Journalist/developer. Interactive editor @frontlinepbs. Builder of @HomicideWatch. Sinophile for fun. Past: @WBUR, @NPR, @NewsHour.
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From Where I Sit, The Trump Era Began In 2014

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People are always trying to pinpoint the moment that the free-wheeling, summer-of-love spirit of the 1960s died. For those who look back on the era fondly, maybe it faded away after Woodstock. For the pessimists, it’s more like the Manson Family murders and Altamont. It’s futile, of course, but I’ve always liked the idea of trying to pinpoint when an era begins or ends. It’s a nice, digestible way for the brain — soft and squishy with emotion and memory — to bookend vast swaths of history.

A year into this president’s first term, I’ve been trying to answer a similar question about the era of Donald Trump: When was America’s emotional table set for his election? Trump has been driving the American political conversation in one way or another for a while now, ever since he floated, tanned and confident, down an escalator to the strains of Neil Young, like an aging mallrat. But I think the real emotional buildup to Trump started before he appeared on that escalator. I think it starts with a year: 2014.

Donald Trump at the groundbreaking of the Trump International Hotel in Washington, D.C., on July 23, 2014.

Kris Connor / Getty Images

People have offered plenty of theories for why Trump won — racial resentment, economic anxiety, hyper-partisanship — but many of those things have attracted voters to other candidates in other years, candidates who were far less successful than Trump. The difference in 2016 seemed to be that Trump turned the campaign into something deeply personal for all Americans, a referendum on our national self-worth — were we already great or were we in need of great improvement? Trump disgorged sentiments of fear, loathing and hope in a way wholly unfamiliar to our sober, straight-laced politics. He was a one-man ayahuasca brew tripping Americans the hell out. It was a bad trip for some, clarifying for others.

Of course, the results of the 2016 election can’t be traced back to a single year. History elides, one event melts into the next, one year builds on the last — the sentiments of people growing and changing year over year. But a series of events can also surface strong feelings in a group of people and feed the idea that a change is afoot, that Americans’ self-presumed exceptionalism has atrophied.

Consider that all this happened in 2014: ISIS executions of American captives; the killings of Eric Garner, Michael Brown and Tamir Rice by police and the ensuing protests; the annexation of Crimea by Russia; the downing of a civilian airliner by Russia; and a wave of unaccompanied minors from Central America crossing the border illegally in what then-President Obama called “an urgent humanitarian situation.”

Numbers can’t prove that 2014 was a pivotal year for the Trumpian political era to come, but they can show it was a year when Americans’ institutional trust bottomed out, something that would come into play in 2016. A few days after the election, I wrote about the erosion of trust in American institutions over the past decade. There was a link, I wrote then, between our loss of trust and electing a man who promised to start a new American order. And in 2014, overall trust in American institutions, which started falling in the mid-2000s, hit 31 percent — its lowest point since Gallup starting tracking the metric in 1993.

But what does it mean to lose trust in things so abstract as institutions? While I can’t speak for the good people who answered Gallup’s surveys, I’m guessing that what lay behind their anemic faith was a sense that all was not well, or at least all was not being handled well.

Marchers in Los Angeles on Dec. 6, 2014, protest the decision in New York not to indict a police officer involved in the chokehold death of Eric Garner.

David McNew / GETTY IMAGES

Trump’s ultimately brilliant political intuition was to burrow deep into this recess of the American mind and to reflect back the sense of creeping disarray. He capitalized on racial and economic fears, but his campaign kickoff proclamation that “the American dream is dead” didn’t just resonate with the people who might have voted for populist and nativist campaigns of the past. Trump’s appeal was broad, resonating with the relatively well-off and the well-educated. The American economy was doing fine (for the most part), but Trump tapped into Americans’ worry that their children would be worse off while navigating the swiftly shifting 21st-century economy and the potential terrorist threats lurking in subways, schools and places of business. He flipped Republican voters’ views on free trade upside down, seemingly proving that policy didn’t have to matter quite so much as the message did — political scientists might call his voters “symbolically conservative” but “operationally liberal.” “I alone can fix it,” Trump told the cheering crowd at the Republican National Convention. The “it” he was referring to was “the system.” It was a concrete offer to plug a gaping hole, though the plan of how to go about it was vague.

