A relaxing lunch with an emergency physician

I had lunch today with a friend who is an emergency physician. She congratulated me on the recent arrival of our son and said “Oh, don’t let anyone touch him for the first couple of months.”

Why not?

“If he gets a fever he needs to go to the ED and will get

  • stuck with a needle for blood and blood cultures
  • catheter urine specimen or needle into bladder (via suprapubic route)
  • lumbar puncture (what the lay public thinks of as a spinal tap) to rule out meningitis (newborns don’t have a well-developed blood-brain barrier yet)
  • IV antibiotics
  • +/- chest xray
  • hospitalization until results back (culture results take a couple days or so)”

Armed with a little knowledge, I feel much more relaxed now…

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Christmas Gift Ideas for Photographers

If you’re shopping for a photographer this Christmas, here are my best gift ideas (sorted in order of increasing price):

Michael Freeman’s Photo School Fundamentals: Exposure, Light & Lighting, Composition. Michael Freeman has been writing my favorite photo tutorial books for decades. Even experts will find some inspiration here and the book is also good for experts because experts are often called upon to teach beginners.

CowboyStudio light tent. Camera phones have pretty reasonable macro capabilities. If placed outdoors on a sunny day, this will enable some interesting photos of smaller items. Usually it is better to improve the lighting and background than to get a fancier camera.

Westcott folding reflector is a great way to work with natural light but remove shadows from eye sockets and/or add some warmth to the image.

tripod plates and/or ballheads for existing cameras from Really Right Stuff

Genesis by Sebastiao Salgado, arguably the photo book of the year.

On This Earth, A Shadow Falls or Across the Ravaged Land by Nick Brandt. Amazing books because he used film(!) and short lenses to photograph elephants. It is a totally different perspective than the usual long-lens wildlife photo.

a softbox lighting kit is the foundation of most portrait studios

gift certificate for aerial photography at your local flight school (helicopters are ideal)

A Sony NEX camera is perfect for parents because nearly all of the models have rear LCDs that flip up, enabling eye-level photographs of younger children without the grown-up having to bend down. The kit 16-50mm lens is remarkably compact (it retracts when you shut the camera off) and high quality considering the price. The NEX-6 has an eye-level viewfinder that is useful in very bright conditions. The NEX-3 and NEX-5 offer excellent image quality and are as cheap as $370 including lens. Add a Think Tank Mirrorless Mover camera bag if you’re planning to get additional lenses.

Apple iPhone 5s. The practical capability of the iPhone camera is vastly better than similarly spec’d Android devices. The 5s in particular has some interesting innovations that improve image quality.

Carl Zeiss Optical 8×42 Victory HT Binocular. Photographers love good optics. If your loved one does not have binoculars, these are at the top of almost every comparative review.

Sony a7R (check this review on The Verge). This camera has the image quality of the Nikon D800E, the world’s highest quality conventional camera, but in a point-and-shoot-style “mirrorless” format. The body doesn’t do anything without a lens, so add the Sony/Zeiss 35/2.8 lens. Don’t get this camera if the recipient’s main interests are photographing sports, wildlife, or portraits. For those, he or she will still need a traditional Nikon, Canon, or similar SLR system.

Zeiss Otus 55/1.4 lens for Nikon (also available for Canon). Check the DxoMark review. This may be the best consumer lens ever made and is perhaps the only lens that can bring out the full potential of the Nikon D800/D800E.

Canon 200-400/4L 1.4x soccer mom lens. This is a revolutionary zoom lens for Canon EOS system users. Good for sports and wildlife. Don’t forget the Lowepro Lens Trekker 600 AW II Backpack for when the recipient needs to walk more than 10 feet from the car.

Hasselblad H5D-60 medium format digital camera. Good for studio photography of people and clothing. Budget another $20,000 for a few lenses…

[Comments from readers with better gift ideas would be welcome. Also I wish someone who uses a medium format system would tell me why it is better than a D800!]

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End of year charity idea: Kids on Computers

If you’re doing end-of-year accounting and tax planning and trying to find a way around the new Obamacare taxes, perhaps a charitable donation is in order (though when you add the Obamacare taxes to the Alternative Minimum Tax, it is probably unclear to anyone other than KPMG partners what the actual savings from charitable donations might be). One of my personal rules about charity is that I avoid donating to organizations whose employees earn more than I do. I check the Form 990 using Guidestar.org to learn about the compensation of the best paid employees. (Side note: I designed the Oracle data model for an early version of the site and then loaded a huge data set from the IRS into Oracle. To see whether hundreds of thousands of organizations had loaded properly I did a few queries. Harvard quickly popped out as the richest non-profit organization in the U.S.! Side note 2: This doesn’t mean that I think the work of a non-profit where the CEO earns $1 million is unworthy, only that I think the donations for that non-profit would more logically come from hedge fund managers, investment bankers, et al.)

