Later On

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Archive for December 2019

How the Egg Industry Tried to Bury the TMAO Risk

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Dr. Michael Greger blogs:

“Metabolomics is a term used to describe the measurement of multiple small-molecule metabolites in biological specimens, including bodily fluids,” with the goal of “[i]dentifying the molecular signatures.” For example, if we compared the metabolic profile of those with severe heart disease to those with clean arteries, we might be able to come up with a cheap, simple, and noninvasive way to screen people. If heart patients happened to have something in their blood that healthy people didn’t, we could test for that. What’s more, perhaps it would even help us understand the mechanisms of disease. “To refer to metabolomics as a new field is injustice to ancient doctors who used ants to diagnose the patients of diabetes” (because the ants could detect the sugar in the diabetics’ urine).

The first modern foray discovered hundreds of substances in a single breath, thanks to the development of computer technology that made it possible to handle large amounts of information—and that was in 1971, when a computer took up nearly an entire room. “[N]ew metabolomics technologies [have] allowed researchers to measure hundreds or even thousands of metabolites at a time,” which is good since more than 25,000 compounds may be entering our body through our diet alone.

Researchers can use computers to turn metabolic data into maps that allow them to try to piece together connections. You can see sample data and a map at 1:28 in my video Egg Industry Response to Choline and TMAO. Metabolomics is where the story of TMAO started. “Everyone knows that a ‘bad diet’ can lead to heart disease. But which dietary components are the most harmful?” Researchers at the Cleveland Clinic “screened blood from patients who had experienced a heart attack or stroke and compared the results with those from blood of people who had not.”

Using an array of different technology, the researchers identified a compound called TMAO, which stands for trimethylamine N-oxide. The more TMAO people had in their blood, the greater the odds they had heart disease and the worse their heart disease was.

Where does TMAO come from? At 2:19 in my video, you can see a graphic showing that our liver turns TMA into TMAO—but where does TMA come from? Certain bacteria in our gut turn the choline in our diet into TMA. Where is the highest concentration of choline found? Eggs, milk, and meats, including poultry and fish. So, when we eat these foods, our gut bacteria may make TMA, which is absorbed into our system and oxidized by our liver into TMAO, which may then increase our risk of heart attack, stroke, and death.

However, simply because people with heart disease tend to have higher TMAO levels at a snapshot in time doesn’t mean having high TMAO levels necessarily leads to bad outcomes. We’d really want to follow people over time, which is what researchers did next. Four thousand people were followed for three years, and, as you can see in the graph at 3:10 in my video, those with the highest TMAO levels went on to have significantly more heart attacks, strokes, or death.

Let’s back up for a moment. If high TMAO levels come from eating lots of meat, dairy, and eggs, then maybe the only reason people with high TMAO levels have lots of heart attacks is that they’re eating lots of meat, dairy, and eggs. Perhaps having high TMAO levels is just a marker of a diet high in “red meat, eggs, milk, and chicken”—a diet that’s killing people by raising cholesterol levels, for example, and has nothing to do with TMAO at all. Conversely, the reason a low TMAO level seems so protective may just be that it’s indicative of a more plant-based diet.

One reason we think TMAO is directly responsible is that TMAO levels predict the risk of heart attacks, strokes, or death “independently of traditional cardiovascular risk factors.” Put another way, regardless of whether or not you had high cholesterol or low cholesterol, or high blood pressure or low blood pressure, having high TMAO levels appeared to be bad news. This has since been replicated in other studies. Participants were found to have up to nine times the odds of heart disease at high TMAO blood levels even after “controll[ing] for meat, fish, and cholesterol (surrogate for egg) intake.”

What about the rest of the sequence, though? How can we be certain that our gut bacteria can take the choline we eat and turn it into trimethylamine in the first place? It’s easy. Just administer a simple dietary choline challenge by giving participants some eggs.

Within about an hour of eating two hard-boiled eggs, there is a bump of TMAO in the blood, as you can see at 4:51 in my video. What if the subjects are then given antibiotics to wipe out their gut flora? After the antibiotics, nothing happens after they eat more eggs. In fact, their TMAO levels are down at zero. This shows that our gut bacteria play a critical role. But, if we wait a month and give their guts some time to recover from the antibiotics, TMAO levels creep back up.

These findings did not thrill the egg industry. Imagine working for the American Egg Board and being tasked with designing a study to show there is no effect of eating nearly an egg a day. How could a study be rigged to show no difference? If we look at the effect of an egg meal (see 5:32 in my video), we see it gives a bump in TMAO levels. However, our kidneys are so good at getting rid of TMAO, by hours four, six, and eight, we’re back to baseline. So, the way to rig the study is just make sure the subjects hadn’t eaten those eggs in the last 12 hours. Then, you can show “no effect,” get your study published in the Journal of the Academy of Nutrition and Dietetics, and collect your paycheck.

Unfortunately, this appears to be part for the course for the egg industry. For more on their suspect activities, see:

For more on the TMAO story, see:

Written by Leisureguy

31 December 2019 at 3:58 pm

The Family Wanted a Do Not Resuscitate Order. The Doctors Didn’t.

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Caroline Chen reports in ProPublica:

A towering figure at 6 feet, 3 inches, with salt-and-pepper hair and matching mustache, Jurtschenko — known to one and all as Andy — delighted friends and family with his seemingly endless supply of wisecracks and goofball humor. On April 5, 2018, he went into surgery at Newark Beth Israel Medical Center in Newark, New Jersey, for a new heart and what he hoped would be renewed energy. He dreamed of returning to his carpet business and to enjoying New York Mets games on the weekends after years of exhaustion and strain caused by congestive heart failure.

Typically, patients begin reviving within 24 hours after transplant surgery. Andy didn’t. As the days passed, his children, Chris and Megan Jurtschenko, became increasingly concerned. On April 26, a neurologist called Chris and explained what an MRI the day before had shown: Andy’s brain had likely been deprived of oxygen during the procedure. The doctor said he “would basically be in a vegetative state,” Chris recalled in an interview. Chris asked to meet with the medical team the next day.

The devastated family took some comfort in knowing what Andy would have wanted. In several conversations before the surgery, he had made clear that “he did not want to be a burden on us, he did not want to live in an incapacitated form,” Andy’s older sister, Anna DeMarinis, said.

Now that their father could not speak for himself, Chris and Megan, as Andy’s next of kin, had to be his voice. On April 27, they went to the hospital for the meeting. Still hoping Andy might recover, they did not seek to withdraw his feeding tube or medications. But they asked for a do not resuscitate order. If he were to stop breathing or have no pulse, a DNR order would direct doctors not to compress his chest, use a machine to force air into his lungs or give electric shocks to restart his heart.

If his heart stopped, “we weren’t going to force him to stay,” Megan said.

Dr. Margarita Camacho, the surgeon who had performed the transplant, deflected their request, the siblings said. She told them that it was too early for a DNR, and that they shouldn’t give up hope because their father might recover, his children said. At Camacho’s urging, Megan and Chris said, they let it go. No DNR order was signed that day. The family would continue to press the issue and finally secure a DNR more than a month later.

Megan and Chris Jurtschenko waived their privacy rights to allow the hospital to discuss their father’s case with ProPublica. Asked directly about the meeting with the surgeon and why the family’s wishes were not followed at the time, Linda Kamateh, a spokeswoman for Newark Beth Israel and Camacho said in an email: “Physicians are obliged to give their best medical advice based on a patient’s medical condition. However, ultimately the decision to have a DNR resides with the patient. The hospital believes that it adhered to those principles in its discussions with the Jurtschenko family.”

Except for “a very specific set of dire medical circumstances, in which a patient may require resuscitation,” a DNR “does not otherwise affect ongoing care and treatment,” Kamateh wrote in a separate email. “… These decisions are often revisited and reassessed within the course of treatment.”

Andy’s medical record doesn’t mention the children’s request for a DNR. “The family was able to express their concerns and decided to continue to see how PT [patient] progresses over the next few weeks,” a social worker wrote.

Bearing out Camacho’s prognosis, Andy would awaken and recover some cognitive ability — but only enough to attain the incapacitated state he had dreaded, not to become again the man that his children knew and loved. They remained adamant that, if his heart stopped, he would have preferred to die than to be resuscitated for such an existence.

