The Brave New World of Human-carrying Drones will have the same dashboard as the old world

by philg

“Joby Picks Garmin G3000 For eVTOL” (Avweb) suggests that the exciting new world of drones, which I hope will have enough software intelligence to prevent flying into obstacles (see New York helicopter crash: why not robot intelligence? and Aviation weather reports at the time of Kobe Bryant crash), will have the same dashboard as today’s business jets: a Garmin G3000 (seemingly way more complex than it needs to be).

I’m wondering if this will extend the life of traditional flight schools using traditional trainer airplanes and helicopters. If a lot of our skills translate into the Super Drone world (I’m hopeful that “eVTOL” is not the final term for this category of aircraft), perhaps folks with standard pilot certificates will still have a role to play.

Here’s what the G3000 looks like inside a Cirrus Vision Jet (three touch screens on the bottom that control the two non-touch screens on top):

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Public health, American-style: Donuts at the vaccine clinic

by philg

Public Health 101: When confronted with a virus that attacks the obese and unfit, lock people next to their refrigerators for a year.

Public Health 102: When the local government runs a COVID vaccine clinic, make sure that it is amply supplied with donuts.

From a town-run COVID-19 vaccine clinic in the Boston suburbs:

Readers might reasonably ask how many of these health-enhancing items I consumed personally. Answer: zero. I was merely there as driver for a 92-year-old and therefore did not feel that I had earned one. Separately, what’s the process for becoming a volunteer driver in our all-white all-heterosexual town? Look for the rainbow flag and “Black History Month” stickers to find the “Council on Aging” door. Knock and receive a Criminal Offender Record Information (CORI) form to fill out and also a form in which one must supply one’s pronouns and gender ID.

The vaccination process itself was efficient. We arrived at 11:55 am for a noon appointment and were fully checked out by 12:25 pm. My old-but-fit neighbor noted that she hated wearing a mask, but otherwise was happy with her experience.

Readers: Who has vaccination stories to share?

Related:

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Modern poetry in our public schools

by philg

From a friend who snoops on high schoolers’ remote skool:

My daughter was assigned to study the seminal work “The Hill We Climb” by the titan of American poetry, Amanda Gorman.
Teacher: What does she mean by “a force that would shatter our nation”
Chorus of students: The Truuuuump preeeesideeeeeency…..
Teacher: Great!!! What do you think she means by “the new dawn blooms as we free it, for there is always light”?
Chorus of students: The Biiiiideeeen administraaaaaatiooooon…
Teacher: Oh my God, you guys, you are geniuses! You can all be poets because you mastered literary tools!!!

This focus on American 21st century poetry got me thinking about what would happen if our public schools introduced the works of the greatest living American poet, Kanye West. Suppose that “Gold Digger” were the subject of a class. What would happen when teachers and/or students then said “the n-word” or actually quoted the n-word while analyzing Kanye West’s popular opus? If it is a public school and subject to what’s left of the First Amendment, can teachers be fired and students expelled for their speech? In Western Frogland (Quebec), the answer is “yes”. Here’s a teacher who got axed in a similar situation: Quebec literary works (!) that used the n-word: “Montreal North teacher fired after using N-word repeatedly in class”.

Readers: What do you think? If we accept that rap songs are great poetry (which I do) and that they contain some words that some people don’t like, can they be studied in K-12 without the teachers being fired?

Lyrics from Google (uncensored for some reason, but I’ve bowdlerized them):

She take my money when I’m in need
Yeah, she’s a triflin’ friend indeed
Oh, she’s a gold digger
Way over town, that digs on me
Now, I ain’t sayin’ she a gold digger
(When I’m in need) But she ain’t messin’ with no broke n****
(She give me money) Now, I ain’t sayin’ she a gold digger
(When I’m in need) But she ain’t messin’ with no broke n****

….

