“An Image Was Worth a 1,000 Statistical Tables”


HandWithGerms.jpg  Artistic vision of germ-laden hand.  (This is not the photographic image mentioned below, and used as a hospital screen-saver.)  Source of image:  online version of the NYT article cited below.

 

(p. 22)  Leon Bender noticed something interesting: passengers who went ashore weren’t allowed to reboard the ship until they had some Purell squirted on their hands.  The crew even dispensed Purell to passengers lined up at the buffet tables.  Was it possible, Bender wondered, that a cruise ship was more diligent about killing germs than his own hospital?

Cedars-Sinai Medical Center, where Bender has been practicing for 37 years, is in fact an excellent hospital.  But even excellent hospitals often pass along bacterial infections, thereby sickening or even killing the very people they aim to heal.  In its 2000 report “To Err Is Human,” the Institute of Medicine estimated that anywhere from 44,000 to 98,000 Americans die each year because of hospital errors — more deaths than from either motor-vehicle crashes or breast cancer — and that one of the leading errors was the spread of bacterial infections.

. . .

. . . the hospital needed to devise some kind of incentive scheme that would increase compliance without alienating its doctors.  In the beginning, the administrators gently cajoled the doctors with e-mail, (p. 23) faxes and posters.  But none of that seemed to work.  (The hospital had enlisted a crew of nurses to surreptitiously report on the staff’s hand-washing.)  “Then we started a campaign that really took the word to the physicians where they live, which is on the wards,” Silka recalls.  “And, most importantly, in the physicians’ parking lot, which in L.A. is a big deal.”

For the next six weeks, Silka and roughly a dozen other senior personnel manned the parking-lot entrance, handing out bottles of Purell to the arriving doctors.  They started a Hand Hygiene Safety Posse that roamed the wards and let it be known that this posse preferred using carrots to sticks:  rather than searching for doctors who weren’t compliant, they’d try to “catch” a doctor who was washing up, giving him a $10 Starbucks card as reward.  You might think that the highest earners in a hospital wouldn’t much care about a $10 incentive — “but none of them turned down the card,” Silka says.

When the nurse spies reported back the latest data, it was clear that the hospital’s efforts were working — but not nearly enough.  Compliance had risen to about 80 percent from 65 percent, but the Joint Commission required 90 percent compliance.

These results were delivered to the hospital’s leadership by Rekha Murthy, the hospital’s epidemiologist, during a meeting of the Chief of Staff Advisory Committee.  The committee’s roughly 20 members, mostly top doctors, were openly discouraged by Murthy’s report.  Then, after they finished their lunch, Murthy handed each of them an agar plate — a sterile petri dish loaded with a spongy layer of agar.  “I would love to culture your hand,” she told them.

They pressed their palms into the plates, and Murthy sent them to the lab to be cultured and photographed.  The resulting images, Silka says, “were disgusting and striking, with gobs of colonies of bacteria.”

The administration then decided to harness the power of such a disgusting image.  One photograph was made into a screen saver that haunted every computer in Cedars-Sinai.  Whatever reasons the doctors may have had for not complying in the past, they vanished in the face of such vivid evidence.  “With people who have been in practice 25 or 30 or 40 years, it’s hard to change their behavior,” Leon Bender says.  “But when you present them with good data, they change their behavior very rapidly.”  Some forms of data, of course, are more compelling than others, and in this case an image was worth 1,000 statistical tables.  Hand-hygiene compliance shot up to nearly 100 percent and, according to the hospital, it has pretty much remained there ever since.

 

For the full commentary, see:

STEPHEN J. DUBNER and STEVEN D. LEVITT.  "FREAKONOMICS; Selling Soap."  The New York Times Magazine (Section 6)  (Sunday, September 24, 2006):  22-23.

(Note:  ellipses added.)

 

      The screen-saver at Cedars Sinai Hospital.  Source of image:  http://freakonomics.com/pdf/CedarsSinaiScreenSaver.jpg

Turkey Farmer Ben Nelson Avoids Taxes

  Source of image:  screen capture from the campaign ad cited below.

 

Early in the 2006 senate campaign, the supporters of Democrat Ben Nelson made fun of Republican candidate Pete Ricketts for challenging the property assessment on his house.  (They ran newspaper ads with ridiculing poetry, written in the manner of Dr. Seuss, and wore hats associated with the cat in Seuss’s famous Cat in the Hat book.)

Well, they say what goes around, comes around.  Nelson was himself getting a significant tax break on vacation land he owned, based on its being classified as being used primarily for agricultural purposes ("green-belt" status).  The only agricultural use that could be found was that each year, a few turkeys were released on the land.

Now the Rickett’s campaign has released a funny video ad satirizing "Farmer Nelson." 

