conorh

You've pretty much described what happens when a surgeon joins a hospital. Well perhaps that is an exaggeration, but my wife sat through several required classes on basic procedures before starting her surgery job. Hospitals, like any dysfunctional bureaucracy driven partially by lawyers, thrive on this stuff.

My wife is in Myanmar at the moment, in a place called Taunggyi, she was there a few years ago too and it is amazing the change. Now she can reliably Facetime from there to the east coast of the US, whereas a few years ago she couldn't even get internet!

Sorry yes, wasn't saying anything about cardiologists, just wanted to point out that surgery might be different.

I'm familiar with the second study you mention there - I'd take it with a large grain of salt! It highlights the issues with so many medical studies and how hard they are to get right with limited data. The study attempts to generalize surgeon performance based on age for only 22 surgeons that did 'enough' operations that year (for one complication, only 15 for the other), while trying to account for all the other factors (patients, difficulty of operation etc.), and not accounting for the wildly varying volumes for each surgeon and the fact that the study had a large cluster of younger doctors, and not many older doctors (look at the plots) It just doesn't have enough data to be a good study in what they attempted.

Not going to talk about this generally, but this may not be the case for surgeons, and it depends on the procedure etc. This was one study showing that surgical volumes improved outcomes:

http://www.nejm.org/doi/full/10.1056/NEJMsa012337

In places where they have implemented outcome tracking they give patients risk scores and adjust based on those scores - which in itself is tough (bias to give patients worse scores), but you have to start somewhere. I've had this discussion a few times and fundamentally I believe that transparency is better than the zero objective information we have now - currently we don't even know how many operations a surgeon does - let alone the outcomes!

I've posted about this before - my wife is a highly specialized surgeon. This article really only scratches the surface of the issues with surgery around the US, as a software developer working in a pretty transparent and open industry I'm always horrified at how surgeons practice in the US. In my opinion the core of the problem is the lack of transparency in the entire system. There are just very few pressures for surgeons to really improve like they should have to. If, as a surgeon at a academic center, you want to just cruise along, no problem, you can just publish a few papers each year, be nice to patients, and you will be considered a leader in your field - even if you have terrible outcomes. There is little to no data out there to help patients objectively evaluate a surgeon, and to force surgeons to become better.

Speaking of things that I found strange - my wife was blown away at her current practice because for every operation they 'pair-surgeon' full time. This seemed very normal to me, but outside of surgeon training this is considered bizarre - when she tells other surgeons they ask her if it is something to do with billing! (it is not, they can't bill for the second surgeon). She loves it of course, it forces her to up her game and gives her someone she can bounce her thoughts off of during the surgery. I've asked her if she could go visit another surgeon in another facility somewhere and work along side them for a few days to learn, but because of the red-tape and state licensing, this is extremely difficult. The cross seeding of surgical expertise becomes glacially slow after your initial training in residency, you pretty much hope you were trained well and stumble along with a bit of help here and there.

Ex StreetEasy dev here (from a long time back). Is this buying or renting? If it is renting then I would agree with you, the market is so commoditized in NYC for renting that the current broker structure doesn't make sense.

I tried Soylent 1.5 for about a month (not as my sole food source, but for maybe one meal a day), but I was unable to adjust to it well, my stomach was just constantly upset and I didn't feel great after eating it. I then tried Nutren 1.5 [1] thinking it might be different, but same effect for me, so I guess it is just me. I'm going to try 2.0 again, maybe I'll do it in smaller doses at first and see if I can adjust that way. Has anyone else experienced this?

[1] http://www.amazon.com/Nutren-Calorie-Vanilla-Nutrition-8-45-...

We use this as a static site backup for some of our client's sites (site goes down failover to static version on s3) and we built a small tool to help with keeping the static version up to date:

https://github.com/SquareMill/staticizer

  "Yes. I know. He's Vorbis," said Brutha. "Vorbis changed people. Sometimes he
  changed them into dead people. But he always changed them. That was his triumph." 
   -- (Terry Pratchett, Small Gods)

I love this book, Small Gods, one of my favorite books by any author. I think the same could be said of Terry Pratchett, he changed people through his books (and as a bonus generally left them alive). Godspeed Terry.

