Many of you know that I have been writing (and some of you may have termed it ‘ranting’) about health care reform in America for several years. But, that’s because we have allowed ourselves to develop a system of reimbursement that is biased for testing and against outcomes. We also have a system that (in my humble opinion) provides an incentive to those lacking insurance to employ the services of a hospital emergency room.
As a chemical engineer (ok, among other specialties, but this is my first love and it affects how I approach almost everything in my life â€“ business and personal), one of the first things we learn is material balances. This formula:
Input-Output + Generation â€“ Consumption =Accumulation
applies to almost anything. But, the key consideration that I want to discuss here is that you have to determine the system boundaries. If we had a factory making widgets, we could define the system boundary (called the basis) as the entire plant. Then, all the raw materials coming into the plant would be the inputs to the system and all the products coming out would be the outputs; any waste stream would also be an output. Assuming that we are not building inventory explosions occur, our material balance would then be: Raw materials In- Products Out- Waste Streams Out = 0. But, if we were to analyze the mixing chamber alone, we would have a completely different material balance. And, by analyzing this factory on a component basis (and the combining all these components together to provide the full factory system), we would develop a great deal more information about what was going on in our factory. We should be able to determine what any potential changes would have on our ability to make production goals. If we pick the wrong basis, we may not learn anything of use about the facility.
In medicine, our augmented knowledge is forcing us to re-evaluate our bases, the ideas upon which we provide proper patient care. In dialysis, this has meant that, over the decades, we stopped looking at the ability of the dialyzer to remove a (theoretical) middle molecule, to what we thought was a more scientific one of providing the patient a Kt/V of 1.5 or so (where K was the clearance (the removal of toxins by the dialyzer), t was the time of dialysis, and V was the volume of fluid in the patient). In treating cholesterol, we now are learning that itâ€™s not just â€œgoodâ€ (high density lipoprotein, HDL) and â€œbadâ€ (low density lipoprotein, LDL) cholesterol, but that â€œbadâ€ cholesterol is what we could measure before; itâ€™s a specific component of LDL (small density lipoproteins) for which new testing has been developed, that is the true culprit. So, you see that we continually must reevaluate how the concepts upon which we base our decisions to provide patient care.
We need to do the same things when addressing how we run a company. Our basis, the fundamentals by which we run the enterprise may no longer apply. Ten years ago, we based upon business on certain market conditions. But, when the recession came, the market dynamics shifted. We need to reevaluate our assumptions, our bases to insure that our enterprise can compete and grow- at the current market conditions.
Or, we may have been making a specific product that provides a wonderful profit potential. But, our distribution system is not happy that we only provide one product; it wants to â€œrationalizeâ€ the number of vendors. To survive, we either have to develop (or sell) a wider range of products (some with small profit potential), align with other vendors in marketing coop so mutual product lines would be bigger, or some other creative solution.
The key take-away here is that we need to take the time- at least once a year- to evaluate our bases, the assumptions we use to manage and grow our ventures.
I heard this quote (Mohandas Ghandi) earlier this week and it reminded me that this was how many of the new products/ventures with which we have been involved progressed. It is something to take to heart- and use as you grow your venture or introduce a new product.
I will provide an example, with certain information omitted. A few years ago (ok, letâ€™s not get TOO accurate) we developed this household consumer product . It was a pretty novel idea (if I say so myself). But, no one really paid attention to the venture OR the product. After we got a little publicity, a few consumer firms actually called to say that we were crazy. I admit, we were (are?) a cocky bunch, so it did not faze us much, but it was hard to take as it kept coming, even from some of the large chains where we were hoping to have the product shelved and sold.
By the end of the first year, the product (we were managing this for our client) was generating about the sales volume we had projected (we were a month behind in our projections. And, all of a sudden- we found that one of the companies that told us we were nuts- was coming out with a competing product.
The good news is that ours was better. Our tests showed that our product (a cleaning item) provided about a 10% increase in whiteness, compared to theirs. We used that as part of our campaign. We even made an improvement in the packaging (which increased the shelf life of the product), which helped us out. But, our competitor actually matched this change. (Our product was not patented; it was very hard to reverse engineer.)
By then end of the second year (when our involvement was scheduled to terminate), our client had 80% of the market share- and exceeded its goals for sales, as well.
The lesson is you should use the time when the marketplace ignores you to insure that all your ducks are in a row, the testing matches your goals, and you are developing your organization. You will need this to bolster your egos when you are being derided. But, this lead time (especially if you are small entity) gives the time to fine-tune your business processes for the coming battle, when you do have competitors. And, as you refine and calibrate your processes for the changes in the market place, you can insure your ultimate win.
