August 6, 2012

Posted by orrinj at 7:06 PM

Robert Hughes, Eloquent and Combative Art Critic, Dies at 74 (RANDY KENNEDY, 8/06/12, NY Times)

With a Hemingwayesque build and the distinctively rounded vowels of his native Australia, Mr. Hughes became as familiar a presence on television as he was in print, in columns over three decades for Time magazine, where he served as chief art critic and often as a traditionalist scourge during an era when art movements fractured into unrecognizability. "The Shock of the New," his eight-part documentary about the development of modernism from the Impressionists through Warhol, was seen by more than 25 million viewers when it ran originally on BBC, and the book that Mr. Hughes spun off from it was described as a "stunning critical performance" by Louis Menand of The New Yorker. [...]

In the memoir, Mr. Hughes was as expressive about his brush with death as he always was about the art he loved. "At one point I saw Death," he wrote. "He was sitting at a desk, like a banker. He made no gesture, but he opened his mouth and I looked right down his throat, which distended to become a tunnel: the bocca d'inferno of old Christian art."
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Posted by orrinj at 6:19 PM

FIRST, DO NO HARM:

Chemotherapy can backfire and boost cancer growth: study (AFP, 8/06/12)

Cancer-busting chemotherapy can cause damage to healthy cells which triggers them to secrete a protein that sustains tumour growth and resistance to further treatment, a study said Sunday.

Researchers in the United States made the "completely unexpected" finding while seeking to explain why cancer cells are so resilient inside the human body when they are easy to kill in the lab.

They tested the effects of a type of chemotherapy on tissue collected from men with prostate cancer, and found "evidence of DNA damage" in healthy cells after treatment, the scientists wrote in Nature Medicine.

Posted by orrinj at 6:05 PM

HEALTH CARE IS JUST ANOTHER CONSUMER GOOD:

BIG MED : Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care? (Atul Gawande, AUGUST 13, 2012, The New Yorker)

Dave Luz is the regional manager for the eight Cheesecake Factories in the Boston area. He oversees operations that bring in eighty million dollars in yearly revenue, about as much as a medium-sized hospital. Luz (rhymes with "fuzz") is forty-seven, and had started out in his twenties waiting tables at a Cheesecake Factory restaurant in Los Angeles. He was writing screenplays, but couldn't make a living at it. When he and his wife hit thirty and had their second child, they came back east to Boston to be closer to family. He decided to stick with the Cheesecake Factory. Luz rose steadily, and made a nice living. "I wanted to have some business skills," he said--he started a film-production company on the side--"and there was no other place I knew where you could go in, know nothing, and learn top to bottom how to run a business."

To show me how a Cheesecake Factory works, he took me into the kitchen of his busiest restaurant, at Prudential Center, a shopping and convention hub. The kitchen design is the same in every restaurant, he explained. It's laid out like a manufacturing facility, in which raw materials in the back of the plant come together as a finished product that rolls out the front. Along the back wall are the walk-in refrigerators and prep stations, where half a dozen people stood chopping and stirring and mixing. The next zone is where the cooking gets done--two parallel lines of countertop, forty-some feet long and just three shoe-lengths apart, with fifteen people pivoting in place between the stovetops and grills on the hot side and the neatly laid-out bins of fixings (sauces, garnishes, seasonings, and the like) on the cold side. The prep staff stock the pullout drawers beneath the counters with slabs of marinated meat and fish, serving-size baggies of pasta and crabmeat, steaming bowls of brown rice and mashed potatoes. Basically, the prep crew handles the parts, and the cooks do the assembly.

Computer monitors positioned head-high every few feet flashed the orders for a given station. Luz showed me the touch-screen tabs for the recipe for each order and a photo showing the proper presentation. The recipe has the ingredients on the left part of the screen and the steps on the right. A timer counts down to a target time for completion. The background turns from green to yellow as the order nears the target time and to red when it has exceeded it.

I watched Mauricio Gaviria at the broiler station as the lunch crowd began coming in. Mauricio was twenty-nine years old and had worked there eight years. He'd got his start doing simple prep--chopping vegetables--and worked his way up to fry cook, the pasta station, and now the sauté and broiler stations. He bounced in place waiting for the pace to pick up. An order for a "hibachi" steak popped up. He tapped the screen to open the order: medium-rare, no special requests. A ten-minute timer began. He tonged a fat hanger steak soaking in teriyaki sauce onto the broiler and started a nest of sliced onions cooking beside it. While the meat was grilling, other orders arrived: a Kobe burger, a blue-cheese B.L.T. burger, three "old-fashioned" burgers, five veggie burgers, a "farmhouse" burger, and two Thai chicken wraps. Tap, tap, tap. He got each of them grilling.

