Gordon's Notes

Friday, December 02, 2011

Silvio

Italy, Europe and the world will pay a high price for the long reign of Silvio Berlusconi.

Government is like parenting. Good parenting is somewhat helpful, but bad parenting is enormously destructive.

Corruption matters. Elections matter.

Wednesday, November 30, 2011

Are home phones now a sign of vulnerability?

We get a lot of junk calls now at home on our unlisted home wired phone. Many hangup calls, "survey" calls, robocalls -- our home phone number needs a spam filter. It's beginning to resemble my mailbox -- mostly junk.

Of course many homes no longer have fixed phones -- especially in all adult households. We keep ours for everyday use, as a security measure, and because we keep our mobile phone minutes low. As the junk level rises though, a combination of Google Voice and an increase in our mobile voice minutes becomes more appealing. [1]

Some of the calls these days drop as soon as I pick up. I wonder if they're looking for more vulnerable sounding voice. As fixed line phones become less common, they will become a marker for the vulnerable elderly [2]. The sharks will move in ...

[1] Google doesn't support moving a home number to GV, just a mobile number. So we'd have to first move to a mobile, then cancel the mobile...
[2] Not a new trend, Google tells me I wrote about this in 2004! - Phone Phishing (spam): coming soon to the elderly and the vulnerable

The Gordon vs. AT&T iPhone war - Conclusion

Twenty-seven days ago I declared war on AT&T Mobile.

The war is done - for now. At this time I've slashed the amount of money we send AT&T, gotten a new 4S for me, ported away a sweet local phone number, and AT&T's "Executive Response Team" has been phoning me about a letter from the Minnesota State Attorney General.

I am geek, hear me roar.

Yes, even as you read this AT&T is licking its wounds, cowering in the corner.

It wasn't easy. I had to, for example, spend way too much time figuring out the microeconomics of the US iPhone marketplace and how AT&T's response to the end of SMS is killing SMS. Painful - but revenge usually is.

My revenge is not quite complete, however. I still need to summarize what I did, so you too can take revenge. My response was crafted around our family plan, but elements of it could work for any plan. Here were all the things I did and, briefly, why. There are more details in the links and below.

We dropped child #2 from our family plan. He wasn't interested in phoning or texting - he wanted email, games and videos. We were paying $10 (plus taxes and fees) monthly for his plan and we'd have stuck with that, but AT&T's mandatory data plan for out-of-contract smartphones was going to make his cost $25/month. Too much.
I liked child #2's easy to remember mobile number -- any my corporate Google Voice number was non-local (they no longer have MSP numbers). So I ported #2's number to Google Voice. Cheap at $20; I suspect AT&T puts more value on its numbers than that.
I got a new 4S (more below), so phones moved around and child #2 ended up with iMessage and Facebook Messenger for texting with WiFI.
Child #1 was stuck with the data plan, but thinking through iPhone Microeconomics it was clear I should use his off-contract $15/month data plan [2] to get a highly subsidized iPhone [1] that would facilitate iMessage use. He was eligible through our family plan and his voice rate did not increase. I could have been short-term cheap and gotten a 3GS, but a 4S has a longer lifespan and the camera and other features were worth the cost to me. I got the 4S, he got an old 3GS.
I dropped our family plan from 1400 to 700 minutes. With Child #2 off the plan, and using GV at work to decrease my use of the iPhone for business, this was not hard to do.
I dropped our $30/month family texting and any-mobile plan. This was the big cut, but looking at usage patterns it was clear that with iMessage and Facebook Messenger we'd pay less than $10 a month even at 20 cents/message.
We were paying for SmartLimits for Wireless. I studied it and realized it was useless for an iPhone.
We were paying for a Canada Calling service -- but I almost always use Google Voice to call Canada (saves me $1300 a year). Canceled that. [3]
Emily and I had $30/month unlimited data plans - but we never come close to even 2GB. Emily is often under 200, and I'm always under 1GB. That's $10/month we don't need to spend - $240 over tow years. We dropped to 2GB plans. Emily may go to 200MB in time.