Aha, see here you have extrapolated from the framing in the media headlines (and the plaintiff), without actually looking at any context. So to look at what you just said and present it differently: (note: I'm not coming down on either side of this, just presenting the other side, see [1])

1. He was not the Vice President of the United States then. He is (and was then) a KPCB partner.

2. He was not the guest of honor, this was a dinner party at his apartment for the 10 people that could fit. Apparently he is fond of hosting dinners there and does many of them. At this event there were only two KPCB partners.

Is it a stretch to imagine that two out of all the partners at KPCB for this particular dinner might not include a female partner?

Also in Chien's testimony [2]:

Chien called the allegations in Pao’s lawsuit — including that he had declined to invite women to the Al Gore dinner because women “kill the buzz” — “hurtful and untrue,” and denied saying anything like that. Kleiner’s attorneys also showed multiple emails where Chien invited Pao to join meetings and business discussions she was interested in.

[1] http://www.law360.com/articles/625265/kleiner-partner-held-a...

[2] http://www.forbes.com/sites/ellenhuet/2015/02/25/kleiner-per...

Admittedly I'm not unbiased, having done work for KPCB (although I know nothing about this case). However, I am extremely disappointed reading the comments in this thread and in the media. People seem ready to jump to conclusions and crucify having only heard one side of the story, I suppose that makes for great stories in the media, but why not let the court case play out and hear both sides first?

My wife is a highly specialized surgeon, she does one operation, and she does it around 600 times a year (Parathyroidectomy). An average endocrine surgeon might do 20 of these a year. She went through training as an endocrine surgeon and she tells me that the difference between the operation that they do at her center and what an average endocrine surgeon will do is like night and day. It is just not possible for surgeons with normal volumes to be able to achieve that level of skill. What helped them recently was the release of the medicare volume data [1]. This data is probably right now the only way to get an idea of how many operations of a particular type your surgeon does (not for all operations unfortunately, not unless you know a lot about billing codes and practices!).

[1] http://blog.parathyroid.com/parathyroid-surgery-medicare/

I worked on a project with Verzion to wifi enable NYC payphones in 2003 [1], I think we did around 150 in the end. I worked on backend software and then eventually driving around the city in a Verizon van debugging hotspots. The system didn't work very well then - most payphone booths were not in good areas for using wifi, there wasn't enough coverage and there was quite a high failure rate for the equipment (and sometimes it was stolen). I like the idea of having other services available in the booth though, and perhaps it will work better now that everyone has wifi equipped phones and doesn't need to pull out their laptop to use it.

[1] http://www.nytimes.com/2003/05/14/technology/14NET.html

I don't think that anyone outside the field can understand just how bad and pervasive this problem is, it is everywhere and harming patients every day. One more example - my wife is a surgeon working in a specialized field and in this field there are panels of 'experts' that get together and set the guidelines for how to treat the disease:

- The panel is stacked with visiting researchers working for the most senior researcher on the panel.

- The most senior experts on this panel recommend treating with a particular drug. It turns out that these experts also happen to receive money from these drug companies.

- These researchers then use the results of this panel when applying for NIH grants as proof that this is where the treatment is heading AND THEN, next time the panel happens, also use this research as proof that this is where the treatment is heading. Talk about self interest and circular logic.

What is incredibly sad about this is that the results of consensus panels are then quoted by doctors every day and used to lead their treatment of patients.

I would take a London taxi for the same reason that I'd read a paper book, for the experience, not for the result. The Knowledge is such a wonderful anachronism, and I hope that it can co-exist in some form with new services such as Uber and Lyft, but outside of protectionism I can't see any reason why it should - technology is nearly good enough now to replace it, and in some cases probably better. If it does continue to exist I can't imagine that market for people with the Knowledge will be enough to support the number of London taxi's that are on the streets now.

