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Why Doctors Hate Their Computers

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Nobody writes about health care practice from the inside out like Atul Gawande, here focusing on an increasingly important part of clinical work: information technology.

A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient—whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. And these tasks were spilling over after hours. The University of Wisconsin found that the average workday for its family physicians had grown to eleven and a half hours. The result has been epidemic levels of burnout among clinicians. Forty per cent screen positive for depression, and seven per cent report suicidal thinking—almost double the rate of the general working population.

Something’s gone terribly wrong. Doctors are among the most technology-avid people in society; computerization has simplified tasks in many industries. Yet somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.

It’s not just the workload, but also what Gawande calls “the Revenge of the Ancillaries” — designing software for collaboration between different health care professionals, from surgeons to administrators, all of whom have competing stakes and preferences in how a product is used and designed, what information it offers and what it demands. And most medical software doesn’t handle these competing demands very well.

Tags: computing   medicine
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zwol
32 days ago
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attn @haloedrain
Pittsburgh, PA
acdha
32 days ago
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Washington, DC
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1 public comment
mareino
32 days ago
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Hypothesis: it's profitable to hire an assistant to handle data entry for billing, but not to handle data entry for diagnosis.
Washington, District of Columbia
cmlburnett
31 days ago
Counter argument: residents.
satadru
30 days ago
Counter argument 2: medical scribes.

I KNOW WHY YOU'RE SAD.

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On paper, Tuesday was a good day for Democrats. They took the House for the first time in eight years. Several important Governorships (in advance of post-Census 2020 redistricting battles) were won. Notably vile Republicans like Kris Kobach, Scott Walker, and Dana Rohrabacher lost. The high-visibility Senate races Democrats lost (Missouri, Tennessee) were pipe dreams anyway. You already knew that Florida sucks, hard. So you're not sad because "The Democrats did badly."

You're also not sad because Beto lost, or Andrew Gillum lost, or any other single candidate who got people excited this year fell short. They're gonna be fine. They will be back. You haven't seen the last of any of them. Winning a Senate race in Texas was never more than a long shot. Gillum had a realistic chance, but once again: It's Florida.

No, you're sad for the same reason you were so sad Wednesday morning after the 2016 Election. You're sad because the results confirm that half of the electorate – a group that includes family, neighbors, friends, random fellow citizens – looked at the last two years and declared this is pretty much what they want. You're sad because any Republican getting more than 1 vote in this election, let alone a majority of votes, forces us to recognize that a lot of this country is A-OK with undisguised white supremacy. You're sad because once again you have been slapped across the face with the reality that a lot of Americans are, at their core, a lost cause. Willfully ignorant. Unpersuadable. Terrible people. Assholes, even.

You were hoping that the whole country would somehow restore your faith in humanity and basic common decency by making a bold statement, trashing Republicans everywhere and across the board. You wanted some indication that if you campaigned hard enough, rednecks and white collar bloodless types alike could be made to see the light that perhaps the levers of power are not best entrusted to the absolute worst people that can be dredged up from Internet comment sections running on platforms of xenophobia, nihilism, and racism. In short, you wanted to see some evidence that corruption, venality, bigotry, and proud ignorance are deal-breakers for the vast majority of Americans.

And now you're sad because it's obvious that they aren't. Even where horrible Republicans like Walker or Kobach lost, they didn't lose by much.

So I get it. It's depressing. There's no amount of positives that can take away the nagging feeling that lots and lots of people in this country are just…garbage. They're garbage human beings just like the president they adore. These people are not one conversation, one fact-check, and one charismatic young Democratic candidate away from seeing the light. They're reactionary, mean, ignorant, uninteresting in becoming less ignorant, and vindictive. They hate you and they will vote for monsters to prove it.

Remember this feeling. Remember it every time someone tells you that the key to moving forward is to reach across the aisle, show the fine art of decorum in practice, and chat with right-wingers to find out what makes them tick. Remember the nagging sadness you feel looking at these almost entirely positive results; it will be your reminder that the only way to beat this thing is to outwork, outfight, and out-organize these people. They are not going to be won over and they will continue to prove that to you every chance they get.