We've saved several hundred dollars and picked up a new 4S. You can do something similar. Start by dropping that expensive texting plan.

Now to figure out what to do with our increasingly junky home phone ...

See also:

[1] The 3GS costs $1 with a contract. AT&T gets a portion of a data plan to cover the rest of what it owes Apple. A $15 data plan doesn't leave much margin for AT&T to pay Apple, so this is a highly subsidized phone.
[2] He uses about 100MB at most, usually less. We monitor with Dataman Pro, Safari and YouTube are parental control disabled. iTunes video samples is his main data drain, if that increases I'll disable iTunes - but he does well.
[3] To AT&T's credit, it's now easy to add and remove services from their web site and the accounting seems fair.

Update 3/4/2012: H2O wireless turns out to be a cheap way to add voice/SMS service for light use: Gordon's Tech: Pay-as-you-go voice and SMS service for a contract-free AT&T iPhone with H2O Wireless

Update 3/18/2012: Months after I make this change, I realize I have no SMS service at all! I didn't notice because most of my texting is via iMessage. Turns out I've been missing friend's texts, and my own infrequent texts have gone missing. No error messages of course, everything just goes into the ether. It appears when AT&T removed our unlimited messaging plan, they forgot to add in a transactional plan. I wonder if that was once automatic, and has only recently become an opt-in plan. I added it in, and now MyAT&T.app lists text use; I'd wondered why that wasn't included earlier.

Moral of the story: Even AT&T is overwhelmed by the complexity of its mobile plans -- so test everything!

Sunday, November 27, 2011

What Steve Jobs teaches about psyche and adaptive advantage

Steve Jobs bachelor party consisted of him, a reluctant Avie Tevanian, and one other guy. At that point in his life, he had no true friends. It's not clear how many he ever had, though he had many acolytes and several congenial colleagues.

He was a nasty person, though, like most of us, he improved somewhat with age. He never made it within two sigmas of decent however.

He was also a great gift to me and my family. We got the products of his company, without the displeasure of his companionship. It would, however, have been fascinating to observe his mind. It was extraordinary.

It was also completely unsuited to most of human existence. Even his powers of manipulation could not outweigh the enmity he created throughout most of his life. Were he born at another time, he would have likely died young. Throughout most of human existence his mind would have been a disability, not a gift.

There was a place and time where his mind was perfectly suited, and he had the fortune to be born to that time and to that place.

It's a good lesson on the distinction between adaptive advantage and dysfunctional trait. The distinction is not the trait alone, but its suitability to the environment.

It's also a lesson on the evolution of mind. Human minds are astonishing diverse; in physical terms it's as though a single species could have children with fins and children with wings. A winged mind flies in some times, drowns in others.

Saturday, November 26, 2011

Mass disability goes mainstream: disequilibria and RCIIT

I've been chattering for a few years about the rise of mass disability and the role of RCIIT (India, China, computers, networks) in the Lesser Depression. This has taken me a bit out of the Krugman camp, which means I'm probably wrong.

Yes, I accept Krugman's thesis that the proximal cause of depression is a collapse in demand combined with the zero-bound problem. Hard to argue with arithmetic.

I think there's more going on though. Some secular trends that will be with us even if followed Krugman's wise advice. In fact, under the surface, I suspect Krugman and DeLong believe this as well. I've read Krugman for years, and he was once more worried about the impact of globalization and IT than he's now willing to admit. Sometimes he has to simplify.

For example, fraud has always been with us -- but something happened to make traditional fraud for more effective over the past thirteen years. I think that "something" was the rise of information technology and associated complexity; a technology that allowed financiers to appear to be contributing value even though their primary role was parasitic.

Similarly, the rise of China and India is, in the long run, good for the entire world. In the near future, however, it's very hard for world economies to adjust. Income shifts to a tiny fraction of Americans, many jobs are disrupted, people have to move, to change careers, etc. It takes time for new tax structures to be accepted, for new work to emerge. IT has the same disruptive effect. AI and communication networks will further limit the jobs we can take where our economic returns are equal or greater than the minimum wage.

