How Wi-Fi Works - <AUTHOR> http://www.verizoninternet.com/bookmark/how-wifi-works/ <comment><USER2> This is (good) SEO linkbait. Someone at Verizon got $10k to spend getting it created by saying it will boost organic search traffic to Verizon. Right now (during link-building phase) they keep the page completely separate from rest of site. Later, (after most links are created) they'll change it. Not sure whether the goal is just to generally build authority to VerizonInternet, or to get this URL ranking for wifi keywords. (Seems more likely the former.)

<comment><USER3> That page probably cost a lot more than 10K.

<comment><USER4> Absolutely. They did a great job too

<comment><USER5> Browser could not initialize WebGL For more info visit blend4web.com/doc/en/problems_and_solutions.html#problems-upon-startup

Maybe they could have done a good job instead of a great job and this page would actually work.

Not mention the font size issues and overlapping text, luckily they provide images at the bottom that do not have the problem.

When you have to provide images at the bottom as a workaround, it usually means you know there are issues with the page and the job is not that great.

Then again, as pointed in other comments here some of the technical information is incorrect or just plain wrong.

</comment></comment></comment></comment><comment><USER6> As hatsunearu said, the radio modulation described is grossly incorrect. WiFi never uses 8-PSK (encoding 3 bits per symbol). 802.11n and 11ac encode 1/2/4/6/8 bits using a BPSK/QPSK/16-QAM/64-QAM/256-QAM symbol (256-QAM is for 11ac only). The modulation scheme is negotiated based on signal quality. Here is a quick reference: [http://mcsindex.com/](http://mcsindex.com/) (MCS = modulation coding scheme) On Linux you can find the MCS negotiated with "iw dev wlan0 link | grep -i mcs"

14 channels are defined in the 2.4GHz band. For example channel 6 is centered on 2437 MHz. Each channel is 20MHz wide and divided in 52 "data" subcarriers, each occupying a different frequency and spaced out by 312.5 kHz (52 × 312.5 kHz is less than 20 MHz because there are "control" subcarriers and additional spacing.) So 52 different symbols can be sent in parallel at the same time, which is what we call OFDM [https://en.wikipedia.org/wiki/Orthogonal_frequency- division_...](https://en.wikipedia.org/wiki/Orthogonal_frequency- division_multiplexing) (basically, I'm simplifying!)

Remember this is for just 1 channel. So with 14 channels each composed of 52 subcarriers, we could have 728 symbols transmitted at the same time. If they are 256-QAM symbols that's basically 728 × 8 = 5824 bits being transmitted at the same time in the air. And they will all be received and demodulated independently. This high level of parallelism of OFDM is how WiFi can achieve very high throughput.

Then, with wide channels of 40 MHz, which basically aggregate two 20 MHz channels, we get a few more data subcarriers because we don't need as many control subcarriers so a few of them become used as data subcarriers. Hence a 40 MHz channel will have not 52 × 2 = 104 but actually 108 data subcarriers. And 802.11ac defines 80 MHz and 160 MHz channels with respectively 234 and 468 data subcarriers.

Let's calculate the maximum usable throughput of a single 802.11ac 160 MHz channel using 256-QAM modulation... It sends 468 symbols at the same time on 468 data subcarriers. Each symbol encodes 8 bits and takes in the best case 3.6us to be transmitted: 3.2us for the actual symbol + a short guard interval of 0.4us (the GI is normally 0.8us but can be a short GI of 0.4us if negotiated). The raw physical bitrate is:

1/3.6e-6 × 468 × 8 = 1.04 Gbit/s

However there is a mandatory error correction which is 5/6 in the best case so the actual usable bandwidth is:

1.04 × 5/6 = 866.67 Mbit/s

<comment><USER7> Note that, although the 2.4GHz spectrum is formally divided into 12-14 channels (depending on local regulations), these are very _narrow_ channels; in practice there are only 3 non-overlapping 20MHz-wide channels. This is a small fraction of the width of the 5GHz band.

<comment><USER8> There are 3 non-overlapping 2.4Ghz channels (1,6,11) for 802.11b, because of the channel spectrum shape. Not only "b" uses 22Mhz channels with is just a bit too wide, but also, due to the way how single-carrier PSK modulation works, especially on older hardware, "b" has considerable amount of spurious emissions adjacent to the main carrier that widen it even more - could be seen here as smaller "hills" to the left and right [1],[2].

802.1g/n/ac can easily have _4_ non-overlapping channels (1,5,9,13) because (thanks to OFDM) channel spectrum is much neater with rather square 20 (40) Mhz channels with practically no energy outside [3].

Yet, everybody's stuck with 1,6,11 channel scheme which is wasting precious bandwidth. [4] (middle graph) Notice gaps between the channels that could be eliminated by moving 6->5 and 11->9, and gap on the right where channel 13 can fit after that.

[1] [https://villagetelco.org/2009/11/rf- hacking/](https://villagetelco.org/2009/11/rf-hacking/)

[2] [http://ecee.colorado.edu/~ecen4242/wlanb/index_files/image02...](http://ecee.colorado.edu/~ecen4242/wlanb/index_files/image029.gif)

[3] [http://rfmw.em.keysight.com/rfcomms/n4010a/n4010aWLAN/online...](http://rfmw.em.keysight.com/rfcomms/n4010a/n4010aWLAN/onlineguide/transmitter_spectral_mask_test__\(802.11n\).htm)

[4] [https://www.codify.com/wp-content/uploads/2009/07/Central- Ro...](https://www.codify.com/wp-content/uploads/2009/07/Central-Room-A- Spectrum.png)

<comment><USER9> > Yet, everybody's stuck with 1,6,11

Reminds me of:

[https://blog.xkcd.com/2009/09/02/urinal-protocol- vulnerabili...](https://blog.xkcd.com/2009/09/02/urinal-protocol- vulnerability/)

</comment></comment></comment></comment><comment><USER10> "How Wi-Fi Works" \--> 503 Service Unavailable

Seems about right.

<comment><USER11> Hahaha, I was about to post just that. Made me laugh. Reminds me of my time at university... during breaks and boring lectures, WiFi was impossible to use because of the load. You could probably measure how boring a lecture is by recording WiFi latency and stability parameters.

</comment></comment><comment><USER12> Getting a 404 now. Any idea where the page went? (Here's an archive link: [https://web.archive.org/web/20170723145452/http://www.verizo...](https://web.archive.org/web/20170723145452/http://www.verizoninternet.com/bookmark/how- wifi-works/))

<comment><USER13> Are you sure it was a 404? I'm getting a 503 (Service Temporarily Unavailable). Not that it really matters...

</comment></comment><comment><USER14> This is beautiful, but probably still too complex for most of their customers. I wonder what their motive in putting this together was, as it must have been very expensive.

<comment><USER15> Yeah, it is beautiful.

Unlike their overcomplicated phone plans and billing statements which are deliberately obscure and their customer service which they run like a 2-bit boiler room operation.

<comment><USER16> Specially obscure. Which is like scamming, because most people won't try to understand it.

</comment></comment></comment><comment><USER17> Just a reminder that Verizon its the biggest lobbyist against Net Neutrality[0] and if you do support it then it's probably wise to stay away from their services as far as possible.

[0] [https://www.dailydot.com/layer8/lobbyists-net-neutrality- fcc...](https://www.dailydot.com/layer8/lobbyists-net-neutrality-fcc/)

</comment><comment><USER18> Mirror: [http://webcache.googleusercontent.com/search?q=cache:http://...](http://webcache.googleusercontent.com/search?q=cache:http://www.verizoninternet.com/bookmark/how- wifi-works/)

<comment><USER19> google cache doesn't do the page justice. most of the value is in its visualizations.

<comment><USER20> The cache now has the images, though it didn't when first posted. Honestly, the Google cache is _better_ than the original as it doesn't have the CPU- killing animations.

<comment><USER21> No images for me :/

</comment></comment></comment></comment><comment><USER22> Speaking of how wifi works, I learned something interesting about wifi and Verizon's partner in many things, Comcast: Last night I notified my home Internet acting funny, and learned that the admin interface for my Comcast router had username "admin", password "password". SMH.

<comment><USER23> I mean, I just got a 10-gig router,[1] and the stock username/password was "ubnt"/"ubnt." It's always the installer's job to set up a new username/password.

[1] [https://community.ubnt.com/t5/EdgeMAX-Stories/EdgeRouter- Inf...](https://community.ubnt.com/t5/EdgeMAX-Stories/EdgeRouter-Infinity-XG- New-kid-on-the-block-taking-EdgeMax-to/cns-p/1879930)

<comment><USER24> Why not generate a long password and print it on the backside? My DSL provider can do it (for my DSL router)

<comment><USER25> People might be less inclined to change it. And they should change it, because some firm knowing your password isn't safe either.

<comment><USER26> It's worth noting that all the ISPs that encourage you to change your password have a separate maintenance account ("backdoor") with its own password.

</comment></comment></comment></comment></comment><comment><USER27> Does anyone know, if I'm on a WPA2-PSK wi-fi, do other devices that are also on the same network can "sniff" my traffic. For unprotected networks it's obvious, but what about protected?

<comment><USER28> Yes, if you know the PSK (=password) and can capture the initial handshake (which is easy, since you can just force-disconnect a client so it has to do a new one) you can decrypt it. (If I remember correctly, Wireshark has this built in, so you can try it for yourself if you are curious)

<comment><USER29> I'm assuming you mean a malicious device can force a deauth on another client (or more usually, all other clients) and then capture the packets as they reconnect. If so, is there a way to detect this? Is there any way to protect against this? I'm assuming client isolation makes it more difficult.

<comment><USER30> Well, the easiest way to protect against it is making sure an attacker doesn't know your wifi password.

<comment><USER27> Of course, but I'm working in a big office with office-private wi-fi with one password. And who knows what viruses my colleagues have.

Also, I have a pretty special audience of hackers here, so I wouldn't be surprised if someone actually tries it.

Same goes for various events and conferences.

