I got an electric cargo bike 3 years ago and it has fundamentally changed the way I move around my little suburban town. I can do pretty much every errand I'd normally do with a car.
If it weren't for the heavy snowfall we get I would be able to get rid of one car; for now it just sits unused for 1/3rd of the year.
I have rain pants and a jacket and my two kids sit in a tent on the back. They love it. I love it. Together we have put over 2000 miles on the bike in two years.
Patagonia makes great rain jackets that have hoods that can adjust to fit over a helmet.
What about safety? I have an ebike too similar to yours, I bring both my kids (it requires some serious efforts on steep hills with both kids though), but I fell down once in the rain that gave me a decent scare, especially since my wrist is taking so long to recover and I could have hurt my daughter (lucky, nothing happened)
I took a spill with my kids over a bridge that had black ice. Luckily everyone was ok.
We all wear helmets, we almost exclusively use bike/walk infrastructure, and we take it slow.
The biggest risk in my mind is interacting in any way with cars. And so I avoid cars on our routes as much as possible. And I regularly “break the law” by riding on sidewalks because paint on the road is not bike infrastructure and my life is more valuable to me than some ticket for a ridiculous law.
Car dealerships are a black box; feel like so much depends on timing and where they are with their sales numbers for the month.
I tried to lease a car last year and after some research knew what was a fair price for a well stocked model; when I suggested a range one sales manager laughed at me.
I emailed a finance manager at a different dealership with exactly what I wanted and told him I could get all of the paperwork done in the next hour if it was a good fit. They agreed and dropped the car off in my driveway a few days later.
Same here - I was suddenly suspended for the following:
"We’re writing to let you know that your account has been suspended—and will remain suspended—due to multiple or severe violations of our platform manipulation rules"
I am a very boring person and there was zero chance I had done anything like this.
I was able to appeal ~5 times over 6 months and finally got my account reviewed by a person. They restored it and apologized that I was swept up in a spam cleanup. I don't tweet much but I am a daily user.
Agree with all of this, and just to add one thing: liability.
Look at the RaDonda Vaught case or the Michelle Heughins case; terrifying to be looking at jail time for a med error.
Many nurses are watching these cases more closely and deciding that since staffing isn't getting any better and they won't be protected, it's not worth the risk.
That case goes far beyond med error and I don't understand why people keep bringing it up as an example.
She pulled the wrong med, and then injected it and walked out of the room rather than observing for effects. Also the med she pulled had warnings on all sides of the bottle and on the top saying very clearly that it's fatal to administer without ventilation. This went beyond a mistake to negligence.
Janie Harvey Garner, a St. Louis registered nurse:
“In response to a story like this one, there are two kinds of nurses,” Garner said. “You have the nurses who assume they would never make a mistake like that, and usually it’s because they don’t realize they could. And the second kind are the ones who know this could happen, any day, no matter how careful they are. This could be me. I could be RaDonda.”
> Also the med she pulled had warnings on all sides of the bottle and on the top saying very clearly that it's fatal to administer without ventilation.
The linked PDF includes images of medicine in question. There's a single warning on top that reads "WARNING: PARALYZING AGENT" and a red cap. I don't see any warnings on the side. The vial appears to be tiny, smaller than my thumb.
But yes, she made a series of mistakes, listed on the last two pages of the PDF.
I am not a nurse, but I can easily imagine how someone could make the errors she did in an overworked and high-stress environment. It's a cascading series of errors that starts with overriding the medicine cabinet when she can't find the medicine she's looking for. But according to her defense, overriding the cabinet had become almost standard operating procedure at Vanderbilt at that timeframe. Once she starts down this path, she's operating on automatic and almost blind to what she's doing.
I agree she was negligent. I don't think she should go to prison for it. In the bigger picture, this is causing more nurses to quit, likely leading to more medical errors and deaths, not fewer.
> I am not a nurse, but I can easily imagine how someone could make the errors she did in an overworked and high-stress environment.
There are so, so many differences between the two meds, I don't see how confusing them would be possible short of gross negligence (for context, I am a paramedic, and often administer medications (including both of the meds involved here) in a high stress environment).
Vecuronium (the paralyzing drug) is a powder in the vial and you need to first inject saline it into the vial, shake it up, and then draw out the "reconstituted" med. This is very unusual (there are only a handful of medications in common use that require this, and Midazolam, the intended med, is _definitely_ not one of them). The reconstitution process means she would have had to look at the top of the vial several times, and warning on the tops of vials are, again, very uncommon. Also uncommon is the red cap on the vial.
I have made errors before while caring for patients, and I will likely make them again. I am very aware of the fact that we all can make mistakes, but the number of mistakes that needed to be made here far exceeds the standard of what is reasonable, and is well into the territory of "gross negligence", in my opinion.