Americans’ cratering faith was most apparent in numbers tracking trust in the government. Confidence in the presidency fell more than 20 points between 2009 and 2014. Since 1991, when Gallup started regularly tracking numbers on the presidency, the numbers were lower in 2014 than at any time except 2007 and 2008. Congress and the Supreme Court were also at all-time lows,4 and trust in the police was at 53 percent, down 4 points from the previous year. It would slide further in 2015.

Police shootings of black Americans no doubt profoundly influenced Americans’ views on race relations, a metric tracked sporadically by Gallup since 2001. In 2013, 70 percent of Americans overall thought that race relations were very good or somewhat good, but by the next time Gallup asked the question, in 2015, only 47 percent thought so. That Black Lives Matter sparked consistent protests about the treatment of black Americans over these years can be no coincidence. Backlash to the movement would later find its form in a celebration of police and the idea of law and order, centerpieces of Trump’s campaign and presidency.

The rise of ISIS throughout 2014 tracked with a rising fear of terrorism among Americans during the period between 2013 and 2015, when Gallup asked people to rate their worry that someone in their family would become a victim of terrorism. In 2013, 40 percent were very or somewhat worried by the prospect, and by 2015, that number had risen to around 50 percent. ISIS’s viral videos of Westerners’ beheadings heralded a new age of brutal terrorist tactics and a facility with social media that spoke to young potential recruits. Trump’s campaign would later call for a ban on Muslims coming into the country, after an ISIS-inspired attack in San Bernardino, California, in 2015.

John and Diane Foley talk to reporters outside their home in Rochester, New Hampshire, on Aug. 20, 2014, a day after the release of a video showing the beheading of their son, James Foley, at the hands of ISIS.

Jim Cole / AP

Racial injustice and a new threat of terrorism were not the only stirrings in 2014. Russian bellicosity shocked Americans who’d grown used to a foolish-seeming Putin on a horse — favorable views of the country fell by 10 points between February 2014, a month before the invasion of Crimea, and February 2015. And the online harassment and doxing of Gamergate seems in hindsight to have been only a prelude to the dark side of social media in the 2016 campaign.

Trying to pin 2014 as the start of a new era is a subjective exercise, perhaps a fool’s errand. But if politics is driven by emotion and memory, so in this case is its hindsight analysis. 2014 was in my book an annus horribilis, a blur of mortality. Perhaps if Gallup had called me, I’d have told them I’d lost trust.

In June 2014, someone I knew well was murdered. In July, Eric Garner died on Staten Island, in the city where I’d just moved. In August, I remember sitting on a fluorescent-lit subway car and reading about the beheading of a journalist named James Foley by some group called ISIS. A year later, I’d have to watch his beheading video and speak with his family for a magazine story I fact-checked about the vain attempts to save him and other Americans. Michael Brown was killed in August, too. September brought another ISIS beheading video. In October, a doctor in New York City was diagnosed with Ebola — a global terror of its own kind — and I found myself thinking uncontrollable thoughts about biohazards let loose on the subway. In November, Tamir Rice was killed in my hometown, and the midterm election gave the Republicans control of the U.S. Senate — though that’s only a blip in my memory. The emotions stirred by 2014 lingered longer with me than its discrete politics.

Perhaps that’s why the themes of fear and mortality that hovered over the 2016 election made some sense to me with 2014 in the rearview mirror. It’s hard to tell how long it takes for emotional responses like mine to get into the political bloodstream of a country, but when pricked by the right needle, America’s primal worry and righteous anger bled out over an election.













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chrisamico
2 days ago
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No bang, just fizzle: Why Apple’s iPad flopped as a news platform

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Photo (cc) 2011 by Global X.

