hooser
7hr ago
I would love to know why you don't think it wouldn't help with the shortage. I figure that, having a shortage of doctors willing to work in VA, combined with doctors from other countries who are willing to work at VA because it will gain them the higher US pay + a path to US citizenship, would indeed alleviate shortage of doctors at VA. However, I am not a medical doctor, so what am I missing?
hooser
11hr ago
Thanks for sharing the study, it is really very good! Reading it was a Sunday well-spent.
The conclusions that the authors reach have a lot of nuance, and help explain both why so many people have negative impressions of NPs while others have positive impressions: the variability of the productivity[1] within each profession dwarfs the difference between the average NP and the average doctor.
The other useful estimate from the study: randomly pick an NP and a Doctor working for VA emergency department; 6 out of 10 times, the Doctor is more productive, 4 out of 10 times, the NP is.
I understand that VA hospitals have trouble attracting talented doctors, though I assume that they have similar problems attracting talent in other professions, NPs in particular.
If I were in charge of VA, I would make a rule that any doctor who got their license in any OECD country can work unsupervised (provisional on training on HIPPA or whatever other US-specific medical laws). Then get a whole bunch of H1 Visas for any doctor who wants to come work for VA for five years.
[1] "productivity" was operationalized as the total cost of care (negatively coded), including the cost for any avoidable hospitalization due to screwing up, which makes sense in the VA emergency department.
hooser
1d ago
I'm going to push back on the assumption that nurse practitioners, or even registered nurses, tend provide worse care than doctors for most patients. I want something more than an impression of anecdotes--preferably actual studies--because in my circle complaining about getting misdiagnosed made by doctors is a well-honed pastime.
I dig your take that those born to the PMC class who strive for Doctor status don't downgrade to nursing. In my experience, nursing Bachelors programs are still very competitive, and there are plenty of children of PMC that go into it (heck, I know a few). These are young women (for the most part) who like to work with people, who like clearly meaningful work, who are not put off by the prospect of hard work, and who by-and-large aren't strivers.
Nursing Bachelors programs also draw plenty of (mostly) women from the working class--because it's clearly meaningful and hard work that's well-renumerated--and only the smartest and most conscientious tend to make it into--and then through--the competitive Bachelors.
It therefore seems to me that there is a positive selection for a combination of conscientiousness, intelligence, and willingness to work hard. So without looking more into the data on the subject, I predict that a study comparing rates of misdiagnosis would be similar for Nurse Practitioners and Doctors, and probably not much worse for Registered Nurses.
Especially if the study counts the final diagnosis of the system rather than the initial diagnosis: a good Registered Nurse can look at a first-time patient, say "I think it's anxiety, but since I am not certain, so please wait while I consult with the Doctor on staff", and that may be the right call when the Doctor then identifies it as a blood clot. A good diagnosis by Registered Nurse should be "I know it's this" or "I need to send it up the chain of specialization".
(My thanks to @ToaKraka for posting earlier the info on what various nursing type professions require.)
hooser
2d ago
TapWaterSommelier translates some Russian gallows-humor jokes from the start of the current war / special operations. The original source of the collection is great but it's in Russian, and jokes are some of the hardest writing to translate.
My favorite:
“Good morning, here is your conscription notice.”
“Who are we fighting with?”
“Fascists, of course!”
“Ok, and against whom?”
The original source is an anthropologist who studies jokes-as-coping-mechanism in Russian-speaking world. TapWaterSommelier gives a good summary of the trends. The joke I quoted is an example of a "common-man" character who obstinately and deliberately remains clueless about anything political.
hooser
3d ago
Alternatively, end all subsidies for tuition in private educational institutes. Those private institutes who provide a strong-enough return-on-investment to their students will remain, and those who don't will rightfully go under.
The main objective of many of the selective private colleges is to build and maintain a successful alumni association. They are therefore more akin to a private club. There's nothing wrong, I think, with a private selective club choosing among their perspective members based on criteria other than how good they were at school or how well they can score on various aptitude tests. But I don't see why taxpayer money needs to support selective private clubs.