I appreciate your perspective as a medic. The PDF I linked enumerates the mistakes she made and the differences between the two medicines, and I have read all that. From non-professional perspective, it seems like it was inattentional blindness.
But let me allow for a second that this is a case of gross negligence, despite the fact that CMS investigated Vanderbilt and found many other issues in the workplace:
It's not clear to me how criminalizing her mistake helps prevent future medical errors. Do you think criminally prosecuting her was the right decision?
I am neutral on the idea of criminal prosecution here (for the individual, I absolutely thing there should be accountability for the organization). I am generally opposed to criminal prosecution for medical errors, but it's hard to overstate how outlier this series of mistakes was in terms of the severity of the outcome and the degree of negligence demonstrated.
I think the question of "should we put this person in prison for these actions" is equivalent to any other criminal act (which isn't a clear cut answer either, in my opinion).
Yes we do, but we also give DAs discretion over when to enforce it. Given the extenuating circumstances, I don’t think it should have been enforced here.
Her employer, by not creating a culture of safety, set her up for failure.
I just don't see how in the long term this prosecution reduces medical errors and generally disagree with criminalizing mistakes; even ones such as this.
Enforcing criminal liability for homicidal negligence is how you force respect of even basic safety requirements that already existed.
I'm not arguing that hospitals aren't currently a shitshow, I'm aware I've worked in them. That doesn't excuse this nurse's complete lack of respect for the risks she took.
As I've said before, if aviation insisted on criminal punishment for pilots, we'd be far worse off. Many accidents are caused by fear of punishment. Culture of safety can only be implemented and enforced top-down. Why punish the nurses when they're not the ones responsible for what kind of culture exists at their institution?
We do sometimes punish pilots criminaly. For example one easy way to go to prison is trying to fly a plane under the influence of alcohol. (Here is an example [1])
We do not punish criminaly pilots for other kind of mistakes. For example you are unlikely to go to prison if you miscalculate the required fuel for a flight.
I don’t know the details about the nurse. Was it more like the first or more like the second?
I don't particularly care about the nurse being mentioned or the details. I'm far more concerned about the fact that nobody seems to be interested in talking about or making regulatory/process/culture changes at this hospital and/or others to ensure that it can't happen again. It's too easy to make individual nurses responsible for deaths when the actual cause is in the processes that allowed it to happen. I'm not seeing this kind of investigation. Where's the FAA/NTSB equivalent for healthcare?
That enforcement causes nurses to not want to work, as the nurses aren't the decision makers in making a culture of safety. The administrators bear that responsibility so maybe we should enforce it on them.
This nurse was the decision maker in whether she bothered to check the label on the vial for what she was injecting to the patient, and / or bothering to scan it as required before leaving them to die in terror.
I'm not sure what world you live in, but I'd like to live in the one where criminal negligence resulting in avoidable death is prosecuted.
If nurses quit over criminal liability for killing someone by being that careless, everyone is better off by them not being in the field. Pharmacy has had the same rules for over a hundred years. A great example is even in the movie a wonderful life.
If you don't go to jail for this, do you do so for any sort of negligence? What about an Uber driver that runs a red light and kills a pedistrian walking? Or is drunk and kills someone? That worries me a lot more than this story.
Literally every medication has warnings slapped all over it. My partner worked at Vanderbilt (on a different floor) around this time, and one constant complaint I heard (prior to the incident) was how there was hardly any controls around anything there.
Every medication does not have a bright red cap with a bold warning printed on the top (that you have to look at at least twice while reconstituting and then drawing up the med). The warnings on a vial of Vecuronium go well beyond the typical "This medication may case XYZ side effect", and for very good reason.
Yeah, there's no doubt that this is a shitshow from how Vandy is described (and nursing in general especially with these automated pharm boxes), but that should be additional consequences, not this nurse avoiding hers.
The hospital that hires the nurse should be responsible for the nurse. Period. Under all circumstances.
The hospital has far too many incentives to play fast and loose and then leave the nurses in the lurch with a system stacked against them. The hospital has far too many incentives to skimp on training and safety. etc.
Should this nurse also have her license looked into? Yeah, it looks like it. And is it up to the hospital to fire her or not? Yes.
However, barring actual proof of premeditation, all charges and fines should land on the hospital--not the nurse.
My GF is a nurse and I've heard her talk about working a number of 12 hour shifts and not having the ability to go to the bathroom, get water, or have lunch, all because of how strapped the unit is and arduous the requirement is to do these things (usually having to leave the unit). I'm honestly shocked we're not hearing more mistakes, and it should be 100% hospital admins on the chopping block for forcing these insane work environments upon nurses while expecting quality patient care.