</comment></comment></comment></comment></comment><comment><USER31> I had to disable the ad blocker to get the nice web gl graphics.

From a front end perspective I think this it's awesome. No so sure about the content though.

</comment><comment><USER32> I was looking at this and thought it looked nice but then my computer froze so maybe they overdid the 3D graphics a bit?

<comment><USER20> Try the Google cache, it now has the images but not the animations: [http://webcache.googleusercontent.com/search?q=cache:http://...](http://webcache.googleusercontent.com/search?q=cache:http://www.verizoninternet.com/bookmark/how- wifi-works/)

</comment></comment><comment><USER33> the radio stuff is pretty wrong; one glaring one is that PSK is pretty much not used anymore, it's all OFDM.

<comment><USER23> OFDM is orthogonal to PSK (hah). PSK is a modulation--a way of representing bits on a carrier wave. Another type of modulation is QAM. OFDM is a way of combining multiple sub-carriers (each modulated with PSK or QAM) into one signal in order to deal with multi-path distortion: [https://www.csie.ntu.edu.tw/~hsinmu/courses/_media/wn_11fall...](https://www.csie.ntu.edu.tw/~hsinmu/courses/_media/wn_11fall/ofdm_new.pdf).

<comment><USER6> Still, hatsunearu is correct. The page is grossly wrong, absolutely no modern WiFi modulation technique uses 8-PSK. Have a look at [http://mcsindex.com/](http://mcsindex.com/) 11a/11n/11ac all use BPSK, QPSK, 16-QAM, 64-QAM, and (for 11ac only) 256-QAM.

<comment> m-j-fox I know. And not a word on forward-error correction, trellis codes, automatic gain control, beam steering or MU-MIMO. Is this for babies? They don't even touch on low-noise amplifiers. Much less DAC and ADC performance. Where's the link a primer on FFT?

</comment></comment></comment></comment><comment><USER34> Can someone explain the natural resonance of walls of talked about with regards to 5Ghz?

</comment><comment><USER35> Why did CSS stop working

</comment><comment><USER36> Pretty sure that domain isn't owned by Verizon. Looks like an authorized seller creating content to try to build authority.

<comment><USER2> Looks like it is actually owned by Verizon, see email contact on WHOIS [http://whois.domaintools.com/verizoninternet.com](http://whois.domaintools.com/verizoninternet.com)

</comment></comment><comment><USER37> wi-Fi is a best device! but is can work slow than wire. [https://www.webhostingonedollar.com/](https://www.webhostingonedollar.com/) visit for getting more detail about hosting plan.

</comment><comment><USER38> TL;DR: It doesn't.

</comment><comment><USER39> website crashes chrome on windows after a few seconds.

</comment><comment><USER40> In my experience it doesn't. My every attempt at improving this shit ends up in laying more wires everywhere.

</comment><comment><USER41> Stopped reading at "Wi-Fi antennas send information". Antennas don't send anything, they just match the impedance of the feedline into that of the medium.</comment>


The Revolution Will Not Be Televised - <AUTHOR>

Since the dawn of the industrial revolution people have been worked to death in sterile environments, devoid of passion.
In the 21st century the average employee spends 3 hours a day actually doing productive work.
The majority of people on this planet are merely existing.
Playing out their best days waiting for a retirement which may never come.
This has to change.
Startwatch is my first js project.
You plan, execute and review the most important tasks one at a time, in 10 minute bursts, measuring, learning and refining as you go.
The pain of this situation has driven me to learn things I never thought I could.
Check out the prototype and let me know what sucks/ what's awesome: www.startwatchapp.com <comment><USER2> Not every product has to be an earth-shattering revelation to be useful. You made a neat task planner. I hope a lot of people use it. In the grand scheme of things, it's not that important and neither are you. What I'm trying to say is, the text of this post annoys the crap out of me.</comment>


Google's 'Project Nightingale' Gathers Personal Health Data on Millions - <AUTHOR> https://www.wsj.com/articles/google-s-secret-project-nightingale-gathers-personal-health-data-on-millions-of-americans-11573496790?mod=rsswn <comment><USER3> Google was recently handed the confidential medical data of 1.6 million patients treated at a London hospital (Royal Free), for use by Deep Mind, in breach of the Data Protection Act: [https://www.theguardian.com/technology/2017/jul/03/google- de...](https://www.theguardian.com/technology/2017/jul/03/google- deepmind-16m-patient-royal-free-deal-data-protection-act)

<comment><USER4> I'm actually still so struck how literally _nobody_ seems to give a shit or even _know_ that this happened. It's really sad.

<comment><USER5> I'm surprised that people are still surprised by this, but then I've gotten pretty cynical at this point.

This phenomenon goes way deeper than people not caring about privacy. It underlies everything from the bystander effect [1], to the Nuremberg defence [2], and everything in between.

People just don't want to organize, generally speaking. The people who do usually end up as part of the elite. The rest are just focused on their individual lives.

[1] [https://en.wikipedia.org/wiki/Bystander_effect](https://en.wikipedia.org/wiki/Bystander_effect)

[2] [https://en.m.wikipedia.org/wiki/Superior_orders](https://en.m.wikipedia.org/wiki/Superior_orders)

<comment><USER6> > People just don't want to organize, generally speaking

They used to far more. The eighties and nineties disassembled many of the places and means to organising. Disassembly of civic community, unions, restrictions on demos, decline of social societies such as Lions Clubs and others. Now we're all individuals, organising alone.

<comment><USER7> Related:

[https://splinternews.com/organized-labor-is-in-a-life-and- de...](https://splinternews.com/organized-labor-is-in-a-life-and-death- struggle-be-ver-1823353601)

"For an entire century, the corporate class in America has dreamed of destroying organized labor, which eats into their ability to amass endless profits. They've chipped away at unions for 40 years. Now, it is no exaggeration to say that they are two steps away from total victory."

...

"This is a very scary time. Take it seriously."

</comment></comment></comment></comment></comment><comment><USER8> For the people defending Google, can someone explain a 'positive' take on making this arrangement completely in the dark? As far as I know other companies working on healthcare make big announcements on their partnerships (see [https://www.apple.com/newsroom/2019/09/apple-announces- three...](https://www.apple.com/newsroom/2019/09/apple-announces-three- groundbreaking-health-studies/)). Meanwhile, this is uncovered by an exclusive leak to WSJ. Why are they hiding it? Competitive advantage or they are aware of the dubiousness of them doing this sort of moves? Anyways, I hope we get a better message from Google than "Google spokeswoman said the project is fully compliant with federal health law and includes robust protections for patient data. An Ascension spokesman had no immediate comment".

<comment><USER9> There are a million reasons not to make an announcement until a later stage. Here's just one: if they announce, and end up not releasing anything (for whatever reason) people will cynically point to it as another example of something promising killed by Google.

<comment><USER10> "cynically"?

</comment></comment></comment><comment><USER11> While it's not sure what Google is doing here, I can tell what most companies in the healthcare data space do when dealing with data like this - they use an external vendor to essentially encrypt the "personally identifiable data" (mame, exact dob, etc) into some hash tokens before the data hits their servers from the partners. This would mean the data is still tied to a patient but not easily identifiable (at least some orgs would run reidentification risk analyses based on the types of data available within the org). It would also mean that an org like Google can (assuming it chooses to) still work with healthcare data without explicitly tying it to all their other data in a legally compliant manner.

Maybe a HIPAA expert can chime in but I'm reasonably sure it will be a violation to show you ads on your devices based on your personal healthcare data that Google obtained without your explicit consent. It might however be legal if Google uses all the patients healthcare data to train a model that it can use on all users, though.

<comment><USER12> If Google is getting Protected Health Information (names, addresses, dates, etc.) from providers then they have to sign a Business Associate Agreement, which effectively makes them a covered entity under HIPAA. They would be criminally liable for any misuse of the data, which would include using it to inform their advertising.

Using the data to create a model for use at the providers would be a clearly proper use of the data. That's standard practice across the industry.

<comment><USER13> What about Google employees looking for damaging data on adversaries? Or stalkers, looking for information on particular individuals without consent.

Why does Google get PII?

<comment><USER14> To take your argument to its conclusion, what if someone at Ascension wanted damaging information on one of its patients?

They'd be legally liable. Same as those they sign BAA with.

</comment></comment></comment></comment><comment><USER15> Anyone else find it strange in the US with the self-insured health care plans (the norm with large companies) your company has complete visibility into every health care interaction you have while employed through claims data?

<comment><USER16> This is not true. I don't like having my health care tied to my job - they are orthogonal concerns. But in the US, your employer does not have access to your healthcare records.

<comment><USER17> If it's a "self-insured" plan[1], your employer potentially has access to all insurance claims because they _are_ the insurer. That's not the same as access to complete healthcare records but it's pretty telling information.

[1] [https://www.healthcare.gov/glossary/self-insured- plan/](https://www.healthcare.gov/glossary/self-insured-plan/)

<comment><USER18> > If it's a "self-insured" plan[1], your employer potentially has access to > all insurance claims because they are the insurer. That's not the same as > access to complete healthcare records but it's pretty telling information.

No, companies almost never manage the claims themselves. They underwrite the plans, but managing claims is cost-prohibitive, as it's outside the core competency of most large companies.

<comment><USER19> Sure but they can get access to the claims data from whomever is managing it as they're paying for them.

<comment><USER20> Hence Tim Armstrong's comments about AOL spending a couple million dollars on "distressed babies" being the reason 401(k) benefits were cut.

[https://www.newyorker.com/news/amy-davidson/whose- distressed...](https://www.newyorker.com/news/amy-davidson/whose-distressed- baby-is-it)

</comment></comment></comment></comment></comment></comment><comment><USER21> Surely they could have come up with a less alarmist headline for what seems like a much needed initiative in healthcare innovation.

But that's the case for all tech coverage nowadays.

<comment><USER17> The headline is not alarming enough. This is being done without proper consent from patients and the healthcare "innovation" is likely to be inaccessible to many of those same patients due to how unaffordable health care (including preventative care) is in the US.

