National Health

Living in America was something of a culture shock for me when I first arrived. Trivial things for the most part, like missing that brand of biscuits you like with your tea or Cadbury’s chocolate. All small things and easily remedied. The one thing which still stands out in my mind is the difference in the health care systems between the US and the UK and how little each country knows about the other.

During Obama’s first run for president there was a push to go to a system that was similar to the UK which eventually became “Obama care” to suit all parties. A common theme I heard during the election was the term “Socialised Medicine” when they referred to the UK health system (NHS). I still find it hard to believe that people would vote against something that would make health care available to everyone and affordable. The current system in America is hideously expensive, driven by drug and insurance companies and the patient is the one who loses out in the end. The worst is, they don’t know any better as this is how it’s always been.

I have first hand experience of the health care system in the UK and in America and feel I have a good case for comparison of the two. My father and I have also gone through similar surgeries but with far different outcomes. So how do they compare?

First off, I don’t want anyone to think I am bashing the American health system. I am alive today through the work of American surgeons and two major surguries. I had my thyroid completely removed in 2009 when it decided to go rogue and started to crush my windpipe. Then the bugger wrapped around my spinal chord and refused to come out without a fight. So we all thought it was best to part company. The aftercare took a long time due to balancing my hormone levels through hormone replacement.

This is where I first ran into what I like to call; “The Insurance Company are dicks” syndrome. I was settled in to a dose of synthroid which seemed to be working fine, when I noticed my prescription changed, without any consultation from me or mention from my endocrinologist. I was switched to levothyroxine. I trusted my endocrinologist and took the medication and had a bad reaction to it, I had crippling muscle cramps and my hormone levels were all over the place. When I next went in for a blood test, I asked them why I was switched. The answer? The insurance company told them to switch to levothyroxine as it was cheaper. I immediately went back onto Synthroid and I was fine again.

An interesting side note to this story, my health insurance with my company claimed they had the best prices on medication and my prescription each month would only be $40. Which is interesting as with my Wallgreens medication card, it would only cost me $30. So it was more expensive on insurance, than paying for it with a store loyalty discount program. Hence the phrase “The Insurance Company are dicks”.

Next in my tale of adventures in American medicine, my Testosterone levels showed up really low since the operation, resulting in osteoporosis and a number of side effects. My endocrinologist caught it and prescribed “Androgel” which is a gel you put under your arm each day and it provides a steady release of the hormone. At the time I was diagnosed with this I had no insurance and to give my endocrinologist their credit, they never charged me for blood work on a visit to keep costs down, but the Androgel came to $350. I can’t afford that along with synthroid it would be a hefty chunk of change out of my wages each month.

I talked it through with my doctor and they recommended an alternative. Intra muscular injection every week. The cost of the testosterone was only $80 and good for a couple of months each dosage. The insurance companies push the Androgel because of the money they can make on it, but the injection is far more cheaper and carries less risk with my wife coming in to contact with it. So all I need to do is make sure I don’t annoy my wife before she jabs me in the arm every Friday.

More recently my colon decided to carry on from where my thyroid left off and carried on the task of killing me. So a number of trips to the emergency room and one large stomach scar later, my colon was shortened and everything else stretched and rearranged so that all my plumbing was intact.

As part of the prep for the surgery my urologist called me in and as he’s a specialist it costs me $80 to come into his office instead of the normal $40 GP co-pay. I walked in, payed my $80 co-pay and he just wanted to shake my hand and wish me luck for the surgery. I was done in 15 minutes total. There was no need for that visit at all and yet they still charged me the co-pay.

My father has had colon cancer and undergone similar surgeries in the UK, along with keyhole heart surgery and he’s getting on in life. So considering the way i felt with my surgery, I have nothing but respect for my dad going through the same ordeal at his age. Here’s the difference between the two countries.

