I have a blog?

It was pointed out to me (very politely) that I’ve left the blog fallow for more than a month. That’s a first, and hopefully a last.

I have some excuses, and while they’re stronger than ‘the dog ate my homework’ they are still excuses, and I owe the nine of you better. Mea Culpa.

Something I didn’t talk about after the Christmas Cruise was the disappointment of the missing travelers: my folks, for their first cruise. Not quite a total tragedy, but not good. We’d planned ahead, bought the recommended trip insurance from AAA Travel, and we were going to spend a day in Miami before boarding so flight disruptions couldn’t screw up our cruise. Every plan has a flaw: it doesn’t matter spending a day of there are no flights/they’re overbooked when yours is cancelled. That’s what happened to my folks. Oh, the airline did reschedule them for a flight 30 hours later, which would have taken off after the boat shoved off, so they couldn’t come.

Well, there’s always tomorrow, and we have trip insurance, right? The folks got their money back from the airline. The trip insurance company has decided to play the ‘not covered’ card, so we’re appealing through AAA as they recommended this insurance vendor. I’m not going to mention their name on the off chance they do the right thing (eventually), but there’s a bus waiting for them should they reject the AAA appeal.

The Global Warming Winter of 2013/14 has been harshly cold here in Texas, and we have had two days of 70 degree weather back to back, so hopefully that means the CO2 has ganged up to help us out.

I work in a highly functional and generally well regarded ER seeing a little over 100K a year, and January 11th we got to move into our new construction ED. Longer and wider than a football field, 89 rooms (many, many of which can hold two patients in a pinch), it’s so pretty and so big all of us are just now recovering from the shock. We’ve had more than a hundred patients in the ED at one time several times in the new place, and while the staff and docs were humming, and: not crowded! In the legacy ED, we’d have patients on gurneys very literally next to all of us, having to turn sideways to get through the spaces, etc. It’s so nice we aren’t sure we deserve it.

The downside of new construction in an existing hospital footprint means long walks from the hospital to the ED (like, 100 yards down a million dollar bridge). Consultants like the space, but don’t like the walk, especially several times a day. Time will make things better, or at least more normal.

In other news, I’ve briefly mentioned (probably) that I have a man lift, which means a mechanical bucket on an hydraulic set of arms. It all works well when it does; add a squirrel and a winter and there’s wire damage; rather a lot of wire damage, like at least 8 wire bundles eaten through and others denuded of their insulation. The eviction was brief and had I known the damage would have been quite a bit more terminal, and now the lift’s gone to the Land of the Fixer, my father the mechanic. (I’m aware that in modern movies ‘Mechanic’ often means killer or brute, but in my world and my experience it means a guy whose hands and mind can create anything and destruction is secondary to creation, which seems right). In my life Dad has made me and my brother understand mechanics, work and the life it presents.

I have a Tesla Model S car. It’s the closest thing to driving a UFO you can imagine, as it’s all electric and the torque seems limitless and unending. Get one now.

I intend it won’t be more than a month before my next post. Apologies, and live well.

Happy Anniversary honey!

Thanks for the 24 terrific years. I love you.

IMG_0107

Weird things I notice

Carnival cruise lines took some hits recently with ships that had power problems. I figured they’d overcome those issues, but didn’t know how.

Now I know. On both of the Carnival boats we saw on a recent cruise, there’s this:
IMG_0016_2

So it’s easier to see, here’s a cropped one:
IMG_0016

Yep, it’s a Caterpillar generator. There was one in the same place on both boats, which seems a pretty clever way to provide emergency power. Kudos.

A rare Disney screwup

The family (minus a couple) went on a Disney Cruise lines cruise for Christmas. It was the Happiest Boat on Earth while we were there, and a good time was had by all*.

Astonishingly, I accidentally walked into a bar on the ship, which had just come out of a refitting period which had redone this particular lounge. It had the most jarringly-bad decor, a very non-disneylike screwup:
A few too many
(Hint: there’s no lone black key on a keyboard)

Chatting with the lounge staff, they said they were aware, and had been told it’d get fixed ‘sometime’. Heh. For the record, the decor bizarreness didn’t affect the quality of the service or the drinks.

*Head bonk by a thrown menu. By a a Disney cast member. May tell that story someday.

By my brother’ book: Think Fast Enchilada Edition

Until today, Think Fast – The Racer’s Why-To Guide to Winning was available exclusively in paperback form. Here is the link to the Kindle Edition of Think Fast. Everything in the print edition is in there – it’s the whole enchilada, but one that you can carry in your pocket. The dedicated web site for Think Fast has numerous excerpts to give you a sense of what it’s like. The unanimous positive feedback that I have received means that it must be one of the better racing books in print, and the Kindle Edition is yours for a lower price.

via Think Fast Enchilada Edition – Think Fast Engineering.

I recommend it for the racer, or the would-be racer, in your life.

Last minute shopping for a gearhead?

Look no further than KaleCoAuto.com !

Any place that has both blinker fluid and heavy duty clutch belts has just what you need for the speed freak in your life.

(Seriously, how does somebody have the time and talent to make a site like this?)

Via the AerospaceGenius

Birth Day for brother and niece!

For my little brother (who’s taller and smarter than me, thank goodness I’m better looking):

He’s a touch older than in this picture (he was the lead mechanical engineer making this thing fly, in one year):

The Aerospace Genius and one of his creations.

The Aerospace Genius and one of his creations.

 

And, to my niece Annie! I have no pics of her with an airplane, but when I get one, I’ll keep it for her next birthday.

Joy to The World, USAF Band style, at the Smithsonian

Pearl Harbor

If you meet a Pearl Harbor vet, thank ‘em. They’re pretty rare (an 18 year old then would be 94 now…).

