Renee C. Byer/Sacramento Bee/ZUMAPRESS

I’ve been hospitalized once in my life, four years ago, and ever since then a very specific question has rattled around my brain, fruitlessly seeking an answer: Why are hospitals designed to allow patients as little sleep as possible?

Is my phrasing a little too aggressive? Designed to prevent sleep? Maybe that’s going a tiny bit too far. Instead let’s say: Why do the people who design hospitals not give a rat’s ass about patients getting any sleep?

There. That’s better. And it’s nuts. The whole point of hospitals is to care for sick people, and getting adequate sleep is a critical part of recovery. So why would every part of every hospital be designed without the slightest consideration of sleep? I’ll hand the mic over to Austin Frakt for a bit:

Peter Ubel understands the problem as both a physician and patient. When he spent a night in the hospital recovering from surgery in 2013, he was interrupted multiple times by blood draws, vital sign checks, other lab tests, as well as by the beeping of machines. “Not an hour went by without some kind of disruption,” said Dr. Ubel, a physician with Duke University. “It’s a terrible way to start recovery.”

….Solutions aren’t hard to fathom. Dr. Ubel listed some in 2013. Hospital workers could coordinate so that one disruption serves multiple needs: a blood draw and a vitals check at the same time instead of two hours apart. Or they could allow patients’ needs to guide schedules. If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don’t do that check once every four hours.

Small changes in hospital routines like these can go a long way. A clinical trial to test them found that they significantly reduced the proportion of patients reporting hospital-related sleep disruptions, and they cut sedative use in half. These small changes can even increase patients’ ratings of hospitals, which are now part of Medicare quality measures. The key insight seems to be to prioritize patients over tests and other interruptions that can be deferred.

As Frakt says, solutions aren’t hard to fathom. In fact, they’re trivially easy to figure out. This is why hospital routines strike me as deliberate negligence: they could only be put in place by administrators who literally don’t care about anything except the convenience of doctors.

Is there anything we poor patients can do? It’s hard to say. One time I asked a nurse to turn off the sound on the IV drip, and he actually did try to do it. But apparently he didn’t know how, because it kept beeping all night regardless of whether there was a problem. This does not give me great confidence in the possibility of further noise-reduction measures.

FWIW, though, it is sometimes possible to get better treatment. After a couple of days during my stay, I made a sort of handshake deal with my nurses to leave me alone between 11 and 7. This mostly worked (and was reasonable in my case since I was only there waiting for the first round of chemo to start). I also refused to allow the night nurse to draw blood at 4 am, and that was that. She never came back, and that was fine: after all, there are lots of cases where they really don’t need your counts on a daily basis. And they certainly don’t need them at 4 am. That’s merely for the convenience of doctors, who want the results back by 8 am.

There’s much more that could be done about this, but I’ll spare you. This is my rant for the day—now backed up by an official column in the New York Times. I can’t wait for the letters to pour in offering BS excuses for why none of these solutions is really possible.

After I took yesterday’s sunset picture over Big Bear Lake, I picked up my tripod, turned around to return to my car, and…

…saw this picture. It’s part 2 of my quasi-diptych: Sunset and Moonrise at Big Bear. Enjoy.

Yesterday the stock market surged, supposedly on news that a trade deal with China was in the works. Today, the stock market has plummeted, supposedly on news that Trump lied about how likely a deal really is. If all this is actually true, it means that Wall Street investors are idiots. They can’t possibly still be taking Trump’s tweets at face value, can they?

There’s no telling, really. In any case, explanations of why the market has gone up or down on any particular day should always be taken with a shaker of salt. The more likely explanation is shown in this chart:

The market has been volatile ever since October. If I knew why I’d be a billionaire, and for all you know, maybe I am. But I’m not. So I have no idea why everyone has gotten so jittery over the past couple of months. Whatever the reason, though, this week’s ups and downs are most likely just the same jitters that began in October. I doubt they really have anything to do with Trump’s Twitter idiocies at all.

Speaking of which, did you hear that Trump signed the new and improved NAFTA treaty while he was in Argentina? Unfortunately, our dealmaker-in-chief, who’s signed so many deals you wouldn’t believe it, couldn’t figure out where to sign this one.

