The ops is crazy expensive, any service you get or buy into also instantly gets at least a 30% mark up. Look at the price of transport EDI clearinghouses vs healthcare! Yeah, it is stuff we should be doing for all data, but one mistake will leave you(business owner or contractor) with intergenerational debt or leave you criminal liable.
> There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale
There are plenty, in name at least many states have regulations to force this. Those larger roll ups are still clusters of smb doing 1-10m revenue monthly. They constantly fail and change hands behind the scenes, and are usually only protected by government regulations that reduce risk room to investors normally don’t have in other industries businesses. Their margins are like gambling almost and it’s a key driver of the service issues Americans face.
It could be practical, internet speed will be a limitation for sure if it’s hosting a website not just apis. It really depends, also consider vps from hentzer auctions for splitting some services or even a refurbished server from 2016 era they are under valued for sure. How I like to think this through on how much everything is worth is measuring my (personal/organization) capabilities, capacity and quality of life for on going ops and in crisis. How big of an impact is it when things go wrong, how could I fix it and is there a chance it’s irreversible. Basically frame it around risk and your risk tolerance, I prefer to focus spending on ways to make my 2am crisis least stressful budgets allow.
At work I’ve moved us to a hybrid solution where we use cloud for managed database and storage solutions and compute on local servers. I personally prefer to have the budget be spent on the ops/maintenance of the scariest thing losing company data and somehow failing to maintain securing that data. Compute is almost easy to me in comparison, disaster strikes I just switch to another server local or in cloud, let it talk to the database, secure out going access, run my docker compose. More time spent on the write up than the fix. Someone that is a seasoned dba may choose the exact opposite.
I've built and audited medical billing systems and billing practices. It isn't an economics issue in a traditional sense. Infact it would drastically reduce complexity of these systems and payments over time, even allowing private insurers to exist but have to compete with a base general coverage. (many smarter people than me at princeton did economics showing this worked out as a net less expensive than what we are doing now) The biggest reason why its not the simplistic solution, is politics of all the middle men (me) making exponential returns from solutions to these systemic issues.
Too much money in the system being flawed, look at pricing for any HIPAA safe products and thats just technology. Money is so hard to get for healthcare providers it is its own industry of revenue cycle management and thrid party billers. Most of these physician lead practices charge more is because planning your account around reemburcement cycles from insurance companies are 30-120 days if your lucky is an advanced accounting problem. (Thats excluding complexities of audits, LOPs, network rates etc.) Medicare/medicaid the fraud side has lots of tiny wins through leaning on tax information more, taking the model from the successful basic income studies and trials worked out.
I think it is fair to dog on this for being a bit performative, like announcing you are blocking someone or quiting XYZ social media by posting on that social media. I do give some grace for trying to make an offline magazine/newsletter because I'd like to see more of that in the world, especially passion projects in general. All that to say, I think the attempt to be offline or more disconnected from some of these services is ultimately a healthy habit and is noble self improvement goal in itself. In the same way, trying and failing to quit cigarettes is ultimately healthier than not trying to quit smoking cigarettes. (I am biased; I think the way he formatted the post is quite aesthetic for what it is and would enjoy more analog to mellow out my life)
Much appreciated! Thanks for the blog around ADR, I didn't know there was a full ecosystem for the approach and the AI tie in will help me sell the process
As the 'sarah' for an org I'm golden handcuffed to, avoid becoming the 'sarah' at all costs it will cost you so much in your career. I am a founding engineer self-taught from it/software security to full stack dev, and I pushed so we aimed to higher better engineers than myself. When they came in it was a full rewrite, a new abstraction and going down the same paths I learned the hard way not to go down. I was pushed out of enforcing hard-earned business logic, and we are still paying for it. Everywhere from not accepting the inherent complexity of the problem and over simplifying software to trying to get same features we had from 3 years ago. This then has made me the scapegoat for why the new engineers made xyz decision, and was the one in charge of fixing the shortcuts, bugs and workarounds. I have received promotions for this to be in charge of the veterans that didn't listen to me, whom still don't until it's a fire drill. Joke among colleges is I was the first 'agent' our company had, endless work, just enough authority to do current task, not enough respect/authority to solve the symptom. I understand this is also a failure of my office politics and am improving, however its hard to balance blunt productivity, slow careful positioning and letting people struggle with items I don't recommend until circle back.
So there has been increasing issues form the github side for the past year and I believe they also just lost alot of customer/user data on top of several critical vulnribilities and bugs in base service and in actions.
My POV: Github actions are inconsistent in billing, security and require alot of attention to do right. Github has worse uptime than alot of free online videogame services, when most enterprise and business world leans on it for developers. Leaving a lot of users with terrible experience the past year having to constantly examine github firefighting for issues around availability, security, and billing instead of doing work that makes the company/people money.