Edit: It basically doesn't matter what procedure Google's algorithm says you should get. If your insurance doesn't want to cover it, you're not getting it.

<comment><USER21> Evidently "consent" isn't lawfully required. The hope is that any breakthrough might lower healthcare costs, and in the worst case scenario at least some patients might benefit which is still a win.

<comment><USER17> > Evidently "consent" isn't lawfully required.

Ethics != law. Just because it's lawful doesn't mean it's ethical or that we shouldn't be outraged.

Edit: > The hope is that any breakthrough might lower healthcare costs

Perhaps then Google should instead lobby hard for single-payer. Most countries with a single-payer systems have lower health care costs than the US. It's a proven solution that _will_ lower costs, not a "hope".

</comment></comment></comment></comment><comment><USER22> > Staffers across Alphabet Inc., Google's parent, have access to the patient > information, documents show...

And now with Fitbit going Google, it appears that Google wants to know everything about you beyond your name and location. Potentially, serving you ads over your Fitbit or prescription recommendations driven by these ads.

If this is what Google calls the "future of healthcare", then they need more luck than ever, as the healthcare industry is extremely regulated when it comes to healthcare records.

<comment><USER23> I personally suspect the Fitbit acquisition has more to do with making a reliable wearable personal assistant than "ads over Fitbit." Larry and Sergei are still into the idea that we're on the cusp of getting the "everybody has a wearable personal-area-network" part of dystopia cyberpunk futures real soon now, and they want that wearable PAN to be able to track biometrics (for all kinds of reasons; it's just one more signal a personal assistant can tie into).

<comment><USER24> > Larry and Sergei are still into the idea that we're on the cusp of getting > the "everybody has a wearable personal-area-network"

Over my dead body.

<comment><USER23> Especially if you're into extreme hiking and you end up unconscious in a ditch in the wilderness with no biometric monitor connected to a GPS locator and cellular radio. ;)

<comment><USER25> Unless your family members starts seeing personalized ads about funeral services and flowers quick enough, they will never suspect you are in urgent need of medical attention.

<comment><USER23> I don't care if they know. I'm more thinking "The paramedic service that I pay a subscription fee to for LifeAlert-grade monitoring in the event of disturbing vitals."

</comment></comment></comment></comment></comment></comment><comment><USER26> It's ridiculous to think that Google would use this to serve ads.

<comment><USER27> Not ridiculous at all. Ads for (for example) heart pills are on TV now, placed at great cost, but currently blaring to an audience of mostly disinterested targets. Imagine being able to cheaply target the subset of those people who are not just part of a certain demographic, but who actually (for example) saw a cardiologist or went to the ER on a heart-attack scare in the last 12 months.

<comment><USER12> It's not ridiculous because they wouldn't want to do it, it's ridiculous because it would be illegal.

</comment></comment></comment><comment><USER28> > Neither patients nor doctors have been notified

I guess this isn't a HIPAA violation?

<comment><USER29> There is a loophole in HIPAA.

Basically, a hospital can give data to a partner if it has to in order to deliver care. But it was meant for, just as a for instance, your doctor gives a few DICOM studies to GE because they are going to concert on modifying the settings on a CT scanner to do some wiz-bang thing everyone thinks will help the patient. (Maybe even other patients down the line?)

Giving it to Google so they can serve you ads, er, um, I mean, "recommend different treatments" to you, kind of stretches the letter of the law. And definitely breaks the spirit of the law in my opinion.

<comment><USER30> > your doctor gives a few DICOM studies to GE because they are going to > concert on modifying the settings on a CT scanner

Is that actually allowed without patient consent?

<comment><USER29> No. Patient consent is part of the whole "everyone thinks [it] will help" part.

Not really sure how Google finagled their access? It's odd when neither the doctor, nor the patient knows. I wonder if even the hospital administrators knew? Or is this a decision that was made at the system level and the average hospital CEO at Ascension was none the wiser?

<comment><USER31> I hate how patient consent is typically implemented. I've seen two ER's firsthand who have someone come in with a computer, ask some questions about insurance and all, then say "please sign for the HIPPA privacy form, and again to release the information to your insurance provider".

For all you know, you're signing away for an assisted suicide and authorizing your organs to be transplanted. I refuse to sign on the pad, I'm the patient who asks for it to be printed out on paper, signs it, and gets a copy too.

<comment><USER32> That's a bit different that the consent referred to above - this is the hospital covering themselves.

If you are consenting data for a trial or otherwise sharing with a company for development, someone (often paid for separately) will typically come and walk you through the consent form.

</comment></comment></comment></comment></comment></comment><comment><USER33> It's wall-to-wall horrifying news about Google here these days

<comment><USER34> It's almost like your news sources are biased against one of their major competitors.

<comment><USER35> It's more like google is a dystopian spyware company trying to suck in as much data as possible. Not that the news sources are great, but google is genuinely far worse.

<comment><USER36> This is alarmist bullshit. "Dystopian?" Really?

</comment></comment></comment></comment><comment><USER37> [http://archive.is/1E5l9](http://archive.is/1E5l9)

</comment><comment><USER38> We really need a second Bill of Rights.

<comment><AUTHOR> Easy to make that argument when you're not providing any detail and so are giving others no way to respond. What would you put in it, and why?

</comment></comment><comment><USER39> I haven't studied this, but they do claim they're handling it right:

"All work related to Ascension's engagement with Google is HIPAA compliant and underpinned by a robust data security and protection effort and adherence to Ascension's strict requirements for data handling."

[https://www.businesswire.com/news/home/20191111005613/en/Asc...](https://www.businesswire.com/news/home/20191111005613/en/Ascension- Google-working-healthcare-transformation/)

Maybe HIPAA isn't strong enough?

</comment><comment><USER40> I've seen past instances of articles like this getting flagged here - <USER2> by a large amount of Googlers/ HR? I'm glad this didn't occur (yet).

</comment><comment><USER41> This is a compilation and revision of my comments nested deeper in the thread. Let's start from the absurdum argument that was posed:

> There's no incentive for them [Google] to improve health care for the > patients

Ignoring the fact that Google is staffed by humans, and humans have a deep visceral response to engaging in healthcare, the healthcare systems they are collaborating with (e.g. Mayo) are _strongly_ motivated to improve health of their patients, particularly in capitated models like accountable care organizations. Mayo is actually pretty famous for adopting the ACO model. Note the author on this article (1) from Mayo Clinic Proceedings is by David Shulkin, who went on to become the Secretary of Veterans Affairs.

You may also be interested to know Ascension is another ACO (2).

So why would an ACO be motivated to work with Google? Because they know reducing diagnostic variance is almost certainly identical to improving quality of diagnosis, which will reduce poor outcomes and reduce malpractice, cost of overtreatment, cost of undertreatment, and so on.

Further, let me present evidence that I believe indicates Google Health is going to be laser-focused on improving care and will actively shed any work that doesn't advance that goal. Not only their business actions, but also their leadership choices.

In terms of business actions, lets look at the NHS brew-haha. Hard to blame Google for NHS screwing up the research protocol that led to the specific 1.6M patient records being transferred to Deep Mind. And they corrected that research process years ago. Do you really think Google wants to be seen anywhere near the mishandling of private information? That presents an existential risk to their business. They passed muster with Mayo (a deal that no doubt had to pass muster with Shulkin among other world-renown physicians and administrators). They have deals with McKesson, Cleveland Clinic, and now Ascension. These are major players.

Their leadership choices give you additional insight on their motives. Their new Chief Health Officer is Karen DeSalvo, former National Coordinator for Health IT and Acting Assistant Secretary of HHS (and no doubt candidate for next Secretary of HHS). David Feinberg, their new VP for Health, is coming from serving as CEO of Geisinger and UCLA prior to that. These people are reputationally allergic to mixing medicine with adtech.

Finally, keep in mind that healthcare is widely regarded as one of the _weakest_ points in Western cyber security. Bringing in grown-ups sounds like a phenomenal move to me.

Would it be nice if the company's core business wasn't adtech? I suppose. But for all the reasons above, I genuinely believe Google getting into this space is a better net outcome than the status quo.

(1) [https://www.mayoclinicproceedings.org/article/S0025-6196(12)...](https://www.mayoclinicproceedings.org/article/S0025-6196\(12\)00565-4/abstract)

(2) [https://www.beckershospitalreview.com/acos-to- know-2019.html](https://www.beckershospitalreview.com/acos-to-know-2019.html)

<comment> the-rc > They passed muster with Mayo (a deal that no doubt had to pass muster with > Shulkin among other world-renown physicians and administrators

I used to work at both Mayo and Google.

Mayo isn't shy about the need to protect their name and reputation. They consider it one of their most valuable assets, if not the most valuable. After all, they built it over a century of hard work. Sometimes it borders on excessive. If you went to a conference, unless you were presenting, it was suggested for you to just say you're "from a large medical institution in the Midwest". If you sold them software or services, you were allowed to use their name (trademark) in the list of customers on your website, but only if the list had at least 4-5 names and it was in alphabetical order.

The day Mayo signed, also in light of their past collaboration with IBM (I was around in the BlueGene days...), I knew that Google must have committed large amounts of money and resources to the partnership. For those who are not aware, Dr Plummer at Mayo pretty much came up with the modern idea of a medical record a century ago and even had a sort of human-powered Google for records, keeping them in the basement, calling them up over intercom and delivering them over tubes.

</comment></comment><comment><USER42> Nightingale? Cuckoo, more like it.

</comment><comment><USER43> Data being used for services is inevitable, but at this point we really need two things. 1 - Laws around how shared data can be used that are more comprehensive 2 - A secure database either managed by private companies or the government (with strong oversight) that allows companies who want to use the data to access it but not store it. The key is that the companies using the data and the companies storing the data cannot be controlled or owned by the same entity. The companies who store the data also cannot be allowed to make money based on the type of data. They would need to be limited to only monetizing the cost of distributing the data. There will also be need to police that companies do not store the data they have access to.

