Outcome measures

Atul Gawande has a tremendously important article in the 1 June 2009 issue of The New Yorker, which should be read by everyone, regardless of ideological bent, who cares about health care reform in both the United States and Canada. It is very enlightening: does spending a lot of money on health care actually produce better outcomes for patients? (Answer: no! but not for the reasons you might think.)

The truly telling part, for me, was the discussion about overutilization:

I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there’s no issue, but even that might be overkill.

And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.

“Oh, she’s definitely getting a cath,” the internist said, laughing grimly.

I was floored by this passage — and by the later discussion about the motivational role that money plays in clinical decision-making. (That’s an educational piece that probably should be saved for another day.)

What’s really interesting to me, though, is what this implies about scarcity and resource allocation. One of the more annoying complaints from Republicans and their proxies on this side of the border is that Canada’s health care system has shortages of all kinds of stuff, and that you’ll have to get in line to have your MRI or whatever, and it’ll take six months. Ok, fine, that’s probably true a lot of the time, and in the United States you could probably have that test, and a whole bunch more, within a matter of hours. (I think Phoenix has more MRI suites that the entirety of western Canada.) But what I want to know is this: how many of these tests, more freely available in the United States than in Canada, are clinically relevant, how time-sensitive are they, and (this is the critical part) how many fail to turn up anything of significance? Great, so you catheterized that patient, and the coronary arteries were clear. Yay. What have you done? What value have you provided the patient? (We’ll ignore the very real risks of cardiac catheterization here.)

I don’t get it. But that might be why I work here, not there.

"Bruce Springsteen singing for a Cure cover band"

I’ve been trying to figure out how to write about The Gaslight Anthem for a couple of months now. It’s challenging. When I wrote my giant mash note to Edie Carey and Rose Cousins, I was writing about a couple of singer-songwriters who were basically unknown except to a handful of dedicated and devoted fans, in the hopes that other people might start spreading the word.

It’s different for The Gaslight Anthem. They actually are getting airplay, and eMusic even called their sophmore album, The ’59 Sound, released in August of last year, the best album of 2008: “Because they are destined for greatness, and because this album means they’ve already achieved it.” And where I could gush about Edie Carey and Rose Cousins and talk about how they made me feel in ways I hadn’t felt in a long time, I can’t do the same about The Gaslight Anthem — not because their music isn’t emotionally evocative or anything, but because it doesn’t work in the same way. Mostly.

They’re just really, really, really good. And where I loved Another Kind of Fire with my heart, I love The ’59 Sound with the part of my brain that likes to pretend it knows something about music. I love the way Brian Fallon manages to somehow blend Jersey Shore with punk rock sensibilities, the fact that they’re unashamed about cribbing lyrics, titles, and themes from movies and literature, the fact that once again music seems to be telling stories. And the sound — holy hell, it’s good. The post title does a good job of describing it, because it’s not quite like anything you’ve heard before but is immediately familiar if you grew up listening to music in the 1970s or 1980s. Echoy reverb for the vocals and big, pounding arena-rock-ish drums.

You get this feeling, listening to the album, of dusty back roads, old cars, dead-end jobs, and a longing for escape. I’m fascinated by songwriting that can transport you to a specific time and place, and this stuff feels very much like the sort of music you might write if you had to live in Texlahoma circa 1960. Trapped, unhappy, trying to get out — and these are your experiences.

But then there’s “Here’s Looking At You, Kid”:

You can tell Gail if she calls
That I’m famous now for all these rock and roll songs
And even if that’s a lie she should’ve given me a try
When we were kids on the field of the first day of school
I would have been her fool
And I would have sang out her name in those old high school halls
You tell that to Gail, if she calls

And you can tell Jane if she writes
That I’m drunk off all those stars and all these crazy Hollywood nights
That’s total deceit, but she should have married me
And tell her I spent every night of my youth on the floor
Bleeding out from all these wounds
I would’ve gotten her a ride out of that town she despised
You tell that to Janey, if she writes

But boys will be boys
And girls have those eyes
That’ll cut you to ribbons sometimes
And all you can do is just wait by the moon
And bleed if it’s what she says you oughta do

You remind Nana if she asks why
That a thief stole my heart while she was making up her mind
I heard she lives in Brooklyn with the cool
Goes crazy over that New York scene on 7th avenue
But I used to wait at the diner
A million nights without her
Praying she won’t cancel again tonight
And the waiter served my coffee with a consolation sigh
You remind Nana, if she asks why

And then you realize that you can love this album with your heart, too. What can you say to that kind of brutal honesty, the conversation you always wanted to have with your ex-flames or the great, unrequited love of your life? I turn that bridge over and over in my head, and I keep thinking about how you sometimes find music that captures some fundamental truth — and there it is. “And girls have those eyes / that’ll cut you to ribbons sometimes.” Oh, wow. It’s not the sort of song whose meaning you immediately get when you’re under about 25; the true emotional resonance comes later in life.