Example walk through of securing github actions for ci/cd and managing SBOM python dependancy/supply chains (giant complexity) [1], Github has remote code execution[2], Uptime by 3rd party tracker shows 86% past 90 days. (First quarter in 2 years where they didn't have atleast one month above 90% uptime) [3]
Many studies show with in ~10% female ranges of ability , but, having more fast twitch muscle fiber and bone mass from male puberty if they went through it. Bone mass does eventually drop to female levels but over decades not years so athletes would likely be out of athletic prime before that happens. Studies showing more dramatic results that stand out in my memory that lean toward transwomen outperforming transwomen are studies done on military veterans comparing to general population metrics of muscle mass for athletic activity levels also done with a very low population count I believe they only looked at under 300 trans women. Regardless we need more research, but there are a comically small amount of trans athletes seeking professional level sports, like I think <20 for all college level for instance.
Anecdotally, I found as a deskjob, pilates and casual weight lifting trans woman, I lost dramatic amount of strength and muscle mass. 20 pounds now feels like 50 pounds did for myself pre-transition. I usually participate with women and the instructor/personal helps with modifications usually aimed at women just getting into fitness. Running joke amongst friends is how easily I am outperformed by my female friends at the gym/pilates/etc. However, that's since my body is low testosterone even for females, its checked twice a year because of it, normally It's once a year for most trans people. Other friends retained a lot of their strength, but are mechanics, so its really situational in my opinion, and its a super hard and interesting topic of research because of it
Well, trans women given current regulations that allowed competition with cis women, would have had to be on hormone replacement therapy for 3-5 years depending on the sport. So the data and context does matter, because the intuitive conclusion you came to isn't touching a dataset to find the rooted-in-reality conclusion. The question is 'is a male with a female hormone balance for over X period time with in a fair difference in biological function to females.'. Which is a complex question, since so many things are at play. How much does fast twitch muscle fiber is retained? How much does that even matter for the sport in question?(ballet vs sprinting) Did they go through male puberty? Where are they working out to retain their muscle mass through their 3-5 year transition period and not losing any of their originally gained muscle? What would it look like if they intentionally lost the muscle mass and then retrained it back?
I find those to be fascinating questions, the later we have little research on, currently, and it could enlighten so much more of exercise science especially for cis athletes as well.
I feel like the regular weight loss group was? Since it isn't necessarily rocket science for having mostly men stay in an easily determinable caloric deficit to lose weight. (Women have usually would be harder due to more conditions and hormone interactions that make finding a TDEE not as simple.)
Big fan of this push back, because there are alot of projects that have that smell over engineering with the wrong base. (especially with vibecoding now) Thought there are use cases where some have lots of medium-sized data divided up. For compliance, I have a lot of reporting data split such that duckdb instances running in separate processes work amazing for us especially with lower complexity to other compute engines in that environment. If I wanted to move everything into somewhere a clickhouse/trino/databrick/etc would work well the compliance complexity skyrockets and makes it so we have to have perfect configs and tons of extra time invested to get the same devex
I think articles like this need the pre-amble/framing of accommodations given to neurodivergent individuals come with benefits that are not, otherwise, intuitive to those without that 'flavour' of neurodivregance.
Theres alot of what about women arguments which is fair, but I think it's entirely fair to view this as a harm to men's mental health, and it should be the focus.
Right now, we have a societal issue of isolating, vulnerable men. Men have the highest suicide rate, are statistically more likely to commit violent offenses and have a high rate of domestic abuse. 'Incels' who are likely these companies target market have committed domestic terrorism. I think this is an issue we should 100% be looking at, imagine what happens when there is AI misalignment? They could become a risk to themselves and others, the last thing we need is a unreliable tool for someone in that situation to sooth the pains of social isolation.
Largely agree, given your definitions and clarifications, but I see some things are just co-related issues not directly a death of that programming approach. Where I see it is the gap between programmers and end users, scope of 'users' expanding to other programmers, and the increased complexity causes more abstract soft skill code delivery/management roles are entirely co-existing issues. Where they didn't cause the death directly, more a co-morbidity situation, didn't help, but it didn't cause the death. I'd say the primary cause is cost and complexity of operations, forcing the perspective shift from 'help at least one actual human being' to 'help at least <MINIMUM VIABLE MARKET SHARE> of users/developers'. I'd also as an aside argue frameworks and items directed at devs (that are well-designed), are still abstractly utilitarian, because, if they didn't exist a human would have to do the work of programming or doing the work manually so it would directly help at least 1 human.
These people aren't at a funeral, they are online, responding to false glorifications of him. These comments obviously aren't directed at the family but the news publications and media's handling of his passing. If that's not the appropriate space for that criticism when/where is it? Just after the public not ever knowing their real action's in life have moved on with a false glorified image of the person, move on and aren't paying attention anymore?
Sorry if you misunderstood, it is a nuanced take, I'm saying acknowledging one as a terrible person in response to flowery embellishments of their life isn't celebrating that death. My statement wasn't about political violence, rather, we shouldn't be punishing people for pointing out the false depiction of the dead. I think ideally we all should be mature enough to both mourn the loss of a human and also acknowledge who they really were.
> There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale
There are plenty, in name at least many states have regulations to force this. Those larger roll ups are still clusters of smb doing 1-10m revenue monthly. They constantly fail and change hands behind the scenes, and are usually only protected by government regulations that reduce risk room to investors normally don’t have in other industries businesses. Their margins are like gambling almost and it’s a key driver of the service issues Americans face.