As for the non-selective private colleges dependent on the tuition of current students rather than largesse of their alumni association: they are welcome to switch to Lambda School's model.
hooser
6d ago
For math specifically: most US states have adopted some version of the standards that were put together by the National Council of Mathematics Teachers and the US National Research Council's "Adding it up: helping children learn mathematics" report. The latter focuses solely on Kindergarden-8th grade, and in my opinion may explain why the NCMT standards are coherent up to 8th grade but lose serious steam in their recommended standards for 9th-12th grade. I have never understood the sense of teaching Algebra 1 for a year, then switching to Geometry for a year, then once the students have forgotten all about algebra switch back to Algebra 2 and spend the first half just recapitulating Algebra 1 for those who utterly forgot it and boring the rest silly.
hooser
9d ago
Mineral Bluff is a small, isolated, unincorporated community in Georgia (US, not the other one) of around two hundred souls, six miles away from the big city of Blue Ridge--a proper city of over one thousand people (yes, more than ten hundred), the seat of the Fannin County (population just a tad over 25K). Demographics-wise, Mineral Bluff follows similar trend and makeup of its larger neighbor and its county, with almost a 100% non-Hispanic White back in 2000 Census, with that percentage dropping to around 90% by 2020 as more identifying as multiracial.
Mineral Bluff is in the news because a local 11-year-old boy walked about a mile to its center, by himself which precipitated a chain of decisions and actions that led to the arrest of the child's mother:
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While the boy was walking along the road (speed limit 25/35 miles), a woman stopped and asked him if he's OK. He said yes. She called the sheriff's office anyway.
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A female sheriff from Blue Ridge picked up the boy and called the mother. The mother told the sheriff that she didn't know that her boy went off to the town, and was upset he didn't tell her, but was not worried since the boy knows the area and there are plenty of family living within walking distance. The sheriff dropped the boy off at home (a house on 16 acres of land) and left him in the care of his grandfather, who lives with his daughter and her four children (while the husband works out-of-state).
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Later that evening, the sheriff and a back-up came back to the house and arrested the mother--in front of her four children (of which the 11-year-old boy is the youngest)--who after booking was soon released on $500 bail.
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The next day, a case manager from Children Services came to investigate. That investigation resulted in requiring the mother to sign a Safety Plan that requires her to install an app on her son's phone that would track his location, and to designate a Safety Person who will oversee the the children whenever she's not home. Again, the youngest is 11.
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The assistant district attorney says that he'll dismiss the charges if she signs.
But no, that's not why the case is in the news. The case is in the news because the the woman got smart, lawyered up, and told the Assistant DA and the Children Services to take a hike. She got the lawyer who heads ParentsUSA and she ain't gonna sign nothing.
Five years ago, Utah passed a law that parents cannot be investigated for child neglect based solely on the fact that they let their kids walk alone, play by themselves, or wait in the car by themselves. Several states followed suit. I hope that more do so, and that publicity of this case in particular--and cases like it--precipitate adoption of similar legislation.
Because what this case so aptly illustrates is that, under current laws, it takes one stranger with safetyist mindset to see the child unaccompanied and make the call. In this particular case, the call went to the sheriff's office, landing on a sheriff who agreed with the exaggerated sense of danger for the kid (I checked the FBI stats for the county, it's not a dangerous place), which led to the dramatic arrest of the mother.
But the more typical case bypasses the law enforcement and goes to the child protection agency, which is stuffed with social workers that, charitably, over-train on the worst of parenting, and who like all bureaucrats feel the urge to To Something. That potential harassment means that even parents who themselves do not have a safetyist mindset must rationally conclude that the probability that there is one such person in the area where their child would walk or play is so high that they better not allow it. Which leads to fewer kids walking by themselves; which leads to every kid that does walk by itself being a glaring exception, which leads to higher probability that a well-meaning adult with a deranged sense of danger will call the authorities...