Eighteen years, eighteen years
She got one of your kids, got you for eighteen years
I know somebody payin’ child support for one of his kids
His baby mama car and crib is bigger than his
You will see him on TV any given Sunday
Win the Super Bowl and drive off in a Hyundai
She was supposed to buy your shorty Tyco with your money
She went to the doctor, got lipo with your money
She walkin’ around lookin’ like Michael with your money
Shoulda got that insured, Geico for your money
If you ain’t no punk
Holla, “We want prenup! We want prenup!” (Yeah!)
It’s somethin’ that you need to have
‘Cause when she leave yo’ ass, she gon’ leave with half
Eighteen years, eighteen years
And on the 18th birthday he found out it wasn’t his?

Related:

  • “Kim Kardashian and Kris Humphries Divorce Timeline”: “Perhaps the most notable thing about their drawn-out divorce — which was settled Friday in Los Angeles Superior Court — was that it lasted seven times longer than their 72-day marriage.” (Kardashian sued third husband Kanye West just recently, using the same lawyer who represented her in the lawsuit against Kris Humphries.)
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Texas power outages demonstrate enduring human faith in hindsight?

by philg

Texans are suffering with cold weather, power failure, and water supply failure. (In other words, they’re learning what it is like to live in the Northeast; see, for example, the 2011 storm that took out power for 3.2 million people, many of whom went a week without power. In the Boston suburbs it is typical to lose power 4-6 times per year, e.g., due to a fallen tree or a storm, and for durations of up to 48 hours. Also 2013 and 1978 events, in the latter of which more than 100 people died.)

(That we’re calling this the “Texas power outage” might be an artifact of how our media presents things. “Widespread Power Outages Continue in Texas” is the caption the New York Times editors have placed over a map showing that the worst outages are in Louisiana and Mississippi:

)

The media can find an unlimited number of folks who describe this as a trivially foreseeable event, e.g., “Why Texas’ energy grid is unable to handle the winter storms” (NBC):

The crisis has made the state’s energy grid the focus of fresh scrutiny, primarily due to its independence from the rest of the U.S. Critics say that allowed its infrastructure to shirk federal regulations that require cold-weather capabilities.

Heroic regulators could have prevented this from happening? The governor agrees! “‘Massive failure’: Why are millions of people in Texas still without power?” (USA Today):

At the most basic level, the outages have been caused because demand amid the bitter cold has outpaced the supply of energy used to heat and power homes, said Daniel Cohan, an associate professor of civil and environmental engineering at Rice University.

Gov. Greg Abbott called the situation “unacceptable” and said he would add an emergency item to the state’s legislative session on reforming ERCOT. The nonprofit corporation is subject to oversight from the Public Utility Commission of Texas and the Legislature.

There were similar events in 1989 and 2011… “Five things to know about Texas’s strained electric grid” (The Hill):

The 1989 blackouts came amid a cold snap in December, while the 2011 blackouts took place during the first week of February when wind and unseasonably cold temperatures hit Texas and neighboring New Mexico.

In total, approximately 1.3 million electric customers were out of service at the peak of the 2011 event on Feb. 2, and a total of 4.4 million were affected from Feb. 2 to Feb. 4.

In a report following the 2011 blackouts, FERC and the North American Electric Reliability Corporation recommended steps including increasing winterization measures.

The report said electricity generating companies operating within the ERCOT system “failed to adequately prepare for winter,” citing inadequate insulation and a failure to train operators and maintenance personnel on winter preparations.

If this was easy to foresee (and maybe it should have been, given what happened in 1989 and 2011), why weren’t these newspapers and interview subjects out there at least since 2011 beating the drum for more power plants and more winterization of infrastructure?

Could there be a general principle in operation here? After a hurricane hits, it is obvious that we should have put vastly more resources into being prepared for the hurricane. After a bad respiratory virus pandemic, it is obvious that we should have put vastly more resources into stockpiling PPE and ventilators (see Paper titled “Stockpiling Ventilators for Influenza Pandemics” (2017)).

Here in the Northeast we know that we could eliminate nearly all of our outages via putting power lines underground, but nobody wants to pay for it. This utility explains:

The main reason why undergrounding hasn’t been fully adopted in the U.S. is the overwhelmingly high cost of installing underground power lines. Estimates place the cost of undergrounding power lines at roughly $750 per foot, compared with $70 per foot to install power lines the way we do today. At over ten times the cost, this would become expensive very quickly.

