Bicyclist Fatalities in AZ 2009

On Dec 6, 9:34*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.

They look like fairly tame roads. *The speed differential doesn't appear
to be that great, and she never holds up traffic for long enough for
them to get agro, short circuit and go off on a road rage fit.

Yeah, how about that? Even the dreaded truck driver she held up for a
block or two didn't go into a road rage fit. As I've said, you can
use your right to the road.


Lane splitting is acceptable to you, Frank?

Now that's something I do "with great care" because it is "dangerous".

I've always heard the term "lane splitting" used to mean going down
the dashed line between two lanes, not passing stopped traffic at the
curb side, as she did.

But I agree with you. I do that only very rarely, and with great
care, as the rider appeared to do in that video. I wouldn't do it for
just nine cars, as she did, unless I knew by experience that the light
was so short I wouldn't make it through the next green.

But I notice that when she decided to do it, it turned out to be
possible without a bike lane.

- Frank Krygowski

On 12/6/2010 7:32 PM, Dan 0vermªn wrote:
On Dec 6, 1:47 pm, Frank wrote:
On Dec 6, 3:16 pm, Duane wrote:



On 12/6/2010 2:56 PM, Phil W Lee wrote:

Dan considered Mon, 6 Dec 2010 08:22:30 -0800
(PST) the perfect time to write:

On Dec 6, 7:58 am, Frank wrote:
On Dec 6, 10:36 am, Duane 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.

Sounds like he's only saying he'd do that if the truck didn't see him
and he couldn't take the shoulder. What would you do if the truck
wasn't slowing for you? Stay there and control the lane?

No shoulder, Duane. A city street with a curb at the right. Total
space available is 10 feet, no more.

No more? What is this, like an alley?

You can visualize a two lane or
a four lane street, I don't care.

Oh. Then why only ten feet, no more? Is it heavy traffic right up to
the edge of your lane? Why would I go that way in the first place?


So 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?


Well, okay - assuming I was idiotic or unlucky enough to find myself
in this very specific situation - I would be scoping put beyond the
curb and looking for cuts or getting ready to hop it, unless I could
just outrun him, as is often the case in town where they have curbs
and heavy traffic and all that. It's moments like this that separate
the ninjas from the fuddy-duddies :-)

This isn't uncommon, at least in my experience.

Really? Only ten feet available, no more, and a truck driver who's
going to shoot the gap if you don't direct traffic? Happens to you
all the time?

Unless I want to go well out of my way, I often ride across a freeway
overpass with no shoulder. Bailing is not an option, unless falling ~25
feet onto a freeway with vehicles moving at 100-120 kph is considered an
option.

--
Tºm Shermªn - 42.435731,-83.985007
I am a vehicular cyclist.

On Dec 6, 9:51*pm, Tºm Shermªn™ °_° ""twshermanREMOVE\"@THI
$southslope.net" wrote:
On 12/6/2010 7:58 PM, Frank Krygowski wrote:

On Dec 6, 6:17 pm, "Duane *wrote:
"Frank *wrote in message

....
On Dec 6, 3:16 pm, Duane H *wrote:

Sounds like he's only saying he'd do that if the truck didn't see him
and he couldn't take the shoulder. What would you do if the truck
wasn't slowing for you? Stay there and control the lane?
No shoulder, Duane. *A city street with a curb at the right. *Total
space available is 10 feet, no more. *You can visualize a two lane or
a four lane street, I don't care.
So 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?

I would make myself as visible as possible and try to verify that
he sees me. *If so, I would stay in the center of the lane. *If
not, and he keeps coming I would do the same thing that Dan would
do.

So you really bail out and try to jump to the sidewalk, eh? *Wow. *Do
you do this when he's a block back? *Seems you can't delay until he's
50 feet behind, else you may not be able to bail out in time. *So much
for a right to the road!

What would you do if he keeps coming anyway? *Control
the lane? *Don't bother answering.

I'll bother answering. *I retain my legal right to the road. *It has
always worked, for many decades now.

This isn't uncommon, at least in my experience.

It's not uncommon in my experience either. *What's uncommon
is for me to think that I'm taking control.

Well, obviously, if you're bailing out you're not controlling the
lane. *Again, so much for a right to the road.

Where I have this situation, "bailing" would involve a ~25-foot drop
onto the active freeway below. *I take the lane well in advance of the
shoulder disappearing on the bridge.

The "well in advance" part is helpful to everybody. So is being well
out into the lane, as opposed to even being just in the normal car's
right tire track.

When you're further out, it's far more obvious to approaching
motorists that they'll need to change lanes to pass safely. They
realize it sooner, and can more smoothly merge into the adjacent
lane. It's better for everybody.

- Frank Krygowski

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

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

JS.

On 12/6/2010 8:43 PM, James Steward wrote:
Frank Krygowski wrote:

Of course, there aren't _always_ trucks waiting to pass me. There are
frequently cars, though, and it makes little difference; a ten foot
lane is far too narrow to be safely shared.

http://www.youtube.com/watch?v=adTpGj2MFec

I really am amazed to find so much fear in this group.

- Frank Krygowski

You and Tom Sherman will like this one.

http://www.youtube.com/watch?v=2GNEU5cil_E&NR=1


I would have been tempted to ram the car with my large chain ring.

--
Tºm Shermªn - 42.435731,-83.985007
I am a vehicular cyclist.

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 guy even agrees with some of your stats, and I think some of
Andre's, but still says cycling is dangerous.

http://www.youtube.com/watch?v=iIurRqi6ySw

JS.

