Nursing Shortage Forces Hospitals to Cope Creatively

Nursing Shortage Forces Hospitals to Cope Creatively

A study by Dr. Aiken found that patients scheduled for routine surgery were 31 percent more likely to die in a hospital with a patient-to-nurse ratio of eight to one than in a hospital with a ratio of four to one. The study was published last year in The Journal of the American Medical Association.

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There are probably vast differences, particularly in the wealth of the facility and the patient population, between low ratio and high ratio institutions. So the results are noteworthy but not conclusive -- as with all studies of this nature.

That said, I have a strong belief that overburdening health care workers increases error rates. (Duh!) Nursing is under particular stress. It is a peculiar profession in the combination of shift work, physical demands, emotional burden, and cognitive and training requirements. Medicine is not nearly so physically demanding. A paraplegic physician can excel at a very wide variety of work in almost all settings, a paraplegic nurse would probably not do direct patient care. It is not surprising that the role cannot be filled at any affordable price -- particulary as the US population ages. It is hard to be 55 and moving patients around.

Nursing will have to split into several different roles with different training requirements. In particular I think a lot of the physical aspects of nursing, which are often very satisfying to care providers, may shift to other workers.

Nicholas Kristof (NYT): The God Gulf - comment - The Yahwites and the Jesites

Op-Ed Columnist: The God Gulf

America is riven today by a 'God gulf' of distrust, dividing churchgoing Republicans from relatively secular Democrats. A new Great Awakening is sweeping the country, with Americans increasingly telling pollsters that they believe in prayer and miracles, while only 28 percent say they believe in evolution. All this is good news for Bush Republicans, who are in tune with heartland religious values, and bad news for Dean Democrats who don't know John from Job.

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From an email to Nicholas Kristof:

Great article on American religion. You are the only columnist I know of leading on this most critical of issues.

I think you've skirted, however, a second great schism, between the "Yahwites" and the "Jesites". Both call themselves Christian, but they are as different as the Old and New Testaments -- and equally irreconcilable.

The Yahwites worship Yahweh, and draw their theology from the Old Testament -- a quintessentially Republican document. The Jesites follow a blend of the teachings of Paul and Christ, a doctrine that is more comfortably Democrat or even secular humanist. Mainstream Prostestant and Catholic churches, now in decline, lean towards Jesism; the evangelicals tend to Yahwism.

The Yahwites are in ascendance. In their doctrine God rewards virtue with wealth, and punishes his enemies with brutal power -- sowing salt upon the fields of the dead. The Jesites, always a minority, are in retreat. In particular the teachings of Jesus are so peculiar and demanding as to be almost unattainable for most humans. Jesites are always falling short of their ideal. Frustrating and not so marketable as Yahwism.

There is only a small theological gap between the Yahwites and the Wahaabi, so it is ironic that fundamentalist Islam should see Bush as their virulent enemy. Not the first irony in history.

Iraq's Arsenal Was Only on Paper (washingtonpost.com)

Iraq's Arsenal Was Only on Paper (washingtonpost.com)

Iraq's Arsenal Was Only on Paper
Since Gulf War, Nonconventional Weapons Never Got Past the Planning Stage

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A long and thorough article on the Iraqi program. Since the invasion of Iraq we've learned how weak our intelligence has been; Libya has confirmed the suspicion that much that was suspected of Iraq was true only of Pakistan.

Late in the article it presents one of the few mitigating explanations of our intelligence failure -- that we read the same reports Sadaam read, and those reports were deceptions designed to preserve the lives and advance the careers of Iraqi engineers and scientists. This theory has the advantage that it may also explain why Sadaam set himself up for invasion. It will be interesting to see if it survives the inspection of historians.

Yes, the religious right is winning -- roll over Dawin.

Salon.com News | Avenging angel of the religious right

This September, Discovery [front for the religious right] lobbied the Texas State Board of Education to mandate language in its high school biology textbooks challenging what Chapman called 'fake facts' in evolutionary studies. After a heated debate in which dozens of Discovery fellows and their opponents from the scientific community testified, a panel voted to adopt the textbooks after a promise from the commissioner of the Texas Education Agency that all remaining 'factual errors' would be addressed by publishers before the textbooks get into the hands of students. Discovery hailed this as a major victory, but the effect is clear: The fact that both human and other mammal embryos have gill slits -- which proves to mainstream scientists that we share an evolutionary lineage with prehistoric vertebrates -- is slated for 'correction.'

