Tag: failedstate

Medical records failure

Because stupid people demonize managed care, and the standardization benefits can thus not be reaped across the board.
2015-07-11: Coding is crazy.

I was not able to verify the existence of an ICD-10 code for falling from a non-military spacecraft, but there certainly is an ICD-10 code for being burned due to water-skis on fire

2015-07-23: Until this is fixed, we can’t have nice things. The recent progress with open access journals is a tiny first step, but it’s still not common to attach your raw data to your study for easy replication, or to to publish negative results.

So some of the results of this individual trial shifted, under closer examination, and that is definitely problematic. But fundamentally there is only one thing different about this deworming trial and the rest of social science and medicine: Miguel and Kremer had the decency, generosity, strength of character, and intellectual confidence to let someone else peer under the bonnet.

This kind of statistical replication is almost vanishingly rare. A recent study set out to find all well-documented cases in which the raw data from a randomized trial had been reanalysed. It found just 37, out of many 1000s. What’s more, only 5 were conducted by entirely independent researchers, people not involved in the original trial.

2015-10-25: Epic is benefiting greatly from the lock-in it has created.

instead of ushering in a new age of secure and easily accessible medical files, Epic has helped create a fragmented system that leaves doctors unable to trade information across practices or hospitals. That hurts patients who can’t be assured that their records—drug allergies, test results, X-rays—will be available to the doctors who need to see them. This is especially important for patients with lengthy and complicated health histories. But it also means we’re all missing out on the kind of system-wide savings that President Barack Obama predicted nearly 7 years ago, when the federal government poured billions of $ into digitizing the country’s medical records.

2020-04-20: And then we have the usual problems with IRB / EMR

If you want to report the number of times a patient has cut her nails in the last week, you would need approval. And it’s not easy at all to search the EMR for any of this information. You’d have to hire someone specifically to look through it.

“Why are nearly all notes in Epic . . . basically useless to understand what’s happening to patient during hospital course?” Another doctor’s reply: “Because notes are used to bill, determine level of service, and document it rather than their intended purpose, which was to convey our observations, assessment, and plan. Our important work has been co-opted by billing.”

2020-04-22: The software is only designed for billing, not evidence.

Electronic health record software in the US is not set up to make clinical research faster and easier. We have billing claims as, absurdly, our only reliable and easily integratable national source of raw patient data. What we don’t have is anything useful to produce evidence-based medicine.

2020-04-27: EMR might not capture what matters

Is this loose, informal transmission of anecdotal findings—call it chatter, call it rumor—part of medicine? It isn’t what anyone is taught in medical school; it doesn’t fit in with the professional’s image as a purveyor of rigorously tested interventions. But continuous, iterative clinical knowledge—the kind that can be updated minute by minute—is invaluable during this tumult, when time is of the essence and there’s scant research to fall back on.

2023-07-30: Clinical trials keep getting more expensive due to regulatory capture, lack of competition, and luddite tendencies. Vial might do an end run around this if they don’t get stopped by the enemies of progress

Instead of dealing with the difficulty of collecting data on new medicines, both society and government sidestepped it by focusing on treatments for much rarer illnesses: relatively rare cancers, rheumatoid arthritis, and multiple sclerosis to name a few, not to mention very rare illnesses such as cystic fibrosis or paroxysmal nocturnal hemoglobinuria. The North Star for Vial is to drive a 10x improvement in both the speed and cost of clinical trials. This can sound hyperbolic, but it is likely not impossible, given the massive inflation of trial costs over the last 50 years. In the bull case for Vial, the development of TrialOS would enable companies to pursue 10x as many drug candidates in parallel. This would open the aperture for drug development, giving emerging companies more breathing room in pursuit of their first clinical success.

Vial has now had a front-row seat to 10s of trials. They’ve seen the product features that trial sponsors have adopted and shied away from. Their electronic tablets and eSource solutions have been welcomed with open arms. On the other hand, their remote data capture solutions—which could make the difference between a 2-3x cost reduction and a 10x cost reduction—have been less widely adopted so far.

What if they could aggressively dogfood the most cutting-edge features of their platform? This could further accelerate reductions in trial speed and costs and open the door to massive value capture. Taken individually, no part of their stack is groundbreaking. There is fierce competition to innovate within in silico drug discovery. Organoids are not new technology. Faster chemical synthesis won’t spark a revolution on its own. The fundamental insight is that integrating each part together will give Vial a chance to exploit their true advantage: faster and cheaper trial execution.