Of all the good technological innovations that were supposedly going to rescue the news business from the bad technological innovations that had laid it low, perhaps none was more highly touted than Apple’s iPad.

Unfortunately, the iPad has proved to be a huge disappointment for news publishers. The reason, according to Shira Ovide of Bloomberg Businessweek, is that though people like their iPads, they love their smartphones. Sales of the iPad peaked at 71 million in 2013 and slid to about 44 million last year. Meanwhile, about 1.5 billion smartphones were sold in 2017. Against that backdrop, iPad sales are barely a rounding error.

Read the rest at WGBHNews.org. And talk about this post on Facebook.





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chrisamico
9 days ago
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Advice to the newish programmer

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I occasionally field questions about computing and the industry from people starting out, whether it be friends switching jobs or just internet denizens. My answers are opinions, but I wish I had formed some of these opinions earlier. For someone’s benefit, here they are.

Elegant, readable, and a lot of other words don’t mean anything

You’ll be asked to produce readable, elegant code. You won’t know what they mean by that. Neither does anyone.

We all sort of know what bad code is - we know it when we see it. But readable or elegant is, more than anything else, in the eye of the beholder. And generally, it’s meaningless. I’ve worked with people who insist that 4 space indentation is readable but 2 space indentation is completely unreadable. Or that there must be spaces between the () in a function declaration and its parameters. Is it more elegant to use currying and other functional-programming flavor, or just use traditional for loops? Nobody knows.

This is all nonsense. I once wrote an internal blog post for Mapbox, declaring our code style: it was to follow the existing conventions of the project, and that’s it. Don’t reformat your functions to K&R style, don’t add or remove semicolons. Just be consistent. It doesn’t matter.

If you want evidence that style doesn’t matter, look at the code style of three.js, the enormously popular WebGL library. It has over 900 contributors, and an unusual style that I haven’t seen anywhere else. The style hasn’t alienated or puzzled contributors, or caused regressions or bugs. It doesn’t matter: the style works for the author.

Which is the cruel thing about “readability” edicts: they’re a disguised way of saying “code like me.” Some senior engineer wants to see code that agrees with them.

Nobody knows all the levels of the stack

The web is a deep stack of things to learn: browser quirks, networking, CSS, HTML. Below that, JavaScript interpreters, browser rendering engines. Below that, process isolation and the OS. And then the hardware abstraction, the hardware, the power supply, the transistors. The electrons that flow, and the paths etched in the microprocessor. Then sub-atomic particles and quantum dynamics, so you can understand random number generation.

The truth is, I and 99% of people working with computers just have to trust that everything inside of the metal box is doing what it’s supposed to do.

Long ago, the magic of industrialization made computers so powerful and complex that nobody would be able to build one from scratch. We can - and should - dive deeper, understanding each layer as we become able to. But almost all of us start from the top down, understanding heavily abstracted technology like JavaScript before we understand fundamental mechanisms like microprocessors.

Don’t worry if you understand computers as enchanted aluminum boxes: everyone does. It’s not really a problem for your programming career.

You’ll need to work without documentation

Everyone should write better documentation, but nobody does. You will constantly find incomplete or incorrect docs. Raging into the void does no good.

The dirty truth is that everyone who wants to work quickly is reading the source code. Again, this isn’t ideal, but it is reality. Learning to explore and read unfamiliar codebases saves you from the slowest and most unreliable thing in the world: other people. And it helps you be a better open source citizen: instead of opening a ticket saying that the documentation doesn’t work, you can figure out why and propose a fix, upfront.

There’s a broader point here. Debugging strategies are generally worth more than the ability to write code quickly. Debugging is the thing that people spend mythical amounts of time on - “I spent 12 hours debugging this!” - often because (and not to blame the victim here) their debugging strategies consist of re-reading the documentation and guessing code. Guessing is bad: read the code, look at the code that’s actually running, whether it’s in your local copy of a library, or Node.js’s source, or on GitHub. It’s worth it.

Expect chaos always

Programming is a partially-professionalized craft that’s built on compromise and elbow grease. As a result, usually nothing works.