I don't have a Culture War angle to this. I mean, I have heard of cases like this happening in urban areas (coded Blue), but this case happened in a rural place (coded Red). When all it takes is one deranged stranger (to report, not to kidnap!), coordination becomes near-impossible. Thus the need for explicit laws like Utah's: This Is Fine And Thou Shall Not Investigate.
hooser
14d ago
I second the recommendation of Anthropic's 3.5 sonnet, it's much better than OpenAI's models. For the prompts, I would be interested in 0-shot instructions-as-written, and also what results you get if you follow up any output that doesn't work once with "That didn't work, [I get this error: "..."]/[the result doesn't match instructions]. Analyze what went wrong and suggest improvements."
In my experience, doing that follow-up once fixes quite a few problems, but there are diminishing returns after the first time. If there are persistent problems, I have to stop and think on what could be wrong and direct sonnet accordingly to get it to progress.
hooser
14d ago
I thought that the repetition--even the word-for-word repetition--was very effective at conveying the spiral revolution of deja-vu same-but-now-even-worse. Thanks for writing it up!
hooser
20d ago
My view on predictions of political races is the opposite--I think they are great and useful--precisely because I don't really care about politics but I do care about polls (and statistics in general). Predictions of political races are a way to test the poll's methodology.
For example, Gallup is but one of many companies whose business is to poll US adults on various questions of interest--say, what percent of US adults identify as LGBT. That's a reasonably interesting question, judging by The Motte's interest in the subject. Also, businesses may want to know how big the group is, if they are considering catering to it.
So the Gallup's poll says that 7.1% of US Adults identify as some flavor of LGBT. But how well does that reflect reality? Gallup provides a snippet of their survey method at the end--surveyed over 12,000 adults by phone (70% cell, 30% landline)--and they give that standard phrase familiar to anyone who took an introductory Statistics course:
For results based on the total sample of national adults, the margin of sampling error is ±1 percentage point at the 95% confidence level.
So they are saying that their result is likely within one percentage point of reality... except that this nice quantitative statement only accounts for sampling variability, and doesn't even try to estimate the systematic bias of their methods.
For example, for many decades now there has been a huge drop in the proportion of people who pick up their phone when a rando calls them. Two decades ago, when I was teaching intro stats and Gallup still published their non-response rate, it was a measly 5%. Now? It's so bad that most respectable polling companies have dropped randomized calling altogether, and they have switched to recruiting people into panels--like, recruit 100,000 US adults who will have your company's phone number in their caller ID, and so would be more likely to pick up the phone. Then the response rate goes up to like 20%-30%.
But how representative are those panels? Why should you trust that they produce polls that are anywhere close to reality? The one great way to test it is if there is a census coming up, and the poll tries to predict the outcome of that census. Well, that's what an election is--a census of the voters.
hooser
23d ago
I will happily go along with the community norms on the matter, once such become clear. My objective is to be completely upfront where I got the info, and I tried to include only the parts that are relevant to my point. I also put them in block-quote mode, so that they are easy to skip.
hooser
23d ago
Colorado Department of State has put out a press-release on a whoopsie:
The Colorado Department of State is aware that a spreadsheet located on the Department’s website improperly included a hidden tab including partial passwords to certain components of Colorado voting systems.
The Colorado Public Radio elaborates on what kind of passwords these were, and to which machines:
The Colorado Secretary of State’s office says a spreadsheet on the department’s website improperly included a tab with partial passwords to certain components of Colorado voting systems, known as BIOS passwords.
The Colorado Department of State calls these "partial" passwords and says no worries re election integrity:
“This does not pose an immediate security threat to Colorado’s elections, nor will it impact how ballots are counted,” wrote a spokesman for the office, Jack Todd, in a statement Tuesday. ... “There are two unique passwords for every election equipment component, which are kept in separate places and held by different parties. Passwords can only be used with physical in-person access to a voting system,” he wrote.