One 501c3 group that readily meets the above standard is Kids on Computers. It is an all-volunteer organization currently led by Avni Khatri (avni@kidsoncomputers.org). Because nobody draws a salary, 100 percent of donations go to fund operations. (I wrote about them back in July 2013 seeking laptops.) What kind of folks in this day and age actually need any introduction to the digital world? Avni just came back from setting up a lab in India and the school was a two-hour drive from the nearest hotel with flush toilets.

Here are the bragging rights possible:

  • $25,000 will fund a local employee to work for three years on a part-time basis visiting and maintaining labs in one of the countries served (Mexico, Nepal, Argentina, India; your choice). You’ll get credit with a blog posting.
  • $10,000 will fund a new computer lab, to be named after the person of your choice. You’ll get credit with a blog posting and permanent credit on http://www.kidsoncomputers.org/labs
  • $1,500 will fund a volunteer’s travel expenses to go to Mexico for two weeks to maintain the computers in up to eight labs and provide continuing education for the teachers and the students associated with those labs. You’ll get credit with a blog posting.
  • $250 will buy one computer (you get a photo emailed to you of a student using your computer; label attached to computer with “Donated by YOUR NAME” or “Donated in honor of YOUR CHOICE”)
  • $120 will buy shipping for four laptops to an international location. Laptops are shipped in USPS Medium Flat Rate boxes, each of which holds two laptops.
  • $35 provides one child access to a computer, educational software, and internet (where accessible).

[For the last two, add your own bragging rights by commenting on this posting saying why you wanted to help these kids.]

You can donate via PayPal (link). Please contact donations@kidsoncomputers.org if you’d like to mail a check.

You can skip out on Obama’s new tax on capital gains by giving appreciated stock or mutual fund shares directly to the 501c3. The Vanguard form is a good example of how to do it.

Avni is also looking for computer-skilled volunteers who speak Spanish fluently to travel to Mexico for a two-week period and help with the labs. Mostly the kids are learning the basics of using a file system, editing and saving documents using Open Office, watching Khan Academy videos and using offline Wikipedia. So you don’t have to be a wizard programmer to contribute.

If you’re interested in volunteering for the Mexico trip, please send me an email with your qualifications. I will pony up the $1500 to send you to Mexico if you will agree to write a guest entry on my Weblog, complete with photos and a video (to be edited and uploaded by you to Youtube!).

Related: the infamous water buffalo donation of 2006

 

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An insured day in the American health care system

Being the parent of a newborn means never straying too far from the medical system. Today was our son’s first pediatric appointment outside the hospital. Alexander Daniel is on a gold-plated Blue Cross policy so cost is not a concern and we have our choice of physicians to see.

After a short wait and some paperwork, we bounce between the doctor’s office for discussion and an adjacent exam room. Every time we go back and forth or need to adjust an item of the baby’s clothing, the doctor runs out to see a patient whose visit is running in parallel. I’m not sure if this is standard procedure, but given the paltry amounts that insurers pay for office visits (see this 2010 posting about my doctor billing $510 and collecting $83), I can’t think of any alternative for the doctor.

The pedi does apologize that things are a little slow/chaotic on this particular today. How come? “We’re just installing a new electronic medical record system. And to make it work we had to get new computers because the system didn’t support Windows XP.” Was he going to run Practice Fusion, the free Web-based system? “No. We have to run eClinicalWorks. It is required by Mt. Auburn Hospital, with which we are affiliated.” Was he then upgrading to Windows 8? I could see how that would throw the office into disarray for a few months (or years). “No. eClinicalWorks doesn’t support Windows 8 so we installed Windows 7. But on the other hand they are talking about switching everyone over to Epic so we might start over in a year.”

The doctor suggested that we get flu and Tdap vaccines, but since we are not technically his patients he cannot give it to us. So we’ll need another encounter with the health care system to get these.