The American Medical Association’s code of medical ethics states, “The ethical obligation to respect patient autonomy and self-determination requires that the physician respect decisions to refuse care.” Yet Newark Beth Israel’s transplant team was often reluctant to sign DNR orders, according to four former employees and an audio recording of a staff meeting. While the team wouldn’t outright refuse, especially when patients or their family members repeatedly asked, it often delayed or discouraged DNRs, especially before key dates tied to performance metrics such as the one-year survival rate, or the proportion of people undergoing transplants who are still alive a year after their operations, three of the ex-employees said.

The team also lacked a process for discussing beforehand whether patients would want CPR if their pulse or breathing stopped after their operations, the former employees said. Typically, the staff addressed the issue only if a patient’s condition became critical and family members were insisting on a DNR.

Newark Beth Israel’s DNR policies are consistent with best practices, Kamateh said. “These policies guide our clinical teams in support of the treatment decisions of our patients and their families, from the most routine procedures to the most complex and stressful situations,” she said. “We strive to explain care options and deliver sound medical advice in ways that are timely and clear, yet also respectful and sensitive.”

At least indirectly, the concern about DNRs may have stemmed from Newark Beth Israel’s aggressive approach to transplants. Newark Beth Israel’s heart transplant program is one of the top 20 in the U.S. by volume, having grown under Dr. Mark Zucker, its director for three decades, and Camacho, the main surgeon. As of November, the hospital had performed 1,096 heart transplants.

The program is known for taking on sicker patients who might be rejected at other programs. From 2014 through 2017, compared with its counterparts in New Jersey and nearby states, Newark Beth Israel’s transplant team operated on a higher percentage of patients who were older, more overweight or obese, and who had been in an intensive care unit while awaiting transplant, according to the Scientific Registry of Transplant Recipients. (The registry is funded by the U.S. Department of Health and Human Services to track and analyze transplant outcomes.) In those years, Newark Beth Israel also had a higher percentage of patients who had been on a pump or some other support before transplant, which increases the difficulty of surgery. This stance filled an important gap in care and helped the program grow both in size and revenue; hospitals typically bill insurers about $1.4 million for a heart transplant.

“While the Advanced Heart Failure Treatment and Transplant Program at NBI does not seek out cases that are more complex than those handled by other prestigious transplant programs, patients from other programs have been referred to our care and been successfully transplanted,” Kamateh said. “Our clinical decisions are driven by the best interest of our patients, including their personal preferences, not by statistical results.”

Scores of grateful patients say they owe their lives to Zucker and Camacho.

“Dr. Zucker has saved my life again and again,” said Mark Reagan, a retired AIG executive in Bluffton, South Carolina. Reagan received his heart transplant at Newark Beth Israel in March 2003 after suffering from congestive heart failure for eight years. Reagan said his arteries were initially too narrow for a transplant, but Zucker opened his arteries with an experimental treatment so he could get onto the waitlist. After his surgery, Reagan became part of the “Hearty Hearts” volunteers at the hospital who advocate for organ donations and lift the spirits of other transplant recipients. Through “Hearty Hearts,” he said, he has met several transplant candidates who were turned away by other hospitals but “walked out of Newark Beth Israel with a new heart, because of Mark.”

Accepting more difficult cases, though, can raise the risk of adverse outcomes. According to former employees and audio recordings of staff meetings, Newark Beth Israel’s transplant team worried about its one-year survival rate, which would drop below the national average in 2019. That anxiety, the employees said, appeared to underlie the team’s unwillingness to sign DNR orders, since resuscitation might be needed to keep a patient alive.

Besides Andy Jurtschenko’s children, two former NBI employees, including one with firsthand knowledge, said that the transplant team initially balked at a DNR order for him. By ruling out extreme measures to revive him, a DNR could conceivably have hastened Andy’s death and lowered the program’s one-year survival rate. Whether or how much metrics influenced Camacho’s rebuff of the DNR request is unclear. While DNR orders are documented in the medical record, unapproved requests — and the reasons behind those decisions — generally aren’t.

There can be few greater points of contention between physicians and families, few so infused with emotion and anguish on both sides, than whether to resuscitate someone on the verge of death. Hospitals have been sued and nursing homes fined for resuscitating patients who had a DNR order on file. Or families may urge a medical team to initiate resuscitation that a physician believes is futile, or even torture, for a patient with a terminal diagnosis. The decision is inherently subjective, and ultimately, doctors are supposed to respect the wishes of patients — or, if they can’t speak for themselves, their health care proxy.

A heart transplant itself is an act of resuscitation; there is a moment, after the old heart has been removed and the new organ not yet implanted, when . . .

Continue reading.

Written by Leisureguy

31 December 2019 at 2:25 pm

What Happens When Sheriffs Release Violent Offenders to Avoid Paying Their Medical Bills

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Connor Sheets reports in ProPublica:

Joel Tucker was booked into Alabama’s Fayette County Jail in December 2014 after being charged with the violent assault of his sister. According to court records, he punched her in the face, leaving her with a brain hemorrhage, a broken shoulder and other injuries.

“My brother almost killed me,” said Tucker’s sister, Joycelyn Gugaria, now 53.

Nonetheless, the following month, the Fayette County sheriff released Tucker on his own recognizance, citing “medical reasons.”

Sheriffs across Alabama and the U.S. regularly find ways to release sick and injured inmates from county jails to avoid paying for their hefty hospital bills, a practice often referred to as medical bond that and ProPublica reported in September. Some sheriffs defend the practice as a way to keep jail medical costs down while allowing people who aren’t a threat to society to access care.

In Alabama, it’s now clear that some of those inmates were in jail awaiting trial on charges that they’d committed violent crimes, even murder, and ProPublica have found.

Tucker is one of more than a dozen violent offenders released from Alabama jails via medical bond that and ProPublica have identified. One shot and killed another man in a nightclub. Another shot and killed a man outside his house. A third man was released the day after he was charged with second-degree assault.

With convictions that include domestic violence and manufacturing and selling drugs, Tucker, now 47, has been in and out of jails and prisons since the 1990s.

While he was out on medical bond after hitting Gugaria, Tucker committed additional crimes, for which he is now serving a 17 ½ year federal prison sentence in Terre Haute, Indiana. He could not be reached for comment.

Rodney Ingle, who at the time was sheriff of Fayette County, said this month that he did not recall the details of Tucker’s case and could not say whether he believed he was right to allow Tucker to be released. But Ingle, whose term as sheriff ended in January, said he does not “think it’s a good idea” to let violent criminals out of jail on medical bond.

“If you’re a violent offender, just because you’ve got a medical issue you shouldn’t be bonded out,” he said. “I don’t think they should be able to get right back out. I don’t agree with that.”

To be sure, many people charged with violent crimes can post bail and be released pending trial. With medical bond, however, the calculus is less about whether the defendant will show up for future court proceedings and more about how much his or her medical care will cost.

The state of Alabama does not keep statistics on how often defendants are released on medical bond or on the charges they faced when they were let go. Cases receive periodic attention when outraged victims file lawsuits or speak up in news reports.

The way sheriffs in Alabama use medical bond is drawing scrutiny following the and ProPublica investigation. State Rep. Neil Rafferty, a Birmingham Democrat who serves on the House health committee, and several of his colleagues on both sides of the aisle said they plan to tackle the issue of medical bond during the 2020 legislative session.

Rafferty said he was appalled that some violent offenders are released from county jails in Alabama so sheriffs can avoid paying their medical bills.

“That’s not good for public safety, if we’re releasing people who are threats to public safety,” he said. “That is ridiculous.”

Accused of Murder, Out on Bond

In February 2015, James Herrod was arrested and charged with murdering a woman and leaving her on the side of the road in Selma. His bond was initially set at $1 million. In December 2016, Circuit Judge Marvin W. Wiggins denied a motion by Herrod’s attorney to reduce his bond to $50,000.

But three months later, Harris Huffman Jr., who was then sheriff of Dallas County, which includes Selma, requested Herrod’s release. Wiggins turned aside prosecutors’ objections and let Herrod go.

“The Dallas County Sheriff has to transport him to Montgomery twice or three times a week for Chemotherapy treatment,” Herrod’s attorney wrote in a February 2017 court filing.

“There will soon be a time when the Defendant will need to be hospitalized for one week at a time and there will be three or four of such stays in Montgomery,” the pleading said. “The Defendant needs to be home to have the support of his family and spend quality (sic) with his family.”

Huffman defended his decision to ask Wiggins to allow him to release Herrod in an interview with the Selma Times-Journal, saying that Herrod’s treatment had already cost the county over $200,000. Huffman, who did not respond to requests for comment, chose not to run for another term last year and his 24-year tenure as sheriff ended in January.

