Sunday, August 28, 2016

Last days at the best of social networks: (aka Alpha, ADN).

My (@johngordon) services are beginning to fail - including PourOver. Post counts are gone. I still find some great discussions; the community will outlast the infrastructure.

I joined ADN/ Alpha in 8/2012, I’ve paid yearly since. I was a fan in 2013, still am. filled the void left when Google Reader Shares died. It was better than Posterous, Tumblr or Twitter.

Four years isn’t a bad run. I’m not sure Twitter will be here in four years. On the other hand, “the Well” is 31 years old now (and funded by memberships). The Well is private, so I’ve no idea how active it is, but that’s probably a record.

There’s no obvious replacement for on the horizon but I’m keeping my eyes open …

Trumpism: a transition function to the world of mass disability.

We know the shape of the socioeconomic future for the bottom 40% in the post globalization post AI  mass disability world.

But how do we get there? How does a culture transition from memes of independence and southern Christian-capitalist marketarianism to a world where government deeply biases the economy towards low-education employment?

There needs to be a transition function. A transform that is applied to a culture. With the anthropology perspective I’ve long sought Arlie Hochschild makes the case that Trump is, among other things, a transition function that erases Tea Party Marketarianism and embraces the heresy of government support (albeit for the “deserving”).

In a complex adaptive system we get the transition function we need rather than the one we want. No guarantee we survive it though.

See also:

Thursday, August 25, 2016

What socioeconomic support will look like in 20 years

This is what I think socioeconomic support will look like in 2040 based on cognitive [2] quintiles.

The bottom quintile (0-20%, non-voters) will have supported work environments and direct income subsidies; an improved version of what most [1] wealthy nations do for the 0-5% of adults currently considered cognitively “disabled” [1].

The second quintile (20-40%, Trump base if white) will have subsidized employment (direct or indirect).

The fifth quintile (80-100%) will live much as they do now.

I don’t know what happens to the 3rd and 4th quintile.

- fn -

[1] The US is currently “mainstreaming” the cognitively disabled into relatively unsupported work, a well intentioned and evidence-free project by (my) Team Liberal that is going to end in tears.

[2]  In US male euros (avoid racism/sexism effects) maps to academic achievement which tests learning, social skills, temperament and the like.

Wednesday, August 24, 2016

Massive phone spam -- from Weatherby Healthcare

Weatherby healthcare hires physicians for “locum tennis” roles. That’s filling in for someone on holiday and the like.

They’ve contracted with the phone spam company from hell. My Google Voice number is deluged with calls like this (email of transcription):

Good morning. This is Kevin with weatherby Health care. I saw you recently inquired online about some outpatient work. I wanted to touch base with you. I'm currently working with several urgent care and outpatient facilities not only in your area, but throughout the country as well that are looking for a position like yourself to provide temporary full time or sporadic shift coverage they offer a high flexibility in the schedule and competitive pay rates. Give me a call back today would love to give you some additional information and details about these opportunities and see how I can be a resource for you my direct line here is 954 300 77 1821 again. This is Kevin with weatherby Healthcare 954 370-7828 have a great day.

and like this:

is Mike Ruskin weatherby Health Care's primary Care team. Hope you're doing well. I was reaching out to you because I came across your information, and I have some new open a family medicine positions available in Minnesota wanted to see if you or any colleagues should have I might be available. Give me a call back when you get this message. Let me know 954-343-2142 again Mike ross again with weatherby 954-343-2142. Thanks so much. Have a great day. Bye.

I blocked several of the numbers, but their phone spam operation is rotating through a large set. Number blocking doesn’t work.

I’ve turned off text messaging notifications of calls on my GV number and notifications from the GV app and notifications of missed calls. So the only notification I get is now email. In gmail I set a filter for any email with the text “weatherby health” to send it to the trash.

We desperately need a robocall/phone spam solution.

Oh, and if you’re a physician — please don’t answer calls from Weatherby. If you’re Weatherby, you’ve made a disastrous choice of marketing services.

PS. If you’re Google — your Google Voice phone spam filtering needs work.

Friday, August 19, 2016

What a solution for phone spam will look like

The FCC wants a vast and unmanageable array of voice communications carriers to fix the robocall plague.

I’m here to tell you what will happen. It will work much the way email spam was managed in the 1990s. It will also be the end of our legacy voice communication system and, somewhere along the way, the Feds will mandate that Google and Apple support VOIP interoperability.

Yeah, email spam is managed. It’s true that 95% of my email volume is spam, but I don’t see it. Differential filtering based on the managed reputation of an authenticated sending service works. Push the spam management problem down the sending service, then vary filtering algorithms based on the reputation of the authenticated (PKI) sending service. If you still see large spam volumes or losing valuable email it’s because you’re using Apple as an email service provider. Don’t do that.