Then I went to the neighborhood (old-school family-run) pharmacy to get a prescription filled. They had to do some compounding. “We can’t bill your insurance company,” the pharmacist noted, “because even though we start with an FDA-approved drug, if we’ve compounded it then it is no longer FDA-approved. You can submit the receipt to them and try to get them to pay it. Usually the deductible is so high that it isn’t worth it.” I handed over $45 and didn’t ask for a receipt.

I’m wondering why Americans are so confident that they need health insurance and that, indeed, health insurance is such a good idea that people who don’t want it should be forced to buy it. Food is more important than medical care since without food a person will surely die. Yet we don’t force people to carry “food insurance” and then have the food insurance company authorize particular food providers to serve meals at times and places of the provider’s choice. If people are poor we give them a debit card (SNAP or “food stamps”) that they can use at the supermarket of their choice, with roughly the same shopping experience as a customer using cash. Poor people are lifted up to enjoy a middle-class shopping experience. In health care, it is the opposite. Middle class people are dragged down to endure the same customer service experience as a poor person dependent on Medicaid. If we hadn’t been forced by convention and now law to hand over $20,000 per year to insurers for our family’s medical care we would have been delighted to pay $160 for an appointment with a doctor who could spend a calm 30 minutes with us, rather than $83 for a rushed 15-minute appointment. And the $45 bill for the prescription wouldn’t have bothered me at all if I hadn’t already paid for prescription drug insurance that, I thought, paid for prescriptions.

The pharmacist put it in terms of dollars and cents: “People think that they can save money by buying insurance. They never wonder how it is that all of the people who own insurance companies got to be billionaires.”

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Why do people who chose not to study science and math opine on the virtues of studying science and math?

The New York Times editorial board contains people who studied history, economics, law, history (again), journalism, journalism (again), history (again, this time for the “science” expert), journalism, English literature, French literature, English literature (again), comparative literature, law, psychology, international relations, German, modern history, and law. Yesterday, the group signed an editorial entitled “Missing from Science Class; Too Few Girls and Minorities Study Tech Subjects.” The group of history and literature majors confidently wrote about the benefits of a tech education, how to motivate women and people with particular skin colors, and the sagacity of President Obama’s proposal on preschools (my previous post on the subject; note that Obama has previously extolled the virtues of STEM education for people other than himself (example)).

Why would folks who apparently preferred other subjects suggest that women and particular minority groups be encouraged to study tech subjects that they themselves did not like and ended up not needing?

Separately, here is a much more substantive approach to the challenge of getting more women interested in computer science: “Feminism and Programming Languages” by Arielle Schlesinger. Excerpts:

  • “In the scope of my research, a feminist programming language is to be built around a non-normative paradigm that represents alternative ways of abstracting. The intent is to encourage and allow new ways of thinking about problems such that we can code using a feminist ideology.”
  • “The idea came about while discussing normative and feminist subject object theory. I realized that object oriented programmed reifies normative subject object theory. This led me to wonder what a feminist programming language would look like, one that might allow you to create entanglements (Karen Barad Posthumanist Performativity).”
  • “I realized that to program in a feminist way, one would ideally want to use a feminist programming language.”

[Among existing technologies, my personal choice for a feminist programming language would be SQL. The woman expresses her demands for data with five lines of code; a team of 100 men writes 2 million lines of C that must consider all possible ways of satisfying the the query and ultimately supply the answer.]

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Thoughts on observing a birth

My son, Alexander Daniel, was born this morning at 6 am. I attended the birth of my 4-year-old, Greta, but it was a C-section and over before there was any time to think. Also, the docs and nurses strategically place a big white sheet to screen their activities from laypeople.

It was a fairly conventional birth by American standards, with three medical interventions: antibiotics to prevent infection, pitocin to hurry the baby out because the water broke before labor started, and then an epidural to ameliorate the intense pain caused by the pitocin. A midwife presided over an all-female team at Mt. Auburn Hospital in Cambridge, Massachusetts. The actual pushing lasted about 30 minutes during which time the room was active with five or six women monitoring for the mother’s blood loss and blood pressure, the baby’s health and position, the baby’s health once out in the world, etc.

I’ve become moderately accustomed to life-or-death situations, but those that arise during helicopter instruction last for just a few seconds, not for 30 minutes. Sitting next to someone whom you love and who is putting herself at this much risk for the benefit of someone whom you’re going to love deepened my feelings in ways that I wouldn’t have expected. Even from a position up by the mom’s head, it is impossible not to notice the flood of blood and tissue that come out with/after the baby and wonder “How can a person survive that kind of loss?”