I brought up the hibachi-steak recipe on the screen. There were instructions to season the steak, sauté the onions, grill some mushrooms, slice the meat, place it on the bed of onions, pile the mushrooms on top, garnish with parsley and sesame seeds, heap a stack of asparagus tempura next to it, shape a tower of mashed potatoes alongside, drop a pat of wasabi butter on top, and serve.

Two things struck me. First, the instructions were precise about the ingredients and the objectives (the steak slices were to be a quarter of an inch thick, the presentation just so), but not about how to get there. The cook has to decide how much to salt and baste, how to sequence the onions and mushrooms and meat so they're done at the same time, how to swivel from grill to countertop and back, sprinkling a pinch of salt here, flipping a burger there, sending word to the fry cook for the asparagus tempura, all the while keeping an eye on the steak. In producing complicated food, there might be recipes, but there was also a substantial amount of what's called "tacit knowledge"--knowledge that has not been reduced to instructions.

Second, Mauricio never looked at the instructions anyway. By the time I'd finished reading the steak recipe, he was done with the dish and had plated half a dozen others. "Do you use this recipe screen?" I asked.

"No. I have the recipes right here," he said, pointing to his baseball-capped head.

He put the steak dish under warming lights, and tapped the screen to signal the servers for pickup. But before the dish was taken away, the kitchen manager stopped to look, and the system started to become clearer. He pulled a clean fork out and poked at the steak. Then he called to Mauricio and the two other cooks manning the grill station.

"Gentlemen," he said, "this steak is perfect." It was juicy and pink in the center, he said. "The grill marks are excellent." The sesame seeds and garnish were ample without being excessive. "But the tower is too tight." I could see what he meant. The mashed potatoes looked a bit like something a kid at the beach might have molded with a bucket. You don't want the food to look manufactured, he explained. Mauricio fluffed up the potatoes with a fork.

I watched the kitchen manager for a while. At every Cheesecake Factory restaurant, a kitchen manager is stationed at the counter where the food comes off the line, and he rates the food on a scale of one to ten. A nine is near-perfect. An eight requires one or two corrections before going out to a guest. A seven needs three. A six is unacceptable and has to be redone. This inspection process seemed a tricky task. No one likes to be second-guessed. The kitchen manager prodded gently, being careful to praise as often as he corrected. ("Beautiful. Beautiful!" "The pattern of this pesto glaze is just right.") But he didn't hesitate to correct.

"We're getting sloppy with the plating," he told the pasta station. He was unhappy with how the fry cooks were slicing the avocado spring rolls. "Gentlemen, a half-inch border on this next time." He tried to be a coach more than a policeman. "Is this three-quarters of an ounce of Parm-Romano?"

And that seemed to be the spirit in which the line cooks took him and the other managers. The managers had all risen through the ranks. This earned them a certain amount of respect. They in turn seemed respectful of the cooks' skills and experience. Still, the oversight is tight, and this seemed crucial to the success of the enterprise.

The managers monitored the pace, too--scanning the screens for a station stacking up red flags, indicating orders past the target time, and deciding whether to give the cooks at the station a nudge or an extra pair of hands. They watched for waste--wasted food, wasted time, wasted effort. The formula was Business 101: Use the right amount of goods and labor to deliver what customers want and no more. Anything more is waste, and waste is lost profit.

I spoke to David Gordon, the company's chief operating officer. He told me that the Cheesecake Factory has worked out a staff-to-customer ratio that keeps everyone busy but not so busy that there's no slack in the system in the event of a sudden surge of customers. More difficult is the problem of wasted food. Although the company buys in bulk from regional suppliers, groceries are the biggest expense after labor, and the most unpredictable. Everything--the chicken, the beef, the lettuce, the eggs, and all the rest--has a shelf life. If a restaurant were to stock too much, it could end up throwing away hundreds of thousands of dollars' worth of food. If a restaurant stocks too little, it will have to tell customers that their favorite dish is not available, and they may never come back. Groceries, Gordon said, can kill a restaurant.

The company's target last year was at least 97.5-per-cent efficiency: the managers aimed at throwing away no more than 2.5 per cent of the groceries they bought, without running out. This seemed to me an absurd target. Achieving it would require knowing in advance almost exactly how many customers would be coming in and what they were going to want, then insuring that the cooks didn't spill or toss or waste anything. Yet this is precisely what the organization has learned to do. The chain-restaurant industry has produced a field of computer analytics known as "guest forecasting."

"We have forecasting models based on historical data--the trend of the past six weeks and also the trend of the previous year," Gordon told me. "The predictability of the business has become astounding." The company has even learned how to make adjustments for the weather or for scheduled events like playoff games that keep people at home.

