The Takeaways: Week 33 of 2021

A periodic review of articles, newsletters, and podcasts that I found interesting, inspiring, or otherwise worth remembering.

Closed Tab of the Week

I always have many tabs open. A good number of them hang around because of the mismatch between my interest in engaging with them and the time I have available for that engagement. Here I pick one to review, think about, and close out.

Rich Harris, DEV Community. In Defense of the Modern Web (May 15, 2020)

Invoking but not really lingering on a range of web development binaries, Harris puts his main point at the end:

The future I want — the future I see — is one with tooling that's accessible to the greatest number of people (including designers), that can intelligently move work between server and client as appropriate, that lets us build experiences that compete with native on UX (yes, even for blogs!), and where upgrading part of a site to 'interactive' or from 'static' to 'dynamic' doesn't involve communication across disparate teams using different technologies. We can only get there by committing to the paradigm Tom [MacWright] critiques — the JavaScript-ish component framework server-rendered SPA.

Among other observations, MacWright questions the current common pattern of having a frontend in a Javascript framework and a backend API layer through which the front end accesses the data layer. Harris perceives McKnight as wanting to abandon this approach altogether. He instead sees the issue as one where modern development has stopped at the level of the page rather than continuing to unlock interactivity at a finer level: transitions, components, and other primitives.

Take transitions for example. Web developers are currently trapped in a mindset of discrete pages with jarring transitions — click a link, see the entire page get replaced whether through client-side routing or a page reload — while native app developers are thinking on another level... It will take more than technological advancement to get the web there; it will take a cultural shift as well. But we certainly can't get there if we abandon our current trajectory. Which is exactly what Tom seems to be suggesting.

For Harris, then, the future is one where developers and others work in smaller spaces but with potentially a higher burden in keeping the spaces articulated as pieces of a larger whole.

It's a good goal, although the increasing number of moving parts will increase the number of interdependencies, especially in data-rich and interaction-rich applications. If the tooling becomes more accessible, that can make it possible to work more granularly. Will we see a willingness to commit the time and cognitive resources to keeping track of how it all works together once the tooling demands have lessened? If not, will we end up with Conway's Law inside of a page, no longer just at the architectural levels?

Newsletters

Ted Gioia, The Honest Broker. How Jazz Was Declared Dead—Then Came Roaring Back to Life (August 15, 2021)

Yet if you walked into one of the London clubs where the up-and-coming artists and bands perform, you may think you have arrived at the wrong address, so little is this music beholden to traditional conceptions of jazz. You might hear danceable beats, trance-like vamps and riffs, reggae or rock rhythms, electronic sounds and samples, soulful vocals and urban raps, and other aural bric-a-brac drawn from a full global village of sources. But on closer attention, you will also notice the saxophones and trumpets and other time-honored emblems of the genre, and get drawn in by the spontaneity and in-the-moment vitality that have always defined the jazz experience. The sheer diversity of sounds is striking, but even more the lack of pretense and elitism. If you harbor concerns that a soulless generation of degree-certified jazz museum curators has taken over the bandstands, a night of clubbing in London will ease your worries.

Kevin O’Leary and Ryan Russell, Health Tech Nerds. Weekly Health Tech Reads 8/22 (August 22, 2021)

Several good resources to review later, including:

Olivia Webb, Acute Condition. PaaS companies and telehealth engagement numbers (August 19, 2021)

Where and how a patient gets care is guided by the “front door,” a term for the patient journey from deciding to explore care options to actually accessing care. Traditionally, the front door was the patient’s primary care doctor, who guided the patient through care and/or referred them to a specialist. Now that primary care doctors are no longer the gatekeepers they once were, the journey has become much more fragmented.

The problem: Patients don’t really know when to use telehealth, and they don’t think of telehealth when they start to feel sick. The potential solution: Add a better front door.

Rachel Werner, Tradeoffs Research Corner. Private equity's impact on nursing home quality

What they found was startling. Going to a private equity-owned nursing home increased individuals’ short-term mortality by 10% during and for 90 days after the nursing home stay. These stays were also at a higher cost, with Medicare spending 11% more over that time. The authors also showed a decline in nursing home quality (measured using Medicare’s Five Star ratings) and a decline in nurse staffing levels, perhaps explaining why mortality rates rose.