</comment><comment><USER44> How can I opt out of this???

</comment><comment><USER45> Suddenly all the investments into genetics, aging, and biotech from Calico / Verily makes sense.

I imagine Alphabet's end goal is some kind of intrinsic understanding of every single person on a biological level in order to better target and serve them ads that fit them.

<comment><USER23> It always tickles my funny bone to see people attempt to tie every Google move to "How do we use this for ads?"

It's the opposite; Google's seeing that their revenue stream is very near a monoculture and they know monocultures can't last forever. A lot of their initiatives (cloud, video, wearables) are trying hard to find an alternate revenue stream that will be as profitable as ads so that when the industry inevitably crashes (not because of anything specific they can predict, but because all industries eventually do) they're not powering their entire empire off of a single river that just dried up.

<comment><USER46> Sure. Their biggest business outside of search is YouTube. But that doesnt make much money on subscriptions, its ads...

<comment><USER47> With Premium and TV, they are making a big push to change the YouTube revenue model away from as dependence.

<comment><USER48> Don't forget gaming. They're going after the Twitch business model there. Combining that with traditional YouTube and Stadia offers a very robust social gaming platform. They're basically going after digital entertainment all across the board, looking for opportunities to leverage cloud/ai to leapfrog encumbants.

</comment></comment></comment></comment></comment><comment><USER49> Awesome! We need grand innovation in the health records space if we truly want to help people be healthier. I hope Google does something great with this plus Fitbit. If anyone is interested in our research in this space, we are aiming to radically improve medical records and healthcare delivery/research as well. We don't have the resources of Google but everything we're doing is open and public domain: [https://pau.treenotation.org](https://pau.treenotation.org)

<comment><USER50> I completely agree, I work in healthcare data analytics and this is the first step.

My hope would be that the government can step in and make your emr (electronic medical record) something akin to your SSN. It is your data and shouldn't belong to the provider.

It would require an institutional body/government to standardize the EMR and centralize it, allow the individual to share their EMR key to whom they wish (Google, your company, etc) to help provide analytics to tailoring health care to the individual.

Wishful thinking, but I hope Google is able to make significant outcomes with the data to show it is possible.

<comment><USER49> Awesome! We are on the same page on a lot of things.

> It is your data and shouldn't belong to the provider.

Agreed! What do you think of the concept of the "Copy/Paste Test"? The idea is a good EHR should allow you to copy/paste your entire medical history into an email in a non-fragile way. If it can't do that, it's not a good EHR. We think this one dimension encompasses a lot of sub dimensions of what goes into a well designed EHR system.

> It would require an institutional body/government to standardize the EMR and > centralize it

We're thinking the opposite: decentralized, git backed, concatenative grammars. You eventually probably would indeed have one grammar rise to the top, but the idea is to allow anyone to view, suggest edits, and fork the collection of grammars. Here is the current collection of Pau Grammar files: [https://github.com/treenotation/pau/tree/master/grams](https://github.com/treenotation/pau/tree/master/grams). Note: this isn't even v1 yet, but the core ideas are there.

<comment><USER32> > The idea is a good EHR should allow you to copy/paste your entire medical > history into an email in a non-fragile way.

On the surface, this seems to be a poor test. Are you using it as a proxy for a patient to be able to get their EHR records out or something else?

<comment><USER49> > Are you using it as a proxy for a patient to be able to get their EHR > records out or something else?

It's a proxy to test a lot of dimensions at once: not only how accessible the records are to the patient (facilitating care, particularly in acute settings), but also how well designed the grammar and schemas are. Well designed grammars and schemas should survive copy/pasting easily. Any errors should be quickly and readily identified with the potential for autocorrections.

VA created a very cool thing called Blue Button ([https://www.va.gov/bluebutton/](https://www.va.gov/bluebutton/)). It is a step toward passing the copy/paste test. Any veteran can download their complete medical history in a single file. The schema isn't there yet and parsing these things is a pain, but a step in the right direction.

<comment><USER32> Ok, that makes more sense.

I guess initially I would think of this as a round-trip requirement. In theory at least I should be able to download the entirety of my history (in an appropriate format); delete the record on the EHR; re-upload my history and end up with the identical EHR record mutatis mutandis.

Sticking "email" in there had me thinking your were focused on transmission.

<comment><USER49> > I guess initially I would think of this as a round-trip requirement. In > theory at least I should be able to download the entirety of my history (in > an appropriate format); delete the record on the EHR; re-upload my history > and end up with the identical EHR record mutatis mutandis.

I like this test! Yes, passing the copy/paste test should pass this test as well.

</comment></comment></comment></comment></comment></comment></comment><comment><USER51> How to opt out?

<comment><USER52> Move to another country?

<comment><USER53> Another planet more like

</comment></comment></comment><comment><USER54> Just like hackers that violate people's privacy, Google is in the same business, only under the disguise of " terms of service " and other legal shields. It follows us daily from website to website, from location data to usage data, and on on. Surveillance capitalism is contrary to our values.

<comment><USER55> Google's _core business_ and overriding concern is voyeurism and stalking. They're creepy as hell. It should be framed in those, accurate, terms at every opportunity. It doesn't matter _why_ they're doing it—those are the actions they're taking. They're creepy, voyeuristic stalkers, to the core. It's a vital part of their income stream, inseparable from and often motivating everything else they do.

I mean granted most of the other tech giants aren't far off from them. But that just means _none_ of them should get a pass on that crap.

<comment><USER30> Remember to include every business that buys ads from Google as well.

</comment></comment></comment><comment><USER56> At some point in the future I believe there will be insurance comparison sites dealing with health, and using this 'private' data to tailor quotes to each customer. Zero privacy. Then comes spam coupons for Viagra and low cost hemorrhoid treatments.

</comment><comment><USER57> At this point, can we just pin a post to the top of every message board and forum that says:

> [For Profit Company] [verb] [adjective] data of [noun].

The point is, what do people think these thousands of engineers are doing throughout the tech industry? Do people really believe it takes 1k developers to style a login button? Or deploy a kubernetes cluster?

It's painfully simple. Capitalism dictates that companies must acquire and explore new methods of generating profit at all costs. Therefore, it should be assumed that an internet company is hoovering as much data as possible until proven otherwise.

<comment><USER58> In the US maybe. In Europe we have laws against that sort of behaviour, and generally the threat of massive legal fines is an effective counterbalance to the potential gain of data lakes.

<comment><USER59> A shame those massive fines don't get applied to IKEA's tax avoidance schemes

<comment><USER58> Shrug. You can only fine what's actually illegal, and tax avoidance currently isn't. If corporate behaviours are deemed problematic then generally laws are updated to cover that.

</comment></comment></comment></comment><comment><USER60> I read the article, but I'm a little confused. Health data is generally freely for sale in the USA, as long as you store it securely.

Is there some reason to suspect they are lying when they say the data is stored according to federal laws?

I mean, other than it being available to 150 people (a lot perhaps, but not exactly wide open), I didn't really see anything that sounded out of place in terms of the data side?

Maybe I just can't get on board with the panic about the "data is the new oil" this time. Or is it just the worry that eventually the data pipeline could spring a leak?

<comment><USER61> > Health data is generally freely for sale in the USA, as long as you store it > securely.

Huh, I didn't know that. Where does one buy it?

</comment></comment><comment><USER62> I know everyone these days likes to run around like chickens with their heads cut off when they see an article about Google or Facebook and data, but please try and calm down.

First of all, Google has already been involved in health, and will continue to do so, as the health market is 3.5 Trillion dollars. Last week they announced plans to develop a search product for electronic health records. If it works, it has the potential to make health care more efficient (as in costing you less and working out better for you). [https://news.ycombinator.com/item?id=21508205](https://news.ycombinator.com/item?id=21508205)

Second, _lots of companies collect, process, or transmit your health records_. Companies you know nothing about, and that you never scrutinize. This is perfectly legal, as HIPAA ([https://en.wikipedia.org/wiki/Health_Insurance_Portability_a...](https://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act)) provides wide leeway for companies to handle your data, as long as it is under a chain of business contracts and compliance requirements that originate with your health care provider, insurer, etc. Under the Privacy Rule, you have rights that you can exercise to verify this is all being done properly. (However, complaints will probably be ignored as HHS isn't funded properly to deal with them)

If you want to collect your internet pitchforks and go after someone, please start with the government. The rules in place are okay, but they don't mean anything without effective enforcement.

<comment><USER62> I love that this is just factual information about businesses that deal with health records, and it's still downvoted to hell.

HN: where politeness and irrationality go hand in hand</comment></comment>


U.S. Hopes "Internet in a Suitcase" Will Offset Internet Censorship - <AUTHOR> http://www.readwriteweb.com/archives/us_hopes_internet_in_a_suitcase_will_offset_intern.php#.TfakikNi4ds;hackernews <comment><USER2> I sure hope you can buy these that work inside the US :-)

</comment><comment><USER3> It's funny to see the US government pretend to care about Internet censorship.

<comment><USER4> <http://en.wikipedia.org/wiki/Tor_(anonymity_network)>

"Originally sponsored by the US Naval Research Laboratory"

They also operate proxies for China.

They clearly care.

<comment><USER5> I'd say parts of the US government care, but not all of it.

<comment><USER6> Yeah, like ICE.

</comment></comment></comment></comment><comment><USER7> Unfortunately the "freedom" of the US has been corrupted by corporate interest, and thus whilst this is in some ways admirable, there is absolutely no way a sane person could trust the US government again.

</comment><comment><USER8> That's great as long as you're interested in your internet access being provided by US intelligence.

</comment><comment><USER9> Related: <http://wiki.daviddarts.com/PirateBox_DIY>

<comment><USER10> I wonder what they'd do if the dissidents they were trying to help used it for copyright infringement as well as all their normal communications?

</comment></comment><comment><USER11> I'm hoping we can get this in countries with draconian censorship - such as where they confiscate websites outside of the courts or due processes. Much like the US. boom. Irony strikes back.

