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  • dtoub 1:09 pm on Monday, May 23, 2016, 1:09 pm Permalink | Reply  

    iCloud problems: my email to Tim Cook 

    Dear Mr. Cook,
    Greetings. I am a long-time Mac user (since the early 90’s) and have been with iCloud since the early days when it was .mac (and I still use my .mac email address).
    After many issues with iCloud, I have grown very disappointed and frustrated with the service, for which me and my wife each pay every month. Here are some of the problems I’ve found and have also been reported by many others:
    • The Photos app will initially show only empty thumbnail placeholders on my iOS devices and my MacBook Pro when iCloud is turned off then back on. Rather than download the thumbnails automatically, I have to painstakingly scroll through every thumbnail (I have over 18,000 photos) on every device in order to have them displayed. Without the thumbnails, it’s pretty useless as a photo library.
    • I’ve been on .mac/iCloud email since 2002. Two months ago, I just happened to notice that all of my iCloud emails were gone from iCloud. I could even date, based on my backups, when the even occurred, and I was on a plane that day (and as you could imagine, it’s not easy to accidentally delete over 17,000 emails manually). I contacted Apple support, and they were not helpful; after the call got lost by the first support person, I contacted a second who had no idea how to reinstall the backup I had and kept accusing me of manually deleting thousands of emails. It was clearly a server issue, and after researching it online myself, I was able to restore all but a few weeks of emails from a Time Machine backup. But this was clearly not good. I never even got a survey about the support team, which is odd since every interaction I’ve ever had with Apple support led to at least one email asking how they did. That suggests to me that the reps involved knew they blew it.
    • And today, for reasons I suspect are within the iCloud backend, I was locked out of my iCloud account and had to reset my password. Ever since, I have been plagued with frequent requests to log back into iCloud on all my devices, which as you can understand is pretty painful during the work day.
    I still love my Apple devices, but admittedly have had to switch to alternative software at times (Airmail rather than Mail, Fantastical rather than Calendar and Reminders) because it’s become apparent even to a die-hard Apple supporter like me that Apple’s software has become less reliable and lacks many useful features. And this extends to paid services like iCloud. I do not understand why iCloud has such poor reliability of late, despite the status page always showing green, as if there are no problems. The iCloud issues today occupied a good deal of time, and I’m still dealing with persistent requests to log in. I wanted you to know, as that is perhaps the only way to help make things better. I’m not the only person with lackluster iCloud performance and reliability; my experience probably has been even better than what I’ve seen reported by others. But it is disturbing nonetheless. I would be happy to follow up with you or a delegate about this. Thank you for your attention to this matter.


    Best regards,

    David Toub, MD, MBA 

    Sent with Airmail
  • dtoub 1:57 pm on Thursday, December 10, 2015, 1:57 pm Permalink | Reply  

    performance of ‘this piece intentionally left blank’ with video 

    Amazing performance by the University of Tennessee, Martin Contemporary Music Group, led by Stephen Downing. I’m really blown away.

  • dtoub 2:01 pm on Saturday, January 4, 2014, 2:01 pm Permalink | Reply
    Tags: , MOC, nonsense   

    does maintenance of certification (board recertification) really have any value? 

    I was originally board-certified in ob/gyn in 1996. It was tough; besides a written exam, I had to compile a list of every patient I saw in the office, operated upon in the OR, etc. for an entire year. Back then, software for this was pretty horrible and painful to use, and everything had to be done to the American Board of Obstetrics and Gynecology’s strict specifications in terms of page layout, printing, etc. But I did it, and then had to fly to Chicago and sit in a room in the Westin Hotel while three pairs of examiners came in and grilled me for an hour each on gynecology, obstetrics and office practice. I had to defend why I treated specific patients the way I did, and left absolutely convinced that I had failed miserably. Everyone was made to feel that way. But I did pass and had a 10-year certification. While grueling and akin to mental torture, I felt that it was an accomplishment, especially given that many people were failed by the examiners that year.

    Beginning in 2006, I had to undergo recertification. One had the option of taking a live written exam that gave you recertification for a few years, or completing 120 open-book, multiple-guess questions about various papers in the clinical literature; taking the clinical questions route (“ABC” for “annual board certification”) gave one recertification that lasted one year. Nearly all of us diplomates opted for the ABC route. It was easy, albeit pricey, but we all knew it was somewhat ludicrous. The hardest part wasn’t answering the questions, but obtaining the articles. It spawned a small industry of companies that would help provide the abstracts of the various papers needed, which I hope didn’t dupe too many gynecologists out there since the abstracts can be had for free online very easily. We all realized that one really didn’t learn much from reading the articles and answering the questions, and it was also clear that people didn’t remember any of what they had read afterwards; ask any gynecologist if he or she remembers any of the papers used for the ABC exam even a year ago and you’ll likely get blank stares.

    Things got worse around 7-8 years ago, when under pressure from other professional boards to get tougher, ABOG opted into what has been termed “Maintenance of Certification” or MOC. In addition to the usual list of multiple-guess questions about various clinical papers, one had to complete other requirements, including annual case-base testing (which didn’t officially cause one to fail, and I was nevertheless exempt as I am no longer in full-time clinical practice), and a written exam every six years. I took the written exam (really a computerized exam) last year and passed, although I was surprised I never received the questions with answers as was promised at the end of my taking the exam. Without such feedback, how can someone truly learn and know what he or she answered incorrectly and why?