In the end, I’m not sure this album is for everyone. Scouting around, I found a lot of criticism that it’s not actually punk. I don’t pay enough attention to punk to know whether this is a fair criticism or not, but I’m also fairly sure I don’t care. It exists in its own space of awesome; much like lovers of a particular brand of Nova Scotia beer, I suspect that those who like Gaslight will like it a lot, and the rest will be somewhat indifferent. You’ll either get it or you won’t, but it really deserves a good solid listen with an open mind. Either it’ll blow you away from the first track, or you’ll shrug and move on.

On a shorter note, I’m a little embarrassed to admit this, but I also have a guilty, lightweight favorite right now: Valerie Poxleitner, a.k.a. (d.b.a.?) Lights, Canada’s answer to, uh, Bjork. Shut up. It’s good.

Ahhh.

After 6+ months of letting it pile up in my mailbox, I have managed to reduce my “unread, unsorted, and unreplied-to” collection of e-mail from 3,651 messages to 0. Okay, I had to vaporize a bunch of mailing list traffic I probably didn’t care about to do it, but I’m all caught up, and Thunderbird will no longer taunt me with the “hey, lazy bastard!” counter on the left side of my screen. Thank god.

Note to self: Having a Blackberry is great, in that you keep on top of the e-mail you care about. Reading threads on NANOG, on the ‘berry, is not so much fun. So maybe think about how to deal with that problem.

But, hey! I found an interesting gem in my inbox, and it was only from late in April! Yes! Timeliness, thy name is LiT! Brazillians hack US Navy satellites. It’s like Captain Midnight, but 1,000 times cooler.

Quick hits

There’s new 365 content up at Flickr. It pains me to say this, but using Flickr for this project is about 900,000,000 easier than maintaining it locally. So Flickr is where things will stay. Facebook, however, is not in the cards — so stop it, guys.

Must-read blog entry of the day: Five basic questions about the North Korea Crisis probably has the highest information-to-length ratio of anything else you’re going to run into out there during the current 24-hour cycle.

Giving up

So let’s give this a go, shall we? I’m caving in. From brief experimentation, I think this is a much better idea than trying to cram everything together locally. I hate that it has come to this, but… why solve a problem that’s already been solved (and solved much more elegantly than I ever could)?

Forgive me, for I am turning into a Web 2.0 loser.

Learn to suffer

I would really appreciate it if someone could explain to me why I shouldn’t just say “screw it” and spend $24.95 on a Flickr account instead of fighting with locally installed software. Because it’s the manly thing to do? Because struggling with someone else’s design choices builds character? Because I need to rebuild my sysadmin cred? I realize that I will quite rapidly devolve into one of Those People with a Flickr account, and that the true He-Man solution is templating and scripting and a lot of little HTML files and some more scripting glue to hold it all together and publish… but life is short, and so is my patience.

What to do, what to do?

365: Uplink complete

I’ve finally managed to get the first batch of 365 photos up and on-line. It’s over here. I can’t promise that we’re going to stick with this strategy — I’m not very happy with Piwigo at the moment, but it does have the singular advantage that it runs and I don’t have to negotiate with my Webhost to make changes to the global PHP configuration (I’m looking at you, Gallery). Oh, and it doesn’t require me creating a zillion HTML files by hand, too. Ok, so, two advantages.

It would have been nice to do it all within WordPress, but apparently WP’s media manager doesn’t like me and can’t seem to figure out where the ImageMagick binary lives, even though I, you know, told it. I hate computers.

Oh, snap!

CADORS 2009C1111:

User Name: Ridley, Rod
Date: 2009/05/11
Further Action Required: Yes
O.P.I.: Aerodrome Safety
Narrative: Whitehorse FIC reported that the drivers of two Air North vehicles positioned a HS 748 onto Taxiway Echo without contacting Whitehorse Radio for authorization.

