duffpkg

Not speaking to the veracity of the statement but quaise answers this in a different article: "A lot of the challenges are the same as for oil and gas. The subsurface is an uncertain environment. The deeper you go, the more extremes you have, but we've come a long way with the oil and gas industry to develop a whole suite of technologies, techniques and measurement systems to minimise that risk. The main challenge is maintaining wellbores from closing in on themselves as you go deeper. There's a lot of pressure in the rock and these holes eventually will collapse. The way we answer that is by creating a glass wall in the rock as we burn it. When our technology vaporises the rock, it creates a glass wall and that remains on the walls and prevents the hole from collapsing."

https://www.energymonitor.ai/tech/geothermal-can-provide-hal...

Grayjay also has a desktop app that does this very well. https://grayjay.app/

This is better conceived and more carefully controlled than the vast majority of the published research I see pouring out every week.

I am not averse to that but the cooling is an issue. I have the most excess power in the summer. From what I have read I cannot use exterior temperature air which can be 95-105 in summer. Is there any inexpensive water cooling setup for them?

I have a solar plus battery off grid setup at one of my homes. My comment that is the top on this item (https://news.ycombinator.com/item?id=40877337) describes what I did for my solar setup. Two years in, everything has paid for itself. I expect the system to produce for 7-13 years without meaningful maintenance costs.

At the 7 year mark my cost per kwh will be below $0.02 . Power in my area (southwest US) is $0.12 per kwh. Some factors are complex to measure. Such as how much more I run the AC because it is essentially 'free' than I would if it were still $0.12 per kwh. Another complex factor is that I can generate much more power than I consume currently. If I found a sensible use for the surplus power then costs drop even lower even faster. My consumption is about 50% of max, on an annual basis.

In short the article and conclusions are a total mess and made a nice attention grabbing headline with little to no substance.

As someone that has built and managed clinical laboratories for human samples, I find this article from consumer reports extremely misleading. The describe results as a percentage of a theoretically acceptable level. For example, for cadmium, they are saying an acceptable level is 4.1 ug/day . Then they seem to imply that "TJ The Dark Chocolate Lover's Chocolate 85% Cacao" has 229% of the 4.1ug/day if a consumer ate a 30g piece.

They never actually spell out what they mean or what the actual results they found were, or what the limit of detection of the methodology was or the error range of their tests. I guess they are saying that that chocolate has 9.3ug of cadmium in a 30g sample but it's impossible to say from what they wrote.

The FDA states that the maximum daily consumption of cadmium should be limited to 0.21-0.36ug per kg of body mass. For an avg american male that would mean a threshold of 17.64-30.24ug/day. A typical salad containing 250g of romaine lettuce has 2-14ug of cadmium in it. Lettuce and cereal grains are the most common sources of cadmium in american diets.

The amounts we are talking about are extraordinarily small and difficult to measure. We are talking 5-100 quadrillion individual atoms of cadmium.

https://article.images.consumerreports.org/image/upload/v167... https://www.fda.gov/food/environmental-contaminants-food/cad....

For that low a power need Anker and some others make ready to go units you can buy off of amazon that are pretty reasonable.

There is a lot of information on this on the diysolarforum.com but if you purchase name brand cells, CATL/EVE from a good supplier these are the same ones used by all industry. They have a very good track record. I do not advocate buying from any random seller on aliexpress. There are not any mass market non-chinese batteries available for sale. Virtually all solar equipment of any fashion is chinese made.

The panel strings are at ~500v so there are safety, fusing and grounding considerations. Pretty common electrical equipment and cable is rated for use at 600v. There are special locking water resistant connectors for solar panels called MC4.

It would be for the completed battery units with BMS. You would have to install the batteries into the battery cases. It is a bit tedious but it was otherwise straightforward. The batteries are extremely heavy.

I have always had good experiences with signature solar. My inverters are EG4 and I am very happy with their product after trying A LOT of others. I think the primary reasons for the price difference is that you are purchasing US inventory (it's already here), it's preassembled and warrantied as a unit, they provide pretty decent support and their battery packs use 100ah cells instead of 280ah+ cells. So you are buying ~3x as many BMSs, connecting cable ($$$$) and cases for the same power.