 

To download, or watch, the ad, go to:  http://www.petericketts.com/comm_092506.asp

A Tale of Two Churches: Russia Has an Entrepreneurial Tradition Too

 

Two old and exotic churches, St. Basil’s in Moscow and Kizhi in the Russian north, survived the Soviet era and are invariably depicted in brochures and books to suggest the distinctiveness of Russian culture.  Both feature the tent roofs and onion domes that dominated the skyline of medieval Russia.  But each bears mute witness to a very different tradition:  one, imperial centralism; the other, entrepreneurial regionalism.  Both are embedded in Russia’s history; the conflict between them may well determine Russia’s destiny.

St. Basil’s, looming over Red Square, is an enduring symbol of theatrical autocracy; the Kizhi church, of frontier inventiveness.  Authoritarian centralism has been growing recently under President Putin.  But he also is fond of Kizhi and brought its new priest with him on his last trip to New York.

. . .

Tolerance was implicit in the northern tradition of dvoeveria:  the simultaneous belief in both the old pagan spirits and the new Christian God.  Medieval petroglyphs of the Kizhi region freely intermixed symbols of both.  Peasants in the region were not enserfed.  The northern region lost much of its independent power when Moscow sacked and subdued Novgorod.

. . .

Many more people have seen St. Basil’s on Red Square than Kizhi on an island in Lake Onega — and most see Russian history in terms of autocratic power in Moscow rather than creativity amid adversity in the regions.  Kizhi is the supreme monument to this forgotten tradition that continued to unfold as the vast Russian domain spread north to the Arctic Ocean and across the Pacific to Alaska in the 17th and 18th centuries.

No one knows who was the architect of either monument.  But Russian popular folklore suggests that the creator of St. Basil’s was forcefully either blinded or drowned to assure that it could never be duplicated.  In contrast, the creator of Kizhi is said to have simply thrown his ax into the lake and lived on peacefully as a holy man in the northern forests.

During that time, Moscow autocrats looked out from the closed front porch of St. Basil’s to see the enemies of central power drawn and quartered publicly in Red Square.  By contrast, the Kizhi church was wider and open to the sky — and where local people gathered to solve practical problems, facing a vista of lakes and forests.

Much of the renewed vitality in Russia today is coming from young people in the regions.  Their hopes for a more participatory and accountable political and economic future depend on the kind of open community that created Kizhi — not the closed circles that cling to St. Basil’s.

 

For the full commentary, see: 

JAMES H. BILLINGTON.  "MASTERPIECE; Two Churches, Two Russias; One born of authoritarian centralism, the other of entrepreneurial regionalism."  Wall Street Journal   (Sat., September 16, 2006):  P18.

 

“Crystal Fire” Gives Insights on Birth of the Transistor

  Source of book image:  http://www.etedeschi.ndirect.co.uk/homecompbiblio.htm

 

Crystal Fire is a well-written book which highlights many important aspects of the birth of computers.  Not a perfect book—I could have done with a few less details about personal information, like who liked to play bridge and poker, and whose mother was a frustrated artist, and the like.

On the good side, they note how transistors were originally designed to replace vacuum tubes.  The eventual main applications, as memory and processor chips in computers, only came later.  (Another application of Fubini’s Law.)

They have a nice discussion of how American science was applied, versus the pure theory of the Germans.  (E.g., to the Germans, some key phenomena leading to transistors, were dismissed as "dirt effects" (pp. 74 & 78).)  The whole episode is a good example of the claim (see Terence Kealey) that very good science can come out of ‘industrial’ labs. 

They also have a good example of serendipity, in the discussion of the strange chunk of silicon with unusual conductivity properties (circa p. 95).  Reading this episode, it occurred to me that one key enabler of serendipitous discoveries is a scientist or engineer who is carrying around a problem, to which the serendipitous discovery is a solution.  Buddhists need not apply—to carry around problems, you need to be dissatisfied–a milder version of what Tom Peters describes as ‘innovation coming from pissed-off people’  (see his Re-Imagine!)

 

Citation to the book:

Riordan, Michael, and Lillian Hoddeson.  Crystal Fire: The Birth of the Information Age, Sloan Technology Series: W. W. Norton & Company, 1997.

 

Utilities Propose to Build 27 New Nuclear Reactors

W tours one of Constellation Energy’s current nuclear power plants.  Source of the photo:  online version of the NYT article cited below. 

 

(p. C1)  BALTIMORE — Nobody in the United States has started building a nuclear power plant in more than three decades.  Mayo A. Shattuck III could be the first.

As the chief executive of Constellation Energy, a utility holding company in Baltimore that already operates five nuclear reactors, Mr. Shattuck is convinced that nuclear power is on the verge of a renaissance, ready to provide reliable electricity at a competitive price.  He has already taken the first steps toward achieving that, moving recently to order critical parts for a new reactor.