The BIOS passwords, that were stored unencrypted on an Excel spreadsheet that was up on the department's website (but in a hidden tap!), are "partial" in a sense that one needs another password to access "every election component".
I am not a certified IT geek, so I asked Claude for top three security concerns if a hacker got my computer's BIOS password:
Evil Maid Attack: They could modify boot settings to load malicious software before your operating system starts, potentially bypassing your OS security measures. This could allow them to install rootkits or keyloggers that are very difficult to detect.
Hardware Security Bypass: They could disable security features like Secure Boot or TPM (Trusted Platform Module), making your system more vulnerable to other attacks and potentially compromising disk encryption.
Data Theft: By changing boot order to external devices, they could boot into a different operating system to potentially access your hard drive data, even bypassing some OS-level password protections.
Those sound serious. That's OK, though, because I need my usual password to get into my account, so the BIOS password for my computer is just "partial", right? Claude patiently replies "Nope":
With BIOS access, an attacker can bypass your Windows password in several ways... [gives several examples of what one can do when booting from an external drive]. Think of it this way: Your Windows password is like a lock on your house's front door, but BIOS access is like having keys to all the windows and back doors. No matter how strong your front door lock is, if someone can get in another way, it won't help.
The Colorado Department of State, in their press release, give a paragraph describing why one shouldn't worry that this may compromise the voting equipment:
Colorado elections include many layers of security. There are two unique passwords for every election equipment component, which are kept in separate places and held by different parties. Passwords can only be used with physical in-person access to a voting system. Under Colorado law, voting equipment must be stored in secure rooms that require a secure ID badge to access. That ID badge creates an access log that tracks who enters a secure area and when. There is 24/7 video camera recording on all election equipment. Clerks are required to maintain restricted access to secure ballot areas, and may only share access information with background-checked individuals. No person may be present in a secure area unless they are authorized to do so or are supervised by an authorized and background-checked employee. There are also strict chain of custody requirements that track when a voting systems component has been accessed and by whom. It is a felony to access voting equipment without authorization.
I have highlighted all that impressive-sounding security: secure rooms, secure ID badge, secure area... So with all that carefully thought-out security protocol, how the F*@& did the BIOS passwords got stored unencrypted on a Microsoft Excel spreadsheet in the first place? Let alone how that Excel file got onto the Department of state website? According to the Colorado Secretary of State Jena Griswold:
Griswold said the mistake was made by a “civil servant” in the Secretary of State’s Office, who no longer works there. “Ultimately, a civil servant made a serious mistake and we're actively working to address it,” Griswold said. “Humans make mistakes.”
Which mistake, Secretary Griswold? The act of compiling of the unencrypted BIOS passwords onto a Microsoft Excel spreadsheet? The act of hiding that tab and leaving it on a Microsoft Excel document meant for sharing with broader audience? The act of uploading that document to the Department's website, free to download to anyone on the web? I am far more interested in answers to that first question, because it says quite a lot about the level of professionalism that underlies the security system of Colorado voting equipment.
What is the job of the Colorado Secretary of State?
The basic mission of the Department of State is to collect, secure, and make accessible a wide variety of public records, ensure the integrity of elections, and enhance commerce.
The Colorado GOP, therefore, wants to know if Secretary Griswold will resign. Her response:
[Republicans in the state House] are the same folks who have spread conspiracies and lies about our election systems over and over and over again," Griswold told Colorado Public Radio. "Ultimately, a civil servant made a serious mistake and we're actively working to address it," Griswold said, adding, "I have faced conspiracy theories from elected Republicans in this state, and I have not been stopped by any of their efforts and I'm going to keep on doing my job."
So that's a no, then. Plus, a nice implication that this whoopsie is also part and parcel of the "conspiracies and lies about our election system".
Is it too late to switch to that system we had the Iraqis use, with the ink-on-the-finger that stains the skin for the following week?
hooser
26d ago
Back when the internet was younger--but old enough to load png files in seconds--the edgy memes going around my Uni were the various adventures of Smurfette, mostly of the pornographic sort. In one, Smurfette is getting it on with Papa Smurf; in another, she's banging all her fellow Smurfs.