Generally I’m not a medical worrier. If I have a pain in my side I think it must be from playing LEGO with Greta, not rib cancer. And throughout the pregnancy I hardly gave a thought to the possibility of a baby or mother with problems. But in the last hour or so I was plagued with worries about something going wrong or something being wrong. The sometimes-worried looks on the faces of the professionals didn’t help. Nor did it help when a nurse said “I don’t like the way he’s breathing.” Soon enough, however, the new baby was nursing apparently happily.

In http://philip.greenspun.com/politics/health-care-reform I argue against the idea of spending 18 percent of our GDP on health care. And the idea that the typical American hospital charges more to handle a delivery than does the most deluxe private hospital in England where the royal baby was born (story) is kind of ridiculous. But the staff at Mt. Auburn made me a believer for about an hour. I’m grateful to them.

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New software for my Samsung Note 3; user interface still painful

Having switched from an iPhone 4S to a Samsung Note 3, I am amazed almost every day at some of the user interface decisions made by Samsung. (Apple fans: please don’t post comments about how it wasn’t smart to switch; I needed the Note for a work project.) Today I installed an operating system upgrade and was hopeful that some of the most glaring problems had been fixed. Sadly, they hadn’t…

One of the most heavily used parts of the phone is the “Phone” app. This has a “Contacts” tab. If I search for a friend whose last name is “Bailey” I would think that the first result would be the single contact in the phone that has a phone number attached to a person with a last name of “Bailey”. Yet astonishingly the contact with the phone number is not even on the first page. The app, which the owner entered by touching the “Phone” icon (presumably indicating an intent to make a call) shows first three random people that I don’t know at all but perhaps at one time might have replied to an email from them from my Gmail account using a browser. Then I get eight email-only contacts that have the same first and last name as the contact with the phone number. Mr. Bailey is an entrepreneur who wears a hat at a lot of distinct small enterprises and consequently has many distinct email addresses. Google Contacts wasn’t smart enough to merge these when I instructed it to merge whatever it could. But why isn’t the phone smart enough, given a list of contacts with the same name, to show the one with the phone number first?

Another crazy bad interface is from the “Messages” app. It will show a notification of a new text message in red. If I touch the icon, though, it takes me to an unrelated text message conversation with someone who might not have sent me anything for several days, i.e., whatever the last conversation I was in.

The camera is simply unusable if the subjects are humans and moving. It seems that most of the sites that test mobile phone cameras do it with studio scenes. That capability has nothing to do with a mobile phone camera being a practical photographic tool. This seems like something that Google should take over as part of the core Android software. It is too important to leave to the handset manufacturers, particularly if the goal is competing with Apple, whose camera software seems to be the world’s best (Canon, Nikon, and Sony obviously make better cameras, but because they use huge sensors and heavy traditional optics).

I’m thinking the Samsung software for the Note 3 was developed by someone who did not use Google Contacts, did not have many friends, and never used text messaging…

[Separately the phone/contact software freezes frequently, e.g., after one has unsuccessfully tried to make a call to a person’s office phone and then wants to navigate back to the contact and try a mobile number.]

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Obamacare befuddles even our top lawyers

A friend of mine works in a big law firm where attorneys commonly charge $1000 per hour. These are among the best legal minds in the country, but Obamacare has at least some of them stumped. Here’s an email that went out on a firm mailing list….

Client has employed his housekeeper and paid her through payroll over the last few years. Her insurance was cancelled because of Obamacare, and she was told that her employer (our client) has to provide her with insurance. Is there someone who is our Obamacare expert who can tell me why that is false? (Less than 50 employees? She doesn’t work 40 hours? I read the papers but that doesn’t mean I know the law!!)

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How much do teenagers love the iPhone?

Here’s a conversation that I had over Thanksgiving:

  • My 16-year-old cousin: I broke my phone.
  • Me: I will give you an iPhone 5s if you agree to one condition.
  • Young cousin: Deal.
  • Me: I’m also going to send you a three-pound bronze plaque that says “Donated by the world’s best uncle/cousin” and you need to superglue the phone to the plaque and carry both with you at all times.
  • Young cousin: That’s fine.

And then I had to send my old iPhone 4S to her little sister… So now I am firmly committed to the Samsung Note 3 and Galaxy Gear geek watch. The Note 3 is good for reading Amazon Kindle books but it is painful to use as a camera or phone and there are a lot of software freezes.

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