My dad has a nurse visit him at home, once a week to check up on him. The NHS sends food supplements as well as anything else he needs and checks on him to make sure he’s ok. Total cost = £0

For me, I owe around $10,000 in medical bills, each new visit to the doctor increases this by $80. My medication goes from $40 – 80 a month. I don’t want tests as each one costs more. For the prelim for my surgery I had an EKG ($500) and a colonoscopy ($770 and they are hounding me worse than a London bookie trying to reclaim a gambling debt.)

So what do I want to say to anyone from the UK who gripes about the NHS. First “Shut the fuck up“. The NHS is a national treasure and should be preserved. You get treatment when you need it no matter your financial status. The quality of treatment (in my opinion) is much better than the US and you only get prescribed what you need, not some expensive drug with bad side effects that your really don’t need to be taking. I also found after my surgery, the best places for information online for post surgery care was the NHS which had the most practical advice and it was free.

And to my American friends who refuse to go for a single payer system. “Are you fucking mad?” why would you vote to keep a system that would leave you on the street the moment you couldn’t afford treatment. Medical expenses result in 42% of all bankruptcies in the US. Why would you not vote for something affordable? Are you crazy?

I’ll stop ranting now ….. until my next bill comes in and then I’ll add an addendum :-)

Where’s my flying car?

Wait a minute, this is 2013? Where’s my flying car? I was promised a flying car by now!. A mate of mine recently blogged about how we are living in the future and it got me thinking to how much things have changed since I was a nipper.

Taking a look around my living room, I can see:

  • Two laptops
  • An X-Box
  • A Wii
  • DVD player
  • Android Tablet
  • My smartphone.

I was born in 1965, so lets take another look at that list:

DVD’s were invented in 1993 and were first introduced to Japan in 1996 and to the US in 1998.

Microprocessors started the development of personal PC’s post 1975. The first non-car based mobile phone was in 1973.

The Atari 2600 came out in October of 1977.

To put it in perspective, I went from a ZX81 – to a Mac Book Pro, in my lifetime! Just imagine that for a moment, I started with a machine that had 1K of memory, no storage on board and could burn the varnish off your table if you used it too long. While now, I am currently writing this blog post on a Macbook pro with 4 gig of memory and 250 Gig of storage!

I have always been a gadget and technology fanatic and the past 30 years have been exciting beyond belief. I first became enthralled by these machines when I used a Commodore PET to run Newton Raphson iterations while I was at college and thought …

“Why run these calculations on paper over and over, when I can write a program to loop through these in a couple of lines of code as many times as I want!”

No … wait……. it was playing ASCII Space Invaders on the PET that got me hooked on computers…

This got me thinking, what else has changed since I was a kid?

When I was a kid, adults used to bore me to tears with their tedious moaning about how hard things were. When they were growing up; what with walking twenty-five miles to school every morning…. Uphill…Barefoot… in the snow …. fighting off wolves and bears… yadda, yadda, yadda And I remember promising myself that when I grew up, there was no way in hell I was going to lay a bunch of crap like that on my kids about how hard I had it and how easy they’ve got it! (I will admit to failing on this one …. Sorry Walker)

But now that I’m over the ripe old age of forty, I can’t help but look around and notice the youth of today. You’ve got it bloody easy! I mean, compared to my childhood, you live in a damn Utopia! And I hate to say it, but you kids today, you don’t know how good you’ve got it!

When I was a kid we didn’t have the Internet. If we wanted to know something, we had to go to the library and look it up ourselves, in the card catalog and the Dewey decimal system!

There was no email! We had to actually write somebody a letter – with a pen! Then you had to walk all the way across the street and put it in the mailbox, and it would take a week to get there!

Child Protective Services didn’t care if our parents beat us. As a matter of fact, the parents of all my friends also had permission to kick my arse if I caused trouble. Nowhere was safe!

There were no MP3′s or iTunes! If you wanted to steal music, you had to hitchhike to the record store and shoplift it yourself. Or you had to wait around all day to tape it off the radio, and the DJ would usually talk over the beginning and screw it all up.