I think these ideas are starting to get traction. Today Herman Gans is writing in the NYT about the age of the superfluous worker. A few days ago The Economist reviewed a book about disequlibria and IT

Economics Focus: Marathon machine | The Economist

... Erik Brynjolfsson, an economist, and Andrew McAfee, a technology expert, argue in their new e-book, “Race Against the Machine”, that too much innovation is the bane of struggling workers. Progress in information and communication technology (ICT) may be occurring too fast for labour markets to keep up. Such a revolution ought to be obvious enough to dissuade others from writing about stagnation. But Messrs Brynjolfsson and McAfee argue that because the growth is exponential, it is deceptive in its pace...

... Progress in many areas of ICT follows Moore’s law, they write, which suggests that circuit performance should double every 1-2 years. In the early years of the ICT revolution, during the flat part of the exponential curve, progress seemed interesting but limited in its applications. As doublings accumulate, however, and technology moves into the steep part of the exponential curve, great leaps become possible. Technological feats such as self-driving cars and voice-recognition and translation programmes, not long ago a distant hope, are now realities. Further progress may generate profound economic change, they say. ICT is a “general purpose technology”, like steam-power or electrification, able to affect businesses in all industries...

... There will also be growing pains. Technology allows firms to offshore back-office tasks, for instance, or replace cashiers with automated kiosks. Powerful new systems may threaten the jobs of those who felt safe from technology. Pattern-recognition software is used to do work previously accomplished by teams of lawyers. Programmes can do a passable job writing up baseball games, and may soon fill parts of newspaper sections (those not sunk by free online competition). Workers are displaced, but businesses are proving slow to find new uses for the labour made available. Those left unemployed or underemployed are struggling to retrain and catch up with the new economy’s needs.

As a result, the labour force is polarising. Many of those once employed as semi-skilled workers are now fighting for low-wage jobs. Change has been good for those at the very top. Whereas real wages have been falling or flat for most workers, they have increased for those who have advanced degrees. Owners of capital have also benefited. They have enjoyed big gains from the increased returns on investments in equipment. Technology is allowing the best performers in many fields, such as superstar entertainers, to dominate global markets, crowding out those even slightly less skilled. And technology has yet to cut costs for health care, or education. Much of the rich world’s workforce has been squeezed on two sides, by stagnant wages and rising costs.

In time the economy will adjust -- unless exponential IT transformation actually continues [1]. Alas, the AI revolution well is underway and technology cycles are still brutally short. I don't see adjustment happening within the next six years. The whitewater isn't calming.

[1] That is, of course, the Singularity premise, as previously reviewed in The Economist.

Update 12/3/2011: And how does the great stagnation play into this - Gordon's Notes: Ants, corporations and the great stagnation?

Thursday, November 24, 2011

iPhone micro: How SMS pricing is accelerating the smartphone transition

I've been playing with a simplified model of the carrier-locked AT&T American 2011 iPhone marketplace. I think it makes some interesting predictions.

For the purpose of this discussion we'll assume that a minimal phone must include both:

phone system compliant voice services
text messaging: either SMS or non-SMS (example: Facebook Messenger, WhatsApp, etc)

We further assume that voice services cost the same for all phones, that iPhones are assigned AT&T's minimal $15/month [1] data plan and that SMS and non-SMS text messaging are equally valuable [2]

In this model there are only 3 phones:

A: iPhone optimal - today that's the 32GB 4S.
B: iPhone minimal - today the 3GS 8GB. This is similar to the 'A' phone of 2 years ago.
C: pPhone: Plain Phone. Includes SMS and Voice but does not trigger AT&T's

So how do prices and lifespans break down, assuming phones are purchases with a 2 year contract, we get a new contract q 2 years, and the iPhones use non-SMS messaging ($15/month [3]) but the Plain Phone (pPhone) uses SMS ($20/month)?

