Ebola in the USA... Anyone Concerned?

[throttleforward]

1) That represented 80% of the items cited as waste.

2) Visitor centors are also easy to pick on, as are infrastructure improvements at other places like airports. And I agree, $100M goes a long way toward better research.

But let's not get carried away with getting angry at the headline, without doing the background research. We don't know what was included in that visitor center upgrade - often times important things get burried in line items when they can't get funding themselves. Did CDC sneak in better internet connectivity under the "visitor center" upgrade because they were unsuccessful in getting it funded during that budget cycle? Did the visitor center experience a major structural problem (for instance, 50 year old pipes burst, causing flooding in the existing visitor center, rendering it unsafe?) We simply don't know enough to determine if it was waste or not.

And trust me, I've been around some "end of fiscal year, gotta spend the money" waste. It's outragious and happens every year.

But I've also been around for some really important spending, and when I ask where we got the money for that, I'm often very suprised as what trickery was required to get the resources we needed.

 

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[theag]

We're working on it.

Finally an American who appreciates an honest good advice from Nigeria, after throttleforward just shrugged it off and instead boasted about the big and greatly prepared brave forces that do.... nothing (and if they do, they F*ck sth up).

 

[ChickenHawk]

It's easy to throw stones at basic research - the titles seem rediculous and wasteful.

I fear the conversation is getting off-track.

Also, I understand the mods have this handy-dandy new power to ban people from specific threads. Lest I see that power in action firsthand, I'll refrain from responding and classify this under "agree to disagree."

ChickenHawk glances around the darkened corridor. "I've probably said too much already," she says in a hushed tone.

 

[Ryllban]

HOW NIGERIA STOPPED EBOLA
http://www.businessinsider.com/how-nigeria-stopped-ebola-2014-10

This is a blueprint of how we could prevent ebola from spreading. I only hope our government don't ignore stuff like this. I think I will send them an email with links

 

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[throttleforward]

Finally an American who appreciates an honest good advice from Nigeria, after throttleforward just shrugged it off and instead boasted about the big and greatly prepared brave forces that do.... nothing (and if they do, they F*ck sth up).

You're not understanding what I'm saying - I'd love it if we could force hospitals to do commonsense stuff like that, but we can't. We just have to hope that corporate-driven hospitals see it in their generous hearts to supply the extra hand sanitizers out of their profit margin.

 

[Iwokeup]

Our military CBRN responders are not incompetent boobs. Trust me, I understand and have experience with government incompetence, but despite perception it's often much more complicated (and government agencies are much more hamstrung) than the news would let on.

Nope. To all, please remember that blanket statements like "The Government is incompetent" is both inaccurate and misleading. Just like anything in life, there's a Bell curve distribution and there are several extremely competent actors in the government space.

FWIW, the CDC is also pretty competent. Is the Director of the CDC handling this crisis well? No, not at all. But please remember that both parties have continued to cut funding to the CDC (and the NIH, and to all those "teat sucking" researchers out there) and folks are trying to do the best that they can with limited resources.
[/RANT]

 

[Iwokeup]

Finally an American who appreciates an honest good advice from Nigeria, after throttleforward just shrugged it off and instead boasted about the big and greatly prepared brave forces that do.... nothing (and if they do, they F*ck sth up).

I don't think that @throttleforward was shrugging anything off man.

 

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[DeletedUser394]

Y'all got to me.

It's really amazing how unprepared my family and I would be in the event of a natural disaster, or power loss, or anything really. If we had a storm come through and knock out power + dirty the water, we'd literally have nothing to drink.

I've started to pick up water and non perishable goods and supplies to store in the basement.

Never going to get me to the hazmat suit level of crazy, but basic preparedness for any small inconvenience is definitely beneficial.

I figure 3-7 days is reasonable to have on hand. I don't anticipate Armageddon any time soon.

why is the picture so big hahahaha

 

[throttleforward]

Everyone should be prepared to stay in their house with no running water and without opening any doors or windows for 72 hours. If you have a family and especially children, you need to take your responsibility to them seriously.

As an anecdote, a few years ago DC encountered a major blizzard. We lost power and water, and had over 2' of snow where I was just across the river in Virginia. I trudged over to the conveniance store to find that not only was their power out as well, but every single item except for stuff like pepper and gum were wiped clean. It dawned on me that if I truly needed food, I'd have to huff it to the nearest grocery store, which would likely be wiped out as well by that point. So, no realistic chance for regular food or water, and I could see the Capitol dome from my window.