Which means that, even the most elite programmers are constantly dealing with mistakes, whether their own or mistakes that they’ve inherited from programmers before them. Even if you’re batting 1000, your perfect application might be vulnerable to a bug at a way lower level, like the Meltdown vulnerability.

Which isn’t to discourage you, but to reframe the craft: what we’re building are solutions to problems. Things that reflect the environment, history, and limitations of their form.

It’s good for you, emotionally and practically, to expect this going in: that computing is long divorced from mathematical purity or conceptual elegance. The two may reunite, but in this era we’re mostly solving problems as best we can with the means provided. Anticipate the chaos and the catastrophes, just aim to end up with less chaos than you started with.

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acdha
7 days ago
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chrisamico
9 days ago
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Boston, MA
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Why a simple, lifesaving rabies shot can cost $10,000 in America

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Untreated rabies is always fatal — but key drugs leave families with thousands in medical debt.

On November 17, 2016, a bat flew into Ally McNamee’s mouth.

At the time, McNamee was a student at Keene State College in New Hampshire. A bat flew into her house, and she attempted to shoo it away with a broom, assuming the bat would retreat. It did not.

“It flew at my face, and I screamed,” McNamee says. “My mouth was open. I definitely caught a wing.”

When she woke up the next day, she started to worry about rabies. She went to the local urgent care center, which sent her to the emergency room. It was the only facility that stocked the drugs necessary to treat rabies, a situation that is typical across the United States.

A few weeks later, the bill arrived: $6,017. The vast majority of the charge was for a drug to treat rabies exposure called immunoglobulin. The emergency room billed this drug at $3,706.

And it turns out McNamee’s bill was actually at the low end of what hospitals charge for the drug in the United States, which can sometimes be closer to $10,000.

Vox learned of McNamee’s bat incident during a running, months-long investigation into emergency room costs. Readers from across the country have contributed more than 1,000 bills to Vox’s emergency room bill database. In reviewing those bills, I kept coming across something I didn’t expect to see: readers with significant medical debt from rabies treatment.

Michael Cinkosky also sent me a bill from a visit to a hospital near Denver. A bat collided with his 8-year-old son’s chest last summer and left behind two scratch marks, a sign of a possible bite. That hospital billed the same rabies drug at $10,494.

The Cinkosky family was responsible for $3,563 of the hospital bill, which they’re still paying off.

“Rabies is 100 percent fatal. What are you going to do? Not get it?” Cinkosky says. “We’ve been living off our reserves because of the bills, and that’s not a good long-term strategy.”

In England, the drug to treat rabies exposure costs $1,600. Here, hospitals charge $10,000.

The price of rabies treatment in American reveals unique failures of our country’s health care system. It shows that in the United States, pharmaceutical companies can set sky-high prices for lifesaving medication.

Specifically, the drug that prevents rabies from spreading to the brain can cost more than $10,000 in the United States. In some cases I reviewed, hospitals charged more than six times what the identical drug would cost in the UK.

Insurance plans will often negotiate down those charges, but even those lower prices are still multiples higher than what patients pay in our peer countries, such as Canada or England.

“Rabies treatment is more expensive in the United States, as are many medical treatments, because we don’t have price controls,” says Charles Rupprecht, a biomedical consultant who previously ran the rabies control program at the Centers for Disease Control and Prevention.

Emergency rooms, meanwhile, can exacerbate the pricing problem.

ERs typically are the only locations where patients can find the lifesaving treatment. And they charge significant “facility fees” to anyone who walks through their doors to seek treatment — including patients seeking a rabies vaccine.

Because rabies treatments includes a series of four shots delivered over two weeks — all at separate appointments — those costs can add up quickly.

“I have to go to the ER to get the drug, and each time I walk in the door, that is a $250 copayment just to start,” says Lisa Peterson, who went through rabies treatment in Utah in 2016 after being bitten by a raccoon. The public health department told her the only place she could get the injection was at the local emergency department.

