarantine.
You're forgetting the development of a vaccine. With enough time (10 years is way more than enough), a vaccine will be developed and deployed, and that capacity won't be needed because far fewer people will contract the disease and develop symptoms requiring hospitalization.
The problem is, developing and testing a vaccine takes some time. How much time do we have before the global economy totally collapses?
> With enough time (10 years is way more than enough), a vaccine will be developed and deployed
Based on what? It’s been more than 10 since SARS and we still don’t have a vaccine. I think you’re making a lot of assumptions about immunization when it is far, far too early to know. Also, the point is that we don’t want to be quarantined for 10 years, we want to build the capacity now.
They probably never developed a SARS vaccine because it didn't turn into a major worldwide pandemic. There's lots of diseases that don't have vaccines mainly because it's seen as not worth the effort or cost. SARS and MERS looked scary at first but never got this big.
As an addition here, look at Ebola. It was perfectly feasible to create a vaccine, but no one bothered as long as it was confined to Africa. As soon as white people in western nations started getting it, then suddenly there was a huge effort to create a vaccine.
I mean, sure, we should lock down now, but my feeling is that it's mostly too late for the urban areas.
The rural areas might have a chance... they need to lock down hard right now. But... from talking to rural family... I'm not sure that's culturally possible.
No this isn't true. The competition to get any residency slot is insanely difficult. There are people who graduate from medical school that apply to hundreds of residencies every year and still don't get anything.
There are more residency spots than med school grads. If a grad doesn't match its because they didn't list undesirable programs, not because all the slots filled.
so wait, is it OK to use masks now? last time I went out with a mask I got chewed out by a clerk. It was... deeply weird. (I mean, I understand the guy had probably had a hellish day and that probably had more to do with it than anything, and I apologized and did what I could to diffuse the situation. But it was deeply weird, 'cause normally the economic inequality here in the bay area means that I'm treated really well.)
When was this? Last week Trump said this was overblown; yesterday he said he was ringing alarm bells before anyone else. Seems like a lot of tunes have changed in just the last few days.
Also I'm curious what did this person say to you? Seems like a weird thing to get upset about for any reason.
This was the day before the shelter in place order was announced. The guy was going on under his breath about how people don't know how this thing was transmitted, that you aren't supposed to wear them if you aren't sick. He said it in this really sort of stressed out and angry kinda way. I apologized in what I hope was a really sincere kind of way
(I mean, I... am not going to be angry at someone who works retail at a time like this, short of maybe getting physically attacked. I know I'm feeling bad 'cause I am working from home and have to deal with my own lack of discipline and have to cook for myself now. I have top-shelf medical insurance and unlimited sick time. I can only imagine that those on the front lines, getting sneezed on all day with none of those benefits are in bad shape.)
Dude said "It's not your fault, it's the media" and generally seemed mollified - I mean, if this were facebook, I'd fire back something about how I don't see how his media is any more accurate than mine, considering neither of us are experts... and if you are supposed to wear a mask if you are sick, well, almost none of us actually know if we are sick. But this was a face to face interaction, so I sincerely wished him good health and finished the paperwork (before quarantine, I'd use 'order online, pick up in store' orders to minimize time in store)
I'm one of those people who lacks the discipline. I live with someone who works remote full time, and they have that discipline, and are in fact way more productive working from home. But me? I have no problem doing well in the office, but all the full work from home jobs I've had? I've been a miserable failure. I'm worried 'cause my performance is going to drop a lot right as we head into the third recession of my career.
It really varies by personality. Some people do a lot better by themselves. But if you hire me? It's worth paying for the office space.
It's an interesting question. Urban areas, it would seem, are likely to get the spread a lot faster, but they also have way better medical infrastructure. It will spread slower in rural areas, but you have way fewer hospital beds, and less medical infrastructure in general.
The US's rural healthcare is really bad. I was in a very rural part of Ohio recently and was listening to people talk about how they really only have an urgent care facility nearby but the closest hospital is a decent bit away. Even then they talked about how it wasn't a good hospital and recounted horror stories of friends/family and how they always go to a further/different hospital because they don't get good care at the closer one (which again, is not that close).
I live (urban/suburban) in spitting distance of 3-4+ hospitals (I don't even know for sure) with at least 2 of those being ones I would trust my life to in a heartbeat (the others I just don't know enough about). I was really unaware of the disconnect before that trip and it didn't really occur to me that hospital != hospital. So not only do some rural location have limited or no hospitals but they don't trust the ones they do have.