2023-07-31: HIPPA is one of the enemies of civilization.

The path forward is therefore clear. We should be doing more to get more data into the hands of more researchers. Unfortunately, we have laws and regulations surrounding privacy that make that extremely difficult. Reform in this area would do a great deal to advance progress in the fields of science, medicine, and health. Privacy concerns also stand in the way of attempts to make healthcare more affordable. The privacy advocates have 2 arguments:

  1. Someone might make a profit while they’re curing disease
  2. We shouldn’t even try to achieve any more medical progress until we achieve socialism

These objections are almost too silly to refute, but I’m including them because it’s useful to understand the irrational motivations of many privacy advocates.

Waco 2.0

Ed and Elaine Brown have barricaded themselves in what has been described as a “fortress-like compound” after they were convicted of refusing to pay income tax to the federal government earlier this year. In recent days their phone, power and internet have been cut off and camouflaged SWAT teams, helicopters, armored vehicles and possibly combat robots have descended on this formerly quiet area.

some REALLY don’t like taxes

Pay-to-Stay Imprisonment

For offenders whose crimes are usually relatively minor (carjackers should not bother) and whose bank accounts remain lofty, 12 or so city jails across the state offer pay-to-stay upgrades. Theirs are a clean, quiet, if not exactly recherché alternative to the standard county jails, where the walls are bars, the fellow inmates are hardened and privileges are few.

assisted living 2.0

Got Milk?

A maverick dairyman named Hein Hettinga started bottling his own milk and selling it for as much as 20 cents less than the competition, exercising his right to work outside the rigid system that has controlled US milk production for almost 70 years. Soon the effects were rippling through the state, helping to hold down retail prices at supermarkets and warehouse stores. That was when a coalition of giant milk companies and dairies, along with their congressional allies, decided to crush Hettinga’s initiative. For 4 years, the milk lobby spent millions of dollars on lobbying and campaign contributions and made deals with lawmakers. Last March, Congress passed a law reshaping the Western milk market and essentially ending Hettinga’s experiment — all without a single congressional hearing.

the account of the dairy industry cartel

Declaration in defense of Science and Secularism

We are deeply concerned about the ability of the United States to confront the many challenges it faces, both at home and abroad. Our concern has been compounded by the failure exhibited by far too many Americans, including influential decision-makers, to understand the nature of scientific inquiry and the integrity of empirical research. This disdain for science is aggravated by the excessive influence of religious doctrine on our public policies.

this one ought to be shouted from the rooftops

CMS specialists

The Certified Metrication Specialist (CMS) program is the only bona-fide metric certification program available. It is a carefully monitored program under the direction of some of the nation’s top metric-system experts who operate as the USMA Certified Metrication Specialist Board. The CMS program is designed to provide documentary evidence for individuals who can qualify as metric specialists because of their education and experience in the use of the modern metric system which is known as SI (the International System of Units).

Customs customs

All the Arab countries in general and the Gulf countries in particular do NOT want any business done between them. It is probably much easier doing business with even Israel (no we can’t) and Bahrain than Bahrain and Saudi.
…
It took 3 hours this morning to find the big boss who in turned called DHL to find out if this is true and if it was alright to use DHL’s declaration form numbers rather than the government’s! Finally, after a long struggle he gave his go ahead. It took the supervisor assigned to rubber stamp the documents more than 30 minutes just to produce the bloody rubber stamp, photocopy some papers, and fill in the spaces in that rubber stamp!
…
Bottom line. If you don’t know how to be a crook and stick by the book, don’t go into business and most certainly don’t even CONSIDER doing business with your neighboring countries who claim to want integration, customs union and single currency!

such are mahmood’s experiences with the new gulf customs union. this is very much in line with the fact that third world countries are much more protectionist amongst themselves than the supposedly evil west is towards them. if they were to abolish these trade barriers, they would leapfrog 10 years of development (granted, with big turmoil, but taking a collective leap of faith, and a suffering today for a better tomorrow may not be such a bad thing)

Nuclear energy

Watching the mummy returns reminded me of an article i had read some time ago, arguably one of the scariest i ever read. it talks about the problem of marking a site as dangerous for 10 ka into the future.