    I recently registered again for the 2014 MOC process, dutifully paid my annual fee, and submitted my active medical license. All routine. But today I received an email from ABOG telling me that my application is incomplete because I never submitted a signed form from another ABOG diplomate to attest to my character. That was something that we all used to do every year, but for the past two years was not apparently required, so I was a bit surprised to see it return. Does ABOG think I became an axe murderer in the past year? Given that I’ve been board-certified (technically, a “diplomate of the American Board of Obstetrics and Gynecology”) since 1996, has my “moral character” somehow drastically declined now that I’m in my 50’s? No worries; I already have a friend who is happy to attest that I have “demonstrated good moral and ethical character, and have voluntarily elected to have limited or no OB/GYN Admitting Privileges,” but the Board has received the same attestation over a number of years, and I’d be curious if they’ve ever had anyone who couldn’t produce at least one other gynecologist who would sign such a form for him or her. Honestly, it’s silly.

    So every year, all of us board-certified gynecologists must pay several hundred dollars for the privilege of taking an open-book multiple-choice test about articles that are largely forgettable and that probably teach little or nothing. Asking questions like “What was the sample size in the study by Yifnif and colleagues?” has no lasting value whatsoever. Most of us can, and should, be able to read basic clinical papers and understand how to find the information when asked for it. My kids could do the same thing. None of this means anything.

    Maintenance of Certification programs in several specialties have never, ever, been demonstrated to improve clinical outcomes. Not one bit. People aren’t practicing better medicine because of MOC. Patients are not doing better because of MOC. All it appears to amount to is a way for medical specialty boards to feel like they’re doing something to make sure that their board-certified physicians are still up to par, and generate some revenue while doing it. It’s quality monitoring theater.

    Why do I still maintain my board certification status? Two reasons; in my specialty, I could no longer be a Fellow of The American College of Obstetricians and Gynecologists without it, as it is required for continued membership in what is the main professional society for ob/gyns. Second, I worked really hard to become board-certified in the first place, and that board certification itself does mean something, at least to me. So I don’t have any interest in giving it up.

    There was a good paper on MOC not too long ago in NEJM. It makes many good points about the problems with MOC as currently implemented. In fact, i can’t really find many physicians who truly like MOC. We all think it’s silly and don’t like taking the time and money to deal with it. The only people who I can find to really defend MOC are associated with professional medical societies.

    So yes, i’ll go through the same motions again this year. I paid my fee, I’ll answer the questions (which, incidentally, can be re-answered online if incorrect until one gets it right) and print out the automatically-generated certificate attesting to my board certification status for this year. But I won’t have any delusions that it made me a better clinician. Even continuing medical education doesn’t usually produce improved clinical outcomes, so why would making physicians read through a few dozen clinical papers in an open-book format work any better?

    • kempen 10:12 pm on Saturday, January 4, 2014, 10:12 pm Permalink

      No, there is no value to MOC or CMOC as it is called now. Board certification (BC) is only an “entry requirement” to MOC having little if any intrinsic value. Only those in the BC-MOC confidence /pyramid Scheme designed to profit the ABMS corporation only. The whole BC thing has been clearly degraded to an extortion scheme of the ABMS who continues to state that it is voluntary, while lobbying congress, insurance companies and non-physicians in the healthcare industry to demand MOC or fire all doctors. This is a purchasing/advertisement scheme now very similar to :

      ABC News Investigates Top Doctor Awards: Are They Always Well Deserved?
      July 14, 2012

      Take time to read and think.

  • dtoub 9:30 pm on Saturday, September 21, 2013, 9:30 pm Permalink | Reply
    Tags: ,   

    working on another piece 

    I’m pretty excited by this one. Details to follow, but I improvised something I liked a few weeks ago in Palo Alto and started to mold it into an actual composition earlier this week when I was back out West. I also picked up Reason 7.0.1 and when the work is completed sometime next month, hope to record it in Reason rather than Finale. The piano sound in Finale is good enough, but has some harmonics that are readily apparent and often distracting. I originally improvised this piece in Reason 4.0.1 and the piano sounded very nice. Unfortunately, Reason 4.0.1, I came to find, was incompatible with the new version of OS X I’m testing so I had to upgrade. Which is all fine.

  • dtoub 10:31 am on Thursday, March 14, 2013, 10:31 am Permalink | Reply  

    brasstet (1997; arranged 2013) 

    Between 1996 and 1997, I composed a long work for brass sextet called brass piece for arielle victoria. I was pretty fond of it, but wrote it with the idea that, because so much of it required fairly continuous playing, the performers would have to be adept at circular breathing. At the time, I didn’t think it was a big deal, but it turns out that it was, and I’ve since come to realize that there was very little chance that it would ever be heard other than in a suboptimal MIDI performance with sampled instruments. And that’s where things have stood since 1997, except for the last section that was arranged for string quartet and can be heard in an excellent performance by the Rangzen Quartet.

    I had long toyed with the idea of scoring the entire piece for strings to circumvent the performance challenges, and this has now resulted in this arrangement for string quartet and contrabass. Other than some minor tweaks in a few sections, it is identical to the original brass work, but should pose no significant challenges in terms of performance. The audio file is not idea, of course, since strings are harder to convincingly sample compared with piano and a few other instruments, but overall it works

    The score is here. A mp3 file is hereScreen Shot 2013-03-13 at 3.43.21 PM.

  • dtoub 4:08 pm on Sunday, December 30, 2012, 4:08 pm Permalink | Reply  

    2012 in review 

    The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

    Here’s an excerpt:

    600 people reached the top of Mt. Everest in 2012. This blog got about 4,600 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 8 years to get that many views.

    Click here to see the complete report.

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