A: $300 + ($15 * 24) = $660.
B: $0 + ($15*24) = $360.
C: $0 + ($20*24) = $480.

Based on this simple model what can we say will happen to pPhones? Assuming a healthy iPhone can run for four years [4], then at the end of the 2 year contract, what is the rational selling price of a used phone?

Clearly, the pPhone should disappear immediately. It costs 30% more than the minimal iPhone, and it doesn't have apps, wifi browsing, video, calendar, pen light, quality camera, etc, etc. It has no resale value. (A bizarre conclusion, but it follows from the extraordinary high price of SMS services.)

Less obviously, the resale value of 2 year old iPhone is also quite low [6]. A formerly class B phone iPhone is probably no longer supported by Apple at that point and the formerly Class A devices set a low ceiling (below).

The formerly Class A iPhone at age 2 is a 'Class B' phone, but for a new-contract customer it has NO price advantage over a current generation Class B device. Both will cost $360 over two years. The only market for an out of contract 2 year old carrier-locked 'Class A' iPhone is to replace a lost or broken contracted phone.

That's worth something -- but there are a LOT of those 2 year old former Class A iPhones on the market. After all, in this model there's no rational reason to not have a data plan, and since a data plan pays most of the cost of a phone, everyone in this model gets a new phone every two years [5]. That means there's a glut of post-prime iPhones on the market.

If I new Class A iPhone has an initial purchase price of $300, I expect its value after two years to fall to about $70. Indeed, the primary market may be persons wanting a very cheap iPod Touch. Effectively the price difference between the Class B and Class A iPhones over two years is $660-$360-$70 or $230 -- which is what we pay for the storage capacity and features of the Class A device (well worthwhile for most of us).

In this simple model then, it's deeply irrational to buy a pPhone, one should not fear loss or breakage of an iPhone as there will be a glut of affordable used phones on the market, the value of an out of contract iPhone is going to fall, and there are good reasons to buy either a Class B iPhone (save $230) or a Class A iPhone (features, performance).

The real world is a bit more complex - but not much more complex. Data network based texting is not yet a full replacement for SMS texting for example. However, the future of SMS is very limited. An unintended consequence of carrier's addiction to SMS margins is that they're ferociously accelerating the transition to smartphones that will destroy those margins.

See also:

- fn -

[1] Note we're talking contract, so this is fair -- unlike AT&T's mandatory smartphone data plan for non-contract phones.
[2] Clearly SMS is superior at the moment, but this is going to change quickly.
[3] I'm assigning the FULL cost of the data plan to non-SMS messaging.
[4] Based on our experience, assuming even minimal care.
[5] That's probably too simplistic. A two year old former-Class A device may be superior to a new Class B device -- though not by much.
[6] Today businesses that buy used 3GSs are offering only $100 - for a device with an unsubsidized purchase cost of perhaps $300. That's a very low price for a device that may be only two years old and can run iOS 5. It's so low because the primary market is small -- people who need to replace a lost contract phone or who want a 2nd rate iPod Touch (troublesome to activate, flaky iMessage performance, not truly supported by Apple). The market would be much larger if not for AT&T's carrier lock and mandatory data plan policies, and the price would be higher.

Update 11/26/11: A Felix Salmon Reuters post is a good complement to this article. It's a sign that the marketplace is beginning to think through the weird consequences of AT&T's contracts, all-smartphone-data-plan-mandate, and SMS pricing.

Update 11/30/2011: added footnote [6] to clarify.

Wednesday, November 23, 2011

I deleted my Google G+ Profile

I visited my Google Profile today. It includes G+ posts, and more was public than I'd expected.

There's no longer a way to disable the Posts tab in Google Profile. I recall that was once optional.

I can, however, delete my Profile:

Downgrade from Google+
... Delete Google+ content or your entire Google profile If you delete Google+, Google attempts to restore your experience of other Google products to the way it was before you joined Google+ and to permanently delete your Google+ circles, posts, and comments. If you delete your Google profile, you delete Google+ as well as other services and their data that depend on a Google profile...