These standing stones mark an area used to bury radioactive wastes. The area is … by … kilometers and the buried waste is … kilometers down. This place was chosen to put this dangerous material far away from people. The rock and water in this area may not look, feel, or smell unusual but may be poisoned by radioactive wastes. When radioactive matter decays, it gives off invisible energy that can destroy or damage people, animals, and plants.
Do not drill here. Do not dig here. Do not do anything that will change the rocks or water in the area.
Do not destroy this marker. This marking system has been designed to last 10 ka. If the marker is difficult to read, add new markers in longer-lasting materials in languages that you speak. For more information go to the building further inside. The site was known as the WIPP (Waste Isolation Pilot Plant) site when it was closed in …

2006-10-16: Well-researched Thorium piece, but Michael needs to become more concise: he repeats himself too much in this piece.

Sometime between 2020 and 2030, we will invent a practically unlimited energy source that will solve the global energy crisis. This unlimited source of energy will come from thorium. A summary of the benefits, from a recent announcement of the start of construction for a new prototype reactor:

  • There is no danger of a melt-down like the Chernobyl reactor.
  • It produces minimal radioactive waste.
  • It can burn plutonium waste from traditional nuclear reactors.
  • It is not suitable for the production of weapon grade materials.
  • Global thorium reserves could cover our energy needs for 1000s of years.

2007-10-01: Using beta decay for batteries. Now being rehashed as the new hotness.
2008-01-09: Micro Nuclear Reactor

The new reactor, which is only 7m x 2m, could change everything for a group of neighbors who are fed up with the power companies and want more control over their energy needs.

2008-05-22: Why bother with oil-based stuff when you can have distributed nuclear energy with Uranium hydride batteries?
2008-07-24: Uranium Deep Burn

It is projected that volumes of high-level waste could be reduced by a factor of 50, while extra electricity is generated.

2008-12-01: Thorium

Besides the low amount of waste and almost complete burning of all Uranium and Plutonium, another big advantage of liquid fluoride reactors is fast and safe shutoff and restart capability. This fast stop and restart allows for load following electricity generation. This means a different electric utility niche can be addressed other than just baseload power for nuclear power. Currently natural gas is the primary load following power source. Wind and solar are intermittent in that they generate power at unreliable times. LFTR would be reliable on demand power.

Fuck ethanol. Lets have some 21st century nuclear power

Thorium is one of the victims of the brainless scare campaign against nuclear that has infected most western nations over the last 30 years. Instead of doing silly stunts like the germans, whose “exit” from nuclear energy will mean more coal plants being built, an enlightened nation would chose thorium.

Instead, we are stuck with aging reactors (how does that make anyone safer?) and scientific illiteracy both in the general population and elected representatives.

I’m generally dismayed how little discussion about thorium there is in energy circles.

Kirk Sorensen provides an update on the current state of thorium power. The bad news is that it still remains mostly theoretical concept; no operational reactor has been deployed yet — even as a prototype. However, new thorium nuclear molten salt experiments were just started in Europe. We have good “line of sight” on the science to build one — so, at this point, the limiting factor is mostly funding. In a world of privately-funded space travel, such a gating obstacle shouldn’t remain for long. 4 specific difficulties have been mentioned:

  • Salts can be corrosive to materials.
  • Designing for high-temperature operation is more difficult
  • There has been little innovation in the field for several decades
  • The differences between LFTRs and the light water reactors in majority use today are vast; the former “is not yet fully understood by regulatory agencies and officials.”

Andrew Yang has proposed a nuclear subsidy—$50B over 5 years

2008-12-09: Steven Chu Energy Secretary

he is pro-nuclear and has a deep understanding of all the technical issues around energy. Real change from the Bush administration in selecting extreme competence. It is not in any way a guarantee of correct energy choices because there is still political reality.

2014-02-04: The Linear No-Threshold (LNT) Radiation Dose Hypothesis, which surreally influences every regulation and public fear about nuclear power, is based on no knowledge whatever.

