learning to ride the bicycle

Denning

Henderson, the London journalist

Astronomical Exchange

Stent, the Astronomer Royal

Given that engagement and integration(i.e., involvement in the various social and academic ac-tivities of university/college life) are considered key tosuccessful academic achievement (see Tinto2006), theidentifying features of social anxiety, including fear ofnegative evaluation and distress and avoidance of new orall social situations (Ginsburg et al.1998), may be espe-cially disadvantageous in the social and evaluative contexts

Gymnastics is a sport in which athletes called gymnasts perform acrobatic feats – leaps, flips, turns, handstands and more – on a piece of apparatus such as a balance beam, or with a piece of apparatus like a rope or ribbon. 

“It doesn’t just help make hospitalists work better. It makes nursing better. It makes surgeons better. It makes pharmacy better.”

In the last 20 years, HM and technology have drastically changed the hospital landscape. But was HM pushed along by generational advances in computing power, smart devices in the shape of phones and tablets, and the software that powered those machines? Or was technology spurred on by having people it could serve directly in the hospital, as opposed to the traditionally fragmented system that preceded HM? “Bob [Wachter] and others used to joke that the only people that actually understand the computer system are the hospitalists,” Dr. Goldman notes. “Chicken or the egg, right?” adds Dr. Merlino of Press Ganey. “Technology is an enabler that helps providers deliver better care. I think healthcare quality in general has been helped by both.

“This has all been an economic move,” she says. “People sort of forget that, I think. It was discovered by some of the HMOs on the West Coast, and it was really not the HMOs, it was the medical groups that were taking risks—economic risks for their group of patients—that figured out if they sent … primary-care people to the hospital and they assigned them on a rotation of a week at a time, that they can bring down the LOS in the hospital. “That meant more money in their own pockets because the medical group was taking the risk.” Once hospitalists set up practice in a hospital, C-suite administrators quickly saw them gaining patient share and began realizing that they could be partners. “They woke up one day, and just like that, they pay attention to how many cases the orthopedist does,” she says. “[They said], ‘Oh, Dr. Smith did 10 cases last week, he did 10 cases this week, then he did no cases or he did two cases. … They started to come to the hospitalists and say, ‘Look, you’re controlling X% of my patients a day. We’re having a length of stay problem; we’re having an early-discharge problem.’ Whatever it was, they were looking for partners to try to solve these issues.” And when hospitalists grew in number again as the model continued to take hold and blossom as an effective care-delivery method, hospitalists again were turned to as partners. “Once you get to that point, that you’re seeing enough patients and you’re enough of a movement,” Dr. Gorman says, “you get asked to be on the pharmacy committee and this committee, and chairman of the medical staff, and all those sort of things, and those evolve over time.”

Two major complaints emerged early on, Dr. Gorman says. Number one was the notion that hospitalists were enablers, allowing PCPs to shirk their long-established duty of shepherding their patients’ care through the walls of their local hospital. Number two, ironically, was the opposite: PCPs who didn’t want to cede control of their patients also moonlit taking ED calls that could generate patients for their own practice.

Dr. Wachter and other early leaders also worried that patients, used to continuity of care with their primary-care doctors, would not take well to hospitalists. Would patients revolt against the idea of a new doctor seeing them every day?

Some “specialists worried that if hospitalists were more knowledgeable than once-a-month-a-year attendings, and knew more about what was going on, they would be less likely to consult a specialist,” Dr. Goldman explains, adding he and Dr. Wachter thought that would be an unintended consequence of HM. “If there was a reduction in requested consults, that expertise would somehow be lost.”

Perhaps the biggest concerns to hospital medicine in the beginning came from the residents at UCSF. Initially, residents worried—some aloud—that hospitalists would become too controlling and “take away their delegated and graduated autonomy,” Dr. Goldman recalls

But those efforts were few and far between. And they were nearly all in the community setting. No one had tried to staff inpatient services with committed generalists in an academic setting.

The model Dr. Wachter settled on—internal medicine physicians who practice solely in the hospital—wasn’t entirely novel. He recalled an American College of Physicians (ACP) presentation at 7 a.m. on a Sunday in 1995, the sort of session most conventioneers choose sleep over. Also, some doctors nationwide, in Minnesota and Arizona, for instance, were hospital-based as healthcare maintenance organizations (HMOs) struggled to make care more efficient and less costly to provide.

That makes this challenge a lot harder to resolve than if we had tried a century ago

racial preferences still shape where people choose to live today.

behavior that's beyond the reach of regulation

restrictive covenants

Fair Housing Act

"we would still have very segregated cities, because a certain number whites were unwilling to live with blacks."

Shertzer and Walsh are pointing to another set of factors — not the policies of institutions, but the behavior of individuals.

That makes this earlier form of white flight even more striking; their new homes didn't necessarily have lower taxes or better school districts, factors that complicated the motivations of later generations of whites.

"Whites left the neighborhood as a result of blacks arriving," Shertzer says, "not for other reasons."

As blacks arrived in northern neighborhoods, more whites left.

relevant to American cities that are still racially divided today

"White flight" is usually described as a post-World War II phenomenon

Notes

Veronese’s Nozze di Cana,

impairment of left hemisphere functions may enhance the propensity for violent behavior in a subgroup of offenders

focal abnormalities, however, especially of the left hemisphere, were related to a significantly higher number of violent offenses

Indeed, the sampledrecruits were selected under a new police recruitment program that requiresthat all recruits to enroll in and complete a university diploma.

Indeed, the profiler training program of the FBI iden-tifies seniority and accomplishment in policing as essential prerequisites forits training program

the police were no more accurate than anyone else in their depiction oftheoffender

several skillsthat they regard as necessary for effective profiling, among them being anunderstanding of the criminal mind, investigative experience, an ability tothink logically and objectively, and intuition.

Singers

play with

The background puzzle: how identical mutations in the same gene lead to different disease symptoms

This is hardly less arbitrarily unjust or patriarchal than the actualsystem of patrilineal inheritance consolidated in the eighteenth century, formingthe backbone of the British economy and its law, and providing the historicalbackground to Jane Austen’s novels

If a branch reaches the very top line where you can see a10, f10, and m10, then that species avoided extinction.

Septuagint

From the ferocity of pig driven to holiness, From the furred ear and the full jowl come The repose of the hung belly, from the purpose

Out of creosote, gasoline, drive shafts, wooden dollies

the material and the formal

The concept of presearch is an important one for this chapter; Ed-ward’s reliance on Wikipedia and Susan’s reliance on Google are not research crutches, but useful presearch tools

Wikipedia brings ideas together on a single page as well as provides an accompanying narrative or summary that writers are often looking for during their research, particularly in the early stages of it.

The consensus so far has been that Swartz did something wrong by accessing and releasing millions of academic papers from the JSTOR archive.

It is useful, in framing laws, not only to study the past history of one's own country, in order to understand which constitution is desirable for it now, but also to have a knowledge of the constitutions of other nations, and so to learn for what kinds of nation the various kinds of constitution are suited.