I'm going to give this a few days, but I expect I'll delete my TrueName Google Profile. I'll take the opportunity to take another step away from Google 2.0.

It's interesting to reread my first post on my Google Profile in 2007.

Today I have been re-christened 113810027503326386174. It is the ID Google assigned to the persona associated with Gordon's Notes and other blogs. I assume it will be the foundation for Google's future identity management services...

...I will need to add this new number to the page where I park all my public and related personas.

I really didn't expect Google to choose its current path.

In its place, at least for the moment, I have created a John Gordon profile, a companion to my blogs.

Update 12/6/2011: I've deleted my G+ Profile and G+ Content. The dialog I received said ...

Over the next few days, Google will attempt to delete all Google+ features and your Google+ data from your Google Account:
Your circles will be deleted, but people in your circles will remain in your Contacts.
Your +1's will be deleted.
Your posts and comments will be deleted and won't be available to anyone you shared them with.
Any profile information that you did not make public will be deleted.
Many Google+ social and sharing features will be disabled for you on other Google sites.
Content from other services, such as videos, will no longer be visible to people in those circles.
However:
No photos will be deleted: you can still access them in Picasa. To delete them, go to Picasa Web Albums.
Your connections to third-party services will not be affected. To manage them go to Connected accounts settings.
Your chat buddies in Google Talk and Gmail will not be deleted.

The Iran-Mexico assassination plot -- so what about the traffickers?

Everyone I read had the same reaction ...

... Plausible Culpability - By Daniel Byman | Foreign Policy

Incredulity has been the most common response to reports that Iran plotted with Mexican drug traffickers to kill the Saudi ambassador to the United States, Adel al-Jubeir, at a Washington, D.C. restaurant...

Now, six weeks later, the emerging consensus among my sources is that ...

Iranian intelligence really is this stupid ...
Mossad does dumb things too, so why not Iran ...
Come to think of it, we're not that smart either ...

So it's being treated as "real". Lots of CIA operations going on against Iran, Saudi Arabia presumably friendlier now, etc, etc.

That's ok, but what about those Mexican drug traffickers? Didn't they just engage in a proverbial "act of war" against the US government? Does this mean they need to be watching for little dots moving in the night sky?

This really wasn't the smartest move for them.

Too much history

One of the reasons I blog is to engage with a fascinating world, and to track the streams of history.

I'm finding that harder to do. It's not that I don't see the streams, or see ways to connect them -- it's that there's too much. I feel as though history just kicked up a gear.

Partly this is the loss of Google Reader's share/tracking functions. They were a key component of how I engaged with my fragments of the world's knowledge flow. Even if nothing else had changed, losing those functions and my share repository would be disorienting.

I don't think it's just the loss of Reader though. It's more that Reader's capabilities masked the rate of change. Without them, it's easier to see how the world is changing.

These are truly whitewater times.

Tuesday, November 22, 2011

Remembering when the iPhone cost less

Our iPhone-bearing family is going through complex gyrations to claw some money back from AT&T.

Things were simpler, and less costly, there years ago. I came across this 2008 TidBITS article while researching whether it makes sense to get a 4S with a child-contract then transfer various phones around the family (emphases mine) ....

TidBITS iPhone iPad iPod: iPhone 3G Actually $160 More Expensive (2008):

... So buying an iPhone 3G may cost $200 less than before, but paying the monthly bill will set you back $240 more over your 2-year contract with AT&T, for a total of $1,680 in subscription fees instead of $1,440 (previously, the lowest monthly voice+data plan cost $59.99 per month). How exactly is that cheaper?

Wait, it gets worse! Om Malik, in an interview with Ralph de la Vega, president and chief executive officer of AT&T Mobility, learned that SMS messages are no longer included in the data plan either, so you'll have to pay extra for them. Previously, the data plan included 200 SMS messages per month. AT&T's Messaging 200 plan, which includes 200 SMS messages, costs $5 per month, so it would seem likely that the iPhone 3G's SMS plan would be similar...