Articles

Cara Anthony, KHN. In Rural America, Twisting Arms to Take a Covid Vaccine First Takes Trust

Only 16% of residents here in Alexander County are fully vaccinated against covid-19, the lowest rate in Illinois, according to the state health department. And case counts of coronavirus infections are rising. So the Cooperative Extension System, which is tied to a network of land-grant universities, plans to spend the next two years talking about vaccines in this community and elsewhere. It may take that long or more to persuade enough people to get vaccinated.

The extension system has a tradition of bringing research-based information to communities on a wide variety of topics, including water quality, food safety and disaster preparedness. With its roots sunk deep in rural America, where vaccines have been slow to catch on, the system is now using state and federal funding to pay for immunization education efforts tailored to specific communities.

Already 4-H clubs have been making masks and face shields. In Illinois, the agency has a covid resource guide for families, business owners and farmers. The office covering the southern portion of the state is now looking to hire someone in the community to help get out the word on why vaccinations matter. Johnson also wants to team up with local churches, civic groups and business owners to get the job done.

“This is not our first global pandemic,” said Carissa Nelson, a spokesperson for 4-H programs in Illinois. The organization’s agents and club members nursed patients during the 1918 flu pandemic that devastated the world.

Helen Branswell, STAT. The fine print: Understanding the new policy authorizing extra Covid vaccine doses for the immunocompromised (August 15, 2021)

The free-for-all: It’s widely known that lots of Americans aren’t waiting for the government to decide whether to authorize booster doses for everyone who has been vaccinated. The CDC is aware that at least 1.1 million people have managed to get themselves another dose, ABC News reported recently.

Lev Facher, STAT. ‘It’s soul-draining’: Health workers deployed to Covid hot zones are overwhelmed by deaths among the unvaccinated (August 18, 2021)

No team of health workers in this country feels the brunt of Covid-19 more acutely than [nurse Bren] Ingle’s unit [of the NDMS]. The National Disaster Medical System is the team of clinicians called to action when things go wrong — and for the past year and a half, nothing has gone right. Time and time again, they have been dispatched to staff hospitals short on nurses or set up parking-lot field hospitals in states where no patient beds remain.

One physician assistant working a two-week shift in Baton Rouge, Erin Lennon, said she received her request to deploy to Louisiana while halfway through a noon-to-midnight shift at her full-time job in Colorado. Like Ingle, she was given a night’s notice to pack and board a plane at the crack of dawn.

She came despite personal risk — she is pregnant with a child due in November — and despite the pent-up exhaustion of a year and a half of work treating Covid-19 patients.

“It’s soul-draining,” she said. “But we all have our ethos and our calling for why we’re doing this. This is what we trained for. This is what we do. I can’t walk away from something that’s important just because it’s hard.”

Andrew Gelman, Statistical Modeling, Causal Inference, and Social Science. Here’s why I don’t trust the Nudgelords ... (August 17, 2021)

They don’t admit their mistakes. In particular, they don’t admit when they’ve been conned.

Megan Hernbroth and Shelby Livingston, Business Insider. Dollar General hired a key health executive, but that's just the start. Here are 3 ways the discount chain could upend the $3.8 trillion healthcare industry. (August 9, 2021)

Insider spoke with four analysts, experts, and healthcare insiders to learn the different ways in which Dollar General could take on the healthcare industry. They laid out three distinct strategies the chain could pursue.

  • Low-cost, over-the-counter medications could bolster Dollar General's bottom line
  • In-person or online pharmacy partnerships could alleviate inequities but come at a cost
  • Primary-care clinics aren't likely, but Dollar General could wade into telemedicine

Ben Kuhn. You don’t need to work on hard problems (February 23, 2020)

When I first graduated, I was afraid that if I worked with boring technology, I’d get bored. Instead, I learned it was possible—and fun—to optimize on other dimensions, or play a different game. Rather than competing for an A+ on a hard problem, I could try to solve an easy problem as quickly as possible (like Wave’s accounting), or find the easiest problem whose solution would be useful (like identifying Kenyan names), or hire a team to solve easy problems faster than I ever could myself.