“My concern is he is extremely ill, and to be in a county jail and being that sick, it’s really hard to give him the medical attention that he needs,” Huffman told the newspaper. “It’s expensive, and it’s taxpayers’ money. … I think with him being this sick after several months it was time to do something else.”

Michael Jackson, district attorney for Alabama’s 4th Judicial Circuit, which comprises five counties in the center of the state including Dallas County, said that he’s long advocated for violent offenders to be kept behind bars.

“I understand that when somebody gets sick it can cost a lot of money, and these sheriffs don’t want to pay for that,” Jackson said. “But certain crimes like murder and rape, these people don’t need to be walking around.”

Herrod died on June 2, 2017, 10 days before his trial was slated to begin.

Martin Weinberg, a Birmingham lawyer with experience suing Alabama jails over medical issues, said some county jails in the state notoriously provide substandard in-house care and inadequate access to outside medical providers for sick inmates. Yet he and other experts said it is important to weigh those considerations against the potential societal risks of releasing inmates accused of violent crimes.

“We certainly don’t want to release violent offenders who wouldn’t otherwise be released because they have medical issues and we don’t want to pay for their care,” he said. “They get released and they can’t afford care and they get into more trouble and find their way right back into custody.”

Some sheriffs said they oppose releasing inmates accused of violent crimes for medical reasons.

“We’re just gonna bite the bullet,” Geneva County Sheriff Tony Helms said. “I’m not gonna go to the judge and say they need to be released. If it costs us, it costs us.”

Marshall County Sheriff Phil Sims agreed. “If they’re a threat to someone or if it’s a crime that’s a violent crime, they shouldn’t be released.”

“He’s Always Been Violent”

Gugaria has lived in fear of her brother for most of her life.

Sitting in the living room of her late father’s home deep in the woods of Bankston, a rural community west of Birmingham in Fayette County, Gugaria recounted stories of the “hell” of living through Tucker’s violence, drug abuse and rage.

“He’s always been violent, even when he was a little kid,” Gugaria said. “Something’s just wrong with him.”

In 2013, Tucker was released early from a 15-year sentence for the manufacture of a controlled substance. In August of the following year, he punched Gugaria in the face. She was hospitalized for a day and has required multiple medical procedures over the past five years.

“I had a brain hemorrhage, my right shoulder was broken in two places, all the little bones in my nose were broken, my cheekbone was broken and my sinus cavity was crumpled,” she said. “I still have some paralysis in my face.”

Gugaria, who once worked as a secretary for the city of Tuscaloosa and loved to play poker, now collects a disability check as a result of her injuries.

Gugaria said she waited three weeks to file charges against her brother because she was afraid of him, and by that time, he had fled to Chicago. Local law enforcement obtained a warrant for Tucker’s arrest and went looking for him.

Sheriff’s deputies found Tucker in Fayette County and arrested him in December 2014. His bail was set at $25,000, but Tucker was released at the end of January 2015, on his own recognizance “due to documented medical reasons,” according to his release paperwork, which is part of his public court file.

The only officials who signed the bond were Ingle and his chief deputy. No judge, clerk or other officer of the court signed the document, which goes against standard procedure in Alabama. . .

Continue reading.

Written by Leisureguy

31 December 2019 at 2:16 pm

Russia’s State TV Calls Trump Their ‘Agent’

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Julia Davis reports at the Daily Beast:

Sometimes a picture doesn’t have to be worth a thousand words. Just a few will do. As Russian Foreign Minister Sergey Lavrov returned home from his visit with President Donald Trump in the Oval Office last week, Russian state media were gloating over the spectacle. TV channel Rossiya 1 aired a segment entitled “Puppet Master and ‘Agent’—How to Understand Lavrov’s Meeting With Trump.”

Vesti Nedeli, a Sunday news show on the same network, pointed out that it was Trump, personally, who asked Lavrov to pose standing near as Trump sat at his desk. It’s almost the literal image of a power behind the throne.

And in the meantime, much to Russia’s satisfaction, Ukrainian President Volodymyr Zelensky is still waiting for that critical White House meeting with the American president: the famous “quid pro quo” for Zelensky announcing an investigation that would smear Democratic challenger Joe Biden. As yet, Zelensky hasn’t done that, and as yet, no meeting has been set.

Russian state television still views the impending impeachment as a bump in the road that won’t lead to Trump’s removal from office. But President Vladimir Putin’s propaganda brigades enjoy watching the heightened divisions in the United States, and how it hurts relations between the U.S. and Ukraine.

They’ve also added a cynical new a narrative filled with half-joking ironies as they look at the American president’s bleak prospects when he does leave office.

Appearing on Sunday Evening With Vladimir Soloviev, Mikhail Gusman, first deputy director general of ITAR-TASS, Russia’s oldest and largest news agency, predicted: “Sooner or later, the Democrats will come back into power. The next term or the term after that, it doesn’t matter… I have an even more unpleasant forecast for Trump. After the White House, he will face a very unhappy period.”

The host, Vladimir Soloviev, smugly asked: “Should we get another apartment in Rostov ready?” Soloviev’s allusion was to the situation of Viktor Yanukovych, former president of Ukraine, who was forced to flee to Russia in 2014 and settled in the city of Rostov-on-Don.

Such parallels between Yanukovych and Trump are being drawn not only because of their common association with Paul Manafort, adviser to the first, campaign chairman for the second, but also because Russian experts and politicians consider both of them to be openly pro-Kremlin.

Tightly controlled Russian state-television programs constantly reiterate that Trump doesn’t care about Ukraine and gave Putin no reasons to even contemplate concessions in the run-up to the recent Normandy Four summit in Paris.

State-television news shows use every opportunity to demoralize the Ukrainians with a set of talking points based on the U.S. president’s distaste for their beleaguered country. The host of Who’s Against on Rossiya-1, Dmitry Kulikov, along with pro-Kremlin guests, took repeated jabs at the Ukrainian panelist, boasting about the meeting between Trump and Lavrov.

“There are no disagreements or contradictions between Trump and Russia,” argued Valery Korovin, director of the Center for Geopolitical Expertise, appearing on the state-television channel Rossiya-24. Korovin insisted that the Democrats in Congress are the main antagonists in the relationship between Russia and the United States.

Dmitry Kiselyov, the host of the Sunday news show Vesti Nedeli, accused the Democrats of joining forces with Hollywood, carrying out various conspiracies in order to undermine Trump’s popularity. Reporting for Vesti Nedeli from Washington, Mikhail Antonov used the term “the Cold War,” a fraught rhetorical twist to describe the clash between Trump and the Democratic majority in the House of Representatives.

Appearing on Sunday Evening With Vladimir Soloviev, Mikhail Gusman noted: “The scariest part of our relationship with America is that the level of trust between our countries, our governments, our political powers, is precisely at zero.”

“But not between the presidents,” chimed in the host.

Rudy Giuliani, acting as the president’s personal attorney and determined to divert attention from Trump’s impeachment to former Vice President Biden’s alleged corruption, recently embarked on an “evidence-gathering” trip to Ukraine. Shortly after Giuliani’s return to the United States, Russian state television started airing video clips of his OAN (One America News Network) “documentary.” It purports to prove . . .

Continue reading.

Written by Leisureguy

31 December 2019 at 11:43 am

The Dead Sea and Esbjerg aftershave gel go together like bread and butter

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My Vie-Long horsehair brush, which I soak as I do a boar brush (wet knot, let brush stand sopping wet while I shower), has a pleasantly coarse feel on the face with a soft knot. It make a fine lather from The Dead Sea, which has a fragrance (and a lather) that I like a lot: Lemon, Rosemary, Cannabis, Saffron, and Sandalwood—not a common fragrance. The vendor description:

This soap has been a dream of my uncle for the last two years. Since discovering and using other skin care products that contained Dead Sea Salt, the idea of a luxury shaving soap using this ingredient has been brewing inside his mind. A lot of formulating and testing was required but the finished product is truly something special and a shaving soap both of us are very proud of. The scent of THE DEAD SEA is very unique, containing two oils not typically used in scent building, golden cannabis oil and saffron. I can guarantee you’ve never smelt a soap quite like this one. On top of the wonderful skin care properties of Dead Sea salt, we have added both lanolin and aloe vera extract for a perfect post-shave feel. A shaving soap of this quality wouldn’t be complete unless packaged in an Italian heavy glass jar with an aluminum top. RazoRock THE DEAD SEA is not just another shaving soap, it’s a traditional wet shaving experience you won’t soon forget!