People like you are part of the problem. "It was covered in all kinds of scary warning labels"—just like every other medication in that drawer. Medical professionals are totally blind to alerts given off by their EMRs because everything has a password-protected warning so that the audit logs can say "yes, this physician/nurse read and understood the warning"
No, very different from every other med in the drawer. The red cap on the vial is very unusual (reserved for very dangerous meds like this), and the bold printed warning on the top (that you have to look at at least twice while while preparing to administer this medication) is also something used very rarely.
I believe you can even be personally liable for HIPPA security violations as a user or dev of a healthcare system. That seems a bit scary. I agree that regulation persuades people not to do things out of fear of breaking the law. We see this in it's intentional form with regulation of other things such as abortion, guns, etc. Put so many laws in place that risk of accidentally breaking one and receiving an extensive punishment isn't worth it.
> I believe you can even be personally liable for HIPPA security violations as a user or dev of a healthcare system.
Welcome to being an engineer, if that's what you want to call yourself. The engineer who approves a bridge design can be held liable if it collapses due to a design fault.
One difference is that HIPAA has a bunch of statutory penalties for "technical violations" that might or might not harm anyone. For example, if a call center staff discloses patient information to, say, the child or parent of a patient, that comes with an automatic fine and (potentially) jail time.
Another aspect is that certain HIPAA allowances for data usage require a lawyer's expertise, not an engineer's. For example, can a health insurer use patient data to train a model w/o first obtaining patient consent? If the model will be used for "healthcare operations" (i.e., adjudicating claims), you might argue that the answer is yes. If the same model will be used for suggesting treatment options to doctors, you might argue that the answer is no. If you answer wrongly, you are hit with a statutory fine.
It's like having a fine for painting the bridge the wrong color because there is a law that bridges must be green, but you used lime. Not because you're worried about the bridge collapsing, but because the law says so.
Generally, civil engineers don't need to worry about fines or jail as long as things stay up.
Generally the firm's insurance will cover an engineer since they are a "professional". Software "engineers" generally have not been individually liable for bugs. Usually the software user agreements don't allow for this sort of thing.
Basically, contracts can control the liability in most cases, but HIPPA prevents that by explicitly defining liability under the statute.
Lot's of better paid gigs with better working conditions where you aren't personally legally liable if you write a bug. I don't especially care about what job title some board thinks I'm allowed to use.
Yep. I believe that's really the core of the article - overhead like regulation and liability on top of working conditions have people looking to other professions.
Married to an RN and absolutely sympathetic to the staffing/pay plight they're currently facing. I'm unfortunately not very familiar with the case of Michelle Heughins, but I've heard a lot of the RaDonda Vaught case. The high points of the case as I understand them:
* Vaught stated her department was not understaffed, nor was she tired. The incident also occurred in 2017, so pre-pandemic
* Vaught went to dispense Versed (generic name midazolam) by the brand name, instead of the generic name as they're trained to do. This led to her selecting vercuronium bromide instead
* Vaught stated she had dispensed midazolam several times before, which would have had to have been by the generic name
* Vaught ignored several warnings from the dispensing machine stating the patient was not prescribed vercuronium bromide
* Vaught ignored the red cap on the vial dispensed that stated it was a paralytic agent
* Vaught ignored that vercuronium bromide needed to be reconstituted with sterile water (unlike midazolam, which comes as a liquid). She stated she thought it was odd that she didn't have to reconstitute it before when dispensing the correct medicine
* Vaught did not scan in the medication before or after giving it to the patient, which would have likely prompted another warning about it not being prescribed
* Vaught could not recall exactly how much she gave to the patient
* Vaught immediately left the room after injection, and did not wait to observe the patient for any side-effects
The opinions on the case I've observed have been nurses who aren't aware of this and saying she should not have been convicted, and the nurses who are aware who think the conviction is fair ...ish. The latter is at least unanimous she should have her license revoked.
Most agree that Vanderbilt should be held responsible for negligence as well. My wife's hospital for instance does not stock _any_ paralytics within machines, to prevent it being accidentally dispensed without involving the pharmacy. There's also evidence that Vanderbilt tried to cover the incident up.
I've made a point of stressing to any RN I've talked about it with the importance of having a lawyer with you when talking with investigators. Vaught straight up incriminated herself multiple times during her initial interview.
I'm not familiar with the case, but assuming what you've outlined above is accurate, I have no doubt a jury would convict. Negligence actually sounds like too nice of a word for that train wreck of events.
> When you’re the founder of a startup that takes in a $50M investment like this, you’re all set to live off the money however you want. You can pay yourself a “market salary” of $500,000/yr+
This is just not true, even for a venture backed company like this. The Board of Directors should be approving all executive comp; seems like a baseless claim to suggest there isn't some basic governance at play here
I don’t know what the situation is here but a startup can setup the board or governance in different ways. Founder could control everything directly or indirectly and the board might have one or no external directors.