Since Texas is the second-largest purchaser of textbooks in the nation (next to California), it has a major influence on what publishers decide to put in their books. And so, as it has gone with other cleverly orchestrated Ahmanson-funded campaigns, Discovery's small victory is intended to have national consequences.

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If you don't like the facts, then change 'em. It worked for Mao, it works here too.

Ahmanson and Christian Reconstructionism -- Wahaabism for the west

Salon.com News | Avenging angel of the religious right

... It was then that he found his salvation in the church and in R.J. Rushdoony, a prolific author and an influential theologian of the far right. Rushdoony is the father of Christian Reconstructionism, a strange variant of Calvinism that stresses waging political struggle to put the earth, and in particular the U.S., under the control of biblical law. In his 30-some books, he advocated everything from the end of government-administered social welfare and public schools to the execution of homosexuals. For around 20 years, until Rushdoony's death in 1995, Ahmanson served on the board of his think tank, Chalcedon, granting it a total of $1 million. In exchange, Rushdoony acted as Ahmanson's spiritual advisor, imbuing him with a sense of order and a mission.

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Biblical Law for the US. Islamic Law for Saudi Arabia. There's less distance between Wahaabism and GWB than is commonly thought.

Salon.com | Joe Conason's Journal - Cockburn on Rupert Murdoch

Salon.com | Joe Conason's Journal

Murdoch offers his target governments a privatized version of a state propaganda service, manipulated without scruple and with no regard for truth. His price takes the form of vast government favors such as tax breaks, regulatory relief (as with the recent FCC ruling on the acquisition of Direct TV), monopoly markets and so forth. The propaganda is undertaken with the utmost cynicism, whether it's the stentorian fake populism and soft porn in the UK's Sun and News of the World, or shameless bootlicking of the butchers of Tiananmen Square.

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More interestingly the Wall Street Journal's editorial page does the same thing, but only for Republicans and without a very clear payoff.

Robert Rubin joins the Krugman Coalition: Shrill and Shriller

Op-Ed Columnist: Rubin Gets Shrill

...Those of us who have suggested that the irresponsibility of recent American policy may produce a similar disaster have been dismissed as shrill, even hysterical. (Hey, the market's up, isn't it?) But few would describe Robert Rubin, the legendary former Treasury secretary, as hysterical: his ability to stay calm in the face of crises, and reassure the markets, was his greatest asset. And Mr. Rubin has formally joined the coalition of the shrill.

In a paper presented over the weekend at the meeting of the American Economic Association, Mr. Rubin and his co-authors, Peter Orszag of the Brookings Institution and Allan Sinai of Decision Economics, argue along lines that will be familiar to regular readers of this column. The United States, they point out, is currently running very large budget and trade deficits. Official projections that this deficit will decline over time aren't based on 'credible assumptions.' Realistic projections show a huge buildup of debt over the next decade, which will accelerate once the baby boomers retire in large numbers....

'Substantial ongoing deficits,' they warn, 'may severely and adversely affect expectations and confidence, which in turn can generate a self-reinforcing negative cycle among the underlying fiscal deficit, financial markets, and the real economy. . . . The potential costs and fallout from such fiscal and financial disarray provide perhaps the strongest motivation for avoiding substantial, ongoing budget deficits.' In other words, do cry for us, Argentina: we may be heading down the same road.

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Bushies belittle Krugman by calling him "shrill", "hysterical" and a "girlie-boy" (I made up the last one.) Kudos to Krugman for adopting "shrill" as his slogan.

The Economist is beginning to mutter the same sort of thing -- hard for them since they sold out to the Republicans two years ago.

This forecast, and the real estate bubble, are good reasons not to put all assets in a hot market, and to look for investments that go up if the US goes down. (But do they exist?)

Scientist at Work: On Crime as Science (a Neighbor at a Time) - NYT

Scientist at Work: On Crime as Science (a Neighbor at a Time)

...In a landmark 1997 paper that he wrote with colleagues in the journal Science, and in a subsequent study in The American Journal of Sociology, Dr. Earls reported that most major crimes were linked not to 'broken windows' but to two other neighborhood variables: concentrated poverty and what he calls, with an unfortunate instinct for the dry and off-putting language of social science, collective efficacy.