Now, we certainly weren't going to starve or die of thirst, but it became very apparent very quickly that dependence on normal infrastructure and government services was not something to expect, even in DC, and even in something as simple and predictable as a snowstorm. It was really a wakeup call.

It's one thing to read about it, it's another to experience the twinge of panic yourself.

 

[Bananas]

Y'all got to me.
It's really amazing how unprepared my family and I would be in the event of a natural disaster, or power loss, or anything really. If we had a storm come through and knock out power + dirty the water, we'd literally have nothing to drink.

Good going.

Last year, due to unexpected levels of ice and the fact we need to cross a bridge to leave our block, we were stuck in our home for a total of six days. We had power, luckily. We also had several conversations about how great it was we had extra supplies like food, medicine, and toilet paper on hand. Some people dine out for every single meal and are 'just in time' shoppers who only visit the store for TP when they're on their last roll.

Those six days sucked for families like that.

 

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[Unknown]

Everyone should be prepared to stay in their house with no running water and without opening any doors or windows for 72 hours. If you have a family and especially children, you need to take your responsibility to them seriously.

As an anecdote, a few years ago DC encountered a major blizzard. We lost power and water, and had over 2' of snow where I was just across the river in Virginia. I trudged over to the conveniance store to find that not only was their power out as well, but every single item except for stuff like pepper and gum were wiped clean. It dawned on me that if I truly needed food, I'd have to huff it to the nearest grocery store, which would likely be wiped out as well by that point. So, no realistic chance for regular food or water, and I could see the Capitol dome from my window.

Now, we certainly weren't going to starve or die of thirst, but it became very apparent very quickly that dependence on normal infrastructure and government services was not something to expect, even in DC, and even in something as simple and predictable as a snowstorm. It was really a wakeup call.

It's one thing to read about it, it's another to experience the twinge of panic yourself.

Luckily during winter you could always melt the snow inside your house for water, and most people can survive 30-40 days without food (probably 60-70 for the average overweight American). I stock up on canned vegetables any time there is a big sale, so we've always got food if we need it. I used to have water in the basement, but we drank it all during a tornado warning one day (I suppose I should keep more than a few bottles down there :-D)

 

[MJ DeMarco]

What's truly unnerving is it seems the CDC is going to deploy the political playbook on this thing.

Obfuscate, distract, and then deflect.

Notice how blame was originally ascribed to the nurses (I'm guilty as charged) when it turns out it was the CDC's fault and their failed management of protocols, or non-existent protocols. Sounds oh so familiar from the bureaucratic apparatuses that try to run this country. It's always someone else's fault. It's never the executive in charge, always deflected to some low-level employee that will be "reprimanded".

Meanwhile the hospital administrator says he's "deeply sorry" for the oversights. Wow. So glad he wasn't just sorry, but "deeply" sorry.

 

[throttleforward]

What's truly unnerving is it seems the CDC is going to deploy the political playbook on this thing.

Obfuscate, distract, and then deflect.

Notice how blame was originally ascribed to the nurses (I'm guilty as charged) when it turns out it was the CDC's fault and their failed management of protocols, or non-existent protocols. Sounds oh so familiar from the bureaucratic apparatuses that try to run this country. It's always someone else's fault. It's never the executive in charge, always deflected to some low-level employee that will be "reprimanded".

Meanwhile the hospital administrator says he's "deeply sorry" for the oversights. Wow. So glad he wasn't just sorry, but "deeply" sorry.

His testimony today was very disappointing. This has been totally bungled from a crisis communications perspective, and ununfortunatelye has eroded trust in what was, until recently, one of the most respected federal government institutions.

 

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[MJ DeMarco]

Now they're saying the Vinson may have been symptomatic onward to Cleveland. Add another flight to account for.

http://abcnews.go.com/Health/ebola-stricken-nurse-joy-vinson-symptoms-early-friday/story?id=26256189

 

[Iwokeup]

Excellent link from a nurse calling BS on our Fearless Leadership.

http://shepherdofthegurneys.blogspot.com/2014/10/do-math.html?m=1

 

[Iwokeup]

And an excellent article from a fellow ER physician blogger. It's all true.

http://edwinleap.com/how-could-an-er-miss-ebola-let-me-explain/

How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola? Despite the fact that blame spreads through hospitals faster than hemorrhagic fever viruses, I’m not interested in pinning down a single person, or a single thing, which may have allowed that to happen. I am very interested, however, in offering a few insights into what combination of factors might make it easy to send home a West African with a fever, without establishing the fact that he had a dangerous, contagious disease which finally caused his death.