It also doesn't help that Trump is still keeping up his cult rallies and still has one scheduled next week.
The current White House is essentially the worst case scenario in dealing with this outbreak and is going to get people killed. There is still current exponential growth in the USA, and there is near zero testing going on due to incompetence and coverup. Things are going to get much worse.
I didn't downvote, but the politicization is unhelpful. When Trump pondered travel restrictions to/from China a month ago, the media jumped at him for being racist/isolationist. All the "experts" explained us that open borders are necessary to fight an epidemic.
Which legitimate person would ever say open borders help an epidemic? The virus spreading as it is a direct bad side-effect of globalization such as it is.
The main issue right now is the lack of testing and covering up just to try and bump the stock market, and it obviously is having the opposite effect since the problem is just getting worse the longer the problem is ignored.
The WHO's official guidance in late January was that countries should not restrict travel to fight the coronavirus. Travel restrictions "cause more harm than good by hindering info-sharing, medical supply chains and harming economies", they said.
Property values will fall after the next recession. It looks very likely that this set off what will become the next recession. (I mean, a recession is two quarters, so it hasn't happened yet... but it seems really unlikely to me that we won't see a recession, considering.)
The next question is, will they. I know of a town in Indiana where a surprising number of people don't get medical help. Some of it is money, but a big part is cultural. Indianapolis scares them. I dare say, for too many Indianapolis is scarier than COVID-19.
Something like a stroke requires immediate action (say, within 2 hours) to be able to use the best treatments available. Living very far away from a good hospital makes your survival chances quite lower.
For Covid-19, as far as I read, some people have gone to the hospital (already having trouble to breath) and died after a few hours. But those seem extreme cases. Normally you would have a couple days to go to the hospital from the moment you realize something is odd.
Yes, but those bounds are not binary. The faster you arrive, the higher the chance survival (specially for things like strokes, arriving in 30 minutes is way better than in 2 hours).
Then there is the issue of cost for that flight and the poor state of healthcare.
The quality of medical infrastructure is going to play a small role in outcomes when the entire system is overwhelmed many times over in the next month or so.
For Movies, I find that Ebert aligns a lot with my taste. If he says it's good, it's really good. I mean, that doesn't help with recent movies, but there's more than enough of the old good stuff. (There's a lot to be said for consuming old media; it gives it time for critical opinion to stabilize. )
I mean, of course, all of these methods will leave out a lot of really good stuff. But... that's kind of the point; there's way more media than I can consume. There are professional reviewers that can give you more really good media than you could consume in a reasonable lifetime. I'm not quite halfway through the 'Pulitzer prizes awarded in my lifetime' list, and I've started a few years back. (I mean, I was 40 or so by the time I started, and so I had read a few of the books just 'cause they were popular books that people recommend. McCarthy's "The Road" is exactly the sort of thing I like, so I read it before on another person's recommendation. But still, like, you see some really great work outside your genre; I'm not normally a romance novel kinda guy, but Lurie's "Foreign Affairs" was absolutely beautiful, and absolutely not a thing I would have read without this project.)
I haven't completely solved the problem for technical books, just 'cause people who have good up to date knowledge of an area have often built up that knowledge over time. they read some books but those books are long out of date, they've brought their skills up to date with mailing lists, which they then vet based on their knowledge of the reputation of the person posting.
I mean, I think it's pretty easy for the non-perishables, "The C Programming Language" is a thing you should read if you work with computers. But which tomb on docker is up to date enough and pretty good? that can be a difficult question to answer, and is often answered based on the author's reputation for other technical work they do, which usually tells me something about the accuracy of the book, but doesn't tell me if it's well written or if it's up to date enough. (On the other hand, if you are well known for writing a big part of the subsystem I wanna learn, eh, I don't feel too bad about giving you money for a book even if I later decide that the book is not written in a way I find engaging, like, you earned it and I'll buy another book.) And... I dunno. often you can get sample chapters, and that gets you a pretty good idea of how engaging the writing is.
I mean, one way to address it is to start at the base... "go read the gang of four design patterns books, and then use your knowledge of object orientedness to make sense of modern object-oriented configuration management systems" - which does make some sense. But still, I should spend the time to find the tech book awards that match up with my taste.