dr_

I grew up in NJ and still have family there and I agree. It also an incredibly diverse state and, as of now, that diversity is reflected in the state government - more so, I think, than any state government in the country.

I'm raising my family in NYC, I disagree that it's one of the worst imaginable places to try and raise a family. There are a lot of activities for children, from the parks, to indoor play areas, to the libraries, etc. You can just about anything you need by walking. The public schools have been improving - you can try for one of the elite gifted and talented schools but even if that doesn't work out, there are many more good school options than there have been in the past. It's certainly not a cheap place to live, but I actually can't imagine a better place to raise a family. I don't know if there's any more pollution than any other major city. There's no major manufacturing that happens in NYC, so the pollution would mostly be from cars. In general, the city is becoming less and less car friendly - they are seriously considering a congestion pricing program - so I would expect whatever pollution there may be to actually improve. Nevertheless, pollution has never been one of the major complaints of most NYC folk. Yes, taxes can run high. You can always live outside the city if this is an issue but despite this, people prefer to live in the city as long as they can. High stress is really more a virtue of your job, not the city. There are many people who live here and don't want to live anywhere else. As they say, your bedroom is where you sleep - your living room is the entire city.

>The medical team was concerned that because Dr. Lown was having trouble swallowing, he was at risk for recurrent pneumonias. So we restricted his diet to purées. Soon the speech therapist recommended that we forbid him to ingest anything by mouth. Then the conversation spiraled into ideas for alternative feeding methods — a temporary tube through the nose followed, perhaps, by a feeding tube in the stomach.

Maybe not the main point of this article, but there are numerous occasions where I’ve encountered just this. Allied health professionals, all of whom are very well intentioned, making recommendations that physicians readily follow without taking into consideration the needs or desires of the patient and family. If as a physician you are being advised to declare a patient NPO or to send them off to a skilled nursing facility instead of home - please remember that this is just a recommendation and that it’s your job to look at the patient as a whole, including their general medical condition, likelihood of their family supporting them, etc. before following through.

Having spent years working in such facilities, I see some potential here, primarily because they are supplementing telemedicine with the use of local care specialists, and not just relying on the facility’s nursing staff. The issue becomes, who pays for it? Regulations require the facility have a medical director to help them set procedure and policy and to be able to provide overall care if the pcp is not available. So they are already paying for the medical director who they expect to be able to perform this task - even though the commitment of the director varies greatly from facility to facility. Many facilities also hire nurse practicioners now to help manage patients acute medical issues that arise within the facility. And finally there are times the patients really need to go back to the ER - if as a hospital you are trying to push them out in the shortest amount of time possible, you shouldn’t be surprised by this. Personally I think , in the era of value based care, the entire concept of skilled nursing and how it is paid for and regulated, needs to be completely reworked.

Although having a great champion is important, I’m not so sure if that person necessarily has to be a physician at the hospital. Dave Chase touches on this briefly here (I don’t necessarily agree with the title of the article): http://hitconsultant.net/2017/03/30/new-walking-dead-digital...

Just as you are working with colonoscopy centers, working with large medical groups that do a lot of their procedures through surgical centers (pain management, basic ortho stuff), would be a good way to start before working into hospital systems.

It also indicates a timeline, where cars would have to pay by 2020. The public transit system cannot be fixed in 2 years.

I can attest to the fact that Aetna does cover flu shots now.

I don't have the Bolt, but I do have a vehicle with top down view, which was not something I was interested in much when looking for cars, but it came with the package. i agree, it's a god send, and has prevented my car from getting dinged or scratched in more than one occassion.

I think the simplicity of the iPhone X lies in the fact that you don’t have to use all of the gestures to make the phone work for you. Swiping to go home is something you get used to relatively quickly, and I personally think faceID is great for unlocking the phone.

The N.Y. Times once reported on the lifespans of the people of Ikaria, who apparently have the longest recorded lifespans, as a group, in the world. Their diet includes moderate amounts of wine.

“Wine — in moderation — had been shown to be good for you if consumed as part of a Mediterranean diet, because it prompts the body to absorb more flavonoids, a type of antioxidant”

Not a medical research study, but I wonder how oncologists would reconcile their recommendations with reports such as this. Presumably the studies they have reviewed control for other factors such as diet and lifestyle.

(Original article: https://mobile.nytimes.com/2012/10/28/magazine/the-island-wh...)