The original iPhone looked expensive, but that was only because most of us, including most journalists, can't do grade school arithmetic -- and because the modern corporation has made an art form of misleading marketing.

I suspect Steve Jobs was disappointed that we couldn't do the math back in 2007. The iPhone became a contract-phone with a higher cost of ownership -- and then AT&T's obligatory data plans and unending carrier lock dramatically reduced the resale value of old phones...

Sunday, November 20, 2011

The checklist in aviation and medicine

Four years ago Atul Gawande wrote an astounding article on the "stupid little checklist" and its impact on health care.

It was a great article, and of course it's been largely forgotten since. Progress is slow. It's hard to keep something so simple and obvious in the public mind; there's no business model.

I remembered this article after a recent experience in my own world of corporate software development. For want of a checklist a release was lost.

This is a good time to refresh memories ... (emphases mine)

Annals of Medicine: The Checklist - The New Yorker 2007 by Atul Gawande

... For every drowned and pulseless child rescued by intensive care, there are many more who don't make it-and not just because their bodies are too far gone. Machines break down; a team can't get moving fast enough; a simple step is forgotten. Such cases don't get written up in The Annals of Thoracic Surgery, but they are the norm. Intensive-care medicine has become the art of managing extreme complexity-and a test of whether such complexity can, in fact, be humanly mastered.

... Fifty years ago, I.C.U.s barely existed. Today, in my hospital, a hundred and fifty-five of our almost seven hundred patients are, as I write this, in intensive care. The average stay of an I.C.U. patient is four days, and the survival rate is eighty-six per cent.

... A decade ago, Israeli scientists published a study in which engineers observed patient care in I.C.U.s for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions-but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail...

... intensive-care medicine has grown so far beyond ordinary complexity that avoiding daily mistakes is proving impossible even for our super-specialists. The I.C.U., with its spectacular successes and frequent failures, therefore poses a distinctive challenge: what do you do when expertise is not enough?

On October 30, 1935, at Wright Air Field in Dayton, Ohio, the U.S. Army Air Corps held a flight competition for airplane manufacturers vying to build its next-generation long-range bomber.

...The plane roared down the tarmac, lifted off smoothly, and climbed sharply to three hundred feet. Then it stalled, turned on one wing, and crashed in a fiery explosion. Two of the five crew members died, including the pilot, Major Ployer P. Hill.

An investigation revealed that nothing mechanical had gone wrong. The crash had been due to "pilot error," the report said. Substantially more complex than previous aircraft, the new plane required the pilot to attend to the four engines, a retractable landing gear, new wing flaps, electric trim tabs that needed adjustment to maintain control at different airspeeds, and constant-speed propellers whose pitch had to be regulated with hydraulic controls, among other features. While doing all this, Hill had forgotten to release a new locking mechanism on the elevator and rudder controls. The Boeing model was deemed, as a newspaper put it, "too much airplane for one man to fly." The Army Air Corps declared Douglas's smaller design the winner. Boeing nearly went bankrupt.

Still, the Army purchased a few aircraft from Boeing as test planes, and some insiders remained convinced that the aircraft was flyable. So a group of test pilots got together and considered what to do.

They could have required Model 299 pilots to undergo more training. But it was hard to imagine having more experience and expertise than Major Hill, who had been the U.S. Army Air Corps' chief of flight testing. Instead, they came up with an ingeniously simple approach: they created a pilot's checklist, with step-by-step checks for takeoff, flight, landing, and taxiing. Its mere existence indicated how far aeronautics had advanced. In the early years of flight, getting an aircraft into the air might have been nerve-racking, but it was hardly complex. Using a checklist for takeoff would no more have occurred to a pilot than to a driver backing a car out of the garage. But this new plane was too complicated to be left to the memory of any pilot, however expert.

