spartango

Ah yea, I forgot about this application. It's definitely a good one, although for some reason Theranos isn't explicit about targeting it.

It's all about speed and costs. The finger-prick is a distraction; phlebotomy is not a huge deal.

Instead, the important things are the turn-around-time and billed cost. If Theranos can offer 4 hour turnaround and a clinic/hospital cannot (or even get close), they will pay for it because it is good for doctor productivity and patient outcomes. If Theranos can maintain a half-medicare cost structure, that's also good for the provider because they can expand their margins.

Additionally, Theranos might do deals with insurance companies such that they reduce their reimbursements/push providers to use Theranos, which reduces the insurer's costs. The outcomes-case is even more pressing for an insurer these days.

Now, none of these directly translate to lower insurance premiums, but that doesn't mean that there aren't economic reasons to adopt the service.

> From the outside, it seems like the entire healthcare industry is built on being purposefully inefficient so as to create large costs that they can in turn mark up.

This is generally untrue, as much as it is a public perception. The system lacks simplicity and thus comes across as opaque; this is its failing. Its complexity is not malicious, though.

My experience in the space is that this is a mischaracterization of the FDA, but also misses an important point:

Theranos does not fall under the FDA's mandate in its current form. It is a CLIA-certified laboratory operation, regulated under CDC rules and scrutinized most likely by the College of American Pathologists(CAP). The CLIA/CAP scrutiny is very different from the FDA device/drug process, focusing on protocol and output. Even if they have novel technology, it is often classified as a laboratory developed test(LDT) and falls outside of the FDA's mandate (for now).

Many startups have achieved CLIA-certification without too much difficulty, from Foundation Medicine to Veracyte to Counsyl. It's totally reasonable and doesn't take too long.

This capability depends on your medical care provider in the US. I know that Sutter Health and Kaiser are both providing patients with systems where they can see their lab results on the web, along with all of their medical history. Reaching out to your doctor via email is even included. It works pretty well in my experience (Sutter).

This board seems heavily geared to do deals for defense-related applications. That's fine; getting deals with the Armed Forces and VA is feasible and quite rewarding.

What they overtly lack is connections to the healthcare world. I'm surprised they aren't publicly roped into Cleveland Clinic, Mayo Clinic or Kaiser, as they to support novel technologies in this space. I suppose you can argue that the business model is fundamentally incompatible, but I've seen Mayo and Kaiser go in anyway; they can acquire these labs and roll them into operations pretty easily.

Given that they are going up against massive, automated operations like those of Labcorp and Quest Diagnostics ($9B market cap each), they'll probably need this tech to keep up.

While the thumb-prick and low sample volumes are cool, in the grand scheme of patient care they are somewhat gimmicky. Until doctors request higher-frequency testing, this doesn't pinch that hard. Still cool.

The big sign that they need to be wielding novel capabilities to compete with Quest and Labcorp is the offering of their menu at half of the medicare reimbursement rate. Each of those companies run ~40% gross margins off of medicare reimbursement, so Theranos without novel tech would be running a pretty substantial loss.

While I have no idea if any of the other claims are true, it's important to note that they do claim to be regulatory-cleared (not FDA, not relevant in this case): they claim to be running a CLIA-certified lab.

CLIA (Clinical Laboratory Improvement Amendments)[1] defines the regulatory standards for clinical labs which take in samples and perform medical tests on them. It works very differently from FDA drug or device approval. Most often the certification is done by an organization such as the College of American Pathologists (CAP), which scrutinizes a lab's protocols and output[2].

In any case, if they are CLIA-certified they are open for business, legally speaking.

[1]: http://wwwn.cdc.gov/clia/ [2]: http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_act...

This looks simple and yet elegantly built. Nice work! I'm definitely a fan of the use of ListenableFutures as a way to integrate this into applications. Blocking, non-blocking, callbacks? Pick your poison.

I haven't seen Apache's HttpAsyncClient used in many places. The API looks sane enough. I'm not sure how stable it is compared to Netty; performance seems to be less of an issue given that it uses NIO.

How's jetcd on thread-safety?

I'd be interested to cook up a version that uses Netty or Vert.x, although there's not quite an excuse to do so...

If you do happen to update and lose your 2FA keys, the AWS people are turning around these lost login requests in <15 minutes. You fill the form out, they call you and verify, and life carries on.

If you reach out to AWS people, you may get some of this information before it goes public. AWS likes to do private (NDA'd) beta tests of new products with AWS-heavy customers. They work off of the feedback while bigger customers get their needs satisfied.

Any reasons not to work with Nate? It seems like the social stuff could be built in tandem with his strong editor.

Draft's editing/version control is rather awesome and easy to use. It would be neat if Loren and Nate could work together to get some of the github-like "social" features into Draft--following updates and broadcasting progress.

My feeling would be that having one platform with both features would be better than having two very similar things here.

This is some nasty, tabloid-esque "reporting". It shows little respect for Brin or his wife, regardless of what the situation is. I wish we could not promote or spread this kind of rubbish, as it's not healthy at all.