(Again: I get no kickback or remuneration or discounts from any vendors. I provide the information to my readers because I like the products and I think they might as well. That link is not an affiliate link.)

My RazorRock MJ-90A is the razor the Edwin Jagger would be if it grew up, went to college, and got a good job: the same person, but stronger and more capable and poised. It produced a perfect shave, though I will take some credit for providing guidance along the way (and doing a good job of prep, including MR GLO).

A tiny squirt of Esbjerg Aftershave Gel Sensitve completed the shave. Esbjerg’s fragrance, which is clean and light, differs from The Dead Sea’s, but it seems to me to complement it quite well. I was interested to read at the link the suggestion that this product can also be used as a pre-shave treatment. They note that the product has no fragrance oils included but has a light scent from the ingredients, which they characterize as “rose.” I would say it’s not quite rose, being slightly in the direction of a lemon fragrance (but definitely not lemon itself).

A great shave to close out the year and the decade of the teens, and tomorrow we start the decade of the 20’s. I was bemused to read a column claiming there was some controversy over when the decade starts. What struck me was the use of the definite article “the,” as though there were one decade. A decade can begin on any date — March 15, 1978 can mark the beginning of a decade (that ended March 14, 1986). The decade called “the 20s” will start tomorrow and will end December 31, 2029, the next day beginning the decade called “the 30s.”

Written by Leisureguy

31 December 2019 at 10:55 am

Posted in Shaving

Instead of “Any questions?” say “What questions do you have for me?”

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And other tips in this Twitter thread.

Written by Leisureguy

30 December 2019 at 4:34 pm

Brave New World, Deepfakes Dept: The coming deepfakes threat to businesses

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Kaveh Waddell and Jennifer A. Kingson reported in Axos last July:

In the first signs of a mounting threat, criminals are starting to use deepfakes — starting with AI-generated audio — to impersonate CEOs and steal millions from companies, which are largely unprepared to combat them.

Why it matters: Nightmare scenarios abound. As deepfakes grow more sophisticated, a convincing forgery could send a company’s stock plummeting (or soaring), to extract money or to ruin its reputation in a viral instant.

  • Imagine a convincing fake video or audio clip of Elon Musk, say, disclosing a massive defect the day before a big Tesla launch — the company’s share price would crumple.

What’s happening: For all the talk about fake videos, it’s deepfake audio that has emerged as the first real threat to the private sector.

  • Symantec, a major cybersecurity company, says it has seen three successful audio attacks on private companies. In each, a company’s “CEO” called a senior financial officer to request an urgent money transfer.
  • Scammers were mimicking the CEOs’ voices with an AI program that had been trained on hours of their speech — culled from earnings calls, YouTube videos, TED talks and the like.
  • Millions of dollars were stolen from each company, whose names were not revealed. The attacks were first reported in the BBC.

And in March, a Twitter account falsely claiming to belong to a Bloomberg journalist reportedly tried to coax personal information from Tesla short-sellers. Amateur sleuths said the account’s profile photo had the hallmarks of an AI-generated image.

Big picture: This threat is just beginning to emerge. Video and audio deepfakes are improving at a frightening pace and are increasingly easy to make.

  • There’s been an uptick in sophisticated audio attacks over the past year, says Vijay Balasubramaniyan, CEO of Pindrop, a company that protects call centers from scammers.
  • But businesses aren’t ready, experts tell Axios. “I don’t think corporate infrastructure is prepared for a world where you can’t trust the voice or video of your colleague anymore,” says Henry Ajder of Deeptrace, a deepfakes-detection startup.

Even if companies were clamoring for defenses, few tools exist to keep harmful deepfakes at bay, says Symantec’s Saurabh Shintre. The challenge of automatically spotting a deepfake is almost insurmountable, and there are hurdles still ahead for a promising alternative: creating a digital breadcrumb trail for unaltered media.

  • Pindrop monitors for audio attacks like altered voices on customer service lines.
  • Symantec and ZeroFOX, another cybersecurity company, say they are developing technology to detect audio fakes.

What’s out there already isn’t cheap.

  • New Knowledge, a firm that defends companies from disinformation, says its services can run from $50,000 to “a couple million” a year.
  • Just monitoring the internet for potential fakes comes at “a substantial cost,” says Matt Price of ZeroFOX. “And that’s not even talking about the detection piece, which will probably be fairly expensive.”

As a result, businesses are largely defenseless for now, leaving . . .

Continue reading.

Written by Leisureguy

30 December 2019 at 3:56 pm

Queuing theory is counter-intuitive: What happens when you add a new teller?

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This is from October 2008, but I just stumbled across it. John Cook writes at his consulting company website:

Suppose a small bank has only one teller. Customers take an average of 10 minutes to serve and they arrive at the rate of 5.8 per hour. What will the expected waiting time be? What happens if you add another teller?

We assume customer arrivals and customer service times are random (details later). With only one teller, customers will have to wait nearly five hours on average before they are served. But if you add a second teller, the average waiting time is not just cut in half; it goes down to about 3 minutes. The waiting time is reduced by a factor of 93x.

Why was the wait so long with one teller? There’s not much slack in the system. Customers are arriving every 10.3 minutes on average and are taking 10 minutes to serve on average. If customer arrivals were exactly evenly spaced and each took exactly 10 minutes to serve, there would be no problem. Each customer would be served before the next arrived. No waiting.

The service and arrival times have to be very close to their average values to avoid a line, but that’s not likely. On average there will be a long line, 28 people. But with a second teller, it’s not likely that even two people will arrive before one of the tellers is free.

Here are the technical footnotes. This problem is a typical example from queuing theory. Customer arrivals are modeled as a Poisson process with λ = 5.8/hour. Customer service times are assumed to be exponential with mean 10 minutes. (The Poisson and exponential distribution assumptions are common in queuing theory. They simplify the calculations, but they’re also realistic for many situations.) The waiting times given above assume the model has approached its steady state. That is, the bank has been open long enough for the line to reach a sort of equilibrium.

Queuing theory is fun because it is often possible to come up with surprising but useful results with simple equations. For example, for a single server queue, the expected waiting time is λ/(μ(μ – λ)) where λ the the arrival rate and μ is the service rate. In our example, λ = 5.8 per hour and μ = 6 per hour. Some applications require more complicated models that do not yield such simple results, but even then the simplest model may be a useful first approximation.

Related postServer utilization: Joel on queueing

Continue reading for comments.

BTW, I’ve noticed in several branch banks they have two tellers active…

Written by Leisureguy

30 December 2019 at 3:10 pm

Posted in Business, Daily life, Math

Faulty Equipment, Lapsed Training, Repeated Warnings: How a Preventable Disaster Killed Six Marines

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The US Navy is badly broken and it’s starting to affect the Marine Corps.  Robert Faturechi, Megan Rose, and T. Christian Miller report in ProPublica:

Capt. Jahmar Resilard and Capt. Austin Smith were hurtling over the Pacific Ocean at 280 miles per hour. From inside the cockpit of their U.S. Marine Corps fighter jet, they kept their eyes on the hulking fuel tanker flying ahead. Off to their right, two Marines in a second jet assigned to Fighter Attack Squadron 242 did the same.

The moon was below the horizon. The lights on all three aircraft were turned off. In total darkness, 50 miles off the coast of Japan, the two jets were to stick their noses into fuel hoses trailing behind the tanker’s wings.

Even for the most prepared aviators, the training mission was not simple. Doing it at night made it even trickier. The night vision goggles fastened to their faces badly constricted how much they could see, like wearing binoculars to operate heavy equipment.

It didn’t help that Resilard had only executed a nighttime refueling once before in his career, more than a year earlier. His qualification to do so had formally lapsed, but no one realized it because a known glitch in the Marine Corps’ training tracker had yet to be fixed.

Resilard gained on the tanker, a behemoth capable of carrying more than 12,000 gallons of fuel. He connected gingerly to the hose.

“Good flow,” Smith assured him from the backseat of their cockpit.

The second Hornet had connected to the tanker’s other fuel hose. As the gas poured in at a rate of hundreds of gallons a minute, the three Marine Corps aircraft turned a wide, careful oval inside the safety of their approved airspace.

The December 2018 flight was part of a week of hastily planned exercises that would test how prepared Fighter Attack Squadron 242 was for war with North Korea. But the entire squadron, not just Resilard, had been struggling for months to maintain their basic skills. Flying a fighter jet is a highly perishable skill, but training hours had been elusive. Repairs to jets were delayed. Pleadings up the chain of command for help and relief went ignored.