With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident. The Army ultimately ordered almost thirteen thousand of the aircraft, which it dubbed the B-17. And, because flying the behemoth was now possible, the Army gained a decisive air advantage in the Second World War which enabled its devastating bombing campaign across Nazi Germany.

Medicine today has entered its B-17 phase. Substantial parts of what hospitals do-most notably, intensive care-are now too complex for clinicians to carry them out reliably from memory alone. I.C.U. life support has become too much medicine for one person to fly.

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.. 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 .

. 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.
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. 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. ..

... 2003, however, the Michigan Health and Hospital Association asked Pronovost to try out three of his checklists in Michigan's I.C.U.s. It would be a huge undertaking. Not only would he have to get the state's hospitals to use the checklists; he would also have to measure whether doing so made a genuine difference.
This past summer, I visited Sinai-Grace Hospital, in inner-city Detroit, and saw what Pronovost was up against ... between 2000 and 2003 Sinai-Grace and eight other Detroit hospitals were forced to cut a third of their staff, and the state had to come forward with a fifty-million-dollar bailout to avert their bankruptcy.

... they were, I discovered, filling out those pages. Mostly, it was the nurses who kept things in order. Each morning, a senior nurse walked through the unit, clipboard in hand, making sure that every patient on a ventilator had the bed propped at the right angle, and had been given the right medicines and the right tests. Whenever doctors put in a central line, a nurse made sure that the central-line checklist had been filled out and placed in the patient's chart. Looking back through their files, I found that they had been doing this faithfully for more than three years.

Pronovost had been canny when he started. In his first conversations with hospital administrators, he didn't order them to use the checklists. Instead, he asked them simply to gather data on their own infection rates. In early 2004, they found, the infection rates for I.C.U. patients in Michigan hospitals were higher than the national average, and in some hospitals dramatically so. Sinai-Grace experienced more line infections than seventy-five per cent of American hospitals. Meanwhile, Blue Cross Blue Shield of Michigan agreed to give hospitals small bonus payments for participating in Pronovost's program. A checklist suddenly seemed an easy and logical thing to try.

In what became known as the Keystone Initiative, each hospital assigned a project manager to roll out the checklists and participate in a twice-monthly conference call with Pronovost for trouble-shooting. Pronovost also insisted that each participating hospital assign to each unit a senior hospital executive, who would visit the unit at least once a month, hear people's complaints, and help them solve problems.

The executives were reluctant. They normally lived in meetings worrying about strategy and budgets. They weren't used to venturing into patient territory and didn't feel that they belonged there. In some places, they encountered hostility. But their involvement proved crucial. In the first month, according to Christine Goeschel, at the time the Keystone Initiative's director, the executives discovered that the chlorhexidine soap, shown to reduce line infections, was available in fewer than a third of the I.C.U.s. This was a problem only an executive could solve. Within weeks, every I.C.U. in Michigan had a supply of the soap. Teams also complained to the hospital officials that the checklist required that patients be fully covered with a sterile drape when lines were being put in, but full-size barrier drapes were often unavailable. So the officials made sure that the drapes were stocked. Then they persuaded Arrow International, one of the largest manufacturers of central lines, to produce a new central-line kit that had both the drape and chlorhexidine in it.

In December, 2006, the Keystone Initiative published its findings in a landmark article in The New England Journal of Medicine. Within the first three months of the project, the infection rate in Michigan's I.C.U.s decreased by sixty-six per cent. The typical I.C.U.-including the ones at Sinai-Grace Hospital-cut its quarterly infection rate to zero. Michigan's infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative's first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years-all because of a stupid little checklist.

Apple and self-delusion

Jobs was the best salesman of the past 50 years.

I wonder, though, if deep down he knew what was real and what was not.

His Heirs don't seem to know ...

AppleInsider | Apple VP shares four keys to company's success:

... Drawing from 20 years of experience at Apple, Greg Joswiak, the company's vice president of worldwide iOS product marketing, has explained four keys to the company's success: focus, simplicity, courage and a commitment to being the best....

