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#901
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Kill-filing
On 12/7/2010 8:16 AM, Tºm Shermªn™ °_° wrote:
On 12/6/2010 10:26 PM, Edward Dolan wrote: "T�m Sherm�nT " wrote in message ... On 12/6/2010 10:08 AM, Duane H�bert wrote: At home I use Outlook Express for a news reader.[...] Bill Gates holding a gun to your head? Most of us are already paying enough for our Internet connection without the extra expense of a newsreader. I paid $0.00 for Mozilla Thunderbird. http://www.mozilla.org/ I didn't pay of OE. What difference does it make anyway? The point was that you are preventing people from replying to you with the same method that you're trying to prevent them from kill filing you. Just saying. |
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#902
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Kill-filing
In article ,
Tºm Shermªn™ °_° " wrote: On 12/6/2010 10:26 PM, Edward Dolan wrote: "T?m Sherm?nT " wrote in message ... On 12/6/2010 10:08 AM, Duane H?bert wrote: At home I use Outlook Express for a news reader.[...] Bill Gates holding a gun to your head? Most of us are already paying enough for our Internet connection without the extra expense of a newsreader. I paid $0.00 for Mozilla Thunderbird. http://www.mozilla.org/ You can get it for half of that if you shop around... |
#903
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Bicyclist Fatalities in AZ 2009
On 12/7/2010 12:43 AM, Frank Krygowski wrote:
On Dec 6, 11:22 pm, wrote: On Dec 6, 7:29 pm, Frank wrote: On Dec 6, 2:45 pm, wrote: On Dec 6, 12:35 pm, Frank wrote: So DR, when you're bicycling in a 10 foot lane with a truck that's 8' 6" wide coming up behind you, what exactly do you do? Frank, you're ignoring me. Remember? No, obviously, I'm asking you a question.. When you're bicycling in a 10 foot lane with a truck that's 8' 6" wide coming up behind you, what exactly do you do? Are you really so afraid to answer? No, Frank not afraid, just bored and exercising a bit of restraint. With regard to the situation you describe one might wonder why it is necessary to do anything unless it is a dangerous or extremely dangerous situation. So is it? It's not dangerous for me, because I do control the situation by controlling the lane. I think it's dangerous for a cyclist to ride the road's edge so as to not displease the trucker. It's unacceptably dangerous to imply to the trucker (or any motorist) that he's welcome to pass you with only tiny clearance. There is no room for the truck to pass within the lane in any case. Why are you making a big deal of it? Don't you feel adequately safe? I feel extremely safe handling it the way I do. I'm making a big deal of it because Duane mocked the fact that I control the trucker's behavior. I didn't mock you. I questioned your assertion that you on a bicycle are controlling the trucker's behavior. This is only true if the trucker sees you and allows it. I've had cases where the truck didn't see me and cases where they didn't allow it. Your claim that you can control a truck that weighs several tons more than you traveling at higher speeds than you, in every case is what is dangerous here. Not cycling. So DR, what _do_ you do in that situation? 10 foot lane, 8.5 foot truck. Do you suddenly bail to ride the sidewalk, or do you bump along in the gutter, or do you control the lane? - Frank Krygowski |
#904
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Bicyclist Fatalities in AZ 2009
On 12/7/2010 9:19 AM, Duane Hébert wrote:
On 12/6/2010 9:57 PM, James wrote: Frank Krygowski wrote: http://www.youtube.com/watch?v=adTpGj2MFec I really am amazed to find so much fear in this group. - Frank Krygowski This is fun.. http://www.youtube.com/watch?v=ALn2KXD852Y&NR=1 http://www.youtube.com/watch?v=eiz6U...eature=related Pretty normal stuff. I assume it's illegal to overtake over double lines? At about 4 minutes and 4 seconds is a good bit too. http://www.youtube.com/watch?v=UF2eLT0VRVA&NR=1 In Quebec, cars must maintain 1.5 meters from a bicycle. They can cross double yellow to pass as long as it's to maintain the distance from a bike. Of course, if the bike is in the center of the lane they can't pass. This tends to **** off some drivers. This should say that they may not be able to pass. There's no law that says they can't pass the bike when it's in the center or even to the left of the lane. They typically won't though. Our club instructs us to move to the right to allow the motorists to pass. Seems like a good way to share the road. |
#905
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Kill-filing
["Followup-To:" header set to rec.bicycles.tech.]