Many of you know that MIT is one of my almae matres. I chose it both due to a personal reason (my ex-wife was accepted to BU) and because it was the antithesis of my undergraduate haunts. Brooklyn Poly basically taught one how to make things work (and minimized the theory). MIT was “gung-ho” on the theoretical aspects and less interested in real-life situations. I melded both of those attitudes into a balanced approach to engineering/business issues. Well, I just attended an MIT event that â€“ at least for these disciplines- demonstrated that MIT is now interested in both.
MIT Professor Franz Ulm described his work with concrete. This is the most widely used man-made material in the world. Cement is among the oldest engineered construction materials, dating back to the Roman Empire (remember seeing all those extant aqueducts?). It basically starts out as limestone and clay mixtures that are then crushed into powder, and then subsequently heated to a very high temperature (1500 C) in kilns. This forces transformation of the materials, with tremendous potential energy bound into the powder. Upon mixing with water, the energy employed to bond the units into calcium-silicate-hydrate (C-S-H) complexes. . (Cement is NOT a molecule; while one could consider the composition to be (CaO)1.65(SiOs)(H2O)1.75, this is an approximation. ) At the microscopic level, these CSH units serve as a binder for the added sand and gravel ; this mixture is the concrete. Most of the carbon dioxide emissions in this manufacturing process result from heating the kiln to a temperature high enough to transfer energy into the powder. (Limestone is CaCO3; the heating removes the CO2 and the calcium oxide (CaO) is the active unit in the precursor)
There are some 25000 million tons of cement produced annually; all metals only account for 1350 million tons. More importantly in light of our desire to lessen our carbon footprint, this represents 32.5 billion GJ (gigaJoules) of energy, compared to 26.5 for metals. (And, notice how much MORE energy is required for the production of those metals.) This is equivalent to the power produced by some 700 nuclear power plants. There is one (1) cubic yard of concrete for each person on earth and 5% (some say 10%) of the earthâ€™s CO2 emissions results from concrete manufacture.
Another way of looking at this is that 8 tons of concrete or 1 ton of cement is equivalent to 1 ton of carbon dioxide. If we could cut the carbon dioxide use by altering our cement technology, we could go a long way to solving our carbon crisis. This is even more critical when one recognizes that we are currently using some 3200 million tons of timber, while the earth is creating 2500 million tons a year.
If we converted all our heating to clean energy and sequestered carbon dioxide (solar, wind, etc.), our carbon dioxide emissions in 2050 will be on par with those of 2005- not much change. If we improved our concrete production technology, we would REDUCE our impact by 83% compared to 2005. It was estimated that if Europe (or America) would impose a carbon tax of $ 40/ton, it would wipe out concrete production in those areas, since it would be cheaper to import the concrete from Egypt.
By improving the strength of our concrete, we could reduce the size of our concrete beams and columns. There is an inverse relationship between size and strength for columns and perfect shells; the relationship for beams is X to the -2/3 power [ed:Â NO superscripts seem to work here] . If we double the strength, we halve our carbon dioxide usage.
The process that he discussed involves ordering the atoms. (Remember, cement is NOT a molecule- see above) ; while one could consider the composition to be (CaO)1.65(SiOs)(H2O)1.75, this is an approximation. ) Normal concrete has a random structure; if we order it to make it more closely compacted (from 64% of volume to 74%), the strength is radically improved. [Although this was not discussed, these numbers closely match how crystals exist in nature. The most common structure is body centered cubic, which has a packing factor of about 68%; face centered is 74% packed.]
Even with all of these factors, the best approach is not for universal changes in concrete production, since there is a higher need for quality control and more skilled workers. The best approach for this use is in precast concrete used for bridges and special buildings. One example he cited was the Jakway Park Bridge In Iowa. This bridge used precast concrete 7.5 cm thick- instead of the normal 20 cm or so thick beams.
In addition to ordering the atoms to be more closely packed, the discussion included the incorporation of fibers and nanoparticles of titanium dioxide. The former usage increases the durability dramatically; the latter provide an added environmental benefit. When you incorporate the TiO2 nanoparticles, the ultraviolet irradiation in sunlight activates the oxygen atoms at the surface to break down NOx molecules; reducing air pollution. (This technology is in use at the Jubilee Church, formally known as Dio Padre Misericordioso. In addition to the air pollution benefit, the TiO2 keeps the concrete white (aesthetically pleasing; titanium dioxide is how we get â€œwhiteâ€ paper) and the concrete maintains the temperatures more evenly.)
What was NOT discussed was the water needs for this new concrete. When I inquired, Dr. Ulm pronounced that this would reduce the water usage concomitantly. It should be noted that concrete is one of the largest consumers of water in industry; it is why most concrete facilities are near water sources and why water reuse projects have focused on just that industry segment, as well.