On Dec 6, 7:29*pm, Frank Krygowski wrote:
On Dec 6, 2:45*pm, DirtRoadie wrote:

On Dec 6, 12:35*pm, Frank Krygowski 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.

OK, So you don't remember. Not really a surprise.

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?
- Frank "I'm talking to you!" Krygowski

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?

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?

DR

"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.

Regards,

Ed Dolan the Great - Minnesota
aka
Saint Edward the Great - Order of the Perpetual Sorrows - Minnesota

On Dec 6, 6:58*pm, Frank Krygowski wrote:
On Dec 6, 6:17*pm, "Duane Hebert" wrote:

I'll bother answering. *I retain my legal right to the road. *It has
always worked, for many decades now.

Let's see, we have a rider population with N=1.
Now Frank is it the statistic you are relying upon or your personal
experience?
Tick Tock Tick Tock.
I can envision someone whose karma is overdue for an "adjustment."
DR

In article ,
Peter Cole wrote:

On 12/5/2010 3:16 PM, Tim McNamara wrote:
In ,
Peter wrote:

As I explained before, very few processes convert directly to
computers with any degree of efficiency.

Hence the problem with EMRs. Typing narratives is something that
works very very well on computers. Spreadsheets, ditto. Three
dimensional modeling, yup. In medicine, imaging software is
excellent and a critically important tool- no computers, no MRIs
for example. Lots of other examples possible.

The problem is pretty specifically with clinical documentation. It
takes much longer to enter and much longer to read. I can get
through a paper chart in half the time as it takes on an EMR. My
last physical (2009) took more than twice as long as normal because
of the EMR. Time loss is a very serious issue and increases rather
than decreases the costs of health care.

The data does not seem to support your anecdotes.

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.

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.

Let's put it this way: I'm the customer, the product doesn't meet
my needs and therefore I don't want to buy it. This wouldn't be my
problem except for potentially being mandated to buy a product
which doesn't meet my needs *and* interferes with my productivity.
How'd this happen? The vendors of the product convinced legislators
to force a market for the product when the product itself could not
create its own market.

And you call me arrogant. As far as I'm concerned, as a patient, I am
the final customer and beneficiary. My primary care provider and the
affiliated hospitals have EMR implemented and I have been quite
pleased with the benefits. Then again, my medical facilities are
urban, large, and affiliated with medical schools, where EMR's are
most prevalent in this country. I'm impressed by the level of
coordination between primary care, emergency care, various specialist
services and diagnostic facilities, etc. Unfortunately, I've had the
need to use them all.

Sorry to hear that and glad that you've been pleased with the outcome.
My experience has been otherwise and we'll have to leave it at that.

This is why EMRs suck, man.

"In UK veterinary practice, the replacement of paper recording
systems with electronic methods of storing animal patient
information escalated from the 1980s and the majority of clinics
now use electronic medical records. In a sample of 129
veterinary practices, 89% used a Practice Management System
(PMS) for data recording "

Better to be a dog in the UK it seems.

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.

My point was that UK vets are more computerized than US human
hospitals& clinics. I doubt that the vets have been coerced into
purchasing such systems. I could be wrong.

Dunno. But there appeared to be an implied value judgment in your
statement that "computers = better care."

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.

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.

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.

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.

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.

Oddly enough we don't have widespread moral outrage over Bill Gates
making millions a year (although for some reason there is moral
outrage over Steve Jobs making millions a year). But we seem to
have moral outrage over a physician making $150,000-300,000 a year
even though the expertise and liability demanded of the physician
is orders of magnitude greater than is demanded of Jobs or Gates.

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.

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).

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.

No. "Death panels" will have to exist in one form or another. A
price tag will be (or already is) placed on the value of a human
life, by someone. Pragmatism requires that some costs will be
spared.

This is generally incorrect because of regulatory limitations
placed on insurance companies to deny coverage of treatment (this
is on a state by state basis because that's where most insurance
regulation happens under the current commerce laws). Decisions are
made by the patient and the doctor as to what treatments are
pursued (and thus as to the costs incurred).

See Arizona organ transplants. It's the future.

I've missed out on this story.

So do lots of businesses that aren't considered health care.
There are a lot of life and death issues in the world. Toyota
accelerator pedals, for example. Proper installation of furnace
exhaust vents. Carbon fiber steerers and fork blades.

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.

In the US, something like 60% of bankruptcies are related to health
problems. In much of the rest of the developed world, it is 0%.
There are really no valid economic arguments against universal
insurance under a robust public option. The arguments against it
are primarily those of political philosophy (e.g., the canard of
"freedom"). The benefits are massive- reduced total costs,
elimination of bad debt for services provided which in turn can
reduce costs of care, removing the cost of insurance from payrolls
and putting US businesses on a more even footing with businesses in
other countries (benefitting small businesses as much or more),
etc. Funding can be diversified across large segments of the
economy (a combination of payroll taxes and broader taxes) which
can distribute the burden quite tolerably.

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.

What I am doing in this discussion is separating the components of
health care in a way that identifies where the problems are located
which makes them more addressable. Making the problems smaller
makes it easier to conceptualize solutions. There are problems
attendant with health care finance (mostly insurance companies)
that IMHO are the biggest problems that have to be addressed.
While I favor the public option for a lot of reasons, that is not
the only possible way to address the deficiencies (as models in
other countries have shown).

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.

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.

The problems between health care provider and patient can also
exist, but these are much less systematic and are specific to those
relationships. In the past 20 years there has been a concerted
effort in health care to be more user-friendly, to provide better
patient education and to facilitate better treatment decisions.
This is a discussion that is held regularly at all hospitals and
most clinics.

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.

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.).

--
Gotta make it somehow on the dreams you still believe.