A computer program known as Net Chef showed Luz that for this one restaurant food costs accounted for 28.73 per cent of expenses the previous week. It also showed exactly how many chicken breasts were ordered that week ($1,614 worth), the volume sold, the volume on hand, and how much of last week's order had been wasted (three dollars' worth). Chain production requires control, and they'd figured out how to achieve it on a mass scale.

As a doctor, I found such control alien--possibly from a hostile planet. We don't have patient forecasting in my office, push-button waste monitoring, or such stringent, hour-by-hour oversight of the work we do, and we don't want to. I asked Luz if he had ever thought about the contrast when he went to see a doctor. We were standing amid the bustle of the kitchen, and the look on his face shifted before he answered.

"I have," he said. His mother was seventy-eight. She had early Alzheimer's disease, and required a caretaker at home. Getting her adequate medical care was, he said, a constant battle.

Recently, she'd had a fall, apparently after fainting, and was taken to a local emergency room. The doctors ordered a series of tests and scans, and kept her overnight. They never figured out what the problem was. Luz understood that sometimes explanations prove elusive. But the clinicians didn't seem to be following any coördinated plan of action. The emergency doctor told the family one plan, the admitting internist described another, and the consulting specialist a third. Thousands of dollars had been spent on tests, but nobody ever told Luz the results.

A nurse came at ten the next morning and said that his mother was being discharged. But his mother's nurse was on break, and the discharge paperwork with her instructions and prescriptions hadn't been done. So they waited. Then the next person they needed was at lunch. It was as if the clinicians were the customers, and the patients' job was to serve them. "We didn't get to go until 6 P.M., with a tired, disabled lady and a long drive home." Even then she still had to be changed out of her hospital gown and dressed. Luz pressed the call button to ask for help. No answer. He went out to the ward desk.

The aide was on break, the secretary said. "Don't you dress her yourself at home?" He explained that he didn't, and made a fuss.

An aide was sent. She was short with him and rough in changing his mother's clothes. "She was manhandling her," Luz said. "I felt like, 'Stop. I'm not one to complain. I respect what you do enormously. But if there were a video camera in here, you'd be on the evening news.' I sent her out. I had to do everything myself. I'm stuffing my mom's boob in her bra. It was unbelievable."

His mother was given instructions to check with her doctor for the results of cultures taken during her stay, for a possible urinary-tract infection. But when Luz tried to follow up, he couldn't get through to her doctor for days. "Doctors are busy," he said. "I get it. But come on." An office assistant finally told him that the results wouldn't be ready for another week and that she was to see a neurologist. No explanations. No chance to ask questions.

The neurologist, after giving her a two-minute exam, suggested tests that had already been done and wrote a prescription that he admitted was of doubtful benefit. Luz's family seemed to encounter this kind of disorganization, imprecision, and waste wherever his mother went for help.

"It is unbelievable to me that they would not manage this better," Luz said. I asked him what he would do if he were the manager of a neurology unit or a cardiology clinic. "I don't know anything about medicine," he said. But when I pressed he thought for a moment, and said, "This is pretty obvious. I'm sure you already do it. But I'd study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute."

This is not at all the normal way of doing things in medicine. ("You're scaring me," he said, when I told him.) But it's exactly what the new health-care chains are now hoping to do on a mass scale. They want to create Cheesecake Factories for health care. The question is whether the medical counterparts to Mauricio at the broiler station--the clinicians in the operating rooms, in the medical offices, in the intensive-care units--will go along with the plan. Fixing a nice piece of steak is hardly of the same complexity as diagnosing the cause of an elderly patient's loss of consciousness. Doctors and patients have not had a positive experience with outsiders second-guessing decisions. How will they feel about managers trying to tell them what the "best practices" are?



Posted by orrinj at 4:07 PM

TRYING TO SALVAGE SOME DIGNITY:

Syria's prime minister confirms defection to 'join revolution of freedom' (Ian Black, 8/06/12, guardian.co.uk)

Riyad Hijab, Syria's prime minister, has confirmed he has defected to join "the revolution of freedom and dignity" to overthrow President Bashar al-Assad - a propaganda coup for the opposition as the country's crisis escalates.

Posted by orrinj at 3:50 PM

John Ellis Double-Wide, Live In Concert: Newport Jazz 2012 (NPR, August 4, 2012)

[H]is band shows that while you can take the boy out of New Orleans, you can't take New Orleans out of his musical vision.

Posted by orrinj at 3:46 PM

Pedrito Martinez Group, Live In Concert: Newport Jazz 2012 (NPR, August 4, 2012)

Behind the congas and microphone, he leads a quartet which goes way beyond what you'd think of Afro-Cuban music or jazz.
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Posted by orrinj at 4:33 AM

WAS UNCLE BILLY IN CHARGE OF THAT BRANCH?