She is still paying off her bills for the treatment — about $4,500 in total — with $100 a month. She still has about $600 to go, from emergency room visits that happened in the fall of 2016.

“When I got the bill, I called them crying,” she says. “I can’t pay this. Each time, the doctor comes in for a minute, looks at the bite, and gives me a shot. How do they feel comfortable billing me so much?”

Depending on where you go, a key rabies drug could cost $280 — or $9,912

Between 20,000 and 40,000 Americans are treated each year for rabies exposure, typically after encounters with wildlife including bats, raccoons, and skunks.

The first step in treatment involves two drugs: a rabies vaccine and something called rabies immunoglobulin. The immunoglobulin essentially kicks the immune system into overdrive, staving off the rabies virus until the vaccine begins to take effect.

“The immunoglobulin is what intervenes before the illness can go from the periphery of the body into the central nervous system, and eventually into the brain,” Rupprecht explains. “That buys you time.”

Rabies immunoglobulin costs more than something like a flu shot because it’s derived from human blood, which has to be carefully screened for disease. The cost means the drug is often unavailable in developing countries.

But the prices in the United States are still exceptionally high. Derek Evans, a British pharmacist who is the chair-elect of the International Society of Travel Medicine professional group, helped me look up the price of rabies immunoglobulin in the United Kingdom.

The British National Formulary shows that in the UK, one vial of rabies immunoglobulin costs £600, or $813. Evans says the average male would require two vials (the drug is dosed based on weight) bringing the total price to £1,200, or $1,626 — a fraction of the costs I’ve seen on American hospital bills. The British government also covers all the costs for rabies exposure treatment, leaving patients there with no bill.

“It’s a long way off from $14,000, isn’t it?” Evans remarked when I told him about the charges I’d seen here in the United States.

Finding out the price of this rabies treatment in advance can prove vexing, if not impossible. The CDC estimates that it costs between $3,000 and $7,000.

The health data firm Amino combed through 45,000 claims for rabies treatment and found about half of the bills ranged from $280 to $4,500. Five percent of the bills were above $9,912, suggesting that emergency rooms and possibly drug manufacturers have wide leeway on what they charge for the exact same medications.

The Amino data represents the actual price paid for the rabies vaccine by patients and insurers, and not the hospital charges.

“If this were a flu shot, the variation in prices would be really narrow,” says Sohan Murthy, chief data scientist at Amino. But he says this kind of price variation is typical when you move into the emergency room setting, where patients often have little idea what their treatment will cost until the bill arrives.

“High variation in prices for emergency room-type things is something we see a lot of in different types of medical encounters,” Murthy says.

The Swedish Medical Center near Denver — the hospital that saw Benjamin Cinkosky, the 8-year-old boy who was struck by a bat — did not respond to multiple requests for comment on how it set its prices.

Sanofi, which manufacturers one of the two brands of rabies immunogloublin provided Vox with a statement regarding its prices: “Rabies is a serious viral infection that is nearly always fatal. We believe the price of the immunoglobulin is appropriate taking into consideration the life-saving value the product may provide and the complexity of its manufacturing.”

Pricey “facility fees” drive the costs of rabies treatment even higher

Most health care providers do not stock rabies immunoglobulin because the expensive drug has a short shelf life, typically expiring a few years after production. There’s a decent chance the drug would expire on a primary care doctor’s shelf.

Emergency rooms, however, do keep this lifesaving medication in stock. The Amino data set shows that 95 percent of post-exposure rabies treatment happens in ERs.

Emergency rooms typically tack on hundreds or thousands of dollars in hospital and doctor fees just for receiving the injections in an ER setting. “Facility fees” are the price emergency rooms charge for walking in the door and seeking care. These fees have risen steeply in recent years: up 89 percent over just six years, according to my recent investigation with the Health Care Cost Institute.

The fees also vary significantly from hospital to hospital — and even within the same hospital.

Lisa Peterson learned this firsthand after a raccoon bit her in October 2016. She called the public health department, which told her the only place she could seek treatment was her local emergency room.