Was Russia being the GOP server hack? I have no idea. Really. But I'm going to use this sinister stock illustration of Vladimir Putin and a shaky American flag anyway.Jaap Arriens/NurPhoto via ZUMA

From Politico:

The House GOP campaign arm suffered a major hack during the 2018 election, exposing thousands of sensitive emails to an outside intruder, according to three senior party officials. The email accounts of four senior aides at the National Republican Congressional Committee were surveilled for several months, the party officials said. The intrusion was detected in April by an NRCC vendor, who alerted the committee and its cybersecurity contractor. An internal investigation was initiated and the FBI was alerted to the attack, said the officials, who requested anonymity to discuss the incident.

….None of the information accessed during the hack — thousands of emails from senior NRCC aides — has appeared in public, party officials said. And they said there were no attempts to threaten the NRCC or its leadership during the campaign with exposure of the information.

INCOMPETENT DEFENSES! EMBARRASSING TO GET HACKED LIKE THIS. EVERYONE IS SAYING DEM CYBERSECURITY MUCH BETTER.

WHY WASN’T PAUL RYAN NOTIFIED? COVERUP!

WHERE’S THE SERVER? WHY WON’T REPUBLICANS HAND IT OVER TO THE FBI? HAS IT BEEN ACID WASHED?

NO EMAILS LEAKED? DID NRCC MAKE DEAL WITH WIKILEAKS AND ASSANGE? MAYBE!

TOTAL DISGRACE THAT WE’RE ONLY HEARING ABOUT THIS 8 MONTHS AFTER IT HAPPENED!!!

HUGE $$$ PAID TO GOP LOBBYING FIRM TO INVESTIGATE HACK BUT NO RESULTS! WHAT ARE THEY HIDING?

Check out the results of Wisconsin’s gorgeous, computer-generated Republican gerrymander:

In other Wisconsin news today, the state posted the official 2018 Assembly election results. It’s a beautiful gerrymander. Dems got 190,000 more votes but Reps got 63/99 seats. Key is assuring many GOP districts get just over 50% of vote even in a bad year for the party. pic.twitter.com/WEOvpr4EUD

— Barry Burden (@bcburden) December 4, 2018

Recall that the goal of a gerrymander is to stuff as many opposition votes as possible into the smallest number of districts. In this case, Republicans wanted to create as many districts as possible that were 100 percent Democratic, and boy howdy did they succeed. There are 30 (!) districts that are entirely Democratic compared to only eight that are entirely Republican.

What this means is that in 30 districts there are a ton of “wasted” Democratic votes. Every vote over 50 percent does nothing except give the Democrat in that district a bigger win. If the district lines were fairer, many thousands of those Democratic voters would instead be in competitive districts giving Republicans a run for their money.

The end result is that Republicans won 46 percent of the statewide vote but 64 percent of the seats in the state Assembly. Now that’s gerrymandering!

This is not North Carolina. It's not even 2018. It's a rally against election fraud in Brooklyn in 2017. But it was the best I could do.Sachelle Babbar/ZUMA

Here’s a super-short North Carolina explainer: A Republican candidate for Congress hired a guy who then hired another bunch of guys¹ to walk neighborhoods asking people for their absentee ballots. They were “picking up ballots,” they said. When they got them, they turned the ballots over to their guy, who presumably kept the ones that voted Republican and tossed out the ones that voted for the Democrat.

This is probably the most blatant case of election fraud we’ve seen in a long time, and it’s possible that it flipped the race. Note, however, that it is absentee vote fraud, the kind that Democrats keep warning about. It is not in-person vote fraud, the kind that Republicans keep saying we need voter ID laws to stop. I’m sure you are all shocked.

Here’s the longer version if you want to torture yourself:

You know who’s being investigated for election fraud during the midterms?
Bussed-in students❌
Immigrants❌
Dead people❌
Felons❌
Republicans ✅https://t.co/xmMexJXCzM

— James West (@jameswest2010) December 4, 2018

¹Or whatever the gender-neutral version of “guys” is.

Sculpture: ''Brain G (2018)'' by Michael Sailstorfer; Photo: Christophe Gateau/DPA via ZUMA; Colorizing: Kevin Drum

I saw this headline in the New York Times on Monday and was immediately annoyed:

Can We Finally Stop Talking About ‘Male’ and ‘Female’ Brains?