At stake is the 100s of billions spent on meaningless levels of “safety” around nuclear power plants and waste storage, the projected costs of next-generation nuclear plant designs to reduce greenhouse gases worldwide, and the extremely harmful episodes of public panic that accompany rare radiation-release events like Fukushima and Chernobyl. (No birth defects whatever were caused by Chernobyl, but fear of them led to 100K panic abortions in the Soviet Union and Europe. What people remember about Fukushima is that nuclear opponents predicted that 100s or 1000s would die or become ill from the radiation. In fact nobody died, nobody became ill, and nobody is expected to.)
2014-02-14: You can power the world for 72 years with the nuclear waste that exists today, at a price cheaper than coal. Of course it will likely not happen due to collusion between the coal industry and the fear industrial complex.

2015-03-18: China nuclear

China approved 2 reactors this month as it vowed to cut coal use to meet terms of a CO2-emissions agreement reached in November between President Xi Jinping and US counterpart Barack Obama. About $370b will be spent on atomic power. Plans to 3x nuclear capacity by 2020 to as much as 58 gigawatts.

2015-06-15: Amazing energy densities

Assuming a 25% conversion efficiency, a Radioisotope Power Source (RPS) would have 400K MJ / kg (electric) compared to 0.72 MJ / kg for Li-ion batteries. The goal is make a 5 watt “D cell” but with nuclear power that lasts decades

2016-05-16: TerraPower

Bill Gates is funding Nathan Myhrvold’s Terrapower, a fast breeder reactor that burns a U238 duraflame log for 60 years, with 99% efficiency vs 1% for today’s U235 reactors. No fuel to reload or waste to ship around. Existing nuclear waste could be used as fuel.

2016-11-14: Molten Salt Fission

“It is the first time a comprehensive IAEA international meeting on molten salt reactors has ever taken place. Given the interest of Member States, the IAEA could provide a platform for international cooperation and information exchange on the development of these advanced nuclear systems.” Molten salt reactors operate at higher temperatures, making them more efficient in generating electricity. In addition, their low operating pressure can reduce the risk of coolant loss, which could otherwise result in an accident. Molten salt reactors can run on various types of nuclear fuel and use different fuel cycles. This conserves fuel resources and reduces the volume, radiotoxicity and lifetime of high-level radioactive waste.

2016-11-28: Making nuclear energy radically less expensive

“The big thing is that the government is making national lab resources available to private companies in a way that it wasn’t before. If you are a nuclear startup, you can only go so far before you need to do testing, and you are not going to build a nuclear test facility, because that is hard and expensive. But now you could partner with a national lab to use their experimental resources. I’ve been talking about how to set up a pathway from universities for this kind of research.”

2016-12-01: Coal to nuclear can rapidly address 30% of CO2

The high temperature reactors can replace the coal burners at 100s supercritical coal plants in China. The lead of the pebble bed project indicates that China plans to replace coal burners with high temperature nuclear pebble bed reactors.

2017-02-22: 1m tons of nuclear fuel

The amount of used nuclear fuel will continue to increase, reaching around 1M tons by 2050. The uranium and plutonium that could be extracted from that used fuel would be sufficient to provide fuel for at least 140 light water reactors of 1 GW capacity for 60 years. “It makes sense to consider how to turn today’s burden into a valuable resource.”

2017-08-16: How it is going with China nuclear

The overall cost of this first of a kind nuclear plant will be in the neighborhood of $5K/kw of capacity. That number is based on signed and mostly executed contracts, not early estimates. It is 2x the initially expected cost. 35% of the increased cost could be attributed to higher material and component costs that initially budgeted, 31% of the increase was due to increases in labor costs and the remainder due to the increased costs associated with the project delays.

Zhang Zuoyi described the techniques that will be applied to lower the costs; he expects them to soon approach the $2k / kw capacity range. If this can be achieved then the 210 MW reactor would be $525m. A 630 MW reactor would be $1.5b. It could be less if the 600 MW reactor only had to have the thermal unit and could use the turbine and other parts of an existing coal plant.

2018-11-09: Towards approval

Terrestrial Energy is leading the way to getting regulatory approvals for its molten salt
fission reactor design. Terrestrial Energy aims to build the first walkaway safe molten salt modular reactor design in the late 2020s. IMSR generates 190 MW electric energy with a thermal-spectrum, graphite-moderated, molten-fluoride-salt reactor system. It uses standard-assay low-enriched uranium (less than 5% 235U) fuel.