“Everyone believes us to be under-resourced, under-manned,” the squadron’s commander wrote to his superiors months earlier.

And now, in perhaps the world’s most volatile theater, a Marine Corps general had ordered up a rushed set of exercises. The aviators in the air over the Pacific, investigators later found, had been given so little time to adjust their sleep schedules in order to fly at night that inside their F/A-18D Hornets that night it was as if they were legally drunk.

“Don’t have a good feeling,” Capt. James Wilson, the pilot of the second Hornet, had texted to his wife before taking off that night. “Love you.”

Smith, Resilard’s weapons officer, had flown so little of late that he was getting nauseous when he did fly. On the night of the refueling, he’d violated regulations and taken a motion sickness pill, risking drowsiness.

But both Hornets managed to refuel and disconnect without incident. Success felt close. They just had to safely separate. The mood over the radio was light.

“If you guys will go ahead and start a left turn to the middle of the area, we will give you a little show on the way out,” Wilson said to the tanker crew.

“Fuck yeah,” one of the tanker pilots replied.

Then, suddenly, Resilard’s Hornet drifted over the top of the tanker and to its right, a dangerous and unexpected maneuver.

It’s possible Resilard’s night vision goggles malfunctioned. They were a known menace. In fact, they were so problematic — the image could blur, even accidentally turn upside down — that the Air Force had recommended they not be fielded at all. The Marine Corps did so anyway.

“Oh … sheeitt … what are they gonna do?” the tanker pilot, still excited, said over the intercom, unaware Resilard was in danger.

Then Resilard corrected back. For 11 seconds, his jet dove down and to the left, straight for the tanker. One of the Marines in the second Hornet tried to radio a warning to Resilard but fumbled in activating the communications line.

The jet lanced the side of the tanker; the impact was shattering. Smith slammed into his Hornet’s canopy. He instantly yanked the ejection handle, activating the rockets under his and Resilard’s seats. The force of being launched out into the night sky ripped the helmet and goggles off Resilard’s head.

From the cockpit of the second Hornet, all Wilson could see below him was fire. He watched the burning tanker fall for 10 seconds. At 12,000 feet, it disappeared into a thick marine layer. The clouds glowed red. Five Marines were fatally trapped on board. All that could be heard over their intercom was wind whipping in and men hollering.

His parachute deployed, Smith began a 15,000-foot fall. He shot off flares into the night sky hoping someone would see, pausing when he passed through a freezing layer in the sky and his hands went numb. He struggled unsuccessfully to get his steel-toe boots off before he hit the water.

Falling 800 feet per minute, Smith and Resilard splashed into the Pacific. Smith was bruised, and he was shivering, but his head bobbed above the water and the reflective tape on his helmet could help rescuers spot him.

Resilard, who had landed far from Smith, was in worse shape. Blood was pooling on his brain. But he was active and conscious. He had a wristwatch, the kind runners use to keep track of distance traveled and calories burned. It showed Resilard’s pulse was strong, over 100 beats per minute.

Rescuers should have been on the way.

Smith’s location beacon failed in the water, but he got his radio to transmit his location.

Resilard had less luck. Injured, cold, he couldn’t get his radio to work. He couldn’t punch in the broadcast sequencing right. While the radios can be configured to transmit coordinates automatically, the Marine Corps had chosen not to adopt the practice.

Resilard’s circumstances only worsened. His location beacon had also malfunctioned in the water. The Marine Corps’ senior leadership knew the beacons were flawed but hadn’t replaced them.

After a deadly mishap involving a beacon two years earlier, Squadron 242’s commander tried to remedy the problem by getting replacements. But weeks before the crash the Marine Corps ordered a halt to their use because they were not officially authorized.

In the sky, the Marines on the second Hornet tried to help, radioing their Japanese allies and asking for rescue aircraft. It was all but futile.

Years earlier, the U.S. had struck an agreement giving responsibility for the search and rescue of American forces in the region to the Japanese military. The American commanders who’d ordered up the December training mission, however, were unaware of one wrinkle: The Japanese would only be available to help in emergencies if their forces were also actively training.

That night in December, the Japanese were not. Help, if it could make it, was hours away.

At 68 degrees, the sea water was not immediately lethal. But hypothermia would eventually set in.

Three hours after the crash, Smith and Resilard were still waiting. Smith had managed to . . .

Continue reading. There’s much more.

This is part of a continuing series of articles on the US Navy’s loss of competence over the past several years, a series that is a damning indictment of irresponsibility and unaccountability up through the ranks of the Navy to the Executive Branch and Congress. It is another indicator that the US has lost the ability to get things done at the Federal level.

Written by Leisureguy

30 December 2019 at 8:22 am

RazoRock Bruce, Mama Bear Buttercream, iKon X3, RazoRock Barberpole, and Stetson

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Every item in today’s shave is really first-rate. The Bruce brush made a superb lather — in both fragrance and consistency — from Mama Bear’s Buttercream shave stick. Mama Bear’s soaps do lather uncommonly well, at least if the water’s not terribly hard. The iKon X3 produced an extremely smooth result, perhaps assisted by the stubble’s two-day length (I never understood why the result should be better if the stubble’s longer, but it does seem to happen), and that RazoRock Barberpole handle is marvelous.

A splash of Stetson, and the week is well launched. I used Stetson to again see whether it bears any relation (in terms of Western theme) to Solstice, and it does not, but it is a very nice aftershave on its own, introduced in 1981. identifies the scent profile:

  1. Top Notes
  2. Heart Notes
  3. Base notes

I, of course, love the vanilla note that Tonka provides. But no trace of Sage, as you see. It really is a fine fragrance, and I notice that it was a FiFi award winner in 1982. A very nice aftershave to have in the cabinet.

Written by Leisureguy

30 December 2019 at 8:13 am

Posted in Shaving

Inside the secret food bank that keeps farmworkers from going hungry

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This is a good article about one aspect of the US: how it grinds the poor into the dust. The dateline on this piece is Watsonville CA, which is just up the road from where I lived — between Monterey and Santa Cruz. Patricia Lee Brown writes in the Christian Science Monitor:

The early winter storms gathering in the Pacific bring welcome rains to California’s tinder-dry landscape. But for farmworkers picking strawberries for less than minimum wage, the rains signal the end of the harvest season and regular work, and deliver a downpour of hunger and worry.

That’s why about 170 indigenous Mexican women from Oaxaca line up for hours in an alley to obtain sacks of produce, diapers, and other essentials from a secret food bank once a month. For those who spend grueling days harvesting America’s bounty, this surreptitious pop-up – organized solely by word of mouth – provides a safe place for accessing free, nutritious food and supplies without fear of deportation by la migra, or U.S. Immigration and Customs Enforcement agents (ICE).

Once the self-proclaimed “Frozen Food Capital of the World,” this predominantly Latino agricultural city of 53,900 is located in Santa Cruz County, the least affordable county in the state for renters.

Though synonymous with beaches and surfer dudes, the county is home to some of the country’s most vulnerable – the thousands of indigenous farmworkers in California, an unknown number of unauthorized residents, who live in severely substandard conditions and speak a variety of pre-Columbian languages rather than English or Spanish.

The stealth food operation – not far from the canneries where striking workers rallied in the 1980s – is meant to take a bit of the edge off. It is organized by Ann López, in conjunction with the Second Harvest Food Bank of Santa Cruz County. An emerita professor, “Dr. Ann” as she is known, started a nonprofit called the Center for Farmworker Families after interviewing numerous agricultural laborers for her Ph.D. dissertation. “There was a family with four little girls crying for food,” she recalls. “I opened the refrigerator and they had a head of lettuce, one third of a gallon of milk, and two Jell-O cups. That was it. What I found was a population inordinately poor and suffering.”

The “devil’s fruit”

Ernestina Solorio, who has legal status to work in the U.S., spends 10 hours a day, six days a week in the fields during the season. Strawberries are among the most labor-intensive crops, known as la fruta del diablo, or the devil’s fruit, for the hours it takes hunched over low-to-the-ground berries to pluck them without bruising.

Ms. Solorio earns $20,000 in a good year, well above average for a farmworker but also well under the federal poverty rate for Ms. Solorio’s family of four children. Sky-high rents eat up roughly 75% to 80% of a farmworker’s income, and a typical scenario is paying $600 a month for a family to sleep in a living room, says Gretchen Regenhardt, regional directing attorney for California Rural Legal Assistance, which provides legal services for low-income communities.