First of all, America’s emergency departments are straining to keep up with the volume of patients that come through their doors. In 2010, the number of visits in the US was 129.8 million, according to the CDC. This numbers rises every year, despite the belief that the Affordable Care Act would direct people to primary care doctors and away from the ER.

The emergency departments of America bear the brunt of trauma, poisonings and drug abuse, of chronic diseases and social drama. They hold suicidal and psychotic patients for days to weeks when there is no other option available. An Ebola victim, with general, initial symptoms of fever, chills, vomiting, diarrhea, abdominal pain and headache, is a small needle in a big hay-pile of feverish, vomiting, suffering humanity.

Furthermore, many people with insurance (including Medicaid and Medicare) can’t find doctors, and large numbers who had insurance before subsequently lost it in the reshuffling of health benefits that has been going on since the ACA was passed. The emergency department is often all they have.

Second, it’s getting much, much harder to focus on that pesky but ubiquitous feature of the modern hospital, the patient. There is data to enter (which keeps nurses and physicians more focused on screens than adolescent boys playing on their Xbox). The electronic medical records systems are unfortunately complex and rarely intuitive. They require so much information that often, relevant points like ‘fever and came from West Africa,’ can be lost in the midst of endless time stamps, and required fields like ‘feels safe at home,’ ‘denies suicidal thoughts’ and ‘bed rails up, call light at bedside.’

Also, there are rules to follow to avoid censure. There are metrics to measure: time to stroke treatment, time to the cardiac cath lab for heart attacks, time from lobby to room, time from triage to doctor, time to discharge and many more; all of them contributing to the Holy Grail of modern health care, the high patient satisfaction score. (Which is being increasingly tied to job security and reimbursement, despite the bad science involved in the process.) Who has time to focus on a single, sick patient when so much depends on screens, rules and data entry?

Third, the rules for admission are ever more complex, based on what Medicare, Medicaid and private insurers are willing to cover. Patients we admitted without question ten years ago are now sent home and told to ‘come back if you get worse.’ In fact, it’s so hard to admit people that I now send home patients I would never have discharged, simply to avoid the misery of explaining the problem to already over-taxed hospitalists who are themselves constrained hand and foot by impossible rules. In this milieu, an otherwise healthy man with a fever is barely a blip.

I know this because earlier this year I was working in a teaching hospital and called the infectious disease specialist on call. My patient had just returned from a mission trip to the Caribbean and had a high white blood cell count, a fever, chills and rash. I was curious if I should have any particular exotic concerns. The specialist’s annoyed answer was this: ‘Sounds like he has a virus. He needs to see his family doctor this week.’

Now that we have Ebola in the US we are reminded that we in medicine, on the front lines, might miss something important. The medical pundits are wagging fingers and lecturing everyone about how best to manage this crisis. (Lecturing, that is, from the relative calm and safety of television studios, rather than the in the mind-numbing chaos of the ER.)

I agree. We need a plan. But the system, as it stands, functions every day on the very razor’s edge of disaster. We need to address that fact if we’re going to have any hope of dealing with Ebola, or other disasters, in the future.

 

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[loop101]

The best conspiracy theory right now, is that if everyone in the US could be put under quarantine/martial law, that would be a really good time to re-value the US dollar. You can't have riots if everyone is locked inside their houses afraid of a virus. As Hillary Clinton and Rahm Emannuel both said, never let a good crisis go to waste.

 

[MJ DeMarco]

Excellent link from a nurse calling BS on our Fearless Leadership.

http://shepherdofthegurneys.blogspot.com/2014/10/do-math.html?m=1

Truly scary.

 

[throttleforward]

The best conspiracy theory right now, is that if everyone in the US could be put under quarantine/martial law, that would be a really good time to re-value the US dollar. You can't have riots if everyone is locked inside their houses afraid of a virus. As Hillary Clinton and Rahm Emannuel both said, never let a good crisis go to waste.