Their rackable units are not light but can be moved by a capable person without too much fuss. A fully loaded 280ah unit in it's case is over 250lb so you really need a lift cart or such. The 280ah units and now maybe 320ah are more economical.

This is in the american southwest so winters are very mild and the sun is still strong. Summer is the much more demanding part where AC is 90% of electricity use for the year. There would certainly be challenges in other locations but I think you could do the napkin math on it with panels being as cheap as they are. The solution to pretty much any deficit these days is to just add more panels. The biggest issue there is, is if you do not have sufficient space. My panels are ground mounted.

All of the quotes and interactions I had with the local solar installers were reminiscent of the used car lot if not outright fraud. I was able to do what was permissible myself and a regular licensed electrician did the rest. The equipment is UL listed. There was some learning curve but I found the diysolarforum.com to be a pretty good resource to learn what I didn't know. I ran the whole setup standalone for about 6 months before switching the house over to it. The only problem that happened was a loose battery cable connection which the BMS and inverter alerted to and handled correctly.

That does not include the costs for inverters and other electrical system parts. I am not endorsing these vendors but I am happy with the result. My system paid for itself in less than 18 months. I have many years of experience buying from China in industry. I purchased batteries from Docan Power and BMS/battery housings from EEL Battery. My inverters are from EG4 and UL listed. You can see current pricing on their respective websites. I would say there is some learning curve for a complete novice. The diysolarforum.com is a good vendor neutral and honest resource for information.

Yes. Totally disconnected, zero power bill. That home is in a jurisdiction where that is permissible.

Lifepo4 (lithium iron phosphate) batteries for the home are pretty cheap as of today. Power storage for residential use in a 48v metal rackable linkable system with battery management system (BMS) is $89/kwh shipped/duty paid from reputable chinese suppliers CATL/Seplos etc. You have to wait for sea shipping, add $30/kwh if you want to buy it in the US today.

From the same suppliers sodium batteries are currently $130/kwh and about 26% less efficient in the same form factor. I look forward to this changing.

Due to rising power costs I moved one of my homes completely to solar and battery (lifepo4) and haven't had any problems. I can't imagine ever going back to the power company. Panels have gotten to the point of being ridiculously cheap. I have a lot of space. I purchased pallets of used panels for more or less the cost of transportation ($34 per panel 270w). They produce about 85% of their nominal rating.

I mention this because other comments mention costs that are much much higher.

If you consult https://chpl.healthit.gov/#/listing/10938 you will see that it is a certification of a subset of the full criteria (toggle 'see all certification criteria'). OpenEMR foundation says they had to raise $125k to do the partial certification, that sounds right. That is a good thing but some items like eprescribing are not certified, which is an absolute deal breaker to most providers. I would guess it's because you have to license a drug database. At ClearHealth we built and maintained our own drug db as open source also, it was a large endeavour. We had to lobby federally for there to be a carve out in the HITech legislation to even allow for an open source drug database to exist rather than the original requirement of two dominant existing providers codified in law. You can stitch together some other third party offerings to meet those needs but hardly anyone wants to do that.

ClearHealth and it's affiliated companies were acquired in 2017. ClearHealth the EMR stopped open source releases in 2017/2018. You can kind of hair split what is and isn't an "EMR" but if you want a system most providers would call an EMR it is extremely difficult to have it be any sort of open source anymore. Basic fundamentals like procedure codes, diagnosis codes, eprescribing, billing, drug databases, interoperability, mandatory reporting and certifications all involve large fees, licensing and other ongoing costs. At ClearHealth our main business was healthcare management. We spent about ~2 million a year on those things, we released what was not encumbered otherwise under the GPL. The EMR is still used and maintained internally by some larger institutional users.

There are several others like eClinical in wide use. Depends on acute/outpatient etc. Open source is more a less a losing proposition for a mainstream EMR because of certification and integration requirements that amount to at least hundreds of thousands of dollars per year. ClearHealth was, as far as I know, the only open source EMR ever to have surescripts and full federal certification. It cost us about ~2 million a year to maintain all that.

I was the main contributor and maintainer to OpenEMR about ~20 years ago and then decided it was irredeemable and started over with ClearHealth/HealthCloud. Shockingly some of my code code lives on (from PHP 3). I am reluctant to say don't use it but if you do please don't expose it to anything public, which sadly happens most of the time. There are some real problems that exist in that code base from a security and HIPAA perspective.