The math is grim: about $200 a month after rent to pay for everything else. “The work won’t pick up again until mid-April, depending on the weather,” Ms. Solorio explains. “That’s why so many of us are stressed.”

From a makeshift staging area in a garage, her compatriots file past tables piled high with diapers, laundry detergent, and toilet tissue, all while juggling toddlers in pajamas and babies nestled in blankets or shawl rebozos (traditional baby carriers).

Some dig through piles of donated clothes before moving on to the main event – repurposed onion bags heavy with sweet potatoes, carrots, cabbage, kale, and other fresh vegetables and smaller white plastic bags filled with rice, lentils, and canned goods from the USDA. Strollers double as grocery carts. Those on foot weighed down by 30 pounds of goods teeter gingerly down the alleyway.

“You would never see this concentration of Oaxacans,” says Ms. López, dressed for the season in a bright red sweater and snowman earrings. “They are always hiding in the fields or their apartments.”

On edge, then a respite

Fears about ICE raids – such as the arrest of 680 people in agricultural processing plants in Mississippi this past August – ricochet through the community, as did the massacre at a Walmart in El Paso, Texas, that was fueled by anti-Hispanic and anti-immigrant zealotry.

The Trump administration’s proposed changes to federal immigration rules mean that people could be denied status as lawful permanent residents if they receive food stamps, Medicaid, or housing vouchers. In August, Ken Cuccinelli, acting director of U.S. Citizenship and Immigrant Services said: “Give me your tired and your poor who can stand on their own two feet and will not become a public charge.” If the rules survive legal challenges, the linking of food stamps to immigration status would have a chilling effect, increasing poverty, hunger, and poor health in vulnerable communities, advocates say.

In contrast, the underground food bank is “creating circles and spaces of trust or confianza” for indigenous farmworkers, writes Dvera Saxton, an assistant professor of anthropology at California State University, Fresno, in an email.

A monthly phone tree alerts people to the food bank’s hidden locale. “I never dreamed it would expand to the whole community,” says Dominga, who is an unauthorized resident and fears for her family’s safety. She pulls a pink notebook out of her spangly backpack to show off a roster of names and numbers written in impeccably neat handwriting. Her family of six resides in a living room cordoned off from the kitchen by a blanket. There have been as many as 16 people living in the 1,000 square foot house: there are currently 10. Mornings begin with lines for the bathroom. The smell of spices from an unrelated family’s chili permeate the blanket. “It’s hard and sad to share with another family,” Dominga says. . .

Continue reading.

Written by Leisureguy

29 December 2019 at 2:52 pm

Good advice for the young

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An answer posted on Quora:

  1. Save money, don’t spend it. If you don’t need it don’t buy it. I CANNOT STRESS THIS ONE ENOUGH.
  2. Travel cheap and often. Traveling is harder as you go from only you to bringing a family.
  3. Don’t get caught up in useless drama. The girl or guy you are with may or may not be the one for you, so don’t get all twisted emotionally over something that was never going to work. (Especially if you are following #2)
  4. Find out WHO you are. Not what you do, not what you are, or where you want to be. It took me way too long to realize who I am and what I want out of life. Explore and push your boundaries. Try new things and learn what you like. Meet new people, challenge your own beliefs and understanding, walk a mile in someone else’s shoes, and then share your knowledge with others. Become YOU.
  5. Worry less about failing. Try shit, fail, and get back up and try again. You are still young and “failing” now is the best education you can get.
  6. Fuck what people think. Some people won’t like you, some people will hate you, and some will actually hope to see you dead. Don’t get caught up in trying to make everyone happy, because it is an impossible task. Built a close network of people.

No.  6 took me too long to learn. I was in my mid-30’s before I realized that I just rubbed some people the wrong way, and trying to present myself to please them did not work because I was constantly aware that if they knew the “real” me, they wouldn’t like me. I finally realized I should just be who I am, and even though some people would not like me, those who did would like me, the person I really am.

I would modify 1. somewhat: sock away 10% of every dollar you get and don’t touch that. Use a Vanguard fund (low fees) for that. And when you do buy something, save up enough to buy good quality that will last. Cheap stuff dies quickly. That means you won’t buy stuff so often, and that’s good: stuff weighs you down. Be particularly wary of stuff that’s suddenly popular.

Written by Leisureguy

29 December 2019 at 2:06 pm

Posted in Daily life

I love winter squash

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Ambercup is really excellent, and we now regularly have buttercup. I like all of these, but ambercup, buttercup, and delicata are the ones I have most often — roasted, and I now mix the seeds with a little olive oil and spread them out beside the squash and bake those as well, which I eat as a snack.

Written by Leisureguy

29 December 2019 at 12:54 pm

Posted in Food, Non-animal diet

Oral care videos

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Written by Leisureguy

29 December 2019 at 9:00 am

Posted in Health, Video

A former Navy SEAL writes of his first semester at Yale

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James Hatch, a retired wounded serviceman, writes in Medium:

In May of 2019, I was accepted to the Eli Whitney student program at Yale University. At 52, I am the oldest freshman in the class of 2023. Before I was accepted, I didn’t really know what to expect. I had seen the infamous YouTube video of students screaming at a faculty member. I had seen the news stories regarding the admissions scandal and that Yale was included in that unfortunate business. I had also heard the students at Yale referred to as “snowflakes” in various social media dumpsters and occasionally I’d seen references to Ivy League students as snowflakes in a few news sources.

I should give a bit of background information. I was an unimpressive and difficult student in public schools. I joined the military at 17 and spent close to 26 years in the US Navy. I was assigned for 22 of those years to Naval Special Warfare Commands. I went through SEAL training twice, quit the first time and barely made it the second time. I did multiple deployments and was wounded in combat in 2009 on a mission to rescue an American hostage.

Every single day I went to work with much better humans than myself. I was brought to a higher level of existence because the standards were high and one needed to earn their slot, their membership in the unit. This wasn’t a one-time deal. Every time you showed up for work, you needed to prove your worth.

The vetting process is difficult and the percentage of those who try out for special operations units and make it through the screening is very low.

In an odd parallel, I feel, in spite of my short time here, the same about Yale.

After receiving my acceptance email and returning to consciousness, I decided to move to Connecticut and do my best in this new environment. Many people have asked me why I want to attend college at 52, and why at an Ivy League institution like Yale? I could have easily stayed in Virginia and attended a community college close to my home. Well, based on my upbringing in the military, I associated a difficult vetting process with quality and opportunity. I was correct in that guess. More importantly, I simply want to be a better human being. I feel like getting a world-class education at an amazing institution like Yale will help me reach that goal. Are there other places to get a great education? Of course, but I chose Yale.

My first class of the semester was absolutely terrifying. I don’t know if it was for the kids in my class, but it damn sure was for me. It was a literature seminar with the amazing Sterling Professor of Comparative Literature, Professor David Quint. He is an amazing human in that he has dedicated his life to literature, and he knows what he is talking about. The discussion was centered around the Iliad. I had read a bit of the Iliad in the middle part of my military career and decidedly didn’t get it. Listening to Professor Quint demonstrated exactly how much I didn’t “get it.” The other students looked like children to me. Hell, they are children, but when they speak, and some of them speak English as their second language, they sound like very well-spoken adults. My Navy issued graduate degree in cussing wasn’t going to help me out here. These young students had a good grasp of the literature and although they lacked much experience to bounce it off of, they were certainly “all in” on trying to figure out its underlying meaning.

At one point I said, “Hey, I’m just an old guy sitting here with a bunch of smart people, but I think….” And they all smiled, some of them nervously because I was essentially an alien. I was an old dude with tattoos all over his arms and a Dutch Shepherd service dog, brandishing a subdued American flag patch on her harness, sitting next to me. Professor Quint later approached me and said, “Hey, don’t downplay your intelligence. You are smart as well.”

I thought, I’ve got him fooled! Turns out I didn’t fool him at all when I turned in my first paper, but that is another story for another time.

After a few classes, I started to get to know some of my classmates. Each of them is a compelling human who, in spite of their youth, are quite serious about getting things done.

One young woman made a very big impact on me. She approached me after class one day and said, “I am really glad I can be here at Yale and be in class with you. My grandfather came to Yale and when WWII started, he left for the Navy and flew planes in the Pacific theater. After he came home, he came back to Yale, but he couldn’t finish. He locked himself in his room and drank and eventually had to leave, so I feel like I am helping him finish here at Yale and I’m doing it with a veteran, you.”

I was surprised and quite emotional. Exceptionally emotional. She went on: “I can send you a photo of him!” and I told her I would love one. That evening she sent me this photo of her grandfather.