I'd be less worried about riots and more worried about air strikes from nations that require dollars to pay for oil and suddenly find themselves with worthless dollars sitting in their national banks. Highly unlikely scenario.

 

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[throttleforward]

Excellent link from a nurse calling BS on our Fearless Leadership.

http://shepherdofthegurneys.blogspot.com/2014/10/do-math.html?m=1

What I find more concerning about this is that you'll see increased infection and mortality rates if substantial resources are devoted to ebola. The airborne, deadly viruses killing people right now in the US (like enterovirus d68) won't get the negative pressure rooms and special attention that they otherwise would if a hospital was freaking out because they might have an ebola patient.

Which is why I brought up the National Guard - set up a field hospital on a remote part of a military base, fly in ebola patients on private charter like they are doing today, and put those guys to work, so that the already strained health system can serve as sentinels/diagnostic enablers, but not a place for final treatment.

 

[daivey]

What I find more concerning about this is that you'll see increased infection and mortality rates if substantial resources are devoted to ebola. The airborne, deadly viruses killing people right now in the US (like enterovirus d68) won't get the negative pressure rooms and special attention that they otherwise would if a hospital was freaking out because they might have an ebola patient.

Which is why I brought up the National Guard - set up a field hospital on a remote part of a military base, fly in ebola patients on private charter like they are doing today, and put those guys to work, so that the already strained health system can serve as sentinels/diagnostic enablers, but not a place for final treatment.

that would make to much sense

 

[Guest3722A]

How'bout we kick the crazy up a notch! BAM!!! And add onto this:

BUT in the building at the time, perhaps on a month to month was a group of non-english speaking people who were in there bottling an off-brand of juice. Now obviously there's no way that they would've passed code to be able to use this facility to work with any type of food product, and I knew they didn't speak english because I tried communicating and they didn't understand a word. Anyway, maybe about a month later I saw their juice bottles being sold in the gas station that was at the end of the block......

Now, fwiw, who knows??? However, I believe that this is something that should be of concern and thought about. That's all I want to say here. And again, I only say this because I care.

Seeing that the borders are wide open, what's to stop suicidal terrorist types from entering while infected? The source(s) can be easily washed away with a "Ebola is already in the country" type statement. "we apparently didn't contain all of, blah O'blah blah" etc.

Obviously its too easy to enter while infected. So what's to stop an attack like this?

And by the way, those juice bottles were professional looking and obviously priced at a discount. -And I only noticed them in ONE gas station.

 

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[loop101]

It has to be a little unnerving when on your flight from Nigeria to NY, and the guy sitting next to you vomits until he is dead.

http://nypost.com/2014/10/16/alarm-after-vomiting-passenger-dies-on-flight-from-nigeria-to-jfk/


And that second nurse may have been sicker than she admitted.

"A nurse with Ebola may have shown symptoms of the virus as many as four days before authorities once indicated, meaning that she might have been contagious while flying on not just one, but two commercial flights, officials said Thursday."

http://edition.cnn.com/2014/10/16/health/us-ebola/index.html?hpt=hp_t1

 

[SBS.95]

It has to be a little unnerving when on your flight from Nigeria to NY, and the guy sitting next to you vomits until he is dead.

http://nypost.com/2014/10/16/alarm-after-vomiting-passenger-dies-on-flight-from-nigeria-to-jfk/


And that second nurse may have been sicker than she admitted.

"A nurse with Ebola may have shown symptoms of the virus as many as four days before authorities once indicated, meaning that she might have been contagious while flying on not just one, but two commercial flights, officials said Thursday."

http://edition.cnn.com/2014/10/16/health/us-ebola/index.html?hpt=hp_t1

She may have shown symptoms earlier or later than previously thought, and they are expanding their circle from the most likely contacts outwards. Isn't that standard operating procedure- you start with those people who are most likely to have been infected and branch out to the least likely?

 

[loop101]

She may have shown symptoms earlier or later than previously thought, and they are expanding their circle from the most likely contacts outwards. Isn't that standard operating procedure- you start with those people who are most likely to have been infected and branch out to the least likely?

I don't know what their SOP is, but what you said makes sense.


I hope it does not turn out that she hid her illness because she didn't want to cancel her wedding.