Take North Carolina, for example. In 2002, the state looked into undergrounding for their three major power companies after a particularly bad power outage that left 2 million people losing power. After it was priced out, North Carolina found that their project would cost $41 billion (six times the net value of those three companies’ distribution assets) and would require 25 years to complete!

People are regularly killed during power outages. Should we pay any price, bear any burden to save lives via underground power lines? Apparently not. (Even though $41 billion rounds to zero in coronanomics!)

Why can’t people see that (1) we don’t have infinite money and time and therefore can’t be prepared for everything bad that might happen, and (2) they’re using hindsight when they talk about how we should have put more resources into preparing against something bad that actually did happen?

As of yesterday, 4 percent of total customers (poweroutage.us), but I am pretty sure that this figure will never appear in a headline (since Texas has such a huge population the outage will appear as the total number of customers who are out).

I asked a California Democrat (and tenured physics professor), who was expressing outrage that the Texas grid wasn’t subject to federal regulation, what he thought the number would be, if not 4 percent, if Texas had been federally regulated. He answered “0 percent”. Let’s have a look at Mississippi, which has federal regulation and has suffered from a similar cold snap. 13.5 percent of customers in MS are out as of the same time as the above map:

How about Louisiana?

Across the three states, it looks as though the outages line up with the USDA Zone 8b (Austin, Texas being included in this zone).

In other words, a cold snap in Zone 8b results in power failures whether the grid is regulated by the feds or the state. (The failures were slightly different in character, with Texas knocked out by high demand while MS and LA suffered from both excess demand and power lines downed by the ice and snow. Both could have been avoided, however, with additional $$ invested in preparation.)

Update, Feb 20, 11:00 am: 6 percent of folks in Mississippi are still without power, mostly in Zone 8b and some in Zone 8a.

(Texas, where the outages started earlier, is 99.4% powered (0.6% without power).)

Related:

  • Austin and Lockhart, Texas: 10 barbecue restaurants in 72 hours (fortunately, the smokers will continue to operate without power)
  • “The Texas Freeze: Why the Power Grid Failed” (WSJ) sounds like a great analysis. Companies that generate power aren’t paid to sit on standby, so there is an undersupply of standby power, especially during cold snaps when it would be expensive to prep a plant to keep operating. A big nuclear plant tripped off due to a water supply freeze. The authors attribute the problems to the way Texas set up its market for electric power, e.g., paying only for power delivered and not for being ready. But they never look at why the grid failures were nearly as bad in Louisiana and Mississippi. Maybe this is like coronascience and it is only necessary to tell a good story after data are received?
  • February 2013 North American blizzard (Wikipedia), in which 18 people died, the power failed, and it was both illegal and impractical to travel by road here in Maskachusetts.
  • Northeastern United States blizzard of 1978 (Wikipedia) in which 100 people died.

Very loosely related…

From a 2018 business trip to Dallas, extended due to 50-knot winds in the Northeast and the cancellation of airline flights back home, the George W. Bush Presidential Library (closed for a year now due to coronapanic):

And from the art museum, an unfortunately timely painting, Frederic Edwin Church’s The Icebergs:

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Life in the suburbs of Austin, Texas right now

by philg

I caught up with a friend in the hills just west of Austin, Texas today. He was spared from the power failures that have made the news, but life at 0 degrees F was not comfortable. “Even with the heat pumps going full blast and the extra resistive heater that is supposed to be used only occasionally, the temperature inside the house still fell to 55 degrees.” Better now that it has warmed up a bit? “The house has come up to 66, but the water system has been shut down. The treatment plants are back online, but there is simply no water in the reservoirs for pressure. It all leaked out when pipes burst.” If the power hadn’t failed, would these pipes still have burst? “I think so. Our neighborhood did not lose power, but neighbors have still reported on the mailing list that they had pipes burst.”

Earliest this week, I suggested the following to a friend who lives in Austin:

Wouldn’t the best stunt be “drive to Monterrey”? 67F and sunny tomorrow there.