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zwol
34 days ago
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This seems like the right place to tell the story of the dude who drove me to the airport the other day. His other job, apparently, was owning a gun store, and when talking about guns his opinions were informed and reasonable , e.g. "banning bump stocks won't stop school shootings, but we should require gun owners to go through safety training and have proper gun safes," ok, I can see that. But then the conversation took a hard right turn into Fox News conspiracy land: all politicians are corrupt, Planned Parenthood spends 10x as much money on lobbying as the NRA, etc. etc. etc. and I just didn't know what to say.
Pittsburgh, PA
popular
34 days ago
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acdha
34 days ago
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Washington, DC
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5 public comments
tdarby
34 days ago
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Yes.
Baltimore, MD
rocketo
34 days ago
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How many words fit on a sampler? I don’t want to get this as a tattoo.

“Remember this feeling. Remember it every time someone tells you that the key to moving forward is to reach across the aisle, show the fine art of decorum in practice, and chat with right-wingers to find out what makes them tick. Remember the nagging sadness you feel looking at these almost entirely positive results; it will be your reminder that the only way to beat this thing is to outwork, outfight, and out-organize these people. They are not going to be won over and they will continue to prove that to you every chance they get.”
seattle, wa
lelandpaul
34 days ago
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Oh, this is so hard for me. On the one hand, the piece is dead right: This is exactly what I'm feeling today.

On the other: I fundamentally believe people are redeemable and that we shouldn't write them off. (That's sort of core to Christianity...)

I don't know how to reconcile these two things.
San Francisco, CA
sirshannon
34 days ago
You can’t redeem the unwilling.
lelandpaul
33 days ago
But does that give you the right to stop giving them opportunities to redeem themselves?
sirshannon
31 days ago
Yes. You’re not powerful enough to stop someone from redeeming themselves any more than you are powerful enough to make them redeem themselves. As long as you’re not actively working to prevent them from doing the right thing, you’re good.
notadoctor
35 days ago
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“They are not going to be won over and they will continue to prove that to you every chance they get.”
Oakland, CA
cjmcnamara
35 days ago
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gin and tacos absolutely spot on once again

The Moai in Vitorchiano in Vitorchiano, Italy

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The Moai in Vitorchiano.

A 20-foot-tall Moai statue carved in local peperino stone looks towards the city of Vitorchiano. It is claimed to be the only original Moai statue outside of Easter Island. But how did it come to be standing some 9,000 miles away from its Polynesian brethren in the Pacific?

Vitorchiano is a small town about 45 miles north of Rome, near the local provincial capital of Viterbo. It is built above an Etruscan settlement and like other such sites in the region, it clings to a peperino rock bluff perched above two deep gorges, an impregnable position. The town is surrounded by 13th-century walls and the beautifully preserved historical center can be accessed from the main gate, Porta Romana. Several panoramic viewpoints look over the gorges below. One such viewpoint across the gorge, facing the historical town, is adorned by an exotic and unexpected monument.

The lone Moai statue was carved by hand with axes and stones by 11 members of the Atan family (Juan Atan Paoa being a descendant of Ororoina, the only survivor of a civil war between the Long Ears and Short Ears clans on Rapa Nui). The Easter Islanders had traveled to Vitorchiano to visit the Anselmi family, owners of a large peperino quarry in the nearby Cimini mountain range (symbolically connecting the Monti Cimini, an extinct volcanic complex, to the volcano of Rano-Raraku on Easter Island).

Their intention had been to carve a Moai statue in local stone (peperino being a volcanic stone that is high in demand around the world) to raise awareness about the poor state of conservation of the Moai statues on Easter Island. Upon completing and raising the statue, the Easter Islanders performed a sacred ceremony called "Kuranto," which was broadcast on Italian public television.

The statue had initially been placed in the center of Vitorchiano, where it was replaced by a fountain from the 1700s and moved to its present location. Like all others, the Vitorchiano Moai is crowned by a Pukao in pink peperino and its hands are wrapped around its navel.

Today it stands out as one of the most unique and unusual monuments in Lazio, a powerful connection between two ancient civilizations: Rapa Nui and the Etruscans.