High art it was not. But it was definitely more than porn--that is, the art had a point besides causing sexual arousal. The shock of seeing a childhood character (and I did see Smurfs on TV) going triple-X adds to the humor, but the reason these memes featured Smurfette and not, say, Strawberry Shortcake is because Smurfette was such an obviously sexualised character in the first place, yet aimed at children. The porno memes took the corporate-stated premise of the Smurfette and instantiated the subtext that any adult can see was there all along.
hooser
27d ago
I don't know about Pennsylvania, but in California if you are conducting a registration drive, you must, by law, turn in all completed registrations, even if they are obviously crap. I remember volunteering as part of a vote drive, and we were trained that it doesn't matter if the person hands back a filled form with "Mickey Mouse" or "Adolf Hitler" as the name, we must turn those forms in.
hooser
27d ago
I'm going to have a family soon. I would like my child to be able to enjoy a carefree childhood, without needles in the parks and bullies in the schools, and without the chance that they are brainwashed into values that won't give me grandchildren.
Congratulations!
Your vote doesn't matter. Not at the national level, not at the state level. It might, just might, matter a little for your local elections, especially the very boring ones that most people in your area skip because they are boring and most people know nothing about them.
But you know where you really can make a political impact, is showing up to the open sessions of your local school-board, your town-hall meetings, your county supervisors meetings, having read up on the agenda in advance and then taking that opportunity to give your 3-minute speech.
You won't sway votes on every issue, but I have been amazed at how many times an agenda item got tabled or substantially changed based solely on a dozen people showing up and giving their well-reasoned 3-minute opposition.
And that's without being plugged into a more serious local organization that regularly interacts with your local politicians, that's just you yourself. If you do get plugged into such a local organization, you can have even more impact.
(And, of course, get to know your child's teachers and school principal. And be prepared to put them into a competing charter school / private school / homeschool, lots of options out there.)
hooser
27d ago
That’s why almost no romantic fantasies written for women involve female promiscuity
Though my knowledge of the genre is somewhat limited, I know a clear counter-example: Kushiel's Dart, by Jacqueline Carey (plus the following two books). The protagonist is a courtesan, and remains so after her marriage.
I haven't read Twilight, but wasn't there a continual 2-men-1-woman drama?
hooser
28d ago
Perhaps "anti-establishment orientation". It's a measure of how much one is against the current elite establishment. That research article I linked to argues that it's an independent dimension from the Democrat/Republican partisan dimension, and this article goes through political history of the past three decades to demonstrate how voters with anti-establishment orientation keep switching parties.
hooser
1mo ago
The Alabama amicus brief gives a good argument that the medical consensus in this case rests wholly on advocacy and not on science. It demonstrates WPATH as an advocacy-first organization that actively suppresses conflicting or even ambivalent research, and therefore any "consensus" based on its recommendation ought to be suspect--especially given the general climate where medical researchers not part of WPATH also voluntarily suppress research contrary to that org's guidelines.
hooser
1mo ago
That was amazing, and I encourage you to write up more of these and put them as a separate post!
hooser
1mo ago
Beware of making generalizations based on data with massive survivor bias. Yes, the individuals extremely successful in their field may have started young, but you also need to consider all the kids that were pushed into a field just as early. If at five you try to ascertain a kid's interest (ballerina!) and then push them into it with rigorous training (hours of ballet classes!), sure, you will get reasonable competency, but not Anna Pavlova quality. Meanwhile, there is this massive influx of ballerina-wannabees where already there is a glut.
I agree with your idea that it would help to introduce a child to various useful pursuits and to support it in those pursuits in which it shows interest and aptitude. (So something like the Montessori method.)
hooser
1mo ago
A major challenge for comparing literacy (or illiteracy) rates across time or different countries is that the measurements are very different. In US, "functionally illiterate" means you can cipher and sound it out, but if it's a sufficiently complex sentence you can't understand it. (For example, some instructions on tax forms.) In developing countries, "illiterate" means you cannot cipher the alphabet (or kanji, as the case may be).