Later on, spurred by a tweet, I read the piece and got annoyed all over again. But then, while I was stewing over it, I suddenly realized that I was off track. So I went back to read it a second time, and sure enough, I had been annoyed by the wrong thing. Here are a series of excerpted phrases that describe things the authors say are wrong:

men’s and women’s natures can be usefully and meaningfully carved into two categories or “natural kinds,” that are distinct, timeless, and deeply biologically grounded … “extreme male brain” theory of autism … “the male brain,” that drives ways of thinking, feeling, and behaving that distinguish the typical boy and man from the typical “empathizing” girl and woman … two different classes of brains … “male brains” and “female brains,” and “male natures” and “female natures” … exclusively “female-typical” features or “male-typical” features.

What’s going on here is subtle—and may not be clear solely from the excerpts—but the authors are being very, very careful. As it turns out, they aren’t saying there are no differences between male and female brains. They are merely arguing against the extreme notion that these differences are overwhelming.

Years ago it was a pet peeve of mine that the folks who argue about nature vs. nurture spend almost all their time arguing against straw men. In this case—but only if you read fairly closely—Daphna Joel and Cordelia Fine are arguing against the straw man that biological differences are everything. Likewise, when Steven Pinker wrote The Blank Slate a few years ago, the title alone tells you that he’s arguing against the straw man that social differences are everything. Nearly everyone who writes about this topic seems to feel justified in assuming that these opposing straw men are the conventional wisdom, and therefore it’s OK if they overstate their own case since the conventional wisdom is so widespread and so badly needs a righteous debunking.

At the same time, they’re always careful to acknowledge that they themselves believe that both nature and nurture are important. In fact, since the authors of practically every book and article I’ve ever read on this subject admit that nature and nurture are both important, I’ve come to wonder just who they’re arguing against. We all agree! Hooray!

I dunno. What is the conventional wisdom these days? Among scientists, I’d say it’s taken for granted that both biology and culture play big roles in nearly all cognitive characteristics. But what about the popular world of chat shows, tabloid magazines, and TED talks? Do most people think that individual behavior is set at birth? Or do they think that children are mostly a product of their upbringing? Or maybe both, in the weird way that people have of believing two extreme opposite views at the same time?

I’m not sure. But everybody I read tells me that both nature and nurture are important, so that seems fairly likely to be the conventional wisdom. That being the case, it means we should be willing to write more plainly about this stuff. In this case, for example, the authors should say, clearly and up front, that sex differences in the brain are real and important, and then explain just how much practical difference they make and how they interact with social stereotypes and cultural cues. Will some people inevitably take this the wrong way? Probably. But not many. It’s really OK to trust most of us to get the point even if you admit that life is complicated and lots of different things are true at the same time.

This morning I mentioned how excited Republican legislatures have become about stripping state officials of power just before those state officials happen to become Democrats. But I missed one. It turns out that many years ago Florida handed authority over concealed-carry permits to the state’s agriculture commissioner. Why? Because sometimes law enforcement playfully tries to actually enforce the law, and the NRA would prefer that not happen. Instead, they want concealed-carry permits rubber stamped by an elected official. But then this happened:

The agriculture commissioner’s office attracted unwanted attention in early 2018 after it was found that for 13 months, the department’s Division of Licensing stopped using results from an FBI crime database that ensures those who apply do not have a disqualifying history in other states.

This wasn’t a problem for the NRA, of course, but even in Florida it turns out that voters were unamused. As a result, they elected a Democrat as agriculture commissioner. A Democrat! This is the NRA’s worst nightmare, so now they’ve proposed that concealed-carry permits be transferred to…

…the state’s CFO.

The what?

Yeah, Florida has a CFO. It’s an odd office that was created just a few years ago, and the CFO doesn’t really seem to do all that much. But he is a Republican, so he’ll do. Democrats have counterproposed that concealed-carry permits be handled by law enforcement, which actually makes sense, but so far Republicans are having none of it. They’re dedicated to stripping the ag commissioner of authority and giving it once again to a Republican.