There were no CD players! We had tape decks in our car. We’d play our favorite tape and “eject” it when finished, and then the tape would come undone rendering it useless. Cause, hey, that’s how we rolled, Baby! Dig? (Ever notice how all old tapes on your dashboard eventually all sounded like “Queen’s Bohemian Rhapsody”?)

We didn’t have fancy crap like Call Waiting! If you were on the phone and somebody else called, they got a busy signal, that’s it! There weren’t any mobiles either. If you left the house, you just didn’t make a call or receive one. You actually had to be out of touch.

Think of the horror not being in touch with someone 24/7!!! And then there’s TEXTING. Yeah, right. Please! You kids have no idea how annoying you are. And we didn’t have fancy Caller ID either. When the phone rang, you had no idea who it was! It could be your school, your parents, your boss, your bookie, your drug dealer, the collection agent… you just didn’t know!!! You had to pick it up and take your chances!

We didn’t have any fancy PlayStation or Xbox video games with high-resolution 3-D graphics! We had the Atari 2600! With games like ‘Space Invaders’ and ‘Asteroids’. Your screen guy was a little square! You actually had to use your imagination!!! And there were no multiple levels or screens, it was just one screen… Forever! And you could never win. The game just kept getting harder and harder and faster and faster until you died! Just like LIFE!

Remember the Radio Times magazine? We used it to find out what was on telly. You were screwed when it came to channel surfing! You had to get off your arse and walk over to the TV to change the channel. NO REMOTES!

There was no Cartoon Network either! You could only get cartoons on Saturday Morning. Do you hear what I’m saying? We had to wait ALL WEEK for cartoons, you spoiled little bastards!

And we didn’t have microwaves. If we wanted to heat something up, we had to use the stove. Imagine that! And our parents told us to stay outside and play… all day long. Oh, no, no electronics to soothe and comfort. And if you came back inside…you were doing chores!

And car seats – oh, please! Mom threw you in the back seat and you hung on. If you were lucky, you got the “safety arm” across the chest at the last moment if she had to stop suddenly, and if your head hit the dashboard, well that was your fault for calling “shot gun” in the first place!

See! That’s exactly what I’m talking about! You kids today have got it too easy. You’re spoiled rotten! You guys wouldn’t have lasted five minutes back in 1970!

Regards,

The Over 40 Crowd

Master of the Arcane

I met a guy in a coffee shop one time who was a fellow Linux enthusiast and we fell into a conversation about my shiny new Linux desktop running on my net-book. As a fellow geek he was drawn to the screen like a moth to an electronic flame, and we soon fell into a caffeine-fueled conversation about operating systems and programming languages.

He was very passionate about his favourite programming language. He painted a magical picture of a language with immense flexibility and elegance and how none of the current languages were on par with his first and ONLY love: COBOL. That’s right … COBOL …. Did I also mention that he had been out of work for over a year? He was a true master in the arcane art of COBOL. It was like meeting someone who spoke Klingon: impressive though it may be, it’s not a very practical (or marketable) skill.

Our “Comfort” zone

I understand as developers we all have a “comfort zone,” a set of tools or languages we all use daily to do get things done. But there’s something to be said for expanding the tools we rely on and embracing new technologies, or even keeping up to date on enhancements to our existing skills. As languages and technology evolves, no matter the topic, they all have the same goal: to improve on how we do things, so we can accomplish more in less time and effort and expand the scope of what we can achieve. In the early days when Windows was an emerging operating system, the term k-locs was very popular (short for thousand Lines Of Code). As sleep-deprived programmers we used to pride ourselves on how much code we pumped out. Today I am amazed at what I can achieve with just a few lines of code. The Web applications that I wrote many years ago could be recreated today in a fraction of the time using current languages and tools.

Technology moves on … it’s inevitable.