And while technically you should inform the board of executive comp changes, it’s not like the investors generally care that much in the early stages or there is some box they have to officially check. You could just go to your payroll system and increase your comp. They don’t come to check your payroll or accounting unless they suspect something so it’s not that hard fly under the radar for some time.
Do you really think Greylock, A16Z or Azure Capital has no interest in BOD seats and no experience forming a Compensation Committee?
As CEO, the Board is your boss. If you instruct payroll to bump your salary up without proper approval you will probably be looking for another job.
These investors have a basic fiduciary duty to their LPs to make sure there is no blatant fraud, and you don't get to billions under management and not understanding this.
There are hot rounds you have those names involved and they all don't get a board seat. Usually only the lead gets a board seat (not always) and growth investors (Tiger) also don't typically ask for board seats. Depends on the amount of leverage the founder has. If A16Z is wanting to win a deal and Tiger is offering more money and no board seat, and the founder wants that then A16Z either has to pass or offer the same.
You're overestimating the formalness of the early stage startup corporation practices or board (seed-series b) and the reporting requirements. Most of the time it's like any other meeting, you chat about what's going well, what's not and how to improve. It's not like public company board at all, there most definitely are no committees (maybe on paper). If you need approvals, like for employee option grants, you just send them an fyi and a docusign (this case the approval is also after the fact. You already gave someone an offer and the accepted it. It would be hard to go back to change it so approval is just a rubber stamp.)
It's up to you as board define what kind of board meetings you have and what's on the agenda. At the end of the year, most VCs ask you submit some basic financials, cap table etc but for example the CEO's salary is not one of those numbers. The BOD might be also completely fine with $500k/year salary.
As the startup grows and matures, the practices mature too but likely that won't happen before ~100 employees or after Series B.
I can assure you that as CEO, I could go to our payroll service increase my salary. We don't even have a payroll or HR department. No-one would really know until maybe next year when accounting gets done. Obviously, I wouldn't do that but if you don't care about your reputation and there to scam then it's very easy to do. If the investors find out, they might not be able to get rid of the CEO that easily, since like I said before, the founder(s) could control the board by votes or by seats. It's also unlikely these investors would cause any publicity around this because it's embarrassing to them and pushing a founder out could hurt their reputation (like when Benchmark kicked Travis out of Uber), they would just more likely walk away.
My understanding is that "hot" founders receive a tremendous amount of latitude from their BOD - so they wouldn't think twice about "generous" (by startup standards) executive comps.
I'm in the Cybersecurity, Information Security Track. My undergrad was Business Administration. It's been a struggle trying to learn things as I go but so far no issues. I personally feel the MS in CS would be more valuable, but I never thought I would have been accepted into the program. I was accepted into the first semester of the MS in Cyber MS. If I had known that I would be successful, I would have applied to the CS degree years ago.
How difficult was it to transition into the job market? I have always wanted to make the jump (in finance & accounting now) but the most daunting thing seems like convincing someone to hire you.
That is the hardest part. Certain professions give a kind of boost. If you switch from being a lawyer or some type of engineering background managers will assume you are smart. Much harder if you move from being a waiter or actor where the assumption may go the other way.
I’ve known a lot of people that had a hard time breaking into tech, even very “smart” highly educated people. The key is persistence. If someone tells you that you can’t code because you were a waiter or an actor, they weren’t someone you wanted to work for anyway.
Your first point is correct. It is hard to break into tech. For almost anyone. That does not make the fact that having a background that on paper makes one appear "smarter" makes it easier to break into tech any less true.
Your second point is also true. But when getting your first job is the hardest part many people would rather do 3 months to a year under someone they wouldnt want to work for and then move to a better role than continue being a waiter or actor for the rest of their career while they hold out for a first job that is ideal.
I agree that persistence is the key but it is easier for some backgrounds than others.
My twitter account was banned in March without warning (the reason they provided was "due to multiple or severe violations of our platform manipulation rules). Frankly, I'm way too boring on the site for me to be guilty of this so I appealed 5 times over ~4 months.
I must have gotten through to a person eventually because I was unsuspended with the message:
> We’re writing to let you know that we've unsuspended your account. We’re sorry for the inconvenience and hope to see you back on Twitter soon.
> A little background: we have systems that find and remove multiple automated spam accounts in bulk, and yours was flagged as spam by mistake. Please note that it may take an hour or so for your follower and following numbers to return to normal.
If it weren't for the heavy snowfall we get I would be able to get rid of one car; for now it just sits unused for 1/3rd of the year.