 

The full story is strongly biased in favor of the standard politically correct environmentalist antagonism toward nuclear energy.  But if you want to read it anyway, see:

MATTHEW L. WALD.  "Slow Start for Revival of Nuclear Reactors."  The New York Times  (Tues., August 22, 2006):  C1 & C4. 

 

  Source of map graphic:  online version of the NYT article cited above. 

 

Gym Classes Promote Sports, Not Healthy Exercise

 

Here is more evidence that public school physical education classes should be turned over to private sector firms like "24 Hour Fitness."  

Ms. Jackie Lund, who is quoted below, is the President of NASPE, which the article identifies as "an association of fitness educators and professionals.  Note well that she as much as admits that fitness is not the purpose of gym classes.

 

Researchers report that in the typical high-school gym class students are active for an average of 16 minutes.

The report by Cornell University researchers also found that adding 200 minutes more of physical-education time a week had little effect. (See the report.)

"What’s actually going on in gym classes?  Is it a joke?" asked John Cawley, lead author of the study and a professor of policy analysis and management at Cornell.

. . .

The rest of the extra gym time is likely spent being idle — most likely standing around while playing sports like softball or volleyball that don’t require constant movement, Mr. Cawley said.

. . .

. . . , Ms. Lund says merely counting how many minutes students are moving may not be a fair measure of a gym class.  "It’s not supposed to be aerobics class.  The activity level is going to vary depending on the sport they’re learning," she said.

 

For the full story, see: 

"High-Schoolers Get Scant Exercise in Gym Class."   Wall Street Journal  (Weds., September 20, 2006):  D4.

(Note:  the online version of the article has the title:  "Is High-School Gym Class An Exercise in Futility?")

(Note:  ellipses are added.)

 

Life Is Better, But Could Be Better Still

  November 9, 1952 NYT ad announcing the introduction of the snowblower.  Source of image:  online version of the NYT article cited below.

 

(p. C1)  When the first snow falls on the North Shore of Chicago this winter, Robert Gordon will take his Toro snow blower out of the garage and think about how lucky he is not to be using a shovel.  Mr. Gordon is 66 years old and evidently quite healthy, but his doctor has told him that he should never clear his driveway with his own hands.  “People can die from shoveling snow,” Mr. Gordon said.  “I bet a lot of lives have been saved by snow blowers.”

If so, most of them have been saved in the last few decades.  A Canadian teenager named Arthur Sicard came up with the idea for the snow blower in the late 1800’s, while watching the blades on a piece of farm equipment, but he didn’t sell any until 1927.  For the next 30 years or so, snow blowers were hulking machines typically bought by cities and schools.  Only recently have they become a suburban staple.

Yet the benefits of the snow blower, namely more free time and less health risk, are largely missing from the government’s attempts to determine Americans’ economic well-being.  The same goes for dozens of other inventions, be they air-conditioners, cellphones or medical devices.  The reasons are a little technical — they involve the measurement of inflation — but they’re important to understand, because the implications are so large.

. . .

(p. C10)  In the early 1950’s, Toro began selling mass-market snow blowers, which weighed up to 500 pounds and cost at least $150.  As far as the Bureau of the Labor Statistics was concerned, however, snow blowers did not exist until 1978.  That was the year when the machines began to be counted in the Consumer Price Index, the source of the official inflation rate.  By then, the cheapest model sold for about $100.

In practical terms, this was an enormous price decline compared with the 1950’s, because incomes had risen enormously over this period.  Yet the price index completely missed it and, by doing so, overstated inflation.  It counted the rising cost of cars and groceries but not the falling cost of snow blowers.

. . .

Mr. Gordon, besides being a fan of snow blowers, also happens to be one of the country’s leading macroeconomists.  A decade ago he served on a government-appointed group known as the Boskin Commission.  It argued, as Mr. Gordon still does, that the government exaggerated inflation by more than one percentage point every year.

. . .

. . .  Mr. Gordon’s adjustments show that men actually got a 27 percent raise in this period and women 65 percent.  The gains are not as big as those of the 1950’s and 60’s, but they do sound far more realistic than the official numbers.  Think about it:  we live longer than people did in the 1970’s, we’re healthier while alive, we graduate from college in much greater numbers, we’re surrounded by new gadgets and we live in bigger houses.  Is it really plausible, as some Democrats claim, that the middle class has made only marginal progress?

 

For the full commentary, see: 

DAVID LEONHARDT.  "Economix; Life Is Better; It Isn’t Better. Which Is It?"  The New York Times  (Weds., September 20, 2006):  C1 & C10.

(Note:  ellipsis added.)

 

 PayTwoViewsGraph.gif  Source of graphic:  online version of the NYT article cited above.