I have always found this continual evolution of my industry one of the fun aspects of my chosen field. Nothing stands still; something new is always on the horizon. There’s a constant buzz around new technology which fuels new ideas that I can apply to my projects. I firmly believe that we need to keep our skills current and maintain pace with advances in our field. Albert Einstein summarized it perfectly when he stated: “We can’t solve problems by using the same kind of thinking we used when we created them.”

Finding the time

We are all busy and if you’re buried deep in a project with a looming deadline, you don’t always have the time or energy to spend time catching up with what’s happening in your industry. To quote another great thinker of the 20th Century: “Life moves pretty fast. You don’t stop and look around once in a while, you could miss it.” (Ferris Bueller) Wise words Ferris, (hope you’re feeling better by the way). Several tools have been instrumental in keeping my skills current and staying on top of an ever-changing industry: RSS Feeds: These are a lifesaver when it comes to filtering information and staying on top of what is new in your industry. One drawback of using RSS feeds is the high risk of information overload.

Watching too many feeds can consume your attention to the point where good information drowns in a sea of noise. Lifehacker published a great article with useful tips on managing feeds in order to reduce the flood of information and promote the review of quality, relevant information. Instead of breaking feeds out into granular categories, I learned to organize the list by the quality of the feed. I created an A-List, B-List and C-List (which is used for new feeds). If the quality of the feed is good, I move it up the list. If a feed stays in my C-List for too long, I eventually remove it. This approach has enabled me to reduce my list of feeds from nearly 100 down to just 15 – a huge reduction and I am confident that those 15 remaining feeds present information that is highly relevant and valuable to me. Meetup Groups: I recently started getting out and about and starting to meet my fellow geeks at a number of special interest groups here in Atlanta. No matter how much you know on a subject, you will always walk away from these meetings with some new knowledge.

The enthusiasm and passion for the subjects discussed is infectious and you can learn a lot from others who work on similar projects to your own. These groups provide a valuable forum for sharing ideas and best-practices regarding how others use tools to fix the same problems you may encounter on a project. New advances in a field are often discussed and dissected at these group meetings by lengthy, in-depth and often passionate discussions that start with asking “How can I make this work for me?” Social Networks: Twitter has been a great tool for putting me in touch with other developers and thought-leaders in my industry whom I admire. I can often learn something from Twitter before it’s available on the Web. Additionally, the ability to talk to the author of an article puts you more in touch with innovation all around you. Social networks such as LinkedIn, Facebook, Twitter, IRC (Freenode) and Google Groups put knowledge experts directly within reach.

So where does this leave us?

Taking the time out to track my feeds and interact with others has become part of my daily routine. Building online relationships with others who are equally as passionate about your industry will keep you informed of new innovations and emerging trends. I love advances in technology and look at each step forward as a way to manage my workload more efficiently, get more done and meet like-minded people along the way.

My Personal PDA

I started off with Psion organisers before moving on to my beloved Palm pilot. I’m now using an Android. These new tools were part of my endless pursuit of “Getting Things Done.” As I was exposed to new ideas and technologies, I would constantly refine and adapt my process. This was all part of my quest for “Productivity Nirvana.”

In the last few years, SONY DSCthrough advances in technology, I have finally found the perfect piece of technology for my needs. A technology that is complimentary to my digital tools. This amazing piece of technology has the following features:

  1. Never needs recharging
  2. Never crashes
  3. Works offline – no need for an Internet connection
  4. Supports “Cut” and “Paste”
  5. Highly recommended by respected Thought leaders from multiple disciplines.
  6. Did I also mention it doesn’t crash? – worth mentioning twice :-)

And the name of this amazing technology? ……My Midori notebook!

Writing in a notepad strips everything down to its simplest components. I don’t spend my valuable time working out how best to use my time. I can concentrate on getting the work done. It’s easy to spend too much time tweaking a productivity system; putting it on paper keeps it simple.

Planning projects on paper has also helped me see things from a new perspective. As a result, when I commit the ideas to an electronic medium, they have already gone through at least one pass-through on paper. Writing also slows me down, providing clarity of thought while I write up my notes, ideas and projects.