'If you got a crew to clean up the mess,' Dr. Earls said, 'it would last for two weeks and go back to where it was. The point of intervention is not to clean up the neighborhood, but to work on its collective efficacy. If you organized a community meeting in a local church or school, it's a chance for people to meet and solve problems.

'If one of the ideas that comes out of the meeting is for them to clean up the graffiti in the neighborhood, the benefit will be much longer lasting, and will probably impact the development of kids in that area. But it would be based on this community action.

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Crime rates respond to community actions. I have no idea how well done this reasearch was, but I've never come close to publishing in Science. I doubt there've been many such studies published at that level. Lessons for Iraq too? The beauty of the results is they represent something that can be done, and something that both Rebublicans (Raptors) and Democrats (Losers) can agree upon.

News of the Fermi Paradox: Abundant mature galaxies, abundant earth-friendly regions

Galaxies in Young Cosmos More Massive and Mature than Expected

The universe is laden with massive galaxies that formed while the universe was just one billion years old, an era when such mature galaxies were not expected to exist...

and separately

Conditions Ripe for Complex Life at 10 Percent of Stars

As many as 10 percent of all stars in the Milky Way Galaxy might offer suitable conditions for the development of complex life, according to a new computer model...

The study concludes that one in ten stars are in a region where enough heavy elements existed to form Earth-like planets and where supernova explosions were sufficiently rare so as not to squelch life. A final condition the stars met: Each could have supported planets over at least 4 billion years, roughly the time it took for complex life to evolve on Earth.

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Taken together these results further diminish one proposed solution to the Fermi Paradox -- namely that we seem to be "alone" because conditions that are favorable for technologic civilizations are exquisitely rare. In fact they are in line with the sample-of-one theory -- if you have only one sample from a distribution you're best statistical assumption is to assume that it's typical.

That leaves the other common solution -- that expansionist technological civilizations like ours are very short lived; either because they destroy themselves or because they univerallly and fairly quickly turn into something that's not interested in following the Fermi path of exponential growth in the physical universe. Here we don't have a "sample" to go by -- our technological civilization is young but not yet over.

Two weeks to the Mars rover landings ... and fingers are crossed

VOANews.com

A U.S. spacecraft named Spirit is to land on Mars this week. It is to be followed in three weeks by an identical spacecraft named Opportunity, that is to land in a different location. Once on Mars they are to deploy rovers to search for water to determine if the cold, barren planet could once have harbored simple life forms. But the mission is fraught with risks.

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If we have a reasonable amount of luck this could be a fantastic way to start 2004.

BBC NEWS | Americas | US air marshals demand resisted - But what about the armored doors?

BBC NEWS | Americas | US air marshals demand resisted

The American directive, which has come into immediate effect, applies to all flights using American air space. An estimated 800 to 1,000 passenger flights a day could potentially be required to use sky marshals.

According to the regulation, 'where necessary' foreign carriers 'will now be required to place armed, trained law enforcement officers on designated flights as an added protective measure'.

Armed marshals disguised as passengers are already deployed on thousands of US flights each week.

Several countries, including Germany and Canada, already use armed guards, while others are considering, or in the process of implementing, the measure.

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I've been told that the only truly significant plane-related security improvements since 9/11 were armoring the cockpit door and training pilots to dump fuel and drop the plane when an assault is underway. These changes don't directly reduce the risk of a takeover, but they make the plane much less useful as a weapon. So they reduce the motivation for seizing a plane, with indirectly reduces the risk of a takeover.

The abrupt request for air marshalls on international flight causes me to wonder if those changes were made only for US pilots. If that's true, then someone senior ought to lose their job. The training and armored door mandate should have been obligatory for all flights entering North American airspace since early 2002. I hope they were.

Iraq as the Spanish American War?

Krugman: Citizen Conrad

These days, everything old is new again. Income is once again concentrated in the hands of a tiny elite, and money rules politics to an extent not seen since the Gilded Age. The Iraq war bears an eerie resemblance to the Spanish-American war. (There was never any evidence linking Spain to the Maine's demise.) And Citizen Kane is back, in the form of an incestuous media-political complex.