There’s no telling how hard they’ll kowtow to the NRA on this, but for now it looks like we have four GOP states that are desperately trying to strip elected officials of power in lame duck sessions before Democrats take over. Naturally, I have an updated map:

President Trump had dinner with Chinese President Xi Jinping on Saturday. On Sunday he tweeted this:

China has agreed to reduce and remove tariffs on cars coming into China from the U.S. Currently the tariff is 40%.

— Donald J. Trump (@realDonaldTrump) December 3, 2018

Oddly, the Chinese didn’t confirm this. Instead we got headlines like this one from the New York Times:

Hmmm. This is kind of odd, since Trump doesn’t really have much to gain from misrepresenting his agreeement with Xi. But then it got worse as the headlines morphed into weirder ones, like this one from the Los Angeles Times:

One of the things that makes this whole affair peculiar is that auto tariffs hardly matter. Most cars for the Chinese market are made in China. They aren’t made in America and then shipped over. Still, even if the whole thing is a nothingburger, you’d expect Trump and his gang to at least know what they agreed to. But no:

On Sunday night, after returning to the White House from the Group of 20 economic summit in Argentina, Trump declared on Twitter that China “has agreed to reduce and remove tariffs on cars coming into China from the U.S.”….But Trump’s top economic advisors made clear Monday that no agreement to reduce and remove the tariffs yet existed, despite Trump’s boast.

“We don’t yet have a specific agreement on that, but I will just tell you … we expect those tariffs to go to zero,” Larry Kudlow, Trump’s top economic advisor, told reporters in a conference call from the White House….Treasury Secretary Steven T. Mnuchin gave mixed messages, appearing to confirm the auto tariff cut but then backing off….White House trade advisor Peter Navarro also wouldn’t confirm China was lifting auto tariffs.

Beyond this, it turns out that the White House didn’t even have any idea what level the Chinese might reduce their tariffs to. Auto tariffs used to be 25 percent, but earlier this year China reduced them to 15 percent—except for us. After Trump announced his tariffs this summer, the Chinese raised tariffs on American cars to 40 percent, while leaving everyone else at 15 percent. Assuming that there’s any deal in place at all, this probably means that China has only promised to reduce auto tariffs on American cars to 15 percent, which it was planning to do all along until Trump started his trade war.

And what about soybeans? Apparently China agreed to buy a “substantial” amount of American food and energy products. But once again, this is something China had already agreed to do before Trump announced his tariffs.

So is China giving us anything in return for the 90-day tariff truce that both countries agreed to? Hard to say. I guess they’re getting a 90-day tariff truce—although there was even some confusion about when the truce started. Beyond that, who knows?

Tyler Cowen links today to “52 things I learned in 2018” from Tom Whitwell—which seems like it’s coming a little early in the year, but whatever—so I took a look at it. Some of them I knew, some I didn’t. Here’s one from Marcel Freinbichler written after new European privacy regulations came into effect:

They went from a load time of more than 45 seconds to 3 seconds, from 124 (!) JavaScript files to 0, and from a total of more than 500 requests to 34.

— Marcel Freinbichler (@fr3ino) May 26, 2018

And here’s one from Brian Krebs about those occasional books you see on Amazon that are astronomically priced. I always figured they were artifacts of some kind of algorithm screwup, but apparently it’s more sinister than that, as an author named Patrick Reames found out when he discovered a fake book published under his name:

“Based on what I could see from the ‘sneak peak’ function, the book was nothing more than a computer generated ‘story’ with no structure, chapters or paragraphs — only lines of text with a carriage return after each sentence,” Reames said in an interview with KrebsOnSecurity.

The impersonator priced the book at $555 and it was posted to multiple Amazon sites in different countries….Reames said he suspects someone has been buying the book using stolen credit and/or debit cards, and pocketing the 60 percent that Amazon gives to authors. At $555 a pop, it would only take approximately 70 sales over three months to rack up the [$24,000] that Amazon said he made.

“This book is very unlikely to ever sell on its own, much less sell enough copies in 12 weeks to generate that level of revenue,” Reames said. “As such, I assume it was used for money laundering, in addition to tax fraud/evasion by using my Social Security number. Amazon refuses to issue a corrected 1099 or provide me with any information I can use to determine where or how they were remitting the royalties.”

Internet scams are so inventive.