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zwol
34 days ago
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A New Chapter for OSS-Fuzz

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Open Source Software (OSS) is extremely important to Google, and we rely on OSS in a variety of customer-facing and internal projects. We also understand the difficulty and importance of securing the open source ecosystem, and are continuously looking for ways to simplify it.

For the OSS community, we currently provide OSS-Fuzz, a free continuous fuzzing infrastructure hosted on the Google Cloud Platform. OSS-Fuzz uncovers security vulnerabilities and stability issues, and reports them directly to developers. Since launching in December 2016, OSS-Fuzz has reported over 9,000 bugs directly to open source developers.

In addition to OSS-Fuzz, Google's security team maintains several internal tools for identifying bugs in both Google internal and Open Source code. Until recently, these issues were manually reported to various public bug trackers by our security team and then monitored until they were resolved. Unresolved bugs were eligible for the Patch Rewards Program. While this reporting process had some success, it was overly complex. Now, by unifying and automating our fuzzing tools, we have been able to consolidate our processes into a single workflow, based on OSS-Fuzz. Projects integrated with OSS-Fuzz will benefit from being reviewed by both our internal and external fuzzing tools, thereby increasing code coverage and discovering bugs faster.

We are committed to helping open source projects benefit from integrating with our OSS-Fuzz fuzzing infrastructure. In the coming weeks, we will reach out via email to critical projects that we believe would be a good fit and support the community at large. Projects that integrate are eligible for rewards ranging from $1,000 (initial integration) up to $20,000 (ideal integration); more details are available here. These rewards are intended to help offset the cost and effort required to properly configure fuzzing for OSS projects. If you would like to integrate your project with OSS-Fuzz, please submit your project for review. Our goal is to admit as many OSS projects as possible and ensure that they are continuously fuzzed.

Once contacted, we might provide a sample fuzz target to you for easy integration. Many of these fuzz targets are generated with new technology that understands how library APIs are used appropriately. Watch this space for more details on how Google plans to further automate fuzz target creation, so that even more open source projects can benefit from continuous fuzzing.

Thank you for your continued contributions to the Open Source community. Let’s work together on a more secure and stable future for Open Source Software.
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zwol
35 days ago
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CLSI 2018 in Review

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The Citizen Lab Summer Institute (CLSI) brings together technologists, political scientists, academics, researchers, activists, artists, and members of civil society to address some the most pressing issues at the centre of technology and human rights. CLSI reflects the true interdisciplinary nature of the information controls research community and past sessions have lead to cutting-edge work, including: analyzing national security and signals intelligence policy in Canada (2017), investigating censorship of the death of Liu Xiaobo on WeChat and Weibo (2017), conducting security audits of child monitoring apps in South Korea (2017, 2016, 2015), documenting Internet filtering in Zambia (2016), and exposing the “Great Cannon” (2014), an attack tool in China used for large scale distributed-denial of service attacks against Github and GreatFire.org.

CLSI 2018 was a record breaking year in terms of attendance, representation, and diversity. Below are some of the highlights from the event’s four research streams.

Network Interference and Freedom of Expression Online

In this track, participants focused on measurement and circumvention of network interference, including Internet censorship, throttling, application level censorship, and network shutdowns. Specific CLSI sessions this year focused on methods for integrating gender awareness into digital rights, the economic impact of Internet censorship, information controls in the Commonwealth of Independent States, methods for detecting network shutdowns, emerging issues in Canadian speech and censorship online, and mapping the discriminatory effects of information controls.

In a session hosted by Mallory Knodel of Article 19, participants investigated improving HTTP error/status code 451 as an instrument for increasing transparency around Internet censorship. Inspired by Bradbury’s dystopian novel Fahrenheit 451, HTTP 451 is an error code that is delivered when a user attempts access to a page that is blocked for legal reasons, such as when a site is censored by a government entity.

What originally started as an opportunity for those currently engaged in the field to discuss their work morphed into a series of discussions on the merits of the status code itself for censorship researchers, and included discussions on the application of 451 on political, technical, and practical grounds.