I’m in great company as a user of a notepad. Mark Twain, Ernest Hemingway, Jean-Paul Sartre and Benjamin Franklin all carried notebooks around with them and it’s hard to argue the success they achieved. :-)

If you’re interested in joining the paper revolution, here are some tips and links to great resources:

  1. Number your pages and leave a couple of pages blank at the front of your notebook. Use them to build a “Table of Contents.” I maintain a spreadsheet in Google Docs of all my notebooks and indexes. I find it helpful to print it out and paste it inside the front cover when the book is full.
  2. Buy some sticky tabs and leave a couple in the back pocket or inside back cover. They are useful as bookmarks to your notes.
  3. Flip it upside down and from the back cover write your “To Do” items. When your task list catches up with your notes section, it is time to buy a new notebook.
  4. Don’t be afraid to “Cut and Paste.” My notebook is full of function references and cheat sheets. If you use a Moleskine notebook, you can download and print templates from their website to stick in to your notebook.

Below are a few great Starting places to join the Back to Paper Revolution:

  1. PigPog PDA – Using Moleskines for “Getting Things Done”.
  2. Freelance Switch – Monster List of Moleskine tips
  3. 43 Folders – Moleskine Productivity Tips.

Warning

When I am an old woman I shall wear purple
With a red hat which doesn’t go, and doesn’t suit me.
And I shall spend my pension on brandy and summer gloves
And satin sandals, and say we’ve no money for butter.

I shall sit down on the pavement when I’m tired
And gobble up samples in shops and press alarm bells
And run my stick along the public railings
And make up for the sobriety of my youth.
I shall go out in my slippers in the rain
And pick flowers in other people’s gardens
And learn to spit.

You can wear terrible shirts and grow more fat
And eat three pounds of sausages at a go
Or only bread and pickle for a week
And hoard pens and pencils and beermats and things in boxes.

But now we must have clothes that keep us dry
And pay our rent and not swear in the street
And set a good example for the children.
We must have friends to dinner and read the papers.

But maybe I ought to practice a little now?
So people who know me are not too shocked and surprised
When suddenly I am old, and start to wear purple.

by Jenny Joseph

Virtualization and Drupal

Running Drupal under VMware, initial performance planning

Drupal has huge potential for scalability due to its structure. As a result, it can be installed under a multitude of configurations. Splitting the database and search from the main web application server is a common setup. Using a virtualized environment, such as a VMware Server, you can create environments as needed for any possible configuration. Due to the ease of creating and scaling new instances.

With this flexibility, there is the possibility of performance issues which can be negated through performance planning. Specifically in 2 areas.

  • The Files directory being replicated / synced.
  • MySQL performance under VMware

Most sites I have come across which leverage VMware server with a Drupal setup are heavy microsoft shops with a few occasional Linux setups. I have run web applications written in .Net quite comfortably using IIS and Microsoft SQL server running under VMware. However, methods that work for Windows, may not work as well for Linux setups. The database is a prime example.

MySQL in VMware

Database performance is usually reflected through a number of factors, with the most prevalent being, “writing to the disk”. Virtualized filesystems are not recommended for a number of reasons, primarily the time it takes for the database to receive a handshake from the OS to say the database record was written successfully to the filesystem. The time taken to execute this transaction can slow down a database if it is writing to a virtual filesystem.

To improve the response time, you can use a physical disk with hardware raid using 1+0 striping (hardware is recommended over software, such as a volume manager). This can be made available to your virtual machine as a mount in the fstab. If the raid card has memory built in it also reduces the transaction time. This is because the raid card will respond with the handshake and que the transaction in the memory on the card, before the record is physically written to the hard drive.

For optimum performance, separate the OS from your database disks, and spread your virtual disks across physical drives. Also remember to avoid dynamically reconfiguring virtual disks while MySQL is running. This also applies to regular hardware as this can cause problems with the database, and is a common mistake with virtualized hardware. Linux is very memory bound, so you should make physical changes with the service or preferably the OS off, so that everything can be written back to the disks before you make your changes.