I offered this same suggestion to my friend on the phone. It is only a 6-hour drive. Why not follow his senator and go to Mexico? “I can’t leave my neighborhood,” he replied. “Remember that you come up a hill to get to this house and it is still a sheet of ice. They might have one or two salt trucks for the entire city. I said that I would never need AWD now that I’d moved down here.”

T-shirt weather in Austin almost exactly two years ago, February 20, 2019:

(instead of running, I was doing research for Austin and Lockhart, Texas: 10 barbecue restaurants in 72 hours)

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Did 10 percent inflation happen during 2020 without us noticing?

by philg

One of the miracles of 2020 was that the U.S. government could borrow/print money like crazy in response to coronapanic and yet inflation, as calculated by the U.S. government, did not go up.

But what if inflation did happen and we just didn’t notice because we were locked down and prevented from leaving the U.S.?

Here’s the USD versus the Euro:

A dollar was worth 0.92 euro a year ago. As of February 15, 2021 it is worth 11 percent less, 0.82 euro.

How about versus the yen?

The USD is down from 110 to 105 in yen.

The USD is down against gold and silver. On February 15, 2020 they cost $1583 and $18. On February 15, 2021 it took $1819 to buy the same ounce of gold and $28 to buy the same ounce of silver.

Is it fair to say that we’ve had 10 percent inflation over the last 12 months?

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Flush toilets in New York City for $60 per hour

by philg

Our mole inside the New York real estate industry told us about a newly available career path: toilet flusher. “The office towers are empty and if you don’t have someone go in and flush toilets and run sinks, you’ll get Legionnaires’ disease. Even when the sinks and toilets are electronically controlled, nobody ever envisioned a time when buildings would be vacant for months or years. So there is no way to program them to run themselves automatically every few days. We’re paying people $60 per hour to go in and flush toilets.”

Why isn’t it $20 per hour? “There’s government funding for this so it has to be prevailing wage,” he replied. “Union wages start at $60 per hour.”

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Life expectancy scientists never expected a pandemic

by philg

“A Grim Measure of Covid’s Toll: Life Expectancy Drops Sharply in U.S.” (NYT):

American life expectancy fell by one year, to 77.8 years, in the first half of 2020.

Thursday’s data gives the first full picture of the pandemic’s effect on American expected life spans, which dropped to 77.8 years from 78.8 years in 2019. It also showed a deepening of racial and ethnic disparities: Life expectancy of the Black population declined by 2.7 years in the first half of 2020, slicing away 20 years of gains. The life expectancy gap between Black and white Americans, which had been narrowing, is now at six years, the widest it has been since 1998.

“I knew it was going to be large but when I saw those numbers, I was like, ‘Oh my God,’” Elizabeth Arias, the federal researcher who produced the report, said of the racial disparity. Of the drop for the full population, she said, “We haven’t seen a decline of that magnitude in decades.”

The last time a pandemic caused a major decline in life expectancy was 1918, when hundreds of thousands of Americans died from the flu pandemic. Life expectancy declined by a whopping 11.8 years from 1917 to 1918, Dr. Arias said, bringing average life spans down to 39 years.

So… coronavirus was nowhere near as deadly as the last truly bad flu, yet the “scientists” in charge of life expectancy calculations apparently did not budget for even a moderately bad flu pandemic, such as 1957. They assumed that human population could be expanded from 2 billion (1920) to 8 billion (2020) without any virus evolving to take advantage of this expansion in hosts (and the hosts clustering themselves together in cities). They assumed this against a continuous stream of publications from the WHO and others that a pandemic was likely. (See Paper titled “Stockpiling Ventilators for Influenza Pandemics” for example; also Pandemic Influenza Preparedness And Response (WHO, 2009, which incidentally tells governments to do the opposite of what governments have done in response to COVID-19: don’t close borders unless you’re an island and don’t tell the general public to wear masks))

Is it possible to make these scientific conclusions, one about life expectancy and one about the likelihood of future respiratory virus pandemics, consistent somehow?