In fact, these turned out to be even more interesting! Why? Because “hard technical problems” wasn’t my root goal—my root goal was to use my skills to get the most possible leverage on improving the world.

Sarah Kwon, KHN. Apple Aims to Push More Patient Data to Doctors. But Who Can Gauge Its Impact on Health? (August 12, 2021)

While some doctors appreciate seeing records of home-monitored blood pressure, exercise and the like between visits, for others the data is more of a burden than an asset.

Stephanie M. Lee, Buzzfeed. A Big Study About Honesty Turns Out To Be Based On Fake Data (August 20, 2021)

The researchers who published the study all agree that its data appear to be fraudulent and have requested that the journal, the Proceedings of the National Academy of Sciences, retract it. But it’s still unclear who made up the data or why — and four of the five authors said they played no part in collecting the data for the test in question.

That leaves Ariely, who confirmed that he alone was in touch with the insurance company that ran the test with its customers and provided him with the data. But he insisted that he was innocent, implying it was the company that was responsible. “I can see why it is tempting to think that I had something to do with creating the data in a fraudulent way,” he told BuzzFeed News. “I can see why it would be tempting to jump to that conclusion, but I didn’t.”

Claudia López Lloreda, STAT. Elective surgeries are being delayed again. Doctors want to handle it differently this time (August 13, 2021)

As during the pandemic’s first wave a year ago, hospitals in hard-hit places, including Florida, Louisiana, and Tennessee, have in recent days had to pause, delay, or reschedule tests, procedures, and surgeries that are considered “elective” and nonurgent. This means that hospital staff are going through a frustrating moment of déjà vu... Instead of a general pause, most hospitals are examining case by case to determine whether and how long a particular procedure can be delayed.

Jeffrey Morris, Covid-19 Data Science. Israeli data: How can efficacy vs. severe disease be strong when 60% of hospitalized are vaccinated? (August 17, 2021; modified August 22, 2021)

Answer, according to this analysis: Simpson's Paradox.

As a result, we should be wary of any claims that simply report raw counts or overall efficacy figures without stratification, and we need to look to careful data analyses from published papers that take these factors into account using available statistical methods for causal inference, transparently described in detail, if we want an accurate sense of the potential causal effect of vaccines.

Eric Nehrlich, Unrepentant Generalist. The Present Moment Is Everything You Need

Being present is what will allow me to confront the shadow patterns of the past that derail me from creating the future I desire. Paying attention to those patterns is hard work, because they are designed to operate below the radar. To enable that close attention, I have to resource myself through self-care practices like sleep, exercise, good food, and meaningful human connection. And each of those practices yields more when I am mindfully present with them, rather than rushing through them to check them off a list. But when I am acting from a place of resourced presence, I can take the actions that represent the life I want to live, and thereby create the future I choose.

Allie Reed, Bloomberg Law. Medicare Holds Off on Hospital Price Disclosure Fines for Now (August 16, 2021)

The price disclosure requirements has put hospitals in a tough position, which many groups have been vocal about. Hospitals that publish their prices as-is could dissuade consumers from seeking care if they can’t afford the typical fee for treatment. Those that lower their prices as a result of being asked to publish them could hurt their revenue streams. Not complying with the rule opens hospitals up to monetary penalties that could get steeper.

Joshua Rothman, The New Yorker. Why Is It So Hard to Be Rational? (August 23, 2021)

It’s partly because of Charlotte’s example that Lizzy looks more closely at Mr. Darcy, and discovers that he is flawed in predictable ways but good in unusual ones.

Dylan White 173, Gmail Help Community. Gmail is opening and caching urls within emails without user intervention. How and why? (October 15, 2019)

The problem we are seeing is that sometimes gmail will go through an email and follow a url (not just an image link either) to cache it even if the user does not click on the link.