A man walks into a bank (Patrick Combs, 8/03/12, Financial Times)

It was a cheque, made out in my name, for $95,093.35 and it came in a junk-mail letter from a get-rich-quick company. It was worthless, meant only as a financial tease, a lip-licking come-on. "This is how much money you could soon be making." What it was never meant for was deposit. But that's exactly what made the thought of depositing it so irresistibly funny. What could possibly be funnier than depositing a perfectly ridiculous, obviously false, fake cheque? (Did I mention it had "non-negotiable" clearly written on it?) So, as a joke, I deposited the fake cheque into my bank's ATM. I felt like a million bucks doing so. I'd never had so much fun at my bank. Come to think of it, I'd never had any fun at my bank until the moment I endorsed the back of this "cheque" with a smiley face and slipped the Monopoly-like money into the mouth of the hungry ATM. For the first time ever, I walked away from my bank laughing.

What I expected to happen next was a short phone call from my bank. Or a letter informing me of what I already knew, that the cheque I deposited was not real. Admittedly, I also hoped for a compliment on my refined sense of humour. A "Mr Combs, what you deposited was not real but very funny, especially considering your real bank account balance history" (an account always bouncing into overdraft).

But the call or the letter never came and I forgot about my joke. Then, five days later, I returned to withdraw some cash from the ATM, and noticed a much higher than usual bank balance. $95,093.35 higher! The bank had credited my account with the fake, false, stupid cheque!
We all know it should have ended there. Fake cheque. Bank mistake. Give it back. But easier said than done. Especially considering the series of events that happened next.
The first friend I phoned informed me that it was no mistake at all. Just standard bank policy, crediting my account with the dollar amount but putting a hold on all the funds until the cheque bounced. I couldn't touch the money and my bank balance would be embarrassing again in three days.

But seven long days later the lottery-like amount was still there and I visited the bank where an employee told me that the funds were now all available for cash withdrawal. All $95,093.35 was mine for the taking. All I had to do was ask. Windfall money begs us to take it and run. But I restrained myself. And gave the bank another two excruciatingly long weeks to do their job, catch up with their mistake, and bounce the cheque. But at the end of three hellish weeks, during which I hourly resisted the urge to take the money and run to Mexico, where it would be worth twice as much, I was told by my branch manager, "You're safe to start spending the money, Mr Combs. A cheque cannot bounce after 10 days. You're protected by the law."



Posted by orrinj at 4:32 AM

THE REFORMATION IS FURTHER ALONG THERE:

Romney Is Right on Culture and the Wealth of Nations : A 2002 United Nations report written by Arab intellectuals acknowledges the problems the Republican candidate pointed out. (RICHARD LANDES, 8/05/12, WSJ)

Americans tend to assume that everyone shares their cultural attitudes--that everyone strives to get to "yes," to positive-sum, win-win, voluntary relations; that everyone holds productive work in high respect and prizes the principles of fairness embodied in the meritocratic principle of "equality before the law"; that everyone encourages criticism, treasures intellectual capital, promotes risk-taking, prizes transparency and fosters innovation. With institutions built on such values--with a culture dedicated to making, not taking, money--a society can make use of whatever primary products a land offers.

But there are cultures whose favored mode is not voluntary but coerced and zero-sum relations, where the principle of "rule or be ruled" dominates political and economic life. The elites in such cultures hold hard work in contempt, and they distrust intellectual openness and uncontrolled innovation as subversive. They emphasize rote learning and unquestioning respect for those in authority. Protection rackets rather than law enforcement assure the public order and bleed the economy. Public criticism brings sharp retaliation. Powerful actors acquire wealth by taking, rather than making.

Few cultures on the planet better illustrate the latter traits than the Arab world, a fact outlined in painful detail by a 2002 United Nations report written by Arab intellectuals. As "The Wealth and Poverty of Nations" points out, Arab culture intensifies these problems with its attitude of hyper-jealousy and misogyny toward women, which turns out entitled sons and cloistered daughters.

Even the huge influx of petrodollars did not change the basic contours of Arab economies: Rather than fueling economic development that benefited all, it bloated corrupt and opaque elites. Oil-rich countries like Libya and Iraq have social structures akin to those of oil-bereft Egypt and Syria. Change may occur, but it is hindered by an authoritarian culture that fears it. Such societies impoverish the masses, while elites thrive on their debasement.

Strikingly, Palestinian culture compares favorably with that of other Arabs. Palestinians have higher education, a strong work ethic and successful entrepreneurs. Much of that comes from their close association with the Zionists, who (unlike Western imperialists) settled the land without conquest, by dint of making everyone more prosperous.