User Name: Ridley, Rod
Date: 2009/05/13
Further Action Required: No
O.P.I.: System Safety
Narrative: UPDATE Aerodrome Safety reported that Whitehorse airside personnel have had a number of conversations/meetings with the Air North group regarding Air North and their continuing penchant for getting their names up on the CADORS. Both individuals received verbal briefings from the airside /security management. This event had no operational impact.

Ow.

When no one is looking

I have been reading the CADORS database on a semi-regular basis lately, mostly because I’m a big geek and, um, I’m a big geek — much in the same way that I read the Nuclear Regulatory Commission’s incident summaries. Why? Well, why the hell not?

As with most things in life, it’s better with animals — I get the feeling that CADORS must not have a lot of regular readers:

Aerodrome Safety reported that the airside operations manager at P.A. reports that by the time he received a call from FSS and got airside, the foxy lady was long gone. There have been besides the fox, sightings of a coyote and perhaps a wolf however nothing verified. Resident sharp shooters have tried very long shots at the mammals however without success. Airport personnel continue with twice daily patrols and boundary inspections. This occurrence had no operational impact. (CADORS 2009C1033)

The crew of WJA 418, a WestJet B737, reported a bird strike in the vicinity of the ZZD NDB while on approach to Runway 02 at Edmonton. … Aerodrome Safety reported that the crew of WJA 418 advised that the bird struck the right co-pilot’s window. Although the first officer was startled, there was no damage and the starling sized bird only caused a small impact smear. The aircraft was landed without further incident. (CADORS 2009C1020)

JZA 447, a Jazz CRJ 700, was conducting an ILS approach for Runway 31L at Whitehorse but was required to circle for Runway 13R in order to allow a coyote to be chased off the runway. The aircraft subsequently landed without further incident. … Aerodrome Safety reported that airside operations personnel reported that the varmint may have gotten airside either underneath or over a portion of fencing which is snow packed, however the wily fellow is long gone. There are conflicting reports about the animal’s actual walk about. The coyote may have stayed on the apron and in field and not entered runway 13/31L. (CADORS 2009C0812)

The pilots of two departing aircraft at Medicine Hat observed a coyote on the runway. The coyote exited the runway in both cases as the aircraft approached. … Aerodrome Safety reported that the APM reported that the coyote is long gone. Regular inspections of airport boundaries are done by airside operations personnel. They determine access points and eradication positions. The locating of the varmint’s dens is most difficult. Fortunately for the aviation community Coyote strikes are very rare. This event had no operational impact. (CADORS 2009C0932)

C-GRCX, a Super T Aviation Academy Piper Arrow, was about to depart from Runway 21 at Medicine Hat when the pilot was advised by FSS of a coyote about to enter the runway from the east side. The Arrow’s departure was delayed about 3 minutes. Airport staff were called to chase the coyote away. GLR 7242, a Central Mountain Air Beech 1900, was on the backtrack on Runway 21 for departure to Calgary when the driver of TK 399 called holding short. The coyote spotted TK 399 and ran eastbound from the west infield crossing Runway 21. GLR 7242 was delayed about 4 minutes and C-GRCX was in the circuit and had to modify his circuit due to GLR 7242’s delay. … Aerodrome Safety reported that the APM at Medicine Hat reported that the wily fellow was some 400 yards away from 21/03 and was startled from that position onto the runway. The coyote was chased off the property, however the APM was unable to get a shot at the cagey varmint. As a result of this event two departures were delayed. Airside operations staff continue to do airport boundary inspections. (CADORS 2009C0957)

The crew of TSC 273, an Airbus A-330-200 operated by Air Transat reported hitting a rabbit while arriving at Edmonton International (CYEG). … Aerodrome Safety reported that airside operations personnel recovered and removed the remains of a white tailed Jack Rabbit. The aircraft’s right main gear although somewhat discolored did not suffer any damage; sadly the same cannot be said about the hasenpfeffer. This event had no operational impact. (CADORS 2009C0990)

It’s the same guy writing most of these incident reports. I don’t know what I find stranger — that this stuff has to be tracked and logged in such careful detail, or that there’s a guy out there who likes to be creative in his incident reporting.