Health executive, author of Hacking Healthcare...

At the start of the pandemic, the general unavailability of mainstream supply chain covid testing apparatus combined with an absolute torrent of cash, somewhere around 900 billion in total overall, created a cottage industry in covid testing startups. At the time the institutional thinking was that this was "a good thing" because existing infrastructure had a 0% of meeting covid testing demand. The FDA and other regulators more or less abandoned what little oversight of lab developed tests (LDT) there was during this period. They remain lightly regulated. Fast forward to today, a large number of the covid testing startups still exist and are sitting on mountains of cash, having come up in the age of LDTs they are going to continue to min/max that shaky regulatory framework. People in the startup sphere of influence constantly complain about the FDA being too involved in regulation. LDTs will lead to innovations as well as a abuses, I predict many people will complain their regulation is too lax. Such is the way of trying to regulate anything in healthcare.

I don't think this is someting that is well recorded. I mean the way these encounters are documented there isn't necessarily a box to tick that is "meant to take a different illegal drug but accidentally got fentanyl". I speak anecdotally from having been party to tens of thousands of acute care admits and a lot of public health operations. You see "a lot" of "I just smoked a joint" or "we thought we were getting LSD/X/oxy etc" in teenage fentanyl ODs that recover. Also having had exposure to the drug dealing side via public health interactions and community support groups, my visibility into it has told me these are not careful meticulous people as a whole.

A significant issue with fentanyl related mortality is accidental consumption. Fentanyl is so potent and because of its relative ease of synthesis and a careless illegal drug supply chain, contamination is common. Not all but many of these deaths are a result of teens consuming a drug that they percieve as "safe" like marijuana or "adderall" or "oxy" etc but through careless handling by dealers or intentional misrepresentation, end up receiving a fatal dose of fentanyl. I think it is an important point as many comments reference decrimilization and other "fentanyl policy" items.

Oxidation is a problem as is physical debris but touch surfaces are cleaned at least daily in a hospital setting anyway. Plain old Copper/brass that has been used since forever is virucidal without any special treatment.

As someone that has built and operated large multipractice and acute care facilities some of the most vicious fights I've had with medical entities and boards is about changing hardware back to the older brass/copper which is inherently antibacterial and only needs cleaning with soap/water to self disinfect versus stainless steel which needs cleaning with bleach and can foster or even lead to the creation of resistant and other problematic bacteria. The objections were mostly about the visual appearance. I am not sure I see the advantage to this new material over the good old brass/copper. There is a perceived cost premium to it but it isn't meaningful in practice. This paper alleges this new process is cheaper but I would be incredibly dubious of that. At ClearHealth we were successful in substantially reducing hospital acquired infection (HAI) rates at managed facilities to industry best in part because of our "reversion" to copper/brass hardware.

One of the most obvious signs you are in a well managed health system is seeing copper/brassy touch surfaces instead of stainless.

https://www.copper.org/publications/newsletters/ba-news/2010... https://en.wikipedia.org/wiki/Antimicrobial_properties_of_co... https://www.statnews.com/2020/09/24/as-hospitals-look-to-pre...

It's easy to jump to conclusions from this one single meta analysis however based on my experience I would want to see a more deep dive review. I would guess that underreporting, especially in the pre-2010 era after which electronic medical records became much more prevalent, as well as the changeover to ICD10 from ICD9, are likely culprits. Data quality in healthcare today is a D- at best, 20 years ago it was absolute and total garbage. Though this persists today, the excel 65k row limitation and excel date bugs are reponsible for an unimaginable amount of healthcare data destruction.

Up until 2012 even, most CDC reporting was done as manual chart reviews typed into an excel sheet. That was a very error prone process.

Former hospital system executive, wrote hacking healthcare for O'Reilly, created the open source ClearHealth/HealthCloud EMR...