Edward Dolan wrote: I just realized I will not see a response to this post unless I make sure it comes to RBS. I do not monitor RBT. It has become obvious to me that you are not a "technology person". "Tad McClellan" wrote in message ... ["Followup-To:" header set to rec.bicycles.tech.] Edward Dolan wrote: "Tºm ShermªnT °_°" " wrote in message ... On 12/6/2010 10:08 AM, Duane Hébert wrote: At home I use Outlook Express for a news reader.[...] Bill Gates holding a gun to your head? Most of us are already paying enough for our Internet connection without the extra expense of a newsreader. There are over a dozen free newsreaders available to Bill's minions, so the "extra expense" is zero. I think a lot of folks have ISPs which do not provide free newsreaders. ISPs *never* provide newsreaders, neither pay-for nor free! Usenet is a "client-server architecture": http://en.wikipedia.org/wiki/Client%...93server_model Newsreaders are clients, they run on your local computer. News *feeds* are servers, they run on your ISP's computers. I used to use Outlook Express and now I use Windows Mail. Your ISP provided those? I don't think so. It is convenient to use them and they work well enough as far as I can tell. A purpose-built tool is always better than a jack-of-all-trades tool. I am pretty sure Mr. Sherman is paying for his newsreader. You are wrong. It is easy enough to determine that youself by examining the headers of his posts. He uses Thunderbird. Thunderbird is free software. What is a good free newsreader just in case I need one someday? I never use Windows, so I don't know, but it is easy to find out: http://lmgtfy.com/?q=free+windows+newsreaders -- Tad McClellan email: perl -le "print scalar reverse qq/moc.liamg\100cm.j.dat/" The above message is a Usenet post. I don't recall having given anyone permission to use it on a Web site. |
#906
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OT - Medical Costs
On 12/7/2010 12:04 AM, Tim McNamara wrote:
In , Peter wrote: http://www.nejm.org/doi/pdf/10.1056/NEJMsa0900592 "Results On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems." This seems orthogonal to the discussion. I don't think so. There is a very low adoption rate of integrated EMR systems in the US. The barriers most commonly cited are initial cost and projected operating cost, not inaccuracy, security or productivity declines. Those who have implemented have a more positive outlook than those who have not. http://www.ncbi.nlm.nih.gov/pubmed/12773650 "CONCLUSIONS: The quality of care in the VA health care system substantially improved after the implementation of a systemwide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program. These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective." http://www.ncbi.nlm.nih.gov/pubmed/1...t&holding=f100 0,f1000m ,isrctn "Since 1995, the Veterans Health Administration (VHA) has had an ongoing process of systems improvement that has led to dramatic improvement in the quality of care delivered. A major component of the redesign of the VHA has been the creation of a fully developed enterprise-wide Electronic Health Record (EHR). VHA's Health Information Technology was developed in a collaborative fashion between local clinical champions and central software engineers. Successful national EHR implementation was achieved by 1999, since when the VHA has been able to increase its productivity by nearly 6 per cent per year." The data to date suggests that EMR implementation in the US is pretty minimal, and where it has been extensively implemented (e.g. VA), it has significantly improved care and lowered costs. Unfortunately for interpreting the data there has been a spectrum of initiatives of which an EMR is only one part, as your own examples indicate. As a result it is difficult if not impossible to determine which interventions resulted in the improvements in quality of care. Could EMRs contribute to improved quality of care? Possibly. I just haven't seen it happen yet. The VA apparently has, or so they claim. They're hardly a small system, and they have a long track record with technology. More arrogance, since you are assuming that computerization = better health care. When health care is done unerringly by computers, that might work out to be true. It seems to be true according to at least some major studies. The list of benefits is long. Your objections seem to be centered on efficiency, but there is evidence that has been substantially improved, also. If efficiency was actually lowered, it would be rather unique across the very wide range of computer assisted activities. That's nice to hear. I haven't seen it; what I see is a lot of providers sitting behind computers typing and clicking instead of taking care of patients. I hear almost zero accolades for EMRs and a wealth of compiaints. My perspective on it is that health care providers don't treat computers, they treat people. Yes, and