I used to read stories about men like him and they are heroes to me. Clearly her grandfather is a hero to her as well, and she is going to make him quite proud. This connection with a WWII vet through his amazing granddaughter is a gift. One of many I receive on an almost daily basis in this amazing institution. I think it’s worth taking a moment here and acknowledging that this thing we now call “PTSD” has always been around. Some of us veterans escape it while others, like me and likely this gent in the airplane, felt the sting of it.

One day in another lit class, I brought up a book I’d read a long time ago called “Taxi Driver Wisdom” by Risa Mickenberg, Joanne Dugan and Brian Lee Hughes.

After that class a couple of the students approached me and explained that their dads were cabbies when they first came to the United States, and that their fathers had told them that the things they sometimes heard from people in their cabs were amazing.

Think about that for a second. These students are first generation Americans. Their fathers immigrated to this country and started out by being taxi drivers. Now, their children are attending Yale University. I’m a patriotic man and those are the stories that help me understand how, in spite of the seemingly endless stream of negativity surrounding it, the American Dream is still alive and kicking. It makes my heart sing every time I see those kids.

Let me address this “snowflake” thing. According to . . .

Continue reading. There’s much more — including a perceptive discussion of what is meant by a “safe space.”


Written by Leisureguy

29 December 2019 at 7:59 am

Best Healthcare System in the World™: Total bill of $28,395.50 for an out-of-network throat swab.

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Richard Harris writes at NPR:

Alexa Kasdan had a cold and a sore throat.

The 40-year-old public policy consultant from Brooklyn, N.Y., didn’t want her upcoming vacation trip ruined by strep throat. So after it had lingered for more than a week, she decided to get it checked out.

Kasdan visited her primary care physician, Roya Fathollahi, at Manhattan Specialty Care, just off Park Avenue South and not far from tony Gramercy Park.

The visit was quick. Kasdan got her throat swabbed, gave a tube of blood and was sent out the door with a prescription for antibiotics.

She soon felt better, and the trip went off without a hitch.

Then the bill came.

Patient: Alexa Kasdan, 40, a public policy consultant in New York City, insured by Blue Cross and Blue Shield of Minnesota through her partner’s employer.

Total bill: $28,395.50 for an out-of-network throat swab. Her insurer cut a check for $25,865.24.

Service provider: Dr. Roya Fathollahi, Manhattan Specialty Care.

Medical service: lab tests to look at potential bacteria and viruses that could be related to Kasdan’s cough and sore throat.

What gives: When Kasdan got back from the overseas trip, she says there were “several messages on my phone, and I have an email from the billing department at Dr. Fathollahi’s office.”

The news was that her insurance company was mailing her family a check — for more than $25,000 — to cover some out-of-network lab tests. The actual bill was $28,395.50, but the doctor’s office said it would waive her portion of the bill: $2,530.26.

“I thought it was a mistake,” she says. “I thought maybe they meant $250. I couldn’t fathom in what universe I would go to a doctor for a strep throat culture and some antibiotics and I would end up with a $25,000 bill.”

The doctor’s office kept assuring Kasdan by phone and by email that the tests and charges were perfectly normal. The office sent a courier to her house to pick up the check.

How could a throat swab possibly cost that much? Let us count three reasons.

First, the doctor sent Kasdan’s throat swab for a sophisticated smorgasbord of DNA tests looking for viruses and bacteria that might explain Kasdan’s cold symptoms.

Dr. Ranit Mishori, professor of family medicine at the Georgetown University School of Medicine, says such scrutiny was unnecessary.

“In my 20 years of being a doctor, I’ve never ordered any of these tests, let alone seen any of my colleagues, students and other physicians order anything like that in the outpatient setting,” she says. “I have no idea why they were ordered.”

The tests might conceivably make sense for a patient in the intensive care unit or with a difficult case of pneumonia, Mishori says. The ones for influenza are potentially useful, since there are medicines that can help, but there’s a cheap rapid test that could have been used instead.

“There are about 250 viruses that cause the symptoms for the common cold, and even if you did know that there was virus A versus virus B, it would make no difference because there’s no treatment anyway,” she says.

(Kasdan’s lab results didn’t reveal the particular virus that was to blame for the cold. The results were all negative.)

The second reason behind the high price is that the doctor sent the throat swab to an out-of-network lab for analysis. In-network labs settle on contract rates with insurers. But out-of-network labs can set their own prices for tests, and in this case the lab settled on list prices that are 20 times higher than average for other labs in the same ZIP code.

In this case, if the doctor had sent the throat swab off to LabCorp ― Kasdan’s in-network provider ― it would have billed her insurance company about $653 for “all the ordered tests, or an equivalent,” LabCorp told NPR.

The third reason for the high bill may be the connection between the lab and Kasdan’s doctor. Kasdan’s bill shows that the lab service was provided by Manhattan Gastroenterology, which has the same phone number and locations as her doctor’s office.

Manhattan Gastroenterology is registered as a professional corporation with the state of New York, which means it is owned by doctors. It may be the parent company of Manhattan Specialty Care, but that is not clear in its filings with the state.

Fathollahi, the Manhattan Specialty Care physician, didn’t answer our questions about the bill. Neither did Dr. Shawn Khodadadian, listed in state records as the CEO of Manhattan Gastroenterology.

The pathologist listed on the insurance company’s explanation of benefits is Dr. Calvin L. Strand. He is listed in state records as the laboratory director at Manhattan Gastroenterology and Brookhaven Gastroenterology in East Patchogue, N.Y. We tried to reach him for comment at both places. . .

Continue reading.

Written by Leisureguy

29 December 2019 at 7:08 am

Leonard Bernstein offers a quick overview of musical evolution

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Written by Leisureguy

28 December 2019 at 5:29 pm

Posted in Music, Video

Why belief in reality is a dangerous mistake

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Most of us, most of the time, have the sense that we are connected to the real.  The immediate world around us, the objects and people, the buildings and the natural world seem unquestionably present.  Not only in the sense that we are experiencing them but in the sense that they exist independently of us out there in the real world.

Some, we imagine slightly crazed, philosophers may have doubted the existence of those objects and the real world and proposed that it is all a dream and a product of our subjective imagination.  We feel we know better.   Aside from moments of mental instability or those who have taken rather too many psychoactive substances,  we have an abiding sense that the world we experience is for the most part only too real.

This notion of reality is so close to us and so central to our culture that it is hard for us to imagine how it could be otherwise.  It has not always been so.  Our confidence in our access to the real is no doubt in part a product of the success of the Enlightenment and the remarkable achievements of science over the last three hundred and fifty years.  Philosophical realism – the idea that such an independent reality can be described by us – has within academic philosophy been supported by many in the analytic school.  I have argued however that it is a mistake.  A mistake that limits our ability to intervene successfully in the world and encourages division and conflict.

The idea of a reality that we can uncover through precise observation and reason is at the heart of the Enlightenment and enabled its advocates to champion human capacity over the authority of the word of God.  As children of the Enlightenment we are taught the story of Galileo with the metaphysical moral that by peering through his telescope he was able to observe the reality of the Jupiter’s moons and challenge the power and authority of the Church.  Reality though turns out itself to be theological notion.  For the real, like God, is not in the end observable.  Nor can we give an account of how our theories are able to reach through our experience and our particular context to describe an independent reality that we can identify as the ultimate character of the world.  Realists often imagine that they are the ones with their feet on the ground.  The ones without attachments to strange metaphysical frameworks.   Yet realism involves the presumption of something that accounts for all there is, supports our theories, is found everywhere, but is inaccessible and indescribable.  Such descriptions are strangely similar to those that have been used by monotheists to describe their god.  For a simple reason.  ‘The real’ is the god of the Enlightenment.

Of course, the vision of the early scientists and philosophers of the Enlightenment was a great and profound one that was to transform the circumstances of everyone.  Instead of the idea that the world was either unknowable or our knowledge of it came from a higher authority, the proposition that we are capable of uncovering the character of the world from our own observations and investigations was a liberating and transformational shift that propelled research and discovery.  It heralded a new age in which we could see human history as a continuous form of progress that gradually provided a more and more accurate account of the world.  It led to the great theories of science that seemingly uncovered the underlying laws that governed the universe and accurately described its development.

The problem is that the Enlightenment strategy of observing the world and applying reason to determine what is actually the case has uncovered its own limitation and failure, identifying our inability to describe reality. Once only a concern of those with an unusually rigorous turn of mind, it has more recently invaded much of our cultural space as a result of the widespread recognition of the importance of context. We have come to see our theories and accounts of the world as the product of a particular time, a particular culture, a particular language, a particular organism. It is no longer clear to us how these theories can escape their particularity and their context in order to describe the character of the world independently of those constraints.