A while back, a student in my Liberal Arts Math class did a deep dive comparing the literacy statistics for US vs. Bangladesh, because some statistics she found suggested that US was doing worse. Turned out that the US stats were for "functional illiteracy" while the study in Bangladesh asked its participants to sound out a few written words.
Not the same thing.
hooser
1mo ago
When I drive cross-country, McDonalds has the most reliably clean restrooms, and they don't insist on you buying stuff first. (The one exception to that I found was in a Denver suburb, where they had a sign on the bathroom saying "For customers only". I asked a worker to let me and the kids in, and she did without any questions, and without requiring a purchase. I guess that's to discourage the local homeless.)
The food is also fine. I don't subsist on it, but an occasional chicken sandwich isn't going to kill me any faster than anything else I can get quickly on the road.
hooser
1mo ago
I am skeptical that IQ tests measure what we think they measure in developing countries. Even those tests that pertain to be context-free and that don't require one to be able to read. It takes intelligence and cunning to hunt and forage, or to run a homestead farm, or to navigate life in a shanty-town. I think that an American with IQ of 70 and a Papua New Guinean with an IQ of 70 differ greatly in how well they can take care of themselves.
The US Army doesn't specify the IQ cutoff; some people estimate it at 83 (that's what I remember from McNamamara's Folly. Standard deviation of IQ is 15, mean 100, so below 83 is 11.5%.
The US Army by law restricts the employment of the next 20 percentiles (11th--31st) to be no higher than 20% of the applicant pool:
The number of persons originally enlisted or inducted to serve on active duty (other than active duty for training) in any armed force during any fiscal year whose score on the Armed Forces Qualification Test is at or above the tenth percentile and below the thirty-first percentile may not exceed 20 percent of the total number of persons originally enlisted or inducted to serve on active duty (other than active duty for training) in such armed force during such fiscal year.
The corresponding IQs would be in the 83-93 range.
hooser
1mo ago
I appreciate the reality check. I asked Perplexity AI for an estimate of the total number of institutionalized people in US in 1960s, including prisons, mental institutions and institutions for the mentally impaired. The peak for mental institutions was half-a-million a decade earlier (so about 0.3% of the population), the prison population was less than it is now, but as for the mentally disabled:
The search results do not provide specific numbers for institutions housing people with intellectual disabilities (then referred to as "mental retardation") in the 1960s. However, these institutions were common at the time, often housing large numbers of individuals.
I know several institutions for the mentally disabled within my area. They range from assisted living to full-on can't-go-outside-without-an-escort (for those who are mobile). They tend to be out of the way, and people who don't have family members (or family members of their close friends) tend not to think about these places.
So I am going to guess that a large portion of the bottom-10%-IQ were indeed in some form of institution that would take them out of consideration of the labor force participation metric.
I would be open to evidence that it was common for mentally challenged men to get hired and work. Maybe with a lower minimum wage, it makes sense. My friend's sister, for example, works at a doggie day-care for like half the federal minimum wage, something like 20 hours a week.
VA had a hiring spree last year, in large part because of the expanding benefits from the PACT Act.
Your impression of a hiring freeze remains partly correct, because VA has budget shortfalls and plans to lay off staff:
I suspect that VA tends to paint a bleak picture to Congress as a standard operating procedure, in hopes of getting more funding. Though my nephew assures me from his VA experience that more funding would not go amiss.
So back to my off-the-cuff idea of importing doctors: my point is that any VA hospital that finds it challenging to attract a decent US doctor ought to be able to do what the private sector does. Right now, the VA follows AMA's standards, which require any non-US-trained doctor to do 3+ years of residency (plus other things) before they can practice medicine in US. Residency slots are, apparently, the bottleneck for US doctor supply in the first place.
My question is: just how crucial is it for someone already practicing as a doctor in a French or German hospital to do 3+ years of residency in US?
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