In another session hosted by Joss Wright of Oxford University, attendees examined the discriminatory effects that information controls can have. This included ‘primary’ effects when explicitly aimed at a disadvantaged group, but also ‘secondary’ effects when such groups are not directly the focus of the information controls (i.e., groups who are affected when broad topics like sexual health are blocked).

Participants identified a number of useful key case studies, including Kurdish populations affected by blocking news outlets in Turkey, blocking Russian LGBTQ content, and blocking Telegram in Iran. Additionally, they discussed a number of potential methodologies and data sources, and some key literature on the topic.

Surveillance and Counter Surveillance

Throughout various discussions, participants in this stream analyzed the technologies, laws, and policies that enable targeted and passive surveillance across various sectors. Sessions included strategies for protecting offline high rights defenders, cross-cultural digital security training, ethics in malware disclosures, and issues for journalists in exile.

In particular, one CLSI session brought together various experts to investigate the growing and troubling prevalence of ‘stalkerware’: commercial spyware that is sold as a security-product and marketed to businesses, parents, and intimate partners with the ability to remotely collect and observe text messages, phone conversations, real-time GPS location data, internet browsing data, and the capacity to activate the microphone or camera of the target-device.

A joint Citizen Lab-Deakin University project looking at stalkerware was advanced by way of group members that included technologists, lawyers, political scientists, and criminologists. Participants generated some novel methodological directions for the project. These included finding interesting ways to harness information regarding adwords and SEO practices in relation to content/legal analyses, the use of access-requests as a potential method for malware attribution, developing insights from user-level analysis to assist technical inquiry of iOS apps, and further clarity into the legal and policy questions being pursued in the study.

Policy and Transparency

In this track, participants developed research methods for documenting corporate and government transparency and discussed advocacy strategies for pushing for greater transparency in these sectors. Sessions this year focused on  creating assessment tools for algorithmic accountability, technological issues in electoral systems in Colombia, holding businesses accountable for human rights violations, and the implications of law enforcement “going dark” in developing countries.

Who Has Your Back” (WHYB) is a regional investigation developed between EFF and different partners in Latin America. It seeks to gain a better understanding of the best practices that ISPs and other telecommunication companies can adopt in order to align with human rights standards on the Internet. It additionally aims at a general understanding on how companies are currently working in regard to data protection in order to develop recommendations that can be adopted in the short and long term.

This session brought together various representatives from civil society organizations in Colombia, Paraguay, México, and Argentina to present the results of research carried out in each country, giving an overview of the different contexts as well as similarities in how telecommunications companies operate in the region. Presenters additionally engaged with participants in a round table discussion with insightful questions about the challenges of doing these projects in Latin America. Furthermore, participants gave substantive advice, based on their own experience, to improve the work being done in the region. Lastly, participants discussed how Citizen Lab’s Access My Info project can be ‘merged’ with the WHYB report, by adding a specific category that can be ranked and measured across the companies.

Security and Privacy of Apps

In this track, participants analyzed how applications are secured from unauthorized parties accessing or modifying data, as well as the ways in which personal information is collected, processed, or retained by application developers. Sessions included an end-to-end analysis of VPN services and IoT privacy and security.

In particular, one session investigated privacy issues in budget smartphone operating systems. Facilitated by Francis Monyango from CIPIT (Center for Intellectual Property and Information Technology law, Strathmore University) the session focused on the privacy implications of mobile phone affordability and security vulnerabilities for low income segments of the market. These budget smartphones usually have outdated versions of the Android OS which have more modest hardware requirements. They come loaded with a host of default applications like web browsers, messaging apps, and social media apps and limited ability to adjust permission settings. This has the effect of exposing users to security risks while potentially breaching their privacy.

Only 23 African countries have put in place comprehensive privacy and data protection laws. As a result, many of the smartphone owners in the countries without privacy laws are left to their own devices when it comes to privacy and online data protection. These smartphones may be exposing users to unethical data mining by big internet companies.

The session was specifically aimed at addressing the regulation of smartphone OS standards for the purposes of protecting the privacy of low-end smartphones users. The session and the discussion that followed turned out to be wide-reaching and could easily be split into various future meetings. Following the productive conversations, next steps for this subject could be to split into two areas: one focusing on a legal/regulatory review and another on a technical/social review.