Agreed. With the sacrifice in width it is, and very much feels like, a smaller phone, despite the increase in diagonal screen size measurement. I also find that it is not as bright as my 2014 iPhone 6 Plus.

or on the flip side of it, perhaps in a city like NYC, yellow taxi cabs are the cause of major traffic, especially when they are just driving around looking for passengers, slowing down at corners where they may pick someone up, lining up near hotels, carrying only one group of passengers at a time, etc. Or construction vehicles and road blockages have added traffic to major cities - many of which appear to be undergoing a construction boom. And while I'm a proponent of mass transit, id argue that large buses- too large to navigate city streets especially when it comes to making turns - are a cause for major traffic in the city. They should be replaced by services like Via.

Hi Mark, Would this be different from than "cord banking", which is offered to new parents? I don't mean in the technique, I mean in the type of cells retrieved and their potential long term benefit. I only ask because the American College of Obstetrics current position is not to store cord blood as a form of "biologic insurance" ( https://www.ncbi.nlm.nih.gov/pubmed/26595583 ) and was wondering what your thoughts on this are. It's a decision I, and some of my friends, have had to face as new parents.

As a pedestrian crossing the straw in NYC, you will typically wait for cars to stop, then walk about 2/3 of the way into the street, then peer into the bike lane to make sure no bikes are coming, then complete your crossing. Most of the bikers, from my experience, do not follow rules such as stopping at a Stop sign or for pedestrians or at their own bike designated stop lights.

It may be nice to bike in the cities parks or on its outskirts, but it's a dangerous proposition in the city itself. NYC is an urban jungle with a web of cars pedestrians, delivery trucks, garbage trucks and construction zones all over. As a biker, if you are not going to follow the rules, you are going to find yourself in trouble at some point.

I realize that scientific consensus is that gene editing should not be permitted to enhance human performance - be it mental or physical. But if one nation ignores this consensus, and starts producing "super humans" wouldn't other nations be compelled to follow? Otherwise, over time, wouldn't their citizens, and their nation, slowly fall behind as a country of power and status? Just a thought.

Perhaps people who are characterized as such - ADHD, Aspergers (remember these are diagnoses made on observation,there are no lab tests to diagnose them) are in a learning environment that is not conducive to promoting their underlying talent. Perhaps it's the education system that needs change, and not the pupil. If so, we may see fewer of these diagnoses.

I don't know temple grandin, but hawking certainly didn't have a learning disorder.

He went to Yale. He's definitely not average or with a learning disability.

I never really used to listen to podcasts - until I got a car that has Car Play functionality. Now I listen to them all the time. Will Audm be available on Apple Car Play or Android Auto?

Im not sure there's any correlation between young men who are sitting idle and what I was referring to. There are men who do not have children, some gay men for example, who are highly productive members of society.

The selection bias that you indirectly refer to is already happening. And with the availability of ivf, what I am referring to is already happening as well amongst lesbian and gay couples and single educated women who haven't met the right person yet. And what's to stop it? If people who are smart, successful, but haven't found the right mate or don't want to get married, go gamete shopping and find the ideal set of genes, and produce the ideal child - how do other children without these advantages compete against them? My guess is that other potential parents then start going the same route, especially if marriage is on the decline anyhow.

I don't think it leads to violence and truthfully it's not something I even condone without further thought.

"As mentioned in the previous essay, single parenthood correlates with a number of social maladies."

This may be true historically, but does it have to be that way going forward? My thoughts, not based on studies but based on people I know, is that the general interest in marriage has declined as there is a preference for greater autonomy amongst both men and women, not to mention economic independence. Marriage was born out of economic need, and was given a religious stamp of approval. If the same economic need isn't there, and developed countries are becoming more secular in their beliefs, it would seem only natural that marriage rates would decline.

But that doesn't mean people don't want children, or can't have children. With the introduction of ivf, and both egg and sperm donors -known or unknown- its possible for the birth rate to be maintained. It may sound bizarre now just as putting ones profile up online in search of a mate was at one time, but it could be become the new norm. Search for gametes the same way you searched for a partner at one time.

As far as the maladies of single parenthood go, much of that may be attributed to the education levels of the single parent and/or their poor economic circumstances. It doesn't have to be that way though. Of our last 4 US Presidents, 2 pretty much grew up without having a reliable father around for most of their life. They seemed to both have had pretty smart moms.

Perhaps outside of the city, but at least in a place like NYC, there isn't room for a dumpster to be sitting around continuously. And the residents wouldn't like it either.

That's what I was thinking. I'm assuming they go above and beyond what the city may offer. if you are a company like whole foods - you probably don't want trash sitting around until a city assigned garbage is ready to pick it up in a week. same with hotels, etc.