Additional tweaks which can improve performance include:

  • Ensure your queries use indices effectively reducing unnecessary I/O workload
  • RedHat is often prone to frequent timer interrupts which may be managed by the divider command, more information is available here.
  • Reduce the number of virtual CPU’s on your database server to a minimum. As a larger number of vCPU’s will incur more scheduling overhead, your workload will increase in terms of CPU usage on the database server, but will run more efficiently.
  • Disable floppy drive, CD roms, and USB adapters in your virtual machine because they can cause IRQ conflict and reduces overhead.
  • Use physical NICs to reduce network collisions. Split your database traffic out on a different card from your web traffic.

Filesystems

In a Windows “shop” a common configuration for the filesystem is to have a Windows share available to Linux using samba to mount the drive. This is so a backup tool can pick it up and include it in a predominantly Windows backup scenario. This can cause some problems both within Linux and also Drupal.

Rather than have a Windows drive, use a native Linux partition and share it with your Windows system. I would rather have a delay in writing a transaction to my backup, which often runs at low usage times and is not time dependent. As compared to Drupal, finding the ability to write to a Windows partition through a transport protocol causes slowdowns, which are then passed on to our website visitors in the form of performance issues.

Often, writing data between Linux and Windows shares can be slow. This is usually a simple case of a difference in the TCP/IP packet size between the two operating systems. As much as Windows and Linux uses a packet size of 64k. Samba often uses as a default size of 32k. To fix this compatibility issue, you can adjust the size using the CIFSMaxBufSize setting inside your samba configuration. This will significantly improve file system performance for your filesystem when talking to windows.

Summary

VMware is a great tool to have in your sysadmin’s toolbox for creating responsive and scalable Drupal deployments. With some initial performance planning of the architecture, you can avoid performance issues once your site has been deployed.

Additional Reading

​[Article written for Mediacurrent as part of a series on Drupal in the cloud]

Liver Pâté

Quick Recipe for Liver Pâté. This is the basic way I make them, you can add port, wine, other seasonings as you want. I have even made it with Bushmills Whiskey added.

  • 1lb of chicken livers
  • Half pound of salted butter
  • Salt / Pepper to taste

I clean off any grislly bits and wash them, pop them in boiling water for about 5 mins, they tend to be a little pink inside then pop then in a blender with half pound of salted butter and salt / pepper. I used to add a couple of table spoons of port when I made them in the UK. put it in the fridge and its good in a couple of hours. Cheap to make and you get a lot too!

Cover with melted butter when you pop it into the fridge. I know it’s tempting to try it warm, but leave it overnight and go for it the next day.

Haslet – Family recipe

Quick post with a recipe for Haslet, I’ll clean it up later with some pictures and more information.

  • 1lb sausage meat
  • 1lb of liver (traditionally beef or lamb)
  • 2 large Onions
  • 1 cup breadcrumbs
  • Season to taste (salt / pepper / small amount of nutmeg)

I like English bangers which are hard to find over here so I use any sausage meat and generally add some rough chopped sage to it. For the liver, if you go with lamb or beef, soak it for a while in Milk to get rid of the bitterness. Or use chicken liver which I find works well.

Cook the liver for about 3-5 minutes then combine it with the sausage meat in a mixer and mix it really well. Roughly chop the onions and mix that in with the breadcrumbs. You end up with a sticky mixture similar to an American meatloaf recipe.

I use a loaf tin and cover it with tin foil with a couple of small holes, and bake it for about 45 mins on 425 coverred and a futher 30 with the foil removed to brown it off.

When it’s done, take it out and I normally drain off some of the fat at this stage, but leave it to cool before transferring it to the fridge.

It came out exactly as I remember it, when I first had some, it took me back to being a kid again this is a taste of my childhood.