"Over the weekend, Amber Vinson was in Ohio to plan her wedding. Today, the 29-year-old nurse is hospitalized in Atlanta, fighting the Ebola virus."

"...Vinson said she felt fatigue, muscle ache and malaise while she was in Ohio and on the flight home"

http://edition.cnn.com/2014/10/16/us/amber-vinson/index.html?hpt=hp_t1

 

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[DeletedUser394]

It has to be a little unnerving when on your flight from Nigeria to NY, and the guy sitting next to you vomits until he is dead.

http://nypost.com/2014/10/16/alarm-after-vomiting-passenger-dies-on-flight-from-nigeria-to-jfk/

heart attack. poor guy. no ebola

http://www.nydailynews.com/new-york...-briefly-sparks-ebola-fears-article-1.1976465

 

[ChickenHawk]

Ah, the Ebola Cruise!
http://belizean.com/belize-confirms-patient-with-ebola-symptoms-on-cruise-ship-off-its-coast-1814/

Belize Confirms Patient With Ebola Symptoms On Cruise Ship Off Its Coast
Reports tonight are that two individuals possibly infected with the Ebola virus are in Belizean waters. Local TV station Channel 7 monitored in the capital City Of Belmopan tonight, reported having credible reports that a couple from a Texas-based cruise ship presently anchored off Belize City, is on a ship tender, unable to return to the cruise ship, while being refused entry to Belize City to catch an air ambulance awaiting at the International Airport to take them to the their country of origin, the U.S.A....The patient exhibiting Ebola symptoms has been confirmed to be a nurse at a Dallas hospital traveling with her husband....The ship is reportedly carrying 3652 passengers and a total population of 4633 persons.

Soon, we will no doubt hear that this story is mistaken. Like Nurse #1 and Nurse #2, she's probably just a "low risk individual" and was not, in fact, exhibiting symptoms. No need to worry. Move along...

Similar to what @Bananas pointed out so eloquently earlier in this thread, the ramifications of this whole thing can be strange and long-reaching. Can you imagine if you were on that cruse? I love cruises. But man, the humanity is PACKED on those things. You share lawnchairs, serving utinsils, restrooms...

And here's a thought-provoking note. Within the last week, it's become painfully obvious that Ebola-treating nurses shouldn't be travelling. They shouldn't be seeing family. They shouldn't be spending time with their friends. Heck, they shouldn't even have pets. So, what happens when it becomes standard operating procedure to keep Ebola nurses quarantined from the rest of society? Aside from working with a life-threatening disease, who in the heck is going to sign on for that job if it means they'll spend the next three weeks in solitary confinement? And, if the nurses are quarantined, who's going to deal with their community's non-Ebola health needs?

And I repeat a point from earlier -- all from ONE dude who lied to get here.

(EDIT: An additional thought. Even if this particular nurse doesn't have Ebola, think of the disruption and stress for those thousands of people. And think of the potential damage to the cruise industry if people start to worry about such things. Who wants to hop in a communal hot tub under these circumstances?)

 

[Bananas]

Ah, the Ebola Cruise!
http://belizean.com/belize-confirms-patient-with-ebola-symptoms-on-cruise-ship-off-its-coast-1814/

Belize Confirms Patient With Ebola Symptoms On Cruise Ship Off Its Coast
Reports tonight are that two individuals possibly infected with the Ebola virus are in Belizean waters. Local TV station Channel 7 monitored in the capital City Of Belmopan tonight, reported having credible reports that a couple from a Texas-based cruise ship presently anchored off Belize City, is on a ship tender, unable to return to the cruise ship, while being refused entry to Belize City to catch an air ambulance awaiting at the International Airport to take them to the their country of origin, the U.S.A....The patient exhibiting Ebola symptoms has been confirmed to be a nurse at a Dallas hospital traveling with her husband....The ship is reportedly carrying 3652 passengers and a total population of 4633 persons.

Soon, we will no doubt hear that this story is mistaken. Like Nurse #1 and Nurse #2, she's probably just a "low risk individual" and was not, in fact, exhibiting symptoms. No need to worry. Move along...

Similar to what @Bananas pointed out so eloquently earlier in this thread, the ramifications of this whole thing can be strange and long-reaching. Can you imagine if you were on that cruse? I love cruises. But man, the humanity is PACKED on those things. You share lawnchairs, serving utinsils, restrooms...