</comment><comment><USER12> It's hard to lend this effort any credibility after telecom immunity, and the PATRIOT act renewal this year.

</comment><comment><USER13> It's really really cool to see this :). I'm sure everybody here remembers, but back in 2009, lost of geeks were clamoring for ways to try and provide internet to Iranian protestors. Something exactly like this is what we were always daydreaming about on IRC, and wondering why the CIA hadn't already built.

In the modern world, "bombing" a country with these things could be a very very liberating thing for the recipients.

<comment><USER14> If the US distributed these in Iran, the government there would probably consider anyone using them a US agent and arrest them.

<comment><USER13> How would they know?

The point is to drop enough of them (mount them to cheap drone aircraft if you want to, like hobby-grade stuff) that it covers the city in wifi.

It's not literally a suitcase, and it's not something that you take back to your house and plug in to. It's something that is transmitting from a few blocks away.

<comment><USER15> if governments can detect even the passive reception of signals ([http://www.bbc.co.uk/pressoffice/pressreleases/stories/2003/...](http://www.bbc.co.uk/pressoffice/pressreleases/stories/2003/06_june/24/licensing_detector_vans.shtml)), I don't think it would be too difficult to pick up who is talking to these devices. Or, even if they can't, fear of detection would probably keep a large chunk of the populace compliant.

Which isn't to say that such devices wouldn't be useful. Just that they'd be far more effective in situations like Egypt or Libya than in ones like Iran or China. I think they'd be even more useful in the hands of someone like the Red Cross.

<comment><USER16> I am not a physicist, but that's detecting reception of (I think FM) UHF and requires specialised equipment. Detecting Wifi which uses a spread-spectrum modulation at a higher frequency would be even more difficult. Add to that the existing, allowed Wifi networks that probably already exist which overlap the banned ones.

The real problem in security is usually human factors — loose talk, spies, informers, interrogation — not technological ones.

<comment><USER15> But the thing is that using a wifi node is not passive reception. And while wifi uses spread spectrum, in order to be accessible to the people you want to reach, you'd need to make it available using common protocols. The authorities need only go war driving for these nodes, connect and then watch the tcpdump output. Corporations do this now to detect rogue access points, so I don't think it's beyond the means of a sufficiently motivated government.</comment></comment></comment></comment></comment></comment>


Faster parallel computing – MIT News - <AUTHOR> http://news.mit.edu/2016/faster-parallel-computing-big-data-0913 <comment><USER2> MIT, you know I love you guys. I have a tremendous amount of respect for you and your work, and you haven't yet eroded the good will you got for helping to revolutionize computing on multiple occaisions, and also for establishing Switzerland, and thus being responsible to some degree for Hacker culture, and a whole other wide variety of important work, and the Lisp languages (including Scheme) as we know them to today.

However, if you talk about how you've made significant advances to the state of the art in a field, and talk about a really cool project you made with this advance, _and you do not tell us how you did it and link the git repo_ , than I don't care. Software is a collaborative effort. If you don't tell us how you got a result, or only give general overviews, then we have to re-discover it, re-implement it, and/or re-solve all the problems you solved. _if you 've made advances and do not disclose them in detail, than you are holding us back._ and if your implementation is encumbered, write one that isn't, and give us it.

Either way, if anyone claims to have made amazing advances in a certain field, the first question you should be asking is, "where's your code."

<comment><USER3> > for establishing Switzerland

Huh? I know you can't mean that the American university MIT established the European country of Switzerland, so what do you mean? And how did that create hacker culture?

<comment><USER2> The AI Lab was commonly nicknamed Switzerland, as it was a neutral party between MIT's CS laboratories after they split into two.

<comment><USER4> Not the AI Lab, but Sussman and company's group that sort of stood between the AI Lab and the Lab for Computing Science (LCS), which did more classical types of CS.

E.g. artifacts that came from the AI Lab included the Lisp Machine and it's Ethernet style Chaosnet, while LCS was working on a token ring network and aside from their Nu machines and the NuBus, adopted by Apple, never made their own workstations. Or Maclisp (I think at some point) and Scheme, vs. CLU. Other things that came from LCS include RSA and the X window system (the latter due to a weird VAX 11/750 config that DEC created so it could donate them to MIT without suffering (much) from the GSA "Most Favored Customer" requirement to give the Federal government the best price you gave anyone else).

After some point Sussman and company created their own informal? unit which stood apart, getting their money from the NSF and using Scheme, and doing their own things, "Switzerland, Armed but Neutral", staying above/aside from the fighting between LCS and the AI Lab. Which as I recall hearing, was only resolved when the head of LCS died (but not before unduly influencing the architecture of their new and _highly_ dysfunctional building), and the head of the AI Lab, who'd saved it when other AI Labs like Stanford's legendary one died, became the head of a combined Computer Science and Artificial Intelligence Laboratory AKA CSAIL.

All the above is 2nd hand but from reliable sources, and remotely after mid-1991.

<comment><USER2> Ah, thanks. Sorry. I always confuse AI and Switzerland, as both derived from project MAC. Both were important, and are generally more famous than LCS, although LCS was arguably more influential.

It doesn't help matters that Switzerland was sometimes called project MAC, which was the original name for the collective. To further confuse matters, [https://groups.csail.mit.edu/mac/projects/mac/](https://groups.csail.mit.edu/mac/projects/mac/) is the Switzerland website, and it looks like Switzerland is kind of still going, even after the CSAIL merge. Unless the site's just outdated, which is also a possibility.

<comment><USER4> Last time I checked, which was a few years ago but quite some time after the creation of CSAIL, Switzerland was going strong. Last tidbit was their dismay to discover the very high ceiling of the space they were in was a couple or three inches too short per Cambridge zoning rules to subdivide into 2 levels.

BTW, it's really hard to understate how horrible a building the Strata Center is for the people inside it who are, you know, trying to get work done, in fact, it's akin and often directly an example of the current open office fad.

Or for people trying to get to them, due to it's inherently horrible physical security. In terms of sheer incompetence, though, it's hard to beat creating a loading dock area for mail and freight to replace Building 20's modest facilities that trucks can't actually get into and out of....

After blowing most of almost half a billion on it, MIT has a lot of nerve asking for more money for more buildings.

Disclaimer: big fan of Building 20, which served as an indispensable incubator, and allowed me to set up a student run computer center in 1980, there's no place else in the Institute where that would have been vaguely easy, or probably even possible.

Yeah, it was a nightmare to maintain, and occupied very valuable space on campus, but there's no excuse for not creating another space to serve the same function, modulo the ease of knocking vertical or horizontal holes, and its extremely high load bearing capability (200 lb/sq ft as I recall). MIT simply won't be creating new groups of people in new fields as fast as it used to.

<comment><USER2> Being outside of MIT, I don't exactly know what you're talking about, but it doesn't sound good.

<comment><USER5> He/she is talking about the newer home of CSAIL, the Stata Center: [https://en.wikipedia.org/wiki/Ray_and_Maria_Stata_Center](https://en.wikipedia.org/wiki/Ray_and_Maria_Stata_Center)

It is notoriously difficult to work in, with way too many open spaces (open in the sense of being public, as well as open in the sense of having random 3-story-high atriums of air above you in some places for no discernable reason) and not enough quiet nooks that are conductive to focused work.

<comment><USER4> Ah, yeah, sorry about that qwertyuiop924, and thank you tinkerdol for filling him in sooner, and confirming what I've heard from other sources.

It shows every sign of being a two for one own goal in diminishing MIT's future ability to "be MIT".

<comment><USER2> Ouch. Yeah, that would suck. But then, IIRC, people have been saying that X is dimishing MIT's future ability to be MIT since before the death of 6.001. I suspect it's another manifestation of the same kind of human impulse that makes the elders of every generation decry the youth of the next ones. And a bad building design isn't impossible to work around, just very, very, very, very inconvenient.

But then, just because you're paranoid doesn't mean they're not out to get you.

<comment><USER4> There's 2 things here:

The incubator that was Building 20 was is _gone_ , as far as I know. Many many good things came out of it, some of which got very big, starting with the Research Lab For Electronics right after WWII (it was previously the main building for the "MIT Radiation Lab", i.e. a place to prototype and in some cases build small lots of RADARs). As of the '80s, some of its 3 phase ceiling busbars were still live, one of my favorite professor's coffepot ran straight off one.

That's a relatively subtle thing, but to the extent MIT becomes stolid and not doing new things, becomes more of a place run by consensus and the conventional wisdom, that would be an important thing to look at.

The second is of course the Stata Building. It will absolutely diminish the useful output of what's now CSAIL, if for no other reason than those who need to be able to work without distraction by and large won't be able to in the building. It's the sort of thing that can put a ceiling on the difficultly of projects people will be able to do, if they can't get into or stay long enough in flow.

Obviously people will work around this, using e.g. laptops in quiet places, but collaboration will then seriously suffer if past research on the subject is of any validity (e.g. > 30 feet? or a stairway makes a _big_ difference).

I don't know if anyone was out to get them, it's just that a) people who had weird and very wrong ideas about how to do things, like the head of the LCS, who among many other things tried to physically enshrine a permanent disconnection between CS and AI, b) people who simply didn't give a shit about those who really were going to use it, and/or c) people who were grossly incompetent, were in charge of getting it designed and built, but not the actual "users".

And the screwups are legion. Tom Knight, #1 Lisp Machine designer back in the day and someone who did a _lot_ of important stuff, now a "synthetic biologist" AKA into artificial life, asked for _one thing_ , a floor that sloped to a drain. Which he didn't get. And I now notice as of 2008 he's doing this at a company he co-founded.

I suspect those two fact are not entirely coincidental. And potentially a grave loss to MIT, that part of the future just might not be done there, losing "The Godfather of Synthetic Biology" per Wikipedia is not a small thing.

And I have the tiniest window into CSAIL, and can speak freely about it (my one theoretically vulnerable source isn't really, and hasn't told me anything I can't repeat), there's I'm sure much much more to be told, and sifted through by historians or archaeologists of science someday.