EBS has its problems, but I think a blanket rejection of EBS is probably unwarranted. It's true that in 2011, EBS was very shaky. Amazon has since invested quite a bit of energy into EBS; at that time it was a new service that couldn't handle its own growth. EBS has become substantially more reliable, both in terms of availability and performance consistency (provisioned IOPS).

That doesn't mean you should rely on it absolutely, at least within a single AZ. Multi-AZ is a critical part of any AWS deployment at scale, if not multi-region (depending on your needs). EBS is not a cure-all, either; if you have higher performance demands than it offers (between provisioned IOPS and IO-optimized instances) then that's fine, just measure first.

Finally, I'd like to point out that Reddit's complaints about EBS aren't the best to echo as an example of EBS issues: first, they are a few years old, and at the time both Reddit and EBS were architected with substantial deficiencies.

It doesn't quite have to be, from a user perspective. This is the kind of hacking project where just making it work well (boot + drivers + services) is a fun challenge. Further, it's a sandbox where you can play with some of the neat ideas that are at the heart of Darwin, like XNU.

Just because popular hosting companies are not using Solaris zones, that does not mean there are not large Zones-based deployments elsewhere in the industry. Particularly, some major corporations (including banks and telcos) are using Zones in their production Solaris environments. These turn out to be particularly large deployments, with hundreds of machines in data centers across the US.

These users do not broadcast their use of Zones, but having worked with them, they certainly do exist.

*Used to work at Sun on a project related to Zones and ZFS.

An entirely fair point, although if the dependencies are relatively limited it's less painful/more feasible to support iOS 5.

My iPad is reaching its retirement age anyway.

I couldn't upgrade my iPad because it's the first generation one...Again, would love a non-iOS 6 version; what features of this app depend on iOS 6?

This is an interesting case, however its important to point out that the legal debate around this is ongoing. This ruling only applies to the 2nd Circuit at this point. It's looking like a Supreme Court case will be necessary to ultimately decided this issue, given the murkiness around it.

Until then, however, off-label drug marketing is not something companies get away with without a substantial legal battle (often not worth it), and the FDA has so far collected billions of dollars in settlements and fines through successful off-label drug marketing suits.

Fortunately, there is a good historical and photographic record, and it's actually presented to students of US history in school.

Promises, Deferreds, and Futures are all names for the same general idea, that which uses a monad to stand in for the result of operation that may or may not have been completed.

There are implementations of this concept for many languages, from Java's futures to C# Tasks to Twisted Deferred to various JS Promise/Future implementations.

One thing that I find amusing in the callbacks+/-futures discussion is Google Guava's ListenableFutures (http://code.google.com/p/guava-libraries/wiki/ListenableFutu...):

The JDK ships with Futures under java.util.concurrent, and they do what you would expect. What Guava adds is the ability to use Futures in the "pure" sense (get/check result) and with callbacks or delegates. The neat thing here is that you can use whichever paradigm is appropriate for the design of different modules of your system, and safely mix and match as needed.

Guava isn't the answer to all the questions in the Futures world, but I do think it brings a neat idea to the table here.

Last time I did a battery replacement with Apple (for a mid-2009 Macbook Pro 5,5) it cost ~$120 off-warranty.

Doing the research, seems like different machines have different battery replacement costs from Apple:

http://www.apple.com/batteries/replacements.html

* $129 for non-retina 11", 13", and 15" Macbooks (air and pro)

* $179 for the 17" Macbook pro

* $199 for the retina Macbook pros.

I think specifying the requirements for a modern bomber is made difficult by the variety of ground attack missions a "bomber" might fulfill.

The requirements of "high munition capacity, a large combat radius, and long loiter times" closely fit the description of a close air support role, which has been the primary role for bombers and strike aircraft in recent years (Iraq and Afghanistan).

With that said, there are certainly other roles for bombers; missions where strategic facilities, supply lines, and bases/defenses must be destroyed. These are rooted in more conventional warfare than we've seen recently, but I'm less than convinced that they would be rare in a major conflict.

These conventional missions demand speed and stealth not only to penetrate evade enemy air defenses, but also to keep up with intelligence on mobile/time-sensitive targets. This timely delivery problem is hard to accomplish with small numbers of loitering aircraft or where the target has advance warning.

Also, given the proliferation of advanced mobile SAM and radar systems, I'm unsure of the assumption that US aircraft will have clear skies in a future conflict. Certainly in the early days of any conflict this will be untrue, and those are the days where strategic bombing will be most valuable; disrupted enemy infrastructure allow ground forces to move without resistance.

Thus, I think there's a need for both roles--CAS and penetrating bomber--and it seems to me that the USAF is actually tackling these separately, efficiently. While the Reaper lacks a large payload, it seems that the large numbers providing spatial coverage will have sufficient munitions in aggregate. The B-2 was designed to be the penetrator.

Further, the next generation of Littoral Combat Ships (LCS, Freedom- and Independence-class) have large enough "flight decks" that drones and other small aircraft can be launched from them.