One of the few times in managing hospital systems I was actually shocked at unethical behavior was when we took over management of a system that through accidents of history included a series of dentistry clinics. Dentists do not have any equivalent to a hippocratic oath, they have no professional obligation to be honest with their "patients". The overriding operational theme of the clinics was how to defraud "patients" with completely unecessary work to maximize profits and borderline defraud dental insurance. I understand that people have a dim view of ethics in american healthcare but this was what I would consider criminal behavior in a medical setting but as further experiences taught me, is the norm in american dentistry. Suffice it to say that we divested from the dentistry clinics asap.

Here is one swiss study showing that 30% of dentists committed fraud in the studed visits or were so incompetent that their behavior constituted fraud. I would guess that american dentistry is closer to 50%.

Have you had your wisdom teeth out? You are very likely to be the victim of dental fraud.

https://pubmed.ncbi.nlm.nih.gov/3135372/

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3036573

Wrote Hacking Healthcare for O'Reilly, former hospital executive, built and operated hundred of hospitals and multi-practice groups. Created the open source ClearHealth/HealthCloud EMR and WebVista.

I advise a lot of health related startups. I think the list is OK but the two most important things I have seen come up over and over again are 'have a show pony' and KISS.

"Have a show pony" means you need to have a doctor associated with your business, idea, etc that is high profile and a public advocate for it. Doesn't necessarily mean as an employee or consultant, etc, that can get complex because of corporate practice of medicine regulations but advisory boards and research partners are often good fits. This lets you be taken seriously by what are extremely risk averse institutions in most cases, especially when dealing with "two guys and a hard drive" startups.

KISS is the old adage, keep it simple stupid, but really in healthcare the overwhelming high priority problems are insanely simple people issues. Getting people to wash their hands, getting patients to show up at the right time and the right place, having an organized and non-duplicative flow of operating information. A tremendous amount of healthcare is done via spreadsheet, think at that level. Complex solutions can be profitable but almost never endure and can be extremely hard to sell.

I think a lot can be gleaned about the general dysfuction of healthcare as an industry from this previous HN thread: https://news.ycombinator.com/item?id=39186252

Wrote Hacking Healthcare, former hospital system administrator, blah, blah...

I think the comparison to thalidomide is click bait. Thalidomide was such a problem because it was used to treat symptoms of pregnancy, not some other unrelated condition. In this situation all(?) of the first line pharmaceutical treatments for managing epileptic seizures pose at least some developmental risk to unborn children. On the other hand unmanaged epileptic seizures also pose a risk to the parent and child.

This was a situation of gross negligence on the part of the institutions involved in regulation AND the direct providers offering care. A classic "somebody else's problem" field. Institutions failed to identify the actual scale of the risks involved in a way that properly educated providers and providers chose an inappropriate framework with which to manage and communicate the risks to patients who could or did become pregnant.

The drug involved here is not really the problem, it is an effective drug at managing epileptic seizures. A reasonable approach that was not employed would be to properly identify the drugs serious dangers to developing children in those who may become pregnant to providers. As a regulator you need to hit them over the head with it. From a course of treatment standpoint selection of alternative drugs for patients who would like to become pregnant that have slightly less risk to undeveloped children need to be prioritized. Providers need to make sure that proper supplementation happens (folic acid, etc). The risk is meaningfully reduced and the patient would better understand what can happen. This type of comprehensive and nuanced course of treatment is something that is just very very difficult for healthcare, in the US anyway, to achieve.

I created ClearHealth which was the first and possibly only fully federal certified open source EMR. We started with EMR but very quickly became a healthcare operations management company that managed some very large multi-state acute and ambulatory care groups.

A struggle I have seen play out numerous times, and at one point my own company fell victim to it, is that there are these obvious operational inefficiences in healthcare that every tech entrpenuer thinks they can hop onto as an easy oppourtunity. Then they run face first into the wall of a highly regulated industry in which, in most states, corporate power over care is severely restricted. Secondly, the last 5% matters just as much as the first 95%. You have to get to 100% because you are dealing with real people not "transactions".

It took us 10 years to really get the hang of how to create positive operational change in big healthcare systems and it's very nuanced and slow. In a nutshell it's a lot of carrot and stick or maybe a lot of micro-carrot and micro-stick.

Amazon tried the brute force approach with Haven and it failed spectacularly. The pharmacy and one-medical plays were a dip your toes in the water approach but from what I have seen they are replaying most of the same mistakes.