6.001 is a rather different thing, after the dot.com crash, which resulted in a crash of EECS undergraduate enrollment, less than half after being 40% of the student body for decades, people panicked, those with an agenda against Scheme/LISP used the opening, but primarily, MIT decided an MIT EECS degree was going to be a fundamentally different thing.

That doesn't mean they're wrong, just that if you're looking a focus on the 6.001/SICP sort of thing, you might want to look elsewhere, like CMU I think. And maybe this was inevitable, a department like MIT's or UCB's is simply never going to be the same as a CS focused department that didn't grow out of an EE one. And Sussman at least always thought the 2 subjects were both of great importance and should be taught together, he himself just never figured out a way to really make that work, including at least one experimental one year long course covering both prior to the development of SICP and the 4 6.001-4 courses.

<comment><USER2> That's fair enough. I didn't say the removal of 6.001 was bad, but many decried it as the death of MIT.

But in short, you're saying that MIT may no longer be "where the future happens."

That's quite possible. But at the moment, there's still an abundance of talent there. OTOH, the lack of an incubator is a problem.

I guess what I'm saying is that you might be right, ut the future is pretty hard to predict.

<comment><USER4> _But in short, you 're saying that MIT may no longer be "where the future happens."_

Or maybe MIT is now starting to seriously revert to the mean, _some_ of the future will most certainly happen there, just potentially quite a bit less.

I _may_ have seen some of that in the '80s, certainly the midnight execution of the Applied Biology department by envious chemistry and biology professor administrators was a sign of some sort, especially since the fate of the latter should have been much worse than having their administrative careers ended. The faculty as a whole certainly viewed it as a betrayal, which is was in spirit and "law" (MIT has the institution of the Visiting Committee to keep units of it on the straight and narrow, they were of course ignored in this).

And this is part of a bigger trend, pure administrators are growing in vast numbers in US higher education, their costs are one of the biggest drivers in this clearly unsustainable trend, they're funded by ever more Federal dollars (even if laundered as loans, which the Feds entirely took over in 2010), and from money comes power, they're taking over US universities from the faculty. Who themselves are getting segregated into small numbers of high cost tenured and large quantities of low cost associates who care barely make ends meet, plus the old bane of graduate student instructors who aren't good at it.

MIT, at least for now, is not going to succumb to some of these trends, as long as associate professors are rare exceptions that prove the rule, like SF author Joe Haldeman, for classes are otherwise taught by tenured or tenure track faculty, and _adequate_ teaching ability is required for tenure, as well as the _minor_ detail of being #1 or #2 in your subfield (as judged, in part, by those Visiting Committees).

Similarly, like CalTech, there's a high floor on admitting undergraduates, they've got be able to do one term of the calculus beyond the AP BC sequence, and calculus based mechanics and physics (and chemistry and maybe biology).

But....

<comment><USER2> Yeah. My father went to CMU, and told me some stories about a few professors that were... less than enthusiastic about teaching. Like one that was pretty much using the class for his reseach project, and didn't teach the intended subject matter. At all.

</comment></comment></comment></comment></comment></comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER6> Isn't this the same sort of idea as [https://en.wikipedia.org/wiki/Gather- scatter_(vector_address...](https://en.wikipedia.org/wiki/Gather- scatter_\(vector_addressing\)), just with more thought around timing of the loads/stores and cache hierarchy?

<comment><USER7> It's similar, but a key difference is that Milk is deferring the exact timing of access in order to do a sort. You can build the same thing atop scatter/gather primitives but they don't do that for you themselves.</comment></comment>


File Systems Made Easy - <AUTHOR> https://www.zeroequalsfalse.press/2017/12/03/filesystem/ <comment><USER2> Whats the best way to learn operating systems?</comment>


Choosing a vector difference function - <AUTHOR> http://threebrothers.org/brendan/blog/vector-difference-functions/

<comment><USER2> I would advise those reading too much into this article not do so. Using vectors for theory to do basic statistics is likely to confuse matters for you. Vectors, though important in statistics, are primarily used to describe spaces, be they 3d or otherwise. If you understand how this translates to statistics, then you probably don't need the ideas in the article. If you don't, then this article is plainly misleading.

</comment><comment><USER3> There are far better methods than the one linked in the article.

You can train a covariance matrix such that you can get a better distance metric. Particularly, you would use the Mahalanobis Distance:

<http://en.wikipedia.org/wiki/Mahalanobis_distance>

For classification tasks, there are two good ways of training a covariance matrix for distance metrics: neighborhood components analysis and large margin nearest neighbors.

The effect in the article is just a particular quirk of using the euclidean distance. You could, for example, get the same result by using a 1-norm distance.

</comment><comment><USER4> This is usually called a "Norm" (or "Vector Norm").

<http://en.wikipedia.org/wiki/Norm_%28mathematics%29></comment>


The inside story on getting an app in the Apple TV app store for day one - <AUTHOR> http://www.loopinsight.com/2015/11/06/the-inside-story-on-getting-an-app-in-the-apple-tv-app-store-for-day-one/ <comment><USER2> Original source here: [https://medium.com/@mattbraun/sketchparty-tv-for-the- new-app...](https://medium.com/@mattbraun/sketchparty-tv-for-the-new-apple-tv- the-story-so-far-ca4be9076a6a), with the way less sensational (and more accurate) title: _SketchParty TV for the new Apple TV: The Story so Far_</comment>


Protecting Sleep in the Hospital, for Both Patients and Doctors - <AUTHOR> https://www.nytimes.com/2019/06/04/well/mind/sleep-hospital-patients-doctors-fatigue.html <comment><USER2> My wife has been in the hospital regularly over the past 18 months probably 20 days total. This is a renowned research hospital with a gorgeous, vibrant facility and spacious rooms.

They absolutely 100% ignore any semblance of a sleep cycle for their patients (as well as proper nutrition but that's for another day). Constant interruptions to check vitals, ask if we want to pick a meal, beeping infusion pumps, a whole squad going on rounds with banal questions...it seems to never end.

I'd like to find a watch/fitbit for her and either find or write an app that just fills the screen with a color based on her current sleep phase...green she's awake, yellow light sleep and red means she's in REM or deep sleep and should not be disturbed unless necessary. Place that by the door so the nurses can see and hopefully adjust their timing accordingly.

<comment><USER3> Have you had a conversation to address concerns about your spouse's care? There is always some flexibility around the care that she'd be receiving, and one core component to that is your rational/measured input, either in person or by phone. Framing your concern as rational helps _immensely_ in establishing a dialogue with care staff. It sounds like your core problem is that you want to be bothered less.

Nurses are not there to make every patient's stay miserable. At least in my practice setting, we are extraordinarily receptive to suggestions around care and stepping in as informal advocates when families are not available.

<comment><USER4> We ran into this with my daughter who needed multiple surgeries. Two different experiences in two different hospitals.

First hospital was world renowned, ranked #1 in the world for the category of care she needed. This hospital seemed to spend all their money on what I would call "celebrity surgeons". World renowned, only the best. I suspect the side effect is that they spent much less money on nursing care. There was only one or two nurses to a single floor overnight, and they utilized nursing assistants for everything. I got lots of attitude from the nurses, I suspect it was part of the culture. Their schedules were also much more rigid since they had a lot more patients to cover with limited resources. They also seemed to focus a lot more on the raw numbers and not the individuals. We fought tooth and nail to get a schedule that worked, and got a small amount of wiggle room, but it took a lot of work.

Second hospital was a completely different experience. They had a good surgeon, who had good outcomes, but didn't have as many surgeries under his belt, so less data. I suspect this meant he took up less of the budget. This hospital had zero nursing assistants, and each nurse only had one or two patients at any given time. This resulted in the nurses advocating for us, and actually working their schedule around us.

<comment><USER5> Our daughter was in for surgery at a world renowned hospital #1 for what she needed ... and our experience was like your second example. After she moved to the step-down unit from the ICU, she had the same day nurse for the next three days and the same night nurse for four, as well as a consistent overnight NP throughout. We had a private room with a separate vestibule containing a washing station & laundry bin for scrubs/aprons. Also in the room was a whiteboard where the current nurse always wrote the intended schedule and reviewed it with us at the start of their shift. Our room had a single-bed sized sofa _and_ a fold-out chair. It was quiet, and except when we had to wake our daughter for overnight oral meds, the nurses let her sleep. To be honest, while it was a hugely stressful situation, I'm convinced the hospital recovery environment and staff played an enormous role in our daughter being able to be discharged only 4 days after open heart surgery.

<comment><USER4> That sounds almost exactly like the hospital we were at (Rainbow Babies, for the record). Hope your daughter is doing good, my daughter is also a heart baby -- coarctation and bicuspid valve.

</comment></comment></comment></comment></comment><comment> Engineering-MD I'm a doctor and I agree lack of sleep is a huge problem for inpatient care. I (and most of my colleagues) try to avoid waking patients wherever possible. The main reasons I need to wake patients at night is: a) they are unwell. This is unavoidable b) recanullating for fluids/medication that need to be administered overnight. c) for new admissions I need to do more routine tasks (ensure regular meds are prescribed in time for morning, or chase scan results/reassess patient/repeat bloods). This is necessary as for these patients (and patients who have become more unwell in hospital) there are too many unknowns to be able to safely leave it until morning, or need to be ready for theatre the next day.

The main problem I have is that I often wake up everyone else in the same bay due to lack of private rooms and the need to turn on lights and often shout at dead patients so they can hear me.

Beeping machines is a big problem, and the sooner they are made to wirelessly notify the better.

<comment><USER6> I must confess that the main reason I'm replying is to correct the darkly amusing dead->deaf typo that I'm hoping you made.

However, I wonder if you could comment on whether you think a) that you and your colleagues' approach is reflective of the broader medical community, b) you think earplugs could be feasibly issued in shared wards (from a financial/hygiene/other perspective)?

<comment><USER7> Sounds right. I'll add (as in another comment) that nursing hourly rounds is mandated by my institution. Personally i go out of my way to avoid waking you up, but it's not a hotel and if I'm even a little bit worried about your trajectory, I won't hesitate to wake you up.