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Medical School 2020, Year 3, Week 8 (Pediatrics)

by philg

Second week of outpatient pediatrics. My job for 80 percent of the visits is to differentiate between viral and bacterial upper respiratory infections (“URIs”). I take the history and physical for each cold and respond to questions about medication dosing. Then it is time to present the patient for two minutes while the attending fills out a SmartText in the clinic’s Epic system. Mother Mabel: “Once we realize you know how to conduct a basic exam, we want to see if you can parse the relevant findings from the ordinary.”

We see an 5-year-old who has red macules and patches all over her body. She’s not scratching and doesn’t even notice them. The rash started on her leg, and spread over her entire body. I have no idea what the rash is because it does not fit the standard viral exanthems (rashes) of childhood that we learned in medical school. As I am describing the case to Mother Mabel, she starts smiling. “I know exactly what this is.” Pityriasis Rosea. We tell the patient there is nothing to do but wait. “We believe it is caused by the immune system’s reaction to various viruses.”

We see a 13-year-old patient with Addison’s disease for a URI and dizziness. She and her mother knew a huge amount about managing her disease, including about the need to take extra stress dosing. Addison’s disease is an autoimmune attack destroying the adrenal glands. Without any cortisol, the body can become hypoglycemic in times of stress. During an infection, the patient is instructed to take an additional “stress” dose over her daily hydrocortisone level.

Mabel also gets excited by this one. We check her blood glucose to rule out hypoglycemia and prescribe antibiotics for a sinus infection: high dose amoxicillin. I talk to Busy Belle, the patient’s regular pediatrician, about management of Addison’s disease such as stress dosing and risk of other endocrine gland destruction. “I’m not sure, my N is 1.” Last year, Busy Belle saw the patient at the office in hypoglycemic shock. Her blood sugar was in the 30s, blood pressure was 80/35. She gave her some pedialyte solution and sent her to the hospital in an ambulance where she was diagnosed with Addison’s disease. Her most recent labs in the chart show a slightly elevated TSH (thyroid stimulating hormone) at her last visit with the pediatric endocrinologist, with whom she has an appointment next week. It seems that all the exciting management is done by the specialist.

A similar experience occurred on Wednesday with Mercedes Mike. He has accumulated several patients with congenital heart defects. I see an adorable 4-year-old with hypoplastic left heart syndrome who came down with the sniffles. The mother brought her in to ensure she didn’t need immediate intervention. Her oxygen saturations were fine, so we sent her home until her F/U (“follow up”) with the cardiologist in a week. We talked afterwards about the various surgical management of hypoplastic left heart syndrome. Once again, all the interesting management, e.g., echocardiograms, CT surgery referrals, EKG evaluation, etc., is performed by the specialist.

Patterns emerge around risk factors by age group. Every girl with a chief complaint of back pain is going to be either a dancer or cheerleader. An 8-year-old who presented for a typical URI tells us that she dances competitively five days a week. I asked if she has back pain. The mother lights up: “Oh yes, tell him honey.” The expected five minute visit, turns into a complicated 20 minute neurological exam. Afterwards, Mercedes Mike asks: “What’s the elephant in the room you have to rule out in these patients?” I don’t know. I look it up and get back to him. Spondylolisthesis, where one vertebra slips forward from the one below. This can cause serious spinal cord injury if not treated.

My next patient stumbled and hit her head on the gym floor during cheer practice. My presentation: “A CT is not indicated. She has a benign neurological exam, no LOC [loss of consciousness], and only mild headaches. My assessment is she has a mild concussion from the fall and should return to practice only after she feels comfortable at school for a few days.” He responds: “I agree with you, but it’s better to not use your gut when there are evidence-based protocols. Look up the indications for a CT scan.” After 10 minutes of googling I find the PECARN (Pediatric Head/Injuries Trauma Algorithm) guidelines and summarize: “As long as there is not prolonged LOC, signs of basilar skull fracture and no altered mental status, it is unlikely to have a significant TBI requiring further intervention.” Mike responds, “Yep, look above your screen.” Taped to the wall above the nurse’s station is the algorithm figure from the original PECARN paper. According to the these guidelines, there is less than a one percent chance of a clinically-important TBI as long as there are no signs of LOC > 5s, Glascow Coma Score < 14 (GCS, standard metric to assess neurological status) or palpable non-frontal skull fracture. Mercedes Mike: “I’m a new attending, so if I were talking with a more experienced doctor about a patient with suspected TBI, I would definitely mention PECARN just so they know that I am familiar with the guidelines. As a new attending, you need to build trust with other doctors.”