Most modern cruisers or destroyers aren't over 10,000 tons fully loaded, and are thus comparable to the light cruisers of WWII. The Dreadnoughts were a fair bit bigger (2x at ~20,000 loaded), but indeed were not nearly as heavily armored as the WWII battleships of 30 years later. A loaded Iowa-class battleship displaced nearly 60,000 tons.

It's strange...I love the A-10, both its rugged design and its crazy anti-tank capability. Keep in mind that retirement plans for the beast are slated for 2028, and all plans to retire it sooner have been shot down. That's 52 years of service, which is a solid service lifetime.

But that said, I think there's a decent argument that can be made for phasing it out given current operational needs:

The A-10 was originally designed in the Vietnam-era as a close air support(CAS) aircraft for conventional wars, armed with a payload of unguided bombs and shells to destroy tanks.

Helicopters at the time couldn't carry these types of anti-armor heavy weapons, and strike aircraft like the A-1, A-6, and F-4 couldn't survive anti-aircraft fire at low enough altitudes to put their bombs on target. In CAS roles, missing the target meant killing friendlies, obviously unacceptable.

Thus, the A-10 was built like a beast so that it could survive SAM/AAA fire at the low-altitudes needed to deploy these weapons accurately.

Over time, however, CAS munitions have evolved with guidance, from missiles like the AGM-65 and Hellfire, to laser-guided (GBU-27) and GPS-guided (JDAM) bombs. These have longer ranges and thus don't require the carrier aircraft to be nearly as survivable. The A-10s resistance to AAA and small arms fire seems less relevant.

This suggests that the A-10 may be less necessary for strike roles, even if it carries them out admirably.

The public claim is that the quality control and reliability on the WS-10 production lines is poor, but there's evidence that there's more to it than just that. The WS-10 is produced mostly natively, but its design is largely reverse engineered from the AL-31F. In fact, its turbine blades are imported from Russia. This corroborates reports that the Chinese lack the design expertise at present to design a fighter engine from scratch.

Also, keep in mind that the WS-10A is derived from the AL-31F, which was first flown on the Su-27, but has since been replaced in Russia by modernized AL-31FM1 and 2 or the new 117 family engines. The FM and 117 series engines have generally better performance than the older F/FN parts, and likely are more efficient. Thus, we can see that the Chinese are working off an old design.

The focused airframe idea is not without a bunch of tradeoffs. The mission and target capabilities of the F-117 were extremely limited, which meant that the USAF had to have other aircraft around to pick up the rest of the missions.

Further, having a variety of specialized aircraft that do not share an airframe is a maintenance nightmare on the ground, as training and parts are necessary for each different kind of aircraft flown. Operating out of a major air base this is less of an issue, but with FOBs and aircraft carriers this is nigh impossible. Indeed, this was one of the motivating factors that drove the Navy to replace the A-6, F-14, EA-6B, and S-3B with aircraft derived from the F/A-18E/F line.

Yes, the F/A-18E will never have the unique capability of the F-14D, but apparently those planes were a massive pain to maintain. Similarly with the F-117 -> F-35. Beautiful beasts.

There is money going toward the development of a replacement for the B-52, although the exact form it will take is still up in the air/under wraps. Suffice to say that the "Next Generation Bomber" project currently has funding.

Two observations along these lines, however:

* The B-52 originally was the US Air Force's all-purpose bomber when it rolled out in the 50s. It was a conventional heavy bomber, a strategic nuclear bomber, and a cruise missile platform all in one. Over time, however, the USAF's bombing roles have become split; the B-1 now takes on the role of a conventional bomber, while the B-2 is used for deep-penetration strikes and standoffs.

* One big hurdle in the development of a B-52 replacement is the limitations on the number of strategic bombers allowed under the New Start treaty. The US cannot easily develop new nuclear-capable bombers under this treaty, and thus must keep a chunk of the B-52 fleet around to maintain the nuclear capability.

Actually, the Chinese have had a serious problem designing and building quality jet engines for fighter aircraft. The two prototype "stealth" aircraft they've demonstrated (J-31 and J-20) use Russian AL-31 engines pulled from Su-27s, because the native WS-10 engines fail to pass muster consistently.

Indeed, the same is true of the J-15 (an Su-33 clone), which is currently the only carrier-capable aircraft they've flown. Fewer than 16 of these aircraft have been built. Its use of the AL-31F makes the J-15 hard to produce, but also severely limits its payload/range.

For reference, over 500 of the mainstay F/A-18E/F Super Hornets have been built, and ~1500 of the previous models (A-D) were produced.

The Russians are none too pleased about Chinese repurposing and reverse engineering of their aircraft (particularly for engines), and have stopped selling Su-27s and many aircraft parts to the Chinese over IP disputes.

The lack of Chinese airpower and carrier operations isn't a product of posturing or strategic differences. They've invested a huge amount of money retrofitting the Admiral Kuznetsov (now Liaoning), are building a second one, and are training pilots for carrier ops with foreign trainers.

The Chinese air capabilities are instead hampered primarily by a lack of engine technology and production capability. Never mind the lift-fans.