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…

Friday, July 01, 2016

Finding yourself in the mathematical universe of pi

I’m reading Tegmark’s Our Mathematical Universe. It’s the layperson version of a 2007 paper (downloadable)

I explore physics implications of the External Reality Hypothesis (ERH) that there exists an external physical reality completely independent of us humans. I argue that with a sufficiently broad definition of mathematics, it implies the Mathematical Universe Hypothesis (MUH) that our physical world is an abstract mathematical structure. I discuss various implications of the ERH and MUH, ranging from standard physics topics like symmetries, irreducible representations, units, free parameters, randomness and initial conditions to broader issues like consciousness, parallel universes and Godel incompleteness. I hypothesize that only computable and decidable (in Godel's sense) structures exist, which alleviates the cosmological measure problem and help explain why our physical laws appear so simple. I also comment on the intimate relation between mathematical structures, computations, simulations and physical systems.

As best as I can tell, Tegmark, more or less like Einstein, thinks of spacetime as a static thing; we relate to spacetime as a tune relates to a CD. It is a bit of an illusion that one thing follows another, or that we seem to have a past and a future, or that things are created and end. Rather as a block of granite contains all sculpture, or the alphabet all knowledge, meaning is just an arrangement that fits. “I think therefore I am” indeed.

Which made me wonder if I could find “I am John” in pi. Seems a bit similar. If pi is random then that string should show up somewhere.

Happily the “National Energy Research Scientific Computing Center” will search pi for strings based on a 5bit English character set encoding.

Alas, “I am John” is not in the span they search…

search string = "i_am_john"
45-bit binary equivalent = 010010000000001011010000001010011110100001110
string does not occur in first 4 billion binary digits of pi

My daughter’s name does turn up:

search string = "brinna"
30-bit binary equivalent = 000101001001001011100111000001
search string found at binary index = 872397609 

binary pi : 0010101000010100100100101110011100000101111010011010101101000011
binary string: 000101001001001011100111000001
character pi : aqyfuc_nj_--yjbrinnaoiuma.fvfkbv.bcfgz
character string: brinna

This essay should be in there too, assuming pi digits really are deterministically random. Somewhere. Which I think has something to do with the Mathematical Universe. Somehow.

PS. From the arXiv paper: “… quantum field theory states such as the Hawking-Hartle wave function or the inflationary Bunch-Davies vacuum have very low algorithmic complexity (since they can be de- fined in quite brief physics papers), yet simulating their time evolution would simulate not merely one universe like ours, but a vast decohering ensemble corresponding to the above-mentioned Level III multiverse. It is therefore plausible that our universe could be simulated by quite a short computer program.”