[Later, to Jane: “If we ever have kids, they are not doing dance or cheer.”]

A middle-class white 16-year-old girl is next. Mom wants to increase her ADHD medication dose because of bad behavior at home. Instead of acquiescing, Mercedes Mike asked, “Why are you poorly behaved at home?” Teenager mumbles: “I just get mad when my mom and sister ask me to repeat myself.” Mike: “Well neither of you are perfect, but she’s in charge right now until you pay the bills. So try not to mumble” Teen: “I’m going to be working at Taco Bell soon.” Mike: “You’re not paying the bills yet.” Decision: no change in meds.

[Busy Belle suggests skepticism regarding schools’ recommendations for ADHD evaluation. “We always get teacher and coach evaluations as well as a parent evaluation of each kid. The symptoms need to be occurring in at least two different environments. I started to notice a lot of kids at one school were being recommended for ADHD medication. It turned out that the evaluations were the exact same letter with the names substituted. Boy, did they regret that. I contacted the county superintendent and the principal’s secretary was fired with a stern warning to the principal.” (Editor: the stern warning to the bureaucrat was softened only by a monthly paycheck, lifetime health insurance, and lifetime pension.)]

Outpatient pediatrics is helpful for understanding why diagnoses take a long time. A common reason for patients to come in is non-specific abdominal pain without any diarrhea, constipation, or vomiting. It’s not reasonable to get a full work up (CT, CBC, CMP, inflammatory markers) for a one-week history of GI pain. Patients arrive with only a vague story of off-and-on symptoms rather than a precise timeline. One of our common responses is handing out a symptom diary. Mother Mabel: “As a new attending I keep a slightly closer eye on my patients. Instead of telling them to come back in a month with a symptom diary, I’ll have them come back in two weeks for a follow up visit.”

The best part so far is playing with the adorable 4-8 month olds. However, most of what a pediatrician does is educate parents or tell students to get their act together and listen to mom (our typical patient lives primarily with a “single mom” and is well-behaved every other weekend with dad, but out of control in the mom’s house). Should seven years of training be required for this? A successful parent of four could do most of this job. A pediatrician is involved in the “interesting” kids only to manage common illnesses that pop up in between their visits to specialists.

Mike delivers a mid-clinic eval. “You’re doing fine. Use a template when you interview patients to not forget anything, but overall good job.”

Jane on pediatric hematology/oncology, an elective rotation, and has been bored because one of the hematologists is on vacation. Jane’s typical day: arrives at 8:30 am, her first two patients are (Medicaid) no-shows so her attending fills out paperwork in the office. She sits around waiting until her lecture at 12:30 for a journal club on the use of antibiotics and reflux medications in childhood leading to allergies. She waits all day to see two patients at 3 and 4:30 pm. She returns home: “I wanted to strangle a 7 year old today.” Strangle a kid with cancer? “He wouldn’t shut up, and he was in remission.” 

Statistics for the week… Study: 8 hours. Sleep: 8 hours/night; Fun: 1 night. Meet classmates downtown for happy hour margaritas. Pinterest Penelope, also in pediatrics but in a different clinic: :”What I hate about third year so far is that you cannot plan anything. I rescheduled my own doctor’s appointment today so that I could be there for all the patients. The last two were no-shows. It’s just so much waiting, yet no free time.” (Penelope’s clinic serves an all-Medicaid population and there are no charges for failing to show up.)

The rest of the book: http://fifthchance.com/MedicalSchool2020

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Wealth migration from New York measured by K-1s

by philg

A friend of a friend runs a real estate business in Manhattan: “We have 18 limited partners,” he said. “Ten years ago, we mailed 18 K-1s to New York addresses. This year it was 0.” Where did the rich limiteds migrate to? “Two went overseas, one to Switzerland. Most of the rest went to states with no income tax. Florida, South Dakota.”

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