Here’s what I think will happen to enable differential filtering based on the managed reputation of the authenticated calling service. I’m sure insiders know this, but they aren’t talking. 

  • VOIP interoperability will be mandated. No more Apple-only FaceTime audio.
  • Services (AT&T, Verizon) that don’t authenticate or manage their customers are assigned poor baseline scores. Service that authenticate/manage customers (Apple) get high baseline scores.
  • Low score calls get sent to spam VOIP, we never see them. Medium score never ring through, they go automatically to transcription and we get transcription summary.
  • High score calls are eligible for ring through based on user device settings.
The carriers will fight like hell to preserve their domain, Apple will fight interoperability, Google will be fine.
PS. For now we have a home phone number that is purely message, the phone doesn’t ring. Google Voice would be even better. If I could set my iPhone to “Do Not Disturb” status strictly for voice calls I’d be fine. I rarely answer unrecognized and unscheduled calls.

See also

Crab Bucket

Terry Pratchett taught me about “crab bucket” in Unseen Academicals [1]. I don’t know if it’s a metaphor of his part of England, or if it’s unique to the Discworld.

… She reached down and picked a crab out of a bucket. As it came up it turned out that three more were hanging on to it…

… ‘Oh that’s crabs for you,’ said Verity … ‘Thick as planks the lot of them. That’s why you can keep them in a bucket without a lid. Any that tries to get out gets pulled back…’

Crab bucket, thought Glenda … That’s how it works. People from the Sisters disapproving when a girl takes the trolley bus … Practically everything me mum ever told me…

I did find a wikipedia entry for “crab mentality”, which led to a 1994 article

When teachers at Frank W. Ballou … talk about the crab bucket syndrome …

But the author doesn’t describe where the term comes from. It’s a useful concept; reminds me again how much we need to recreate anthropology.

[1] Written when Pratchett was well into his eventually terminal dementia syndrome, so while it’s very enjoyable for fans it’s not his best work.

Wednesday, August 10, 2016

Those moments when you feel the walls of reality fall away

I’m working through a tedious form that requires me to look up old information from dusty files. I step away to eat and locate some documents.

I then return to the form and open it.

And it’s been filled out.

My eyes bug out.

My jaw drops.

I’ve switched timelines. I have a brain tumor. I’m more demented than I thought.

Then I notice the date - February, 6 months ago. I’d filled the same form out for the same people before. Forgetting that is well within the scope of my congenitally poor and not improving memory.

By chance, on returning to my work, I took a different folder path and found the original document.

A perfectly reasonable explanation. At least that’s what I tell myself. In this timeline.

Monday, August 08, 2016

Creaks and clicks in geriatric bikes

I like a quiet bike as much as the next neurotic guy. So the creaks and clicks in my 20 yo Cannondale T400 have been distracting. Like dental surgery.

I finally clear up the problem. Except it was problems, the plural. Plural recurrent actually, which was why it took a year to get through them all, and why the damned bike seemed haunted. The big tubes on this aluminum touring bike didn't help, they sent the sounds everywhere. Danged hard to localize, as is often true.

I went through a lot of diagnostics and replacements, which sometimes seemed to work but they the creak-click would return — though maybe with a bit different sound. In the end of day these were the obvious culprits:

  • The seats: Swapping seats didn’t hep too much. Turned out I had swapped one mediocre old seat for another, both were stretched and creaky. I bought myself a nice (i.e. pricy) Fizik Antares R5 for my birthday and that creak went away.
  • The damned Shimano Shimano PD-A530 SPD Dual Platform pedals: WTFShimano?! The worst pedals every made. Five years ago I compared Shimano’s surprising quality to Apple’s. Since then both brands seem to have gone on a bender. One of my creak-clicks was a bad bearing in the first pair I owned. I bought a replacement and they were defective out of the box. I returned those under warranty and 10 months later that one started a creak-click. Hard to diagnose because the seat was creaking too, but in the end these pedals were 80% of the problem. I’m debating switching to Crank Brothers for all of my bikes. Shimano sells a Deore XT dual platform pedal in Europe, but they are hard to find here. I guess I could try those, but I’m loathe to send Shimano any more money.

These were things I replaced that probably didn’t contribute to the problem.

  • Seat post: For $25 I picked up a Nashbar replacement post that’s much nicer than my original single-bolt post. Didn’t make any difference but I wanted the better adjustment anyway.
  • Bottom bracket bearing unit: This was because I couldn’t believe it was the pedals clicking - again. Original was 20y old, so probably not a bad idea anyway, but didn’t make any difference.