If this is true if uber, that it has no path to profitability, isn't it also true of ubers competitors? Their price points are fairly similar and they all, at some point, offer incentives to ensure you keep using their service.

The affordable care act has enrolled millions on to some kind of health insurance plan. Even if you are stuck with a high deductible plan, oftentimes that annual check up (preventive care) is fully covered without requiring a deductible payment. And, of course, if you are on Medicaid - you have Medicaid.

If you are relatively young and/or healthy, that's all you would really need.

As a result, their patient population likely gradually dwindled.

I was a proponent of dpc at one point but, now enrolled in a high deductible plan myself, i don't see as much need for it personally. I'd rather take the money and throw it into my health savings account and use it when i need to.

I followed homehero and some of its competitors movements for a bit. Home care is not an easy business, and there are many local vendors in any given community. There's always this argument as to whether going "full stack" (providing the workers, technology - the full solution) is a better option in healthcare than just providing a software product for clients to start using. The argument Kyle makes, that is worth noting, is that existing homecare agencies started deploying software more readily than homehero may have anticipated.

Thay being said, some of the messaging and marketing may have been off as well. I found it odd when they started advertising their workers as W2 heros, or something to that effect.

I don't personally have a problem with people paying extra to receive what they perceive to better care. But I think if you look at outcomes, I doubt you will find that they have received better care by paying the extra 40k or whatever it is a year. It's great that the kid in the story was able to be seen by a established orthopedist in a city hospital - but most general orthopedists know how to set a kids leg, and I doubt the outcome would have been much different if they had gone to the originally intended ER.

It's certainly a good gig for the family practitioner, but I think the following quote at the end of the article:

"“The traditional model of having a good internist is dying,” said Mr. Traina, a scion of a prominent family here that arrived with the California Gold Rush.

will apply to the concierge doc in the longer run as well. If you are reasonably healthy, checking your blood work once a year and your blood pressure every so often, you don't have much need for a family doc. If catastrophe strikes, then you will probably need a specialist - and if you're willing to spend the money, it's best to save it for these times - yes your cash will get you in as easily as a concierge doctor can - rather than dishing out 40k annually.

I recently chose a medical clinic that's part of a university system for my own healthcare, as opposed to a family doc who charges $1400 for an initial exam and $400 for follow ups. Do they spend as much time with me? No, I'm in quick and out quick. I get my shots and blood work and I'm out the door. Since I'm pretty healthy, that's the way I want it.

Interesting. I work in Montclair a couple of days a week. It probably is the type of town that could support this, but it's still kind of peculiar. The Montclair Times HQ was shut down - it's now a dialysis center. There is a blog of sorts as the article mentions, Baristanet, that covers local news in Montclair, although I have no clue how many people read it.

I would imagine that most people in Montclair read the NYTimes - perhaps it would make sense for the NYTimes to 'up' it's local coverage game in the tri state area.

A Tesla bought today does have the hardware to implement what they call full self driving, once the software is ready and state regulations, if any, are in place.

That being said, i would imagine said hardware would evolve over time with new releases. It would be nice, and probably safer, if cars could actually communicate with each other, rather than have to rely on their own cameras, to determine another vehicles position. Same with traffic lights, road signs, etc.

that's probably a long way off, although i wonder if Teslas have hardware that would allow them to communicate with one another.

Interesting but they are not the only ones doing this. United and aetna are collecting data as well, and also employ nurses that follow patients into their homes or other settings. The data operation is what is emphasized in this article, but it really remains to be seen how much the data can have an impact on people's overall health - preventing hospitalizations, making sure patients take their medications etc. maybe it can guide clover and let them determine where to allocate manpower - but in the end it's still the manpower that matters.

from my experience, a lot of it depends on having the right family, and perhaps community, support structure in place.

As of this writing, Trump has drawn fewer votes than McCain in 2008 and substantially less than Romney in 2012. He even has less than Hillary. So I'm not sure I agree with this analysis about rural voters - at least not with respect to it being anything unique to this particular election.

What seems more likely is that there was an enthusiasm gap for Hillary Clinton as a candidate. It's about the electoral college in the end, and a Democrat like Hillary, who lacks the charisma of Obama, was going to have to bring out minorities, young voters, and college educated voters in droves to win. She simply was not able to sufficiently do this.

To win the rural vote back, the Democrats need a different kind of candidate, none of the ones that they have offered have been able to do this since 2000.