2019-06-24: Nuclear Waste Storage

Deep in the bedrock of Olkiluoto Island in southwest Finland a tomb is under construction. The tomb is intended to outlast not only the people who designed it, but also the species that designed it. It is intended to maintain its integrity without future maintenance for 100 ka, able to endure a future ice age. 100 ka ago 3 major river systems flowed across the Sahara. 100 ka ago anatomically modern humans were beginning their journey out of Africa. The oldest pyramid is around 4.6 ka old; the oldest surviving church building is fewer than 2 ka old.

This Finnish tomb has some of the most secure containment protocols ever devised: more secure than the crypts of the Pharaohs, more secure than any supermax prison. It is hoped that what is placed within this tomb will never leave it by means of any agency other than the geological.

The tomb is an experiment in post-human architecture, and its name is Onkalo, which in Finnish means “cave” or “hiding place.” What is to be hidden in Onkalo is high-level nuclear waste, perhaps the darkest matter humans have ever made.

2020-05-20: 3D-Printed Nuclear Reactor

The reams of data generated by 3D-printing parts can speed up the certification process and lower the cost of getting a nuclear reactor online.

2021-04-20: Nuclear power failed. We need to deeply understand these reasons, because there won’t be a energy transition without new nuclear.

To avoid global warming, the world needs to massively reduce CO2 emissions. But to end poverty, the world needs massive amounts of energy. In developing economies, every kWh of energy consumed is worth $5 of GDP.

How much energy do we need? Just to give everyone in the world the per-capita energy consumption of Europe (which is only half that of the US), we would need to more than triple world energy production, increasing our current 2.3 TW by over 5 additional TW:
If we account for population growth, and for the decarbonization of the entire economy (building heating, industrial processes, electric vehicles, synthetic fuels, etc.), we need more like 25 TW. The proximal cause of nuclear‘s flop is that it is expensive. In most places, it can’t compete with fossil fuels. Natural gas can provide electricity at 7–8 cents/kWh; coal at 5 c/kWh.Why is nuclear expensive? I’m a little fuzzy on the economic model, but the answer seems to be that it‘s in design and construction costs for the plants themselves. If you can build a nuclear plant for around $2.50/W, you can sell electricity cheaply, at 3.5–4 c/kWh. But costs in the US are around 2–3x that. (Or they were—costs are so high now that we don’t even build plants anymore.)

2022-09-14: Simple reactor designs that can be iterated quickly may be the future

Much of the future lies with KRUSTY-like kilowatt-scale systems. Nuclear has a power density problem that keeps it from powering our cars and planes. The shielding and heat engines are too heavy. The radiation and particles are harmful because they contain a lot of energy. The answer is to make solid-state technologies that convert heat and radiation into electricity. It is theoretically possible to turn gamma rays into electricity with something similar to a solar cell. Shielding gets lighter and generates electricity! It also brings new life to many isotopes that require too much shielding to be practical in radioisotope generators. In the meantime, kilowatt-scale systems can compete in smaller remote power applications and supplement solar microgrids. Further cost decreases could enable electricity customers to defect from the grid where solar is not feasible. Competing manufacturers promise a much more competitive industry than exists today, where incentives rarely encourage falling prices.

The endgame is a chunk of nuclear material that can regulate itself based on user demand, surrounded by energy-capturing devices that soak up every bit of emitted energy. Power density could exceed today’s liquid fuels and batteries while having extreme energy density. We’d finally get our flying cars! Reactors that look like KRUSTY are on the path to that endgame.

2023-03-25: Nuclear has some near-fatal problems that make it a non-starter on earth. Beyond the well-known overregulation, the biggest problem is that nuclear produces relatively low temperature heat that then has to be converted to electricity, which is very inefficient. A process would have to be found to turn radiation and heat directly into electricity, without the steam turbines.
2023-07-13: How we got the current regulatory regime

In a world where industry and activists fought to a standstill, Probabilistic Risk Assessment provided the only credible guiding light. Rasmussen and team first began to compile and model relevant data in the early 1970s. Over the decades the industry’s database grew, and the NRC developed an opinion on every valve, every pipe, the position of every flashing light in a plant. This angered the utilities, who could not move a button on a control panel without reams of test data and its associated paperwork. This angered activists when the refinement of models predicted safety margins could be relaxed.

But Probabilistic Risk Assessment has no emotions. Probabilistic Risk Assessment estimated, validated, learned. Probabilistic Risk Assessment would form the barrier protecting us from catastrophe.