And here's a thought-provoking note. Within the last week, it's become painfully obvious that Ebola-treating nurses shouldn't be travelling. They shouldn't be seeing family. They shouldn't be spending time with their friends. Heck, they shouldn't even have pets. So, what happens when it becomes standard operating procedure to keep Ebola nurses quarantined from the rest of society? Aside from working with a life-threatening disease, who in the heck is going to sign on for that job if it means they'll spend the next three weeks in solitary confinement? And, if the nurses are quarantined, who's going to deal with their community's non-Ebola health needs?

And I repeat a point from earlier -- all from ONE dude who lied to get here.

(EDIT: An additional thought. Even if this particular nurse doesn't have Ebola, think of the disruption and stress for those thousands of people. And think of the potential damage to the cruise industry if people start to worry about such things. Who wants to hop in a communal hot tub under these circumstances?)

3,000+ people potentially exposed on this cruise ship, all because a healthcare worker who treated Duncan did not self quarantine, nor was she directed to quarantine by any authority...instead she decided it was appropriate to go on a cruise!

@ChickenHawk, you were correct about the second nurse and I withdraw my comments and negativity towards her made yesterday. It turns out she reported by phone her condition to the CDC and was directed to get on the plane anyway. So she did not, as it first appeared, disregard everyone else.

In other news it appears someone finally got a brain and decided all the workers exposed to Ebola shouldn't expose the rest of us.

Texas officials moved for the first time Thursday to force health care workers who had contact with a dying Ebola patient to stay home, reversing course after a nurse later diagnosed with the disease flew across the Midwest and deepened anxiety about whether the virus would spread in the U.S.

Seventy-five Texas Health Presbyterian Hospital Dallas employees who had contact with Thomas Eric Duncan were asked to sign legal documents in which they agreed not go to public places or use mass transit, according to Judge Clay Jenkins, top administrator for Dallas County.

http://hosted.ap.org/dynamic/storie...ME&TEMPLATE=DEFAULT&CTIME=2014-10-16-20-17-15

 

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[biophase]

Ah, the Ebola Cruise!
http://belizean.com/belize-confirms-patient-with-ebola-symptoms-on-cruise-ship-off-its-coast-1814/

Belize Confirms Patient With Ebola Symptoms On Cruise Ship Off Its Coast
Reports tonight are that two individuals possibly infected with the Ebola virus are in Belizean waters. Local TV station Channel 7 monitored in the capital City Of Belmopan tonight, reported having credible reports that a couple from a Texas-based cruise ship presently anchored off Belize City, is on a ship tender, unable to return to the cruise ship, while being refused entry to Belize City to catch an air ambulance awaiting at the International Airport to take them to the their country of origin, the U.S.A....The patient exhibiting Ebola symptoms has been confirmed to be a nurse at a Dallas hospital traveling with her husband....The ship is reportedly carrying 3652 passengers and a total population of 4633 persons.

That's a very different story than this: http://www.washingtonpost.com/news/...ng-texas-ebola-nurse-refused-entry-in-belize/

This is saying the person had no symptoms, but the US government contacted the Belize government to tell them that one of the nurses involved in taking care of the 1st patient is on a cruise going to their country.

BTW, I totally agree with the Belize government's response. They just said, F*ck no, nobody on the whole cruise gets into our country, take your ship back to TX. I doubt the USA would ever do that.

 

[ChickenHawk]

That's a very different story than this: http://www.washingtonpost.com/news/...ng-texas-ebola-nurse-refused-entry-in-belize/

Interesting. It appears that my article was written from the perspective of Belize, while your article was written from the perspective of the U.S. Regardless of which one is more accurate, it's fascinating to see the differences, isn't it? It took a few days for the story behind Nurse#2 to come out. I'm betting we'll hear more about this incident in the coming days too.

Still, whichever version is correct, I'd be really concerned if I, or heaven forbid, my child, had potentially shared a hot tub with that health care worker. Talk about something to keep you up at night. Also, now will these thousands of people need to be monitored too?

BTW, I totally agree with the Belize government's response. They just said, F*ck no, nobody on the whole cruise gets into our country, take your ship back to TX. I doubt the USA would ever do that.

I agree 100%. Maybe we can learn a thing or two from them.