Thanks to our Pearl Harbor vets.

Hilarious Tamiflu side-effect

Okay, it’s not hilarious, it’s funny that it’s included as a side effect of Tamiflu (treatment for influenza):

2013-11-26_16-53-35

I’m not a huge fan of Tamiflu (for the neuropsychiatric side effects), but I saw this last night on my pocket brain, and had to look today to see if it’s really listed.

It is, that’s off the Tamiflu full-download of the medication information (Link on the official Tamiflu page).

So you know, when patients are in studies, basically everything that happens while the subject is taking the medication has to be reported to the FDA, which is how all that oddness gets enshrined as less than 1% side effects. I do find it a little amusing that ‘pyrexia’ (fever) is listed as a side effect, since influenza classically has a fever, and the peritonsillar abscess diagnosis quite possibly indicates the patient didn’t have the flu, they had an undiagnosed condition subsequently diagnosed.

Tamiflu is a Genentech product, FYI.

Why the Zero Defect mentality will never work

At least, not in real life:

The idea that “failure is not an option” is a fantasy version of how non-engineers should motivate engineers. That sentiment was invented by a screenwriter, riffing on an after-the-fact observation about Apollo 13; no one said it at the time. If you ever say it, wash your mouth out with soap. If anyone ever says it to you, run. Even NASA’s vaunted moonshot, so often referred to as the best of government innovation, tested with dozens of unmanned missions first, several of which failed outright.

Failure is always an option. Engineers work as hard as they do because they understand the risk of failure. And for anything it might have meant in its screenplay version, here that sentiment means the opposite; the unnamed executives were saying “Addressing the possibility of failure is not an option.”

via » Healthcare.gov and the Gulf Between Planning and Reality Clay Shirky.

Healthcare has this idiocy. It’s a disconnect between the doers, who will tell you what’s possible, and the managers, who either don’t know or don’t remember.

Leaders, by the way, would know the difference.  Need more of those.

Happy Birthday USMC!

SemperFi

I post this every year, and I still enjoy it…
original poster from: stores.ebay.com/WONDERFULART

Grading a Physician’s Value — The Misapplication of Performance Measurement — NEJM

NEJM realized the PQRS Emperor has no clothes.

Perhaps the only health policy issue on which Republicans and Democrats agree is the need to move from volume-based to value-based payment for health care providers. Rather than paying for activity, the aspirational goal is to pay for outcomes that take into account quality and costs. In keeping with this notion of paying for value rather than volume, the Affordable Care Act ACA created the “value-based payment modifier,” or “value modifier,” a pay-for-performance approach for physicians who actively participate in Medicare. By 2017, physicians will be rewarded or penalized on the basis of the relative calculated value of the care they provide to Medicare beneficiaries.

Although we agree that value-based payment is appropriate as a concept, the practical reality is that the Centers for Medicare and Medicaid Services CMS, despite heroic efforts, cannot accurately measure any physician’s overall value, now or in the foreseeable future. Instead of helping to establish a central role for performance measurement in holding providers more accountable for the care they provide and in informing quality- and safety-improvement projects, this policy overreach could undermine the quest for higher-value health care. Yet the medical profession has been remarkably quiet as this flawed approach proceeds.

via Grading a Physician’s Value — The Misapplication of Performance Measurement — NEJM.

How many tens of thousands of hours are spent jumping through hoops like these that turn out to be more meaningless (or worse) ‘government work’?

Spin in the cancelled-policy articles

All the articles about cancelled Individual Insurance plans have some variation of this spin in them:

For some who have received the letters, the new plans being offered are more expensive, but for others — especially those who qualify for a federal subsidy to bring down the cost of the premium — their insurance bill will go down.

via Canceled health insurance plans add to angst of change | Local News | The Seattle Times.

Emphasis added.

Here’s the thing: people (like me) in the Individual market don’t have IBM or Exxon sitting across the table from an insurance company, dealing from a position of some strength. We’re individuals. We’re independent Contractors (me), self employed and scraping by, or doing well. We looked at our options, bought plans we could afford, and realized there are tradeoffs from a cost/benefits standpoint. Not a lot of people in that group bought a soup-to-nuts expensive plan (some did, most don’t).

The emphasized thing above is pure spin on the part of the writers. I have no doubt they’ve been told this over and over, but I have yet to see one article about someone in the Indy market that got a ‘better’ plan that dropped in price. There will be a few, but most if not all will see their costs go up.

Just so you see it for what it is.

AAPS Sues to Stop the Unlawful Revisions to ObamaCare

A constitutional argument. From docs:

The Association of American Physicians & Surgeons (AAPS) has filed a lawsuit today in federal court to halt the unlawful revisions to ObamaCare (the Patient Protection and Affordable Care Act).

The separation of powers required by the Constitution prohibits the executive branch—the Obama Administration—from rewriting laws passed by Congress. Yet that is what Obama has done by changing key parts of ObamaCare in order to implement it.

The AAPS lawsuit, which was filed today in the Eastern District of Wisconsin, asks the Court to enjoin the Obama Administration from imposing its “individual mandate” while delaying the “employer mandate.” The law that was passed by Congress in 2010 requires that the employer mandate go into effect at the same time as the individual mandate: Jan 1, 2014.

“The U.S. Constitution requires a strict separation of powers between the three branches of government, such that the executive branch cannot change laws passed by Congress,” AAPS’s lawsuit explains. By imposing the individual mandate in 2014 without the protection of the employer mandate, the Obama Administration has changed the legislation passed by Congress.

via AAPS Sues to Stop the Unlawful Revisions to ObamaCare.

Bizarre congress is super-cool with the executive branch picking and choosing the laws to bother enforcing.