productivity and accuracy are keys to providing better treatment at lower costs. I think that's a given. The only thing that appears to be controversial is the gains in efficiency and cost/benefit. I would expect that vets are at least as concerned about costs and efficiency as human medics. I think you are drawing unwarranted conclusions about the benefits of EMRs and overlooking the problems. This may be the result of perspective- you're a computer programmer and not a health care provider. I am only citing reports in the public domain. Why not design computers to capitalize on the characteristics and economics of a highly sophisticated, well-developed pre-existing documentation system? To fully take advantage of the benefits of computerization data must be standardized and encoded. And has been so for a long time, long predating computers. Not to the extent that is needed for effective use of computers, including data exchange between systems. There have been fairly recent initiatives, as you might expect, in the medical data standards area, there's clearly the need. This allows both easy data exchange between systems and automated data processing. Those two benefits are enormous. Except they don't exist. Data exchange between different EMRs is cumbersome at best, if even possible. Hence the need for further standardizations. As medical facilities, by necessity, become more distributed and specialized, the need to coordinate and share becomes proportionally greater. The trend, locally at least, is towards a more comprehensive range of services on one campus rather that wider distribution and specialization. There are good business and customer service reasons for this as well as pressure from payers to make more services more conveniently available for their insureds. Small distributed independent practices are going away through attrition, affiliation and mergers. Consolidation seems to be a natural phenomenon in virtually every industry -- economies of scale, etc. In my case, while my specialists, hospitals (explicitly plural), primary care and diagnostic labs are all part of the same system, they occupy geographically separate facilities. This is Boston, a major medical hub, so I think it is pretty standard. It's a real benefit to have all records available to all players. It would be even better if my complete medical records were available to other systems should I travel. Virtually all commercial activities undergo continuous transformation via technological innovation. That's what drives productivity, and has for millennia. That medicine is somehow immune to this is naive. That's not what I've been saying. What I am pointing out is that IME the computerization of medical records has not been helpful to health care providers being able to get their primary job done: providing health care to patients. I'm not sure why you seem to think I am somehow lying to you about my observations and experiences. I am not accusing you of lying. I am responding to your charges of inevitable inefficiency in EMR systems. My argument is that computer systems are primarily driven by efficiency benefits (productivity). Those gains have been reported in actual implementations such as the VA. Medicine, in the US, via a number of mechanisms, is pretty much a cartel. Bull****. But you have to stop mixing things up to be able to understand that. HMO's and pharmaceuticals aside, there's the AMA, called by some "the strongest union in the country". But the hospital/clinic/practice segment is becoming rapacious in its own right: http://www.newyorker.com/reporting/2...urrentPage=all Among other things, it has done a poor job of improving productivity and quality via technology. Bull**** verging on delusional. Technology advances more rapidly in health care than most other fields. The technology of EMRs- as they exist now- hold providers back (again noting that I have never worked with EPIC, which is the most commonly used hospital EMR around here, so I can't comment on that one. It might be fine). Technology has been applied in instrumentation, not (widely) in computer records, medical decision support and quality measurement. Even in instrumentation, the US is not a world leader, despite our leading costs. Are EMRs all bad? No; few things are all bad. EMRs help the bean counters, to be sure. They make inventorying medications, timing procedures, billing, etc. easier (they also make it easier to propagate mistakes: I found a hospital bill for my wife to have been inflated by 30% (yes, that's right) by computer-facilitated data errors. *Always* get an itemized bill and read it line by line; in this case three services were entered multiple times which were only provided once). There is indication that computer technology can reduce medications errors, which is a good thing. As a group, it's a foot dragger, anecdotes aside, the overall numbers tell an unambiguous, and damning, story. It's not all about HMO's and pharmaceutical companies. Most of it actually is. Consider the Mayo clinic. See Arizona organ transplants. It's the future. I've missed out on this story. http://www.tampabay.com/opinion/colu...