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I like the Spanish-American war analogy. We are indeed in an odd variant of the Gilded Age. Looking for other historical examples, the "alien" Iraqi culture of honor, vengeance, violence and family reminds me of nothing so much as the American South @ 1850. Makes one wonder if our soldiers, who come largely from south, really find Iraq so incomprehensible. (Parenthetically, I suspect Iraqis are at least as racist as every other traditional society. I wonder what effect the ethnicity of our polyglot military has on Iraqis? I've not seen mention of that anywhere.)

When more is less: Amazon.com

Amazon.com: All Products Search Results: 1000 places to see before you die

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Amazon now does full text searching. This is a "feature", it took a lot of work to add this.

It's also stupid.

Anyone who's ever done full text searching can tell you that, without a lot of smart tuning, it returns junk. Amazon hasn't doen the tuning.

Google would never have screwed up like this.

A positive view of Iraq -- from an independent source

Telegraph | News | It is stupid to say life in Iraq has got worse

In the streets of Baghdad and other cities, plenty of excitable people tell you that life under the Americans is now worse than it was under Saddam, but that is stupidity of a high order.

Last week one of my BBC colleagues interviewed a man who had been dropped into a vat of acid by Saddam's torturers. They then immediately fished him out because they felt his crime had not warranted such a hideous death. When he eventually recovered from his burns he went to thank them for saving his life; only to discover that they had been executed in their turn.

The mile-long, 24-hour queues for petrol, the power blackouts that last for 14 hours a day, the chronic shortages of clean water and medicine, the sudden and frightening rise in crime that has followed the American and British invasion are all very bad but they don't remotely compare with the viciousness of Saddam's regime, and they won't last for ever.

Iraqis are quick-minded and impatient, and many of them resent the behaviour of the American soldiers in their cities. Yet the level of resistance to the Coalition forces seems to be falling, and it is nothing like serious enough to drive the American forces out. While they stay, the country will hold together.

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A BBC senior editor is a relatively independent voice; indeed the BBC has often been accused on an anti-American bias. (In my opinion they have a mild disposition to carping when things go better for the Americans, and they occasionally go way off track, but 95% of the time they sound right.) This brief report paints a more positive picture than we usually here, and I trust it more than anything I get from Fox.

Humans: Fat by Nature?

Economist.com

... it is not obvious that getting fat is a natural response to plenty. Animals rarely get fat, even when food is abundant, unless they are old and domesticated. Young animals almost never get fat. Young people do all too frequently.

Humans have around ten times as many fat cells in relation to their body mass as most other animals. Polar bears are similarly off the curve, but then they have good reason to be fat: they need insulation and go for long periods without food. Pigs are well-padded, but they were bred for it.

Perhaps humans were bred for it too. That is what the thrifty-gene theory suggests. It was thought up by James Neel, a geneticist, in 1962, as he was seeking an explanation for the extreme porkiness of the Pima Indians. He postulated that they were fat because of the bad times their tribe had been through. They were minding their own business in Mexico and Arizona in the 19th century when incoming farmers disrupted their water supply. Some Pima starved and many were malnourished. Those who survived, suggested Neel, did so because they had some innate advantage%u2014a thrifty gene that meant they were particularly good at storing energy. Their descendants inherited a trait that became a burden, not a benefit.

Andrew Prentice, professor of international nutrition at the London School of Hygiene and Tropical Medicine, reckons that the thrifty gene is widespread among the human race. He puts it down to agriculture. Hunter-gatherers, he argues, did not much need a thrifty gene. They may not have had the plenty that agriculture could provide, but they were few and their food supply flexible. However, after man settled down to farming around 12,000 years ago, the population grew, and soon lots of people depended on a small range of crops in a limited area. When the crops failed, disaster struck. And it did so often, and relatively recently, in Europe.

In 1321, some 20% of English people are reckoned to have died of famine. There was cannibalism in 1563 and 151 famines were recorded in England before 1620, the year the Mayflower sailed to America. American genes may be especially thrifty. Some immigrants were survivors of disasters such as the Irish potato famine. They also had to survive the crossing and the business of making a new life, which wiped out plenty of weaker stock. From 104 passengers on the Mayflower, only 23 left descendants. That was mostly because of crop failures and starvation, relief from which Americans still celebrate at Thanksgiving.

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It is weird that humans should be so different from all other mammals. Surely an ability to tolerate famine is important in rats? I'm not sure the thrifty-gene theory alone makes sense. I wonder if it's just a gene flaw, a side-effect of the very small human gene pool and high level of semi-clonal breeding.