If you follow my musical tastes I just setup a twitter for REPEATR.net https://twitter.com/#!/repeatr My nefarious plan is to only post certain playlists there.
Yet it’s far from obvious that something as simple as a checklist could be of much help in medical care. Sick people are phenomenally more various than airplanes. A study of forty-one thousand trauma patients—just trauma patients—found that they had 1,224 different injury-related diagnoses in 32,261 unique combinations for teams to attend to. That’s like having 32,261 kinds of airplane to land. Mapping out the proper steps for each is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much.
In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.
The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary. This was revolutionary. Nurses have always had their ways of nudging a doctor into doing the right thing, ranging from the gentle reminder (“Um, did you forget to put on your mask, doctor?”) to more forceful methods (I’ve had a nurse bodycheck me when she thought I hadn’t put enough drapes on a patient). But many nurses aren’t sure whether this is their place, or whether a given step is worth a confrontation. (Does it really matter whether a patient’s legs are draped for a line going into the chest?) The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene.
Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.
Pronovost recruited some more colleagues, and they made some more checklists. One aimed to insure that nurses observe patients for pain at least once every four hours and provide timely pain medication. This reduced the likelihood of a patient’s experiencing untreated pain from forty-one per cent to three per cent. They tested a checklist for patients on mechanical ventilation, making sure that, for instance, the head of each patient’s bed was propped up at least thirty degrees so that oral secretions couldn’t go into the windpipe, and antacid medication was given to prevent stomach ulcers. The proportion of patients who didn’t receive the recommended care dropped from seventy per cent to four per cent; the occurrence of pneumonias fell by a quarter; and twenty-one fewer patients died than in the previous year. The researchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half.
The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you’re worrying about what treatment to give a woman who won’t stop seizing, it’s hard to remember to make sure that the head of her bed is in the right position.) A second effect was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. In a survey of I.C.U. staff taken before introducing the ventilator checklists, he found that half hadn’t realized that there was evidence strongly supporting giving ventilated patients antacid medication. Checklists established a higher standard of baseline performance.
These are, of course, ridiculously primitive insights. Pronovost is routinely described by colleagues as “brilliant,” “inspiring,” a “genius.” He has an M.D. and a Ph.D. in public health from Johns Hopkins, and is trained in emergency medicine, anesthesiology, and critical-care medicine. But, really, does it take all that to figure out what house movers, wedding planners, and tax accountants figured out ages ago?
::: Great Article via The New Yorker via Email (Thanks Star!) :::
Do prisoners have a constitutional right to pornography? I dunno that’s kind of a weird thing to think about.
fwiw, i find that language objectionable, as does Hef.
BUT WAIT, back to dick jokes:
The deprivation does not end with porn, though. While you might think of masturbation as a sort of last refuge for the incarcerated—a truly inalienable freedom, given the happy proximity of the sex organs—that is not the case. In fact, a number of state prisons regard jerking off as a rule infraction. American University law professor Brenda Smith, who conducted a 50-state survey of prison masturbation policies in 2006, says restrictions are “well-entrenched” in the correctional environment. In North Carolina, for example, it is a violation to “touch the sexual or other intimate parts of oneself or another person for the purpose of sexual gratification.” Violations can lead to disciplinary segregation or the loss of “good time” credits. Tennessee forbids “[a]ny behavior intended for the sexual gratification of the subject.” Ohio prohibits “[s]eductive or obscene acts, including indecent exposure or masturbation.” Kentucky regards inmate masturbation as “[i]nappropriate sexual behavior.” In California, where some 170,000 men and women live behind bars, masturbation is permissible provided it is stopped immediately if noticed by staff, blue balls be damned. If the masturbator perseveres, even if concealed by bed sheets, he can be cited for “Intentionally Sustained Masturbation without Exposure.” These policies are part of a long correctional tradition to forbid all forms of sexual activity. Prison officials say they need the rules to keep order and deter exhibitionism.