Several years ago I traveled from Rio De Janeiro to Capetown on a freighter (although not nearly as large as this Triple-E ship!) There are some ships that still offer paid passage and staying on board of one of these enormous ships, manned by just a small crew, is an amazing experience. I got to visit all the areas of the ship, could wander about during the day, hung out on the bridge with the night watch, visited the engine room etc. Being on the bridge when the building sized ship docks at port is incredible to watch.

2-3% of the invoice value seems high to me. They aren't providing any additional value for larger invoices, so why should they receive a percentage of the total?

If you look at the network requests when the page loads you can see a good hint that something is going on, 'dialuptone.mp3' is requested from the server (and there are DOM <audio> nodes to play it). I guess if they had wanted to be sneaky they would have generated the sound with the Web Audio API [1], but I'm not sure what browser support is like for that yet.

[1] http://webaudio.github.io/web-audio-api/

If you get a chance I highly recommend visiting this location. I drive by it often and have walked around it a few times. It is a breathtaking building.

It just became available in the US ibook store

https://itunes.apple.com/us/book/swift-programming-language/...

The slideshare embed is having some issues. We added a link to download the PDF directly until slideshare works that out.

I recommend this url instead. It will redirect to the PDF file and will always redirect to the most up to date version:

http://www.kpcb.com/file/kpcb-internet-trends-2014

I'm interested to hear the feedback. We did the design for the site and tested it extensively on mobile. What issue are you seeing? My email is in my profile if you want to drop me a line.

edit: The slideshare embed is having some issues on mobile and desktop unfortunately. Very slow. They are working on it.

Thanks. We had another report of that too, unfortunately we do not have much control over the slideshare embed, but we are working with them on it.

I figured this might appear on hacker news soon enough. If anyone has any questions about the tech behind this microsite (although it is pretty straightforward) let me know. We developed the site and the hosting to account for an enormous amount of traffic in a very short period of time. So far everything is working fine.

6-7pm seems very late to me, but I guess it depends what time you start at, and what time your kids go to sleep at. That wouldn't leave me much time with my kids. I usually stop work around 4:30 in order to have enough time with the kids before bedtime.

I hope that more and more data becomes available around healthcare and outcomes!

Medicare recently produced this data http://www.nytimes.com/interactive/2014/04/09/health/medicar... and the center that my wife works at used it to to produce this graph http://blog.parathyroid.com/parathyroid-surgery-medicare/. They are quite a bit better at this particular operation than anywhere else in the US, not surprising given how many more they do, however it is often difficult for patients to know or understand that - who should they trust? More data please! Interestingly this operation is one that Atul Gawande (who wrote this article in 2004) specializes in too.

Benchmarking using wrk the smallest linode (1024 now 2048) serving a page from an untuned Rails application using nginx/passenger getting almost no other traffic. Hard to compare of course given the various other factors, but produced slightly lower performance after the upgrade. Serving a page from nginx directly (no Rails) had no appreciable difference in performance, I guess the Rails web serving is more vCPU bound?

Before Upgrade:

  Running 30s test @ http://...
    5 threads and 20 connections
    Thread Stats   Avg      Stdev     Max   +/- Stdev
      Latency   308.91ms  135.01ms 985.82ms   80.00%
      Req/Sec    14.15      4.61    24.00     66.36%
    2206 requests in 30.00s, 28.51MB read
  Requests/sec:     73.53
  Transfer/sec:      0.95MB

After Upgrade:

  Running 30s test @ http://..
    5 threads and 20 connections
    Thread Stats   Avg      Stdev     Max   +/- Stdev
      Latency   321.74ms  102.45ms 957.74ms   87.32%
      Req/Sec    12.02      2.18    17.00     80.75%
    1858 requests in 30.01s, 24.03MB read
  Requests/sec:     61.92
  Transfer/sec:    819.98KB

We've also built and upgraded a few projects on Rails 4.1 recently and it has been very smooth.

On a side note: we avoid ActiveAdmin like the plague for the very reason that you specify here; our experience upgrading it between Rails versions has been terrible. We use our own simpler admin 'scaffolding' instead - https://github.com/SquareMill/generic_admin_controller/tree/...