My hospital gives out ear plugs. Luckily never had to test it but the beeping is so loud and annoying that I doubt they'd work for me.

</comment></comment></comment><comment><USER8> There are a lot of exemptions in healthcare, sleep is part of this exceptional world, I was told bluntly 'we are not operating a hotel here' last time I spent a sleepless night in a hospital.

Food is another area of concern. You can starve during a hospital visit or end up broke buying supplemental calories in the shop.

Then there is the sheer difficulty of navigating the typical hospital if you are somewhat disabled or in agonising pain.

It is as if that every hospital operates at some subliminal level as a field hospital in some 19th century war. It is thoughtcrime to think of how the place is run is less than heroic. There is also triage so that people with serious problems get dealt with before those with minor ailments. Therefore it is fine to keep a lot of people waiting. Or is it?

In places that have a customer service ethos you don't keep people waiting. Apart from anything else it is just plain inefficient. The sleep thing is what I would consider inefficient. It is a given that at a typical hospital none of the patients are sleeping too well, if it is not disruption then it can be flimsy blankets. Sure any ward is not going to be your own bed, but we are way off any customer first thinking when it comes to this.

I have had discussions about this with plenty of people and the idea of customer service in healthcare is poo-pooed. Is there anywhere in the world where it has been given a try? Scandinavia? Or even Cuba? It is not rocket surgery giving the patients a good night's sleep and enjoyable food. In our private lives we recommend to others that have a big day ahead of them that they get a good night's sleep. Why does this go out the window in the world of healthcare, whether it be staff or patients?

<comment><USER9> > ave had discussions about this with plenty of people and the idea of > customer service in healthcare is poo-pooed. Is there anywhere in the world > where it has been given a try?

I spent several days in hospital for surgery as a teenager in Australia and my parents (with private health insurance) paid for me to have a private room, which I remember as being pretty comfortable and not filled with interruption. On the other hand I was on serious painkillers and couldn't even stand up so I may not be a reliable witness.

<comment><USER8> Nice parents!

But what if you were born into a family that were not able to look out for you?

From the sibling comments I get the feeling that people in countries where private health insurance is needed that the concept of healthcare for all is not imaginable. I was writing in the context of the NHS, as introduced by the Labour government in the post WW2 UK when Britain was broke and broken.

It goes against the NHS ideal to have some patients be able to pay for an upgrade, you get what you are given. There are no up-sells.

In recent years the neo-liberal politicians have chipped away at the NHS, slashing budgets and outsourcing services. Now that I consider what people in the USA get for healthcare I wish to take back all of my grumblings about the UK's beloved NHS! Sure it can be improved on but the values that go with it - universal and for all - are important to me. I would not feel happy paying for a better bed than the next guy or being the person that can't pay for that better bed. I have a sense of fairness that this goes against. I imagine I would not have that 'survivors guilt' feeling if private healthcare was all I knew.

<comment><USER10> "There are no up-sells."

That's not completely true - when our son was born we paid for a private room in an NHS hospital. Mind you that was ~20 years ago don't know if they still do it.

<comment><USER11> They still do, or did in 2015 and 2018. We were lucky enough to not need the doctor-led hospital unit - using the midwife-led maternity unit instead (where private rooms are standard). However, we were moments away from foreceps being used - a doctor-administered intervention - for the first birth, which would have necessitated a move downstairs to the hospital wing, and thus a ward or payment for a private room.

<comment><USER8> Forceps?

I thought that forceps had been replaced by sink plungers. Obviously not the sort you buy in the DiY store but the expensive medical grade. The same principle applies though, suction cup goes on baby's head and with one pull the baby is born!

I thought the suction cup approach was standard now with the benefit to the technique being no birth marks.

<comment><USER11> Yep - were going for forceps instead of ventouse.

<comment><USER8> I was wrong about the forceps. But there is now a new rabbit hole I need to go down - birth marks and what causes them. Plus this 'ventouse' gadget and the merits of it compared to ye olde forceps.

Haven't got time for this rabbit hole now, I might save it for when I meet someone with skin in the game!

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER12> I know that sleep is critical to healing. And I know that a lot of what happens to you in a hospital is very unpleasant. And I know that some things might seem silly, banal or irrelevant. But please remember that this is all done from a desire to keep you _and other patients_ alive and (relatively) well.

Hospitals are always understaffed. Doctors and nurses don't have the time to keep the sleeping schedule of all their patients into account. If you want that to change, I guess more investments in healthcare would be the way to go.

People die in hospitals every day. If you're woken up a bunch of times while recovering from something, count your blessings that you're well enough to be woken up in the first place.

<comment><USER13> It's basic cost-benefit analysis. I completely appreciate where you're coming from, but despite all your points many of the checks _are_ still silly, banal and irrelevant - the benefit of waking someone up mid sleep cycle to ask them what they want to eat, or to get them to fill out a questionnaire, or to take a blood sample when they've only had one an hour or two before, is not worth the cost. You're giving a passionate response about how lucky we are to have that care anyway, but frankly you are vastly underestimating the devastating effects broken sleep has on the body. Most of the patients are on opiates anyway, so sleep is already at a premium (sedation =/= sleep).

Hospitals _are_ understaffed, but that does not mean they have an excuse to endanger patient safety by ruining their best method of recovery; sleep. Many of my friends work in sleep science. Ask any of them what they think about the current ways we treat patient sleep, and they'll go on an hour long tirade about how absolutely ridiculous it is - how there are 100s of things that we could be doing differently, but don't because of antiquated science and work dogma, and there is almost no reason for close to 50% of times we wake patients up.

I highly recommend "Why We Sleep" by Matthew Walker. He puts a massive spotlight on the health implications that are cause by lack of sleep, especially for the elderly who make up the most hospital patients.

<comment><USER12> If they're waking you up to take blood samples when you're sleeping, it's probably for good reason. Maybe the patient is at risk for some kind of kidney complications and maybe not dying from renal failure is more important than getting a good night's sleep. There could be any number of reasons for this. Maybe another patient had some kind of emergency that had to be dealt with first, and your sleep schedule is less important than someone else's life.

Generally speaking, doctors and nurses care about patients (some more than others, sure). They're also aware of the importance of sleep. If you're a nurse on a night shift, and you have to take care of a ward of 20 patients, you'll quickly find yourself too busy to be terribly considerate. Especially when something unexpected happens.

<comment><USER13> The blood checks I brought up because this was a thing specifically criticised by my friends in the medical trade. For the vast majority of cases where they need to take blood, it just so happens to be the _preferred_ method used for diagnosing the patient, not the _only_ method. There are other things that can be done beyond waking the patient and sticking a needle in their arm. Often they just end up disposing it, as they don't even have the resources to test the blood of every patient every hour; but they will continue to _take_ blood every hour. If the nurses are told to take blood, they will do it to protocol - regardless of what common sense might suggest.

The main criticism they had was that of treatment for patients with infection. It's nice for a doctor to know whether the body is fighting it off effectively or not. Many doctors will ask for blood tests every hour because it's so nice to know, and you'll get a pretty graph to tell you what's going on by the hour. You know what's better than a graph? _Letting the patient fight off said infection_. Best way to do that? Decent sleep. Apparently the education on sleep is abysmal in most institutions currently, purely because it's been a branch of medicine that has bloomed late, and it has resulted in doctors who often don't give sleep the respect it deserves.

Again, this is not from the horses mouth. I am only passing on the information my friends gave me as effectively and accurately as I can. I'm not trying to shit on those in the medical profession, as it's a career I envy, but it is something that is a chronic issue in most wards and many sleep specialists across the globe are trying their hardest to rectify it with significant push back.

</comment></comment></comment></comment><comment><USER14> The arrogance of nurses and physicians in constantly waking patients up, completely unaware and uncaring of the health detriment that comes with loss of sleep, is inexcusable. While some people can go back to sleep after being awakened, there are many of us who have real difficulty getting back to sleep, and sometimes it doesn't happen at all.

<comment><USER7> That's a bit to far in my opinion. I'm a physician. Now days, if you are admitted to a hospital overnight it implies you are probably pretty ill. We push hard to ensure that only patients that _need_ to be in the hospital are (wasn't always that way). Sometimes in sick patients, checking vitals is required (to make sure you aren't dying). Additionally, there is evidence that hourly rounding prevents some bad outcomes like patient falls. So 'well- meaning' institutions like mine, _mandate_ hourly rounding by nursing staff.

Now is this absurd in some patients, yes! In very elderly patients this may do more harm than good by causing delirium, which can be deadly...

Personally, I go out of my way to not wake anyone up, but that's often not an option in some situations.

But to say it is doctor or nursing arrogance is to not really understand healthcare.

<comment><USER15> > Sometimes in sick patients, checking vitals is required (to make sure you > aren't dying).

Could this be accomplished by using devices that monitor patients vital signs and report the data back to the nurses station? Then spot checks would not really be needed.

> Additionally, there is evidence that hourly rounding prevents some bad > outcomes like patient falls.

Could you list some of the studies you're referencing?

<comment><USER7> I'm really excited about [0], but as far as I know there is no way to take blood pressure without touching the patient. If someone here could invent it, I could probably provide a test environment for large scale investigations.

Re: studies. I can't say I know the evidence that well, so I wouldn't want to mislead, this isn't my area. A google search for Hourly Rounding reveals lots of articles, but I haven't poked into the underlying data that proves it is a successful strategy (if that exists). I guess I overstated my confidence above.

[0]: [http://people.csail.mit.edu/mrub/vidmag/](http://people.csail.mit.edu/mrub/vidmag/)

<comment><USER5> For blood pressure, our experience was that the staff were perfectly happy to leave a cuff on our daughter's leg, which automatically took a reading every hour (or on demand).

<comment><USER7> For some patients, with vascular disease for example, the blood pressure cuff can be very painful... (What you describe is usually what we do.)