In addition, the idea that we are able to accurately describe an independent reality requires a theory about how our theories and language are hooked onto the world.  Yet no such theory to support realism has been forthcoming, indeed there has been a shortage of any theories that lay out clearly the metaphysics required to make a realist account of the world possible.  At a commonsense level we assume our words refer to things out there in the world.  Providing an account of how they do so and what sort of things there must be to make this possible becomes more perplexing the more it is pursued.  Wittgenstein, close to the beginning of analytic philosophy, was one of the few to follow through the metaphysics required to make a realist account of language work. Critically however he concluded that any attempt to describe the relationship between language and the world must fail.  It must do so because such a theory would itself have to stand outside of language in order to catch sight of how language itself relates to the world.

Despite Wittgenstein’s identification of the impossibility of a realist theory of language, many philosophers of the analytic school have continued to pursue the realist project, though usually without making any serious attempt to develop an ontology that could make sense of how this could be achieved.  Instead a narrow piecemeal approach has often been adopted, as if in a scientific manner it is possible to make small inroads towards a bigger overall theory without needing to have in mind how the overall theory might be formulated.  All of which would be fine if it wasn’t for the problem that in principle, due to unavoidable paradoxes of self-reference highlighted by Wittgenstein in the Tractatus, such a theory cannot get off the ground. Not surprising therefore that the American philosopher Hilary Putnam, who had spent his career within the analytic school and was one of its leading proponents, concluded, ‘the project to describe the relationship between language and the world is a shambles’.

Meanwhile more broadly in Western culture there is increasing scepticism of the Enlightenment idea that we are progressing towards a better and more accurate theory of the world. Almost every humanities discipline, with the possible exception of some philosophy departments in the English-speaking world, has been absorbed with this question of perspective to such an extent that in some cases, sociology and anthropology for example, it has changed the very character of the discipline itself.  And now more widely in culture as a whole, post truth has invaded our news and politics highlighting our seeming inability to find an uncontentious frame for truth.

Given the profound challenges to the notion of the real why are some philosophers still so attached to it?  And why are most of us still convinced at an everyday level that we are able to access that reality?  There is I think a straight-forward explanation.  Despite the lack of a decent theory, and despite our increasing awareness of the impossibility of an objective account, we are inclined to think that without the notion of reality there is no explanation for the success of our theories and in particular of our scientific theories. Furthermore, realists often assume that the abandonment of the real has the consequence that anything goes, that each perspective is equally valuable.  The strengths and successes of the Enlightenment, our understanding of the world and our culture is imagined to be at risk if we give up on the real and with it the notion that there are correct and incorrect accounts of the world.

But we do not need the Enlightenment god ‘reality’ to make sense of the success of our theories, or to direct our future researches and investigations.  Any more than we need a religious god to make sense of the diversity and wonder of the natural world.  Our theories and our language are a means to intervene successfully in the world, we do not have to imagine that they are uncovering an ultimate truth, a transcendent reality, in order to be effective.  Heisenberg, the quantum physicist, who along with Einstein is perhaps the most influential scientist of the twentieth century, came to the same conclusion.  In his book, Physics and Philosophy, strangely – or perhaps on reflection not so strangely – largely overlooked by realist philosophers, Heisenberg gives up on the notion that science is the uncovering of an ultimate reality.  He argues: ‘We have learnt that exact science is possible without the basis of dogmatic realism’ and goes on to say that in the interpretation of quantum mechanics now central to contemporary physics and with which he is associated, the Copenhagen interpretation, ‘objective reality has evaporated’.

The 18th century German philosopher Immanuel Kant started from the assumption of knowledge and the success of science, and attempted to create a philosophical framework that would account for how that knowledge was possible.  Our current predicament is the reverse.  We have to start from the assumption that we have no knowledge of an independent reality and formulate a theory that accounts for how nevertheless we are able to be so precise and effective in our interventions in the world. I have sought to put forward such an account.  It proposes that  . . .

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Written by Leisureguy

28 December 2019 at 3:25 pm

Posted in Books, Daily life, Education, Science

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“Little Women” as a free ebook

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From Standard Books, who makes high-quality ebook editions of out-of-copyright works freely available in several formats:

  • epub—All devices and apps except Amazon Kindle and Kobo.
  • azw3—Amazon Kindle devices and apps. Also download the Kindle cover thumbnail to see the cover in your Kindle’s library.
  • kepub—Kobo devices and apps.
  • epub3—Advanced format not yet fully compatible with most ereaders.

I wanted to read again Little Women to reacquaint myself with the book, and Amazon has on its site only versions that cost $3-$5, which seems too much more a book for which the copyright has long since elapsed. So I took a look at the Standard Books list of ebooks, and there it is, now on my Kindle.

Written by Leisureguy

28 December 2019 at 12:28 pm

Posted in Books, Software, Technology

The problem with the Right is not that it’s wrong.

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Julian S. Taylor writes in Medium:

To a progressive liberal, the right of all adults to participate directly in their governance seems obvious, so how is it that the authoritarian regime seems to be in ascendancy the world over? Where is the general public gathering to be taught that they need autocratic direction? Where are average people persuaded that they are not actually human beings but instead animals in need of herding? Of course one need look no further than the nearest pulpit. Christ is The Good Shepherd and His flock is comprised of what many of us would call “humans”: humans who believe themselves to be sheep. Televangelist Joel Osteen tells seven million people every week “you’ve got to live an obedient life” and by that he means obedience to an all-knowing god. The motto of Kenneth Copeland Ministries is “Jesus is Lord.” A lord, of course, is the owner of the land and sovereign of all workers on that land. He collects the fruit of the workers’ labor and ultimately controls them. Oral Roberts was a faith healer meaning that members of his flock would come to him offering obeisance in return for the special gift that only he could provide. From these pulpits, the message spreads as each true believer carries their minister’s message to friends and associates. With this ancient and pervasive legacy, no wonder a sizable majority of people believe that a leader is essential to a healthy society. Those people proudly assert the philosophy of the right wing.

Various middle-of-the-road Democrats and Independents seek to express their belief that despite our differences, we are all intent upon the common goal of a functional democracy; but, of course, we do not all believe in democracy. The right and the left identify distinct poles. The words derive from L’États généraux of 1789: the French General Assembly of the Estates just preceding the French Revolution. In that gathering, those who believed that human beings had a right to govern themselves were largely gathered to the left of the president’s seat. Those who believed that humans were merely sheep who needed to be directed by a shepherd of some sort were gathered at the right of the president’s seat. Left versus Right defined those who favored democracy and those who favored monarchy.

By today’s standards the founding fathers of the U.S. were somewhere between left and right. They took their cues from the ancient democracies of Sparta and Athens which often restricted voting rights to an elite subset of the general population. For this reason, our founders suggested that white male landowners were best suited to govern. Fortunately, they provided for amending the Constitution and through that process, we have significantly expanded the voting population as the U.S. has moved consistently leftward over the past centuries.

Despite their firmly held beliefs, everyone on the left spends some time in doubt. It was U.S. voters who gave us “W” and Trump. It was U.S. voters who gave gerrymandering Republicans free reign to assure continuous Republican majorities. It was British voters who decided to Brexit when the U.K. was enjoying all the advantages of E.U. membership without the disadvantage of adopting the Euro. Every lefty knows that there are real rational people who seriously question whether democracy makes any sense at all; and every lefty wonders if that claim may actually be true. I regret to say that I, yes even I, a progressive liberal have occasionally despaired, writing in my 2006 novel The Flying Crossbeam

“[Politicians learned an essential lesson.] That virtue is not only insufficient, it is the heart of failure. That truth is not merely unnecessary, it is misleading. That the shepherd may not guide through reason, but only by sending dogs into the flock and calling repeatedly in a familiar voice.”

This is the hopeless cry of the doubting democrat and the legitimate proclamation of the right-wing autocrat. When Adlai Stevenson was told by an enthusiastic supporter that every intelligent American would vote for him, he responded, “Perhaps, ma’am — but unfortunately I require a majority.” Even Stevenson, an exemplar of the left, did not trust that people were qualified to vote wisely.

The ongoing question confronted by the left wing is how to . . .

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Written by Leisureguy

28 December 2019 at 12:22 pm

Posted in Democrats, GOP, Memes, Politics

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