Today, I am going to talk about taxes- but for the small business owner. Like it or not, taxes are going to go up- not for everyone, but small business is a ripe target. Part of the reason is that small business- just like big business- has found ways (or paid advisors to find ways) to pay the minimum amount of axes required.
We have known for a long time that dopamine is vital to the “reward” function in our brains. But, dopamine seems to have a much wider-ranging impact, than just this. After all, my grandfather, Sol Kuchlik, of blessed memory, was among the first treated with L-dopa (a form of dopamine) to counteract his Parkinson’s Disease symptoms. So, let’s see where we stand today (this is by no means an exhaustive review….).
Dr Tali Sharot, of University College of London, found that addicts overestimated the pleasure they would gain from taking heroin or gambling, because their dopamine system was dysfunctional. Dr. Sharot’s research group found, using imaging techniques, a signal in the brain linked to how much someone enjoyed a given experience. This signal let the group predict the choices that person made. It turns out that signal is dopamine.
It has also been found that ADHD patients had lower levels of dopamine receptors and transporters (both of these are proteins) in the (brain’s) nucleus accumbens and midbrain. Both of these are part of the limbic system, which is responsible for the emotions, as well as for motivation and reward. The more pronounced the ADHD symptomology, the lower the two protein levels. This is probably why stimulant medications (Ritalin, which is related to caffeine, is one such drug) treat ADHD symptoms- by raising the dopamine levels in the brain. I already discussed that raising dopamine levels affords Parkinson’s patients the ability to reach functional levels- no slurring of speech, better fine motor control, etc.
The findings also provide more reasoning as to why people with ADHD seem to be more prone to drug abuse and obesity. It turns out that they may be compensating for the deficient reward system that exists in their brain.
It also means that ADHD children may not be deliberately disrupting their classroom; it may just be a deficiency of the dopamine levels or receptors. (It also means that educators MUST augment the interesting/exciting levels in their classrooms to engage these kids and help them learn. I probably was one among them…)
[There was a study years ago showing that Parkinson’s Disease skips a generation. Maybe, this is why I was/am hyperactive- when I was growing up, attention deficit disorder and hyperactivity were separate syndromes. If Parkinson’s skips generations, AND if- since it can be treated with dopamine- this is related to lowered dopamine or dopamine receptor proteins, then it would make sense that hyperactivity or ADD could manifest itself in one such an individual.
It seems that dopamine also explains why some people are more creative than others. Dopamine receptor genes are linked to the ability to achieve divergent thought. We know (knew) that families with members demonstrating schizophrenia or bipolar disorders often have other members who were highly creative. The ability to make unusual or perhaps bizarre associations is found in both creative individuals and schizophrenics. Dr. Fredrik Ullen of the Karolinska Institutet used this knowledge in a study to demonstrate that the dopamine system in otherwise healthy, but highly creative people matched those of people with schizophrenia. Dr. Ullen found that creative people had lower densities of D2 receptors (there are five dopamine receptors of which were are aware; two are similar to D1, three are similar to D2). Schizophrenia, drug abusers, and now creative people all are affected by D2 receptors. The D2 receptors for creative types and schizophrenics are primarily found in the thalamus, the relay center that filters information prior to its arrival in the cortex (responsible for cognition and reasoning). The lower density of receptors means there is lower signal filters- and a higher flow of information- to the cortex. So, this means that thinking out of the box may really be the fact that the box is much bigger for creative types (little or less filtering of information to the cortex).
So, that’s the science, as we know it. But, here’s more food for thought. While my (ex)wife and I were “working on improving our relationship” (not, as the facts demonstrated), I was offered neurontin, a drug used to treat epilepsy, and in off-label uses for ADHD and schizophrenics. I also was offered the SAME drug by my physician during this same time period, as a means of correcting sleep apnea. While I was taking the drug, I noticed that my brain seemed to work slower- not really (since I did not get tested for this fact)- but I could discern a miniscule time lapse, during which I knew what I was going to say and do- before I did or said it. I now believe this drug may have been affecting my D2 receptors or changing my dopamine levels; maybe not enough to make a large difference, but enough for me to recognize the filtering mechanisms of the thalamus were altered.
I mention this because neurontin is NOT approved for these uses- but maybe it should be, because it does work for drug withdrawal, bipolar disorders (with much fewer side effects), and opiate withdrawal. With these new testing processes and results, it is time to reexamine many of our “hard and fast rules”…
I am somewhat trepidatious about this endeavor. It’s not that have nothing to say- if you know/knew me, you would understand that I am rarely at a loss for words. It’s that having a required schedule is intimidating. And, to be honest, writing about things that interest me may bore the heck out of you- and be too wide-ranging to make you want to come back.