In practice, inmates are seldom sanctioned, so long as they touch themselves discreetly. In Connecticut, masturbation is against the rules only when performed “in a lewd and public manner.”
Anyway, FOR YOUR (too much) INFORMATION, I’m just going to be slightly more smug about california’s general superiority vis a vis the prison industrial complex next time I’m touching myself.
Let me offer two statements, and ask what is the morally relevant difference between them.
1. I don’t socialise with Asians. I just don’t find them that appealing.
2. I don’t date Asians. I just don’t find them that appealing.
(1) is clearly objectionable. It looks like straight-up racism. If someone sitting next to us at a bar made a statement like that, we’d probably quietly slide over a few stools. I think we are more tolerant of (2) — yet it looks exactly the same. And is it any different than:
3. I prefer to date Asians. I really find them specially appealing.
No one can stop you for from feeling more, or less, attracted to a particular type. But we might think you have a moral obligation to try to overcome that preference. You could examine where this particular preference comes from, and you could make a special effort to date other types.
Someone might object here that the harm of prejudice comes not from the attitude itself, but the way the attitude affects society, and our dating choices don’t affect society. People who are racists, for instance, pass qualified people over for jobs, or allow their attitudes to affect their voting behaviour, and that makes us all worse off. There is, on this view, no measurable harm of this kind when it comes to dating.
I think the harm exists, but is more subtle. It is the harm of living in a society that is less tolerant than it might be. Other things being equal, we are better off in a society where people are as free from prejudice as they possibly can be, and where everyone can succeed on their merits in all spheres, including the sexual. In such a society, everyone can feel that they’ll be given a fair chance, and they can be confident that the rest of us will have no patience for anyone who refuses to judge them as individuals. Also, a society where people have strong sexual type-preferences, and these preferences are tolerated, is very likely going to be less efficient at matching up sexual partners, because people miss opportunities. There is therefore less sex being had in aggregate – and I believe that, other things being equal again, a society that contains a greater aggregate quantity of sex is better than one that contains less. For these reasons, our personal preferences decrease the total welfare of the society, and this creates an obligation to work to overcome them.
::: via Moral Lust :::
Craziest Youtube I have seen all week
This is one of those flying around animations that makes something at the end. I’ve heard this style called a “prezi.”
I left Algeria in 1990 to work abroad. In 1997 my family and I moved to Bosnia and Herzegovina at the request of my employer, the Red Crescent Society of the United Arab Emirates. I served in the Sarajevo office as director of humanitarian aid for children who had lost relatives to violence during the Balkan conflicts. In 1998, I became a Bosnian citizen. We had a good life, but all of that changed after 9/11.
When I arrived at work on the morning of Oct. 19, 2001, an intelligence officer was waiting for me. He asked me to accompany him to answer questions. I did so, voluntarily — but afterward I was told that I could not go home. The United States had demanded that local authorities arrest me and five other men. News reports at the time said the United States believed that I was plotting to blow up its embassy in Sarajevo. I had never — for a second — considered this.
The fact that the United States had made a mistake was clear from the beginning. Bosnia’s highest court investigated the American claim, found that there was no evidence against me and ordered my release. But instead, the moment I was released American agents seized me and the five others. We were tied up like animals and flown to Guantánamo, the American naval base in Cuba. I arrived on Jan. 20, 2002.
I still had faith in American justice. I believed my captors would quickly realize their mistake and let me go. But when I would not give the interrogators the answers they wanted — how could I, when I had done nothing wrong? — they became more and more brutal. I was kept awake for many days straight. I was forced to remain in painful positions for hours at a time.
:: OPED from the NYTimes ::
The detention programs at both Guantanamo and Bagram Air Force Base have been wrought with abuse and error. To expand those programs to American citizens is to embrace the flawed notion that the government cannot make mistakes. It is criminal enough to subject anyone to indefinite torture, but to see the justification eroded even further is deeply troubling.