Old bikes are like old men. It’s usually not a weird and exotic disease, it’s more likely two or three common diseases that just coexist.

Sunday, July 31, 2016

In defense of Donald Trump.

Trump is more racist and sexist than most 70+ yo white men. He is amoral and a con man. He may be a sociopath and probably has a narcissistic personality disorder. He is living proof that we need drug and dementia testing for presidential nominees. He is dim. Even by the standards of presidential contenders he is a nasty person.

Trump is the anti-Obama. Irrational, impulsive, thoughtless, intemperate … it’s a long list.

Trump makes paranoid H. Ross Perot look good. He exceeds the sum of the worst of GWB and Richard Nixon. I cannot think of a post WW II major party candidate this bad.

He may be worse that Cruz.

Yeah, America’s two leading contenders for the GOP nomination in 2016 were both awful. Two of the worst options in the past 100 years. That means something. It means despite our immense wealth and overall prosperity, despite our social and environmental progress, America is in trouble. Trump isn’t America’s festering abscess, he’s the fever. It’s not enough to treat the fever. We need to drain the abscess.

So where is the abscess? Why did the GOP drift further and further from reality? How did a political party that once supported science become anti-evolution and, most insanely, pro CO2 production?

I think Noah Smith has a part of the answer. The GOP had deep internal divisions and over the past 15 years the glue gave way.  The Party is broken, it has to reform.

Maybe that’s the whole story. I don’t think it is though. I think the abscess is the bottom 40% of white America. The great unwanted. The Left Behind. The new disabled. A cohort that has seen 40 years of shrinking opportunity. The economy has moved on; we don’t have vast office buildings full of thousands of people who move paper from cabinet A to cabinet B.

The odds are we’ll fix the Trump fever. Hell, even the Koch brothers favor Clinton. Obama is in the game and on top of his form. Women are starting to realize sexism is no more dead than racism.

But the abscess will still be there.

Sometimes fever is a friend. It tells you something bad is happening.

Saturday, July 30, 2016

Life tip: photograph or photo-scan cards and special correspondence

A few years back, around the time the iPhone camera became very good at close photography, I began to photograph Father's Day cards and the like.

Later, when products like “Scanner” made it very easy to create PDFs that went to Google Drive, I began to phone-scan correspondence I wanted to keep.

I store the PDFs on my computer. The photos go into my photo library and become a part of our screensaver slideshows. Most of the originals go to recycling.

It would have been great to save more of my mother's correspondence this way, but that would take time travel. We didn't have the tech back then.

It's a good idea.

Wednesday, July 27, 2016

Double unders

People come to our gym and in two months they’re doing double unders.

I am not those people. After ****** of practice I do about 5 DU with 2 singles between each as I advance backwards across the floor. (I think this is “piking” and is related to using a longer than desired rope)

As someone who has failed at this for so long I’m well placed to recommend these tutorials….

I’d add …

  • If you’re practicing at home a glass of wine might not hurt
  • Try a metronome? (free on iPhone)
  • Chest has to stay high.
  • Warm up with 25 singles, then 10 slow high singles, then to the DUs.
  • I like long handles that amplify my poorly coordinated wrist snap
  • I think my speed rope is too long
  • I might try the beaded rope, they are supposed to help old people. (50 isn’t old …)

I’m on record saying if I ever get 10 consecutive DUs and a single bar muscle up I’ll get a tattoo. Presumably a very small one. I’m not worried.

Signs of progress from O'Reilly and Limbaugh.

Limbaugh says that black Americans really need to stop talking about that unhappy slavery episode. O’Reilly tells us the slaves building the White House were well fed and had good government housing.

I’m going to claim this is progress.

People like Limbaugh and O’Reilly (or at least their listeners, Limbaugh is more cynical, vicious, and venal than ignorant) have lived in blinders all their lives. That’s a lot of people with the white privilege of denying American history. We’re not the only ones who do this of course. Japan has had a bit of trouble with its history too.

Now the blinders are coming off. Americans, especially those who went to high school before 2000, are learning more of the nasty bits of American history. If you’re a white American it’s a disturbing experience. So now we have “get over it” and “the housing was good”.

But this is progress. It’s the difference between, say, Holocaust Denial and “that was long ago”. 

Progress doesn’t mean things turn out well. These are truly scary times. But absence of progress is worse.

Monday, July 18, 2016

Informatics core: US genomic and healthcare standards have a common problem.

My current work means I’ve spent many hours plumbing details of major American and international health care standards, particularly FHIR, HL72, CCDA/HL73 and NCPDP. 

It reminds me of a project from the late 00s when I was exploring genomics database.