-again/1138473 There is the matter of degree. Health care is principally involved with serious physical and mental issues, other industries only peripherally, hence the difference of degree in regulation. There is a matter of degree. Thank you for realizing that nuance, which was not evident in your earlier writings. It's not a "nuance", it's the very core of the matter. "A matter of degree" is nuance, pretty much the definition of nuance. You still overlook the point that health care is not unique, by any means, in it's ability to help or ruin your life; more people are harmed every year by industries other than health care. Again, I cite the Hippocratic oath. It's been obvious for millennia. Even Medicare and Medicaid, with their low overheads, will break the bank if efficiencies aren't achieved. The way forward is to improve productivity in the same manner with which it has been improved in virtually all other segments of both the service and product economies -- with technology, mainly with computers. Medicare is already 98% efficient, spending only 2% of its revenue on overhead and 98% on paying for care. The delusion that you can avoid breaking the bank solely through computerization is a pipe dream. If the VA gets 6% cost savings per year via using computer technology (as they've claimed), which is not unusual across many industries, then it's no pipe dream. Wringing out the overhead costs -- if there's ever the political will -- is only a one-time event. Once overhead is reasonably low, it's the actual productivity of the providers that becomes the only issue. That's naive. No, take your example of Medicare. With only 2% overhead, there's no fat there left to trim. Further reductions in costs come from efficiency -- maximizing the outcome (benefit) per treatment (cost). That requires coordinated exchange of accurate information between all involved and close tracking of treatment and outcomes. You can't do that without computers. Productivity that extends to both treatment and prevention in a coordinated way. And that's radically incomplete. This is a lot more complex than you appear to realize. Yes, and the tool to manage complexity is the computer, not paper. A kinder, gentler, more responsive, and less mistake-prone medical system is all very nice. What is really needed is a much less expensive system. Pretty much not going to happen. The best that can happen is containing the increases in costs over time. Even just looking at the demographic reasons for increasing health care costs over the next 50 years shows an insoluble problem in cost reduction. Unless you plan to massacre 50% of the baby boomers as they hit 65. You make the Malthusian argument, which is the default case -- unless we rescue ourselves with technology. One major type of relevant technology is the use of computers to manage the administration of medical care. That includes aspects of communications, statistical analysis and decision support, among others. The medical industry is not unique in needing to do more with fewer human resources. A system that can both heal and prevent at much greater efficiencies. The US medical system is still pretty much in the past century despite the fancy gadgets. You're running your head into the wrong wall there. Health care is, of necessity, a personal service of generally multiple providers per patient (doctors, nurses, etc.). Yes, and the number of different types of providers and the required coordination keeps increasing -- that is a problem of complexity -- something computers are very good at, humans, not so much. |
#907
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OT - Medical Costs
On 12/7/2010 12:15 AM, Clive George wrote:
On 07/12/2010 05:04, Tim McNamara wrote: I think you are drawing unwarranted conclusions about the benefits of EMRs and overlooking the problems. This may be the result of perspective- you're a computer programmer and not a health care provider. I'm a computer programmer too, and I don't share Peter's belief in the magic power of computers :-) While I do program (and I'm very good), I consider myself more of a systems architect. I've not designed a medical system (or components thereof), but I have designed systems that managed similar problems, and addressed the same issues that Tim raises. I would consider (in this context) almost any system that didn't significantly raise productivity a total failure. That there have been such failures doesn't disprove the concept. On the other hand, a single success does prove it. Don't tell me it can't be done, I've done it. |
#908
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OT - Medical Costs