Lots of people have made the argument that Obama had no choice but to sign the NDAA. For example:
The NDAA is a must pass bill. It is the bill which literally funds the military. That includes paychecks for our military veterans. That includes paying for equipment and gear for our service members abroad. That includes funding our intelligence agencies and contractors which actually do a lot of important work to help protect us from actual terrorists. This means that if Obama does not pass the NDAA then soldiers can’t eat. So why didn’t Obama just veto the crap? Well, if he vetoes the bill, which was passed with enough votes to override that veto, it becomes law anyway. There is a very solid point to be made that he should have vetoed the bill to make the political point that the detention provisions were unconstitutional and unacceptable. That said, again troops need food. Their families need paychecks.
This is BS. Part of the reason there was a majority in congress is because Obama changed his mind andsaid that he would sign the bill! Originally the Administration said that they wouldn’t sign it. Additionally, it’s totally ridiculous to think that the Military would be totally 100% defunded, ever, for any reason…especially because the president vetoed a bill.
Also, the president could have simply employed a constitutionally dubious line-item veto and then let the legislature try to override that specifically.
++ DERPDATE ++
turns out the line-item veto was overturned by the supreme court when clinton used the hell out of it.
Salman Khan, founder of Khan Academy, did a great Ask Me Anything (AMA) on Reddit a couple weeks ago. This comment really hit me:
Hi my name is ****** ** and I’m a second year student in the University of Western Australia (UWA) majoring in Physics and Maths. I was originally from Singapore where I spent the first 15 years of my life failing school, day after day I would not understand a word the teacher was saying as they said, “you must remember this or you won’t get a job in your future.” and every year I would fail school. When I was 14, I started failing pretty badly and fell into a world of drug addiction. When I was 15, my drug addiction got so intense that it affected my grades so badly that I had to be held back a grade in my high school in Singapore. Finally in January 2008 (the year I was 16), my parents decided to move to Perth in Western Australia. They had me enrolled in a private school where within 8 months I was expelled for fighting and drugs. At the end of that ordeal and closely evading arrest, my parents had me enrolled in a local public school where I was faced with the worst problem of my entire life. The final exam of high school that determines if you go to University or not was coming, and I had no idea what to do as I never listened in class since I was 13. All I could do was expand a bracket and that was it, no factorizing, solving an equation or doing trigonometry. I first met the Khan Academy in December 2009 where I stumbled on his videos on Complex Numbers on YouTube. I had a whole load of heavy weight subjects like Literature, Physics, Advanced Maths, Chemistry and Biology. Everyday when I came home from school, it would be a 4pm – 10pm study session driven by my own fears. With 5 years of work to catch up on and only Khan Academy helping me, it was a grueling experience. I failed every test and exam that year, thankfully none of those tests and exams contribute to your final University determination grade. I worked through the Khan Academy playlists on Basic Algebra, Trigonometry, Physics, Chemistry and Biology before moving on to the “higher level” things like Calculus and Differential Equations. Thanks to Salman Khan for quitting his day job as a Hedge-fund Analyst, he has allowed a drug addict whom the public would look down upon to persevere through his A levels and come out on the other side with a result good enough to get into Western Australia’s best University. I hope and pray that the Khan Academy will expand to do subjects like Modern Physics and Maths topics like Topology, Differential Geometry and so on. In any case, I thank you Salman Khan, and the effort you have put into the Khan Academy. You’ve opened doors for us that we would have never been able to unlock alone.
::: I am Salman Khan, AMA via Reddit ::
Salman Khan’s Ted Talk is pretty rad too
There is another question from the AMA that I found pretty interesting:
What made you study for so many degrees? (Three from MIT and an MBA from Harvard!)
Also, thanks a lot and much respect from me, a student from Hong Kong. You make learning truly enjoyable.
MIT let you take as many courses as you wanted for the same tuition. I was the hungry kid at the all-you-can-eat buffet
My prime motivation for going back to Boston in 2001 to get an MBA was to find a wife (and it worked). Silicon Valley in the late 1990s was not a great place to be a young single guy. My secondary motivation was to broaden my experiences and allow me to think about what I really wanted to do longer term (I did end up changing careers).