There’s too much documentation.

Specifically, there are too many information sources that are not well maintained. There’s always funding to create a repository or database or web app, there’s never funding to sustain it. All the partly implemented solutions create a misleading cloud of chaff.

One has to dig through to the core source — if it exists. The core sources for HL7 3 are, unfortunately, very hard to work with (lots of reasons for that, including the way HL7 used to be funded). FHIR core sources are easier to navigate — but already there are various extensions and fissures. Best not to mention use of the Federal Registry as a reference information source.

The structure and maintenance of knowledge sources is a core informatics problem. We need to get back to our roots in the National Library of Medicine and library science. That would require funding though…

Monday, July 11, 2016

Systemic failure in American medicine: combining ICD-10-CM with "leaf code" reimbursement rules

This is very much “inside baseball”. It’s related to professional work I do. It’s incomprehensible to most people, but it’s having a big impact on your healthcare. An impact that the vast majority of healthcare workers and administrators won’t understand. Only the coding specialists in unlit basement rooms know what’s going on.

For several decades American physicians have used a system of codes to justify procedures and bills. They’re like the occupation codes you might use to fill out your tax form, but there are thousands of them. They are called diagnostic codes, the old system was called ICD-9-CM. (ICD codes are also used in public health, epidemiology, research and information exchange, but that’s not what I’m writing about.)

For various reasons, which I personally think were unwise, the ancient ICD-9-CM system was recently replaced with a less ancient ICD-10-CM system. That was a disruptive change with limited value, but the change in coding systems by itself wasn’t the disaster. Yes, I know many physicians think the coding system change was the disaster, but they’re wrong. There are more codes, but there are ways that software systems could have made that proliferation manageable. The real problem is more subtle.

The disaster was that Medicare (CMS) and payers retained an old ICD-9 rule. A rule that only the “leaf” (most detailed) codes in the ICD-10-CM system could be accepted for payment. If you want to know what I mean by “leaf” check out this example from the ICD-10-CM codes for Type 2 Diabetes Mellitus:

Screen Shot 2016 07 11 at 9 51 32 AM

Doesn’t it look a bit like branches of a tree? Only the little green arrow codes can be accepted for payment. They are “most detailed”. They have “no children”. They are “leaves”.

If you’re with me so far, here’s the punchline. ICD-9-CM had “leaf” codes that essentially meant the same as the “root” code, ICD-10-CM doesn’t. (In the example above E11 is a root code.)

I’m simplifying a bit here. ICD-9-CM was a mess. It didn’t always have “unspecified” or “not otherwise specified” leaf codes that meant the same as the root code, but it mostly did. Diabetes Mellitus 250.00 meant the same as 250. 

ICD-10 is more intelligent, it doesn’t have these duplications. If you want to just say a patient has Type 2 Diabetes Mellitus you could just say E11.

Except you can’t get paid for saying E11. Because of the leaf rule. So that’s not an option in health record or billing systems. Instead physicians must choose between:

Screen Shot 2016 07 11 at 9 58 15 AM

But what if they don’t know or care if the patient has complications? Maybe they’re seeing them for a cold. Maybe the patient doesn’t know if they have DM complications. They have to choose one at random. It’s the same everywhere.

This is madness. The problem isn’t ICD-10-CM. It isn’t even the leaf code requirement. It’s the combination of the two.

In a sane world the fact that we combined an essential healthcare code system that lacked redundant leaf codes with a payment system that required leaf codes would be treated as a systemic failure. There would be congressional hearings and root cause analysis.

Instead we stagger on into the fog.

Saturday, July 02, 2016

Fixing disc brake squeaks - mountain bike.

I found 2 techniques for silence squeaky disk (disc) brakes — all involving rotor cleaning. (If pads are contaminated they need to be replaced.)

The PinkBike reference claims “weak break in period” is the number 1 sin:

Brake squeal is most commonly caused by a weak initial break-in period, with the introduction of impurities like chain lube or chemical bike cleaners to the braking surfaces as a close second.

 I bet I’m guilty.

break in your disc brakes with a series of very firm stops from a reasonably good speed before you get out on the trail. This properly deposits the pad material on the braking surface of the rotors. Typically, most riders drag their brakes lightly around every corner in the trail, as well as down easy descents. Lightly dragging a new set of brakes is a perfect recipe to create brake howl - which is why you see so many cross-country riders with noisy brakes. 

Rule one: brake like you mean it, then let go.

The PinkBike reference is hard core. Clean with automative brake cleaner, Sand with 11 and 220 grit abrasive cloth (I’d try an orbital sander) then break it in properly.

I’m going to try the easy step first. The big job will wait until it gets really annoying…