</comment></comment></comment></comment></comment></comment><comment><USER16> When you are given medicines and examinations has more to do with shift changes than anything else.

For example, many doctors write prescriptions at the end of shift and neglect to put a specific time to administer on it. The nurses are then required to use the time the prescription was created as when the medicine must be provided, which is often a very inconvenient time for the patient.

If doctors received adequate training in how hospitals actually worked, in what nursing staff does, and in how they can best interact for optimum care, many of these problems could be resolved.

In the hospital you rarely get patient centric care. Instead, you get institution centric care.

This guy's channel brings up a lot of interesting points:

[https://www.youtube.com/user/ZDoggMD](https://www.youtube.com/user/ZDoggMD)

</comment><comment><USER17> I had an infuriating experience with a young child in the hospital, where routine checks were being performed at the worst possible times for his sleep cycles. Sleeping is so critical to healing. Could it be that hospitals are being counterproductive, sacrificing effectiveness for efficiency?

<comment><USER18> All they care about is the bottom line, which is money

<comment><USER19> All it takes is for one child to die overnight and the parents to sue and you can be sure all patients will get their vitals checked regularly. This is how healthcare works.

Source: am a doctor and see this kind of thing on small and large scales

<comment><USER18> Isn't this why there's monitors? You can also do a visual checkup without waking up the patient.

<comment><USER19> What monitor are you thinking of? Not everyone gets telemetry.

BP cuffs get very tight and will probably wake you up. You may even wake up if a saturation probe is put on your finger.

>You can also do a visual checkup without waking up the patient.

You can get respiratory rate visually. What other vital sign can you get without touching the patient? Transdermal temp. maybe (inaccurate).

</comment></comment></comment></comment></comment><comment><USER20> My main experience with this is every time my wife gave birth. She goes through this long ordeal and is exhausted, but as long as we were there they were in every 2 hours, day and night, waking her up and talking to her. They don't seem to have any concept of people needing to sleep more than 2 hours continuously. The only thing I could come up with is that they really wanted us to get out of there ASAP and were making things a living hell to encourage us towards that end. Except, one of my rules is to follow the money and they make more money the longer we stay, so... it really doesn't make any sense.

<comment><USER21> We've had 4 babies in 3 different hospitals and it seems like it is really dependent on the hospital and the nursing staff. We've had nurses that are younger and just following the playbook all the way to nurses that are much older with several of their own children who are much more willing to use their intuition. While the nurses have all been surprisingly excellent (maybe it's a maternity thing? That hasn't been our experience in other parts of the hospitals) some of them are happy to let you sleep if it seems like there's no bleeding and baby is doing well, and some of them insist on taking all the readings, though they were all apologetic while they did it.

Since we went through different hospitals, it's hard to compare, but at the last one, it seemed like the fact that we had 3 healthy children at home already made the nurses surprisingly willing to defer to our preferences, and we got as close to a full night of sleep in the hospital with a newborn that you can get.

As an added data point, we also told the nurses at every hospital that we wanted to leave as soon as possible, so trying to kick us out wasn't a consideration.

</comment></comment><comment><USER22> When my wife gave birth to our daughter we had a room to stay in. Every 1.5-2 hours the nurses came in to ask questions and run tests. It was maddening. My wife had to finally cry and beg them to stop. Afterward, we managed about a few hours of uninterrupted sleep.

<comment><USER23> Our experience as well. I was in the room as well the whole time and it was ridiculous how often somebody came in to do something.

With exception of one nurse, every single person pushed back against us asking for fewer interruptions and said it was for the baby and mom. One nurse basically acted like my spouse was acting entitled for wanting to sleep. I wanted to swear at that nurse and throw her out of the room.

One of the night nurses realized my spouse was about to collapse and found a way to let her sleep for 3 hours.

</comment></comment><comment><USER24> In the US Hospital reimbursements from insurers and medicare are per procedure, not duration of stay. Hospitals have a strong vested interest in both keeping patients alive and reducing length of stay. Food quality and sleep interruptions for non-critical patients both help the latter metric, even if that is likely not their sole reason.

<comment><USER25> From what I see in Asia and Europe, hospitals charge per night stayed in the hospital, plus the cost for any procedures.

</comment></comment><comment><USER26> My 9 year old son had a hospital stay a while ago. I stayed with him in the hospital, I got less sleep than when he was an infant with the constant interruptions....

When we returned home in the afternoon ....we both took naps.

</comment><comment><USER27> I've recently had similar experiences with a loved one.

Older (Geriatric) friend of mine, serious medical condition, which necessitated (I'm told) continuous tests, medication & checks to be run to make sure he was in a "serious but stable" condition instead of a "on the way to death" situation.

But this was for a number of days (nearly a week) and essentially it meant the few times he was able to sleep past the pain/illness, he'd be woken up within a few hours for another round of tests, medication, etc.

He managed to get through it somehow, and I don't have any solutions to how they could have done it better (I'm no doctor), but it can't help the condition that he was getting by on one to two hours of sleep a day on top of the medical problems.

</comment><comment><USER28> We were in the hospital for 2 nights recently. On the second day we counted how often people got in and out of the room: 29 times. We decided to return home a day earlier than planned.

</comment><comment><USER29> About once a year I have to spend 3-7 days in the hospital (I have cystic fibrosis and a round of antibiotics are often needed to bring my lung function back to baseline). The sleep situation is one of the things that's the most unpleasant.

</comment><comment><USER30> It is universal practice to wake you up all the time. Just to ensure you are not dead or ensure you are dead of sleep deprivation.

</comment><comment><USER31> I wondered this a lot before. I'm lucky enough that I haven't spent much time in a hospital in my life, but visiting people there I often heard how hard it was to sleep for them due to constant interruption, noise from neighboring beds or indensive care units where it's constantly busy.

Yet on the other hand it's so often emphasized how important good sleep is for health. It seems such a nobrainer to do everything possible to make sure people can sleep well in a hospital.

</comment><comment><USER32> Even without awakening by medical staff or sounds (ear plugs do wonders), with some illnesses patients can _only sleep on their back_ which can be a unpleasant experience if you're used to sleeping on your side. It takes time to get accustomed to and in the mean time patients get little sleep with all mentioned effects. Pillows designed for sleeping on your back [0][1] _with special curvatures for your head and neck to relax on_ ease falling and staying asleep. If a 10% of the patients sleep better and are released earlier from hospital or get to work faster, these pillows are a very small costs compared to costs savings, both personal & society.

Anyone seen hospitals with Orthopedic pillows? Or doctors recommending _pillows for sleeping on your back_?

[0] [https://en.wikipedia.org/wiki/Orthopedic_pillow#Back_sleepin...](https://en.wikipedia.org/wiki/Orthopedic_pillow#Back_sleeping)

[1] eg "Emolli Contour Memory Foam Pillow" on [https://www.forbes.com/sites/forbes- finds/2019/02/21/pillows...](https://www.forbes.com/sites/forbes- finds/2019/02/21/pillows-neck-pain/) (advertising article)

</comment><comment><USER33> This is a huge issue. A family member spent two weeks in the hospital last year, and one of the hardest parts of that experience was how difficult it was to sleep there. The light, the noise, the demented patient shouting in the next room, the constant interruptions and questionnaires from nurses and doctors: you just couldn't sleep more than 90 minutes if you were lucky. We called them "the bleeping machines", in the double sense. I would turn them off sometimes, because the stats they were monitoring were not life or death for us. Hospitals are a place where there is no night. The nurses working on the graveyard shift under the bright fluorescents cover a third of the day, and for them, it's just another workday, but it runs from 11pm to 7am. And they treat patients as though it is daytime. Don't get me wrong, the nurses were great, but the structure and incentives don't favor sleep. There is so much that could be done to help patients get better faster, by giving them a more restful environment. But the incentive is to monitor them until you can get them out of the bed, to save everybody money.

</comment><comment><USER34> Don't forget all the interruptions that occur when the staff is visiting your room mate also.

</comment><comment><USER35> Good luck trying to change the hospital mindset. Doctors actually have a term for patients who suffer sleep deprivation: hospital-induced-psychosis. It should be called a crime and the head nurse and doctor in charge of the patient ought to be arrested.

<comment><USER36> Hospital delirium is the current accepted name for this condition. It covers much more than sleep. It includes the stress of complex and potentially life threatening medical and social conditions, confusion related to time of day and time unconscious, the effects of medication, and possible underlying mental health issues. All compound each other.

Your charge against doctors and nurses is extreme and unwarranted. Health professionals don't exacerbate these problems willingly or intentionally. ICU delirium puts doctors and nurses at risk of injury or even assault by patients with vivid hallucinations.

</comment></comment><comment><USER37> Man is this so true. Years ago I had a daughter spend some time in a hospital and they wanted to change her diaper every 2 hours...during...the...night! Sure the child who is recovering from brain surgery should have their sleep interrupted 5 times to change a diaper. I am fairly certain no sane parent wakes up a perfectly sleeping baby to change a diaper. My wife kindly told them we didn't need that and they obliged.

<comment><USER5> Our diapered daughter was recently in the hospital and the only thing they asked us was to weigh a dry diaper as a reference, and then place any soiled diapers on a scale in the room so they could be weighed at the nurse's convenience so they could track I/O, which is otherwise challenging for babies/toddlers.

</comment></comment><comment><USER38> At my recent overnight stay at a large hospital the Nursing staff were very aware of the necessity of good sleep. They worked hard and went out of their way to create an environment where I was interrupted as little as possible. Their first exit interview question was "How well did you sleep? And how can we improve that?"

</comment><comment><USER39> Is there a website or service that scores hospitals? Customer service, outcomes, incidents, and whatever other relevant data

</comment><comment><USER40> Stayed in the hospital in April for about a week for a colon resection - without a doubt worst sleep is in a hospital. It was an amazing environment too and I only had 11:00pm and 4:00am checks. I think it's the nature of the environment.

</comment><comment><USER41> ... and nurses?

</comment><comment><USER42> It's not just tests. It's also constant beeping and the light from the hallway.</comment>