On 12/7/2010 8:12 AM, Tºm Shermªn™ °_° wrote:
On 12/6/2010 11:04 PM, Tim McNamara wrote: In , Peter wrote: [...] Medicine, in the US, via a number of mechanisms, is pretty much a cartel. Bull****. But you have to stop mixing things up to be able to understand that. The financing of medical care in the US is a cartel. It doesn't stop there. |
#909
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OT - Medical Costs
On 12/7/2010 8:14 AM, Tºm Shermªn™ °_° wrote:
On 12/6/2010 11:04 PM, Tim McNamara wrote: In , Peter wrote: [...] A kinder, gentler, more responsive, and less mistake-prone medical system is all very nice. What is really needed is a much less expensive system. Pretty much not going to happen. The best that can happen is containing the increases in costs over time. Even just looking at the demographic reasons for increasing health care costs over the next 50 years shows an insoluble problem in cost reduction. Unless you plan to massacre 50% of the baby boomers as they hit 65. How about drafting them into occupation forces for foreign conquests? Hey, we stopped our war. |
#910
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Bicyclist Fatalities in AZ 2009
On Dec 6, 5:51 pm, Frank Krygowski wrote:
On Dec 6, 3:47 pm, Dan O wrote: On Dec 6, 11:56 am, Phil W Lee wrote: Dan O considered Mon, 6 Dec 2010 08:22:30 -0800 (PST) the perfect time to write: On Dec 6, 7:58 am, Frank Krygowski wrote: On Dec 6, 10:36 am, Duane Hébert wrote: What I like is the idea that when a bicycle is in front of a truck, the cyclist is controlling the truck. The driver is controlling the truck and hopefully he's paying attention, he sees the cyclist and the truck doesn't have any mechanical issues. If you want to be pedantic, when the cyclist is properly in front of the truck in a lane too narrow for safe passing, he is controlling the use of the lane. Sure, but the point is your tendency to think you know what everybody else should be doing. So Duane, when you're bicycling in a 10 foot lane with a truck that's 8' 6" wide coming up behind you, what exactly do you do? Depends on what's ahead, first of all. Then depends on if the audible tells me they've seen me. Then, depends on the shoulder. Then, I go as far right as the conditions allow, brace for the crosswind, and hang on. If you really think you're safer trying to ride in the 18" gap left by the truck trying to pass in the same lane than by staying wide and demonstrating to the truck driver that you are well aware that there is insufficient space to pass in-lane, that's entirely your perogative. I certainly wouldn't recommend it though, and I don't know of any recognised training scheme for cyclists that does. Very few truck drivers would pass a bicyclist by eighteen inches under any cricumstances. Some do, but I'd say they are few. It's not pleasant, but they haven't killed me yet. You need to re-do the math, Dan. Eighteen inches wasn't my figure, Frank. Read the context. Nonetheless, you direct your supercilious condescension personally. Same old same old. If the usable lane width is ten feet and the truck is 8.5 feet wide, he's not going to be passing you with 18" clearance. Not if he stays in the lane, anyway. If the usable space is only a ten foot lane, he can't leave the lane, and in my experience is not going to try and pass there anyway. If he can leave the lane, your ten feet, no more, is BS. So do you _really_ skim the exact edge of the road to let him shave your shirt off your shoulder without leaving the lane? Did I say that? No, not at all. (Aren't you taking to heart any of the feedback you get here, Frank? Your "interpretations" are way off base. Stop making stuff up and ascribing it to others to fit your argument.) I said I move as far right as conditions allow. This signals to the truck driver that I know he's there, that we're going to have to work together, that I trust his good judgement and good faith, and - to my right - how much wiggle room I want. This approach gets cooperation. He's not going to stuff it in there, and if he does, I have sized up my options and am ready to exercise them. Of course the whole problem might well be avoided entirely. I imagine truck drivers really appreciate it when I roll up onto the sidewalk out of their way, let them pass, then roll back down behind them. (Plus, I get some of that creative on/off road transition action that I dig so much :-) Mostly, though, I avoid getting into situations like that; and if I were to find myself in such a situation (ugh!), would employ my sensibility, creativity and consideration of any and every option - not just those rigidly prescribed by traffic law or some vehicular nut - to let the good times roll, not play traffic schoolmarm. Then, I would find a better route if I had to go through there again. Playing traffic Parcheesi just isn't my style, man - you know that :-). |
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