Gender and digital security

For the first time, CLSI convened a  roundtable discussion on gender and digital security. The purpose of the session was to discuss specific concerns related to these issues, intersectional approaches to addressing challenges, gaps in the current literature, and various ways that the Citizen Lan can positively contribute to this area of research.

The session began with an overview of some Citizen Lab work that included a gender component, including a submission to the UN Special Rapporteur on Violence Against Women, a recently launched study on stalkweware, and analyses of Korean child monitoring apps.

The discussion was opened up to all participants to gain a better understanding of the issues at hand. Some of the points raised included:

  • Approaches should be considered that look at the perpetrators of gender-based digital attacks as opposed to only the victims. How can we prevent attacks from happening in the first place?
  • LGBTQ2+ communities would want to have a deeper understanding of technical issues but can often lack the required expertise, so there is a need for digital rights groups to partner with them to ensure their security.
  • Women can often be economically disadvantaged which makes them more vulnerable to surveillance. They are also more likely to use government services which entails handing over data to governments. The institutionalized experiences of being a women/non gender-conforming peoples are integral to these discussions.
  • Analyses put vulnerable communities in situations of victimization. We must find ways of empowering them and keeping them feel empowered. People who are household heads may be reached differently than those who actually facilitate attack.
  • Technology presents a double-edged sword for female and gender non-conforming activists: while technology can help an activist better protect themselves and their communities, it also has the ability to make them vulnerable to targeted attacks and surveillance.

Specifically, suggestions were made for how the Citizen Lab to help address these issues:

  • We need to constantly be asking ourselves: how do we incorporate gender into the tools we develop? What does it mean to have a gender perspective in our work?
  • Citizen Lab can help improve a methodology to understand self-censorship, especially on gender-based attacks. Women often don’t announce attacks because they don’t want to be further attacked.
  • Continue to support the work of gender non-conforming groups and individuals in ICT spaces

CLSI 2019

CLSI 2018 brought together some of the leading experts in the fields of technology and human rights, and the resulting projects and discussions will generate impact in the years to come.

As we look ahead, CLSI 2019 will continue to build on the work of previous years and advance the interdisciplinary and inclusionary nature of the event. Calls for proposals will be released in early 2019, followed by details and logistics of the event.

 

The post CLSI 2018 in Review appeared first on The Citizen Lab.

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zwol
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How Nevada Became the Only State Where You Can Vote for 'None of These Candidates'

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Sometimes voting feels like a very tough SAT question: None of the choices seem right. What to do when you can't put your heart into any of those empty bubbles? In most states, voters are forced to register dissatisfaction with what's on offer by writing someone in, going for a protest candidate, or simply staying home.

In Nevada, though, malcontents have another option: They can cast an official vote for no one.

The "None of These Candidates" option has appeared on statewide Nevada ballots since 1975, when it was introduced as a convoluted get-out-the-vote tactic. According to the Washington Post, after Watergate, officials wanted to make sure that even people who were totally fed up with politics had a reason to come to the polls—even if it was just to vote against everyone.

Since then, the option has topped four elections—most recently in 2014, when it beat out eight actual human beings in the Democratic gubernatorial primary. As "None of These Candidates" has no body, and thus cannot technically take office, the runner-up was given the slot. In other elections, it has served as a potential spoiler. In the 1996 presidential race, Bill Clinton beat Bob Dole in Nevada by just 4,730 votes, a smaller total than the 5,608 garnered by the "We hate 'em all!" option.

Critics argue that the measure has failed to accomplish its original purpose. "Nevada has experienced a nearly uninterrupted decline in turnout since its creation," writes Dennis Myers of community group Nevada Humanities. Why vote for no one when you could just stay home? It remains to be seen whether the sour tone of American politics will lead more people to choose that option.

This story originally ran on September 9, 2016, and was updated with minor edits on November 6, 2018.

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zwol
35 days ago
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I bet this would work better if it actually forced the seat to be left vacant for a full term if it won.
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