... The fourth and final guiding principle that Joswiak shared was Apple's commitment to only enter markets that it believes it can be the best in...

Right. The best.

iWork. iPhoto. Aperture. Calendar.app. iCloud. MobileMe. Must be the very best eh?

Some of what Apple produces is excellent. Some of it is 3rd rate. A lot of it is second rate. If Apple's leadership really believes they are always "the best" they are delusional and Apple will become an average publicly traded company. Another Microsoft, another Google.

Apple's flagship product is the iPhone -- and there are lots of issues with the cost/value it delivers compared to Android. Apple needs to work very hard, and with clear eyes, to increase the value they bring to their customers.

Is there anyone in Apple whose job it is to question Apple's own myths?

The super-optimist take on the super-committee

To the surprise of nobody I read, the super-committee is said to be focusing on how best to present complete failure.

Since this was expected all along, why create a "super"-committee? Much of our political leadership is incompetent, but many have a few functional staffers. So why bother?

The super-optimist view is that this was all a magic trick. Magicians draw attention to the right hand, while the left hand does the real work.

Perhaps the super-committee's only function was to distract the masses, while the real work was done elsewhere. Or else-when, such as around the time the Bush tax cuts expire.

Saturday, November 19, 2011

Quantum action - Pusey's theorem

I'm looking forward to the discussions on this paper by Pusey et al ...

Quantum theorem shakes foundations : Nature News & Comment
... Robert Spekkens, a physicist at the Perimeter Institute for Theoretical Physics in Waterloo, Canada, who has favoured a statistical interpretation of the wavefunction, says that Pusey's theorem is correct and a “fantastic” result, but that he disagrees about what conclusion should be drawn from it. He favours an interpretation in which all quantum states, including non-entangled ones, are related after all.

Spekkens adds that he does expect the theorem to have broader consequences for physics, as have Bell’s and other fundamental theorems. No one foresaw in 1964 that Bell’s theorem would sow the seeds for quantum information theory and quantum cryptography — both of which rely on phenomena that aren’t possible in classical physics. Spekkens thinks this theorem may ultimately have a similar impact. “It’s very important and beautiful in its simplicity,” he says...

Pusey's interpretation is that the wave function models a physical reality. The paper allows, however, that the wave function is a predictive model [1] -- but, in that case, all quantum states are interconnected across space and time, even uncorrelated states.

This ought to be very interesting ...

[1] If you've done basic stats, you have worked with linear regression models that predict systems statistically, but once the system is understood, are found to be weakly related to the fundamental "truth". Sometimes these models do reflect fundamentals, but they don't have to. This is relatively basic math, but it gives me a way to think about statistically predictive models that don't resemble the "true" mechanistic model.

Update: Shtetl Optimized (Scott Aaronson) hates this article, PBR's definition of statistics, and especially Slashdot... (emphases mine)

... There’s an important lesson here for mathematicians, theoretical computer scientists, and analytic philosophers. You want the kind of public interest in your work that the physicists enjoy? Then stop being so goddamned precise with words! The taxpayers who fund us—those who pay attention at all, that is—want a riveting show, a grand Einsteinian dispute about what is or isn’t real. Who wants some mathematical spoilsport telling them: “Look, it all depends what you mean by ‘real.’ If you mean, uniquely determined by the complete state of the universe, and if you’re only talking about pure states, then…”

Aaronson is a theoretical computer scientist. I don't think he's happy right now.

Rick Perry really is an idiot

I knew Rick Perry was ignorant, but this moves it up to a new level...

Republican Financial Plans - NYTimes.com

... This week, Perry laced into Barack Obama as a man who could not possibly understand what ordinary Americans were going through because he “grew up in a privileged way"...

Rick Perry, unlike Mitt Romney, grew up on the wrong side of the tracks. So maybe he considers Obama's lower middle class life to be extraordinarily privileged. By that standard, I was presumably privileged -- and I remember being short of food on occasion.

What an ass.