St. Mark’s Hospital in Salt Lake City billed Peterson $14,444 for her first visit. She was ultimately responsible for $941.

What jumped out at Peterson was that her emergency room would charge different prices for her follow-up visits. To her, the visits all seemed the same: a quick stop by the emergency room to receive a shot of the rabies vaccine.

But sometimes her visits were billed with a “level 1” facility fee, the cheapest fee for the simplest visits. But another visit was coded as “level 2,” which came with a higher price. And still another was “level 4,” typically reserved for some of the most complex visits.

“Every time, the fee was different,” Peterson says.

In addition to her $250 emergency room copayment, these fees got tacked onto her bill. Peterson was charged a $105 facility fee when her visit was coded as level 1, but a $679 facility fee when the hospital coded a visit as level 4.

Peterson’s share of the bill ranged from $51 up to $230 depending on which code the hospital used.

St. Marks Hospital in Salt Lake City, where Peterson was treated, did not respond to a request for comment about how it set the prices for Peterson’s care.

Peterson says it was frustrating that she couldn’t get her care — or at least the follow-up shots, which don’t expire quickly like the immunoglobulin — at a public health department, where she wouldn’t need to pay facility fees. But the department has told her repeatedly that it doesn’t stock the medication or have plans to do so.

Like many Americans, Peterson factors in price when making decisions about health care. She has not seen a doctor about pain she has in her shoulder because she doesn’t think she has the money right now to pay for treatment.

But with rabies treatment, it was different: She was dealing with possible exposure to a disease that is always fatal. She needed to seek treatment — and she didn’t have a choice about where to do so, essentially requiring her to pay whatever prices the emergency room wanted to charge.

“I get it for the first shot, going to be seen by the emergency room,” she says. “But the next three? I don’t get it. It seemed absolutely backward that the only way to get treated with rabies is through the emergency room. That is crazy to me.”


Help us report on the costs to visit the emergency room. Share your bill here.

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chrisamico
11 days ago
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Chicken Pox and Name Statistics

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People with all six of those names agree that it's weird that we have teeth, when you think about it for too long. Just about everyone agrees on that, except—in a still-unexplained statistical anomaly—people named "Trevor."
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chrisamico
16 days ago
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Sometimes XKCD is on the nose: I work with Brians and Sarahs. Logan and Harper are in my kid's preschool class.
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dukeofwulf
15 days ago
And what are their thoughts on Chicken Pox?
spiffytech
15 days ago
I am Brian and I thought chickenpox was normal.
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Creating journalism to engage as well as to inform

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The media world is in full freak-out mode about the changes at Facebook, both the changes in the news feed but now its decision to let the Facebook “community” decide which publications are credible. For the record, I find the latter move much more problematic, but I want to focus on the shift to reward engagement. Like a lot of people, I see the shift as an opportunity for news organisations rather than a threat.

The change in the news feed is only a bad thing for news organisations addicted to passively playing the algorithm for cheap clicks. Even if it juices the pageviews for a while, the end of 2017 showed that simply chasing scale without a method to convert those users into loyal, returning users will not deliver a sustainable business model.

Meanwhile, a model built on winning loyalty was winning. As The Economist pointed out last autumn, many successful news groups are succeeding by working hard to convert the casual users, often from social media, into loyal users, loyal enough that they become subscribers. Those groups have married an engagement strategy with data science. Moreover, as Digiday pointed out with Aftenposten, your content strategy is very different if you focus on keeping paying subscribers happy rather than chasing traffic.

The challenge for many groups will be that as they have with many digital innovations, they treated Facebook as just another channel to passively share their content. They didn’t make an effort to engage with their audience, but rather, they prayed to the gods of virality that their posts would be shared widely. Virality would lead inexorably to clicks, and advertising would lead to revenue. As I said, the end of 2017 put paid to that strategy. It doesn’t work.

What to do?

Martin Giesler highlighted the conundrum for news publishers in a very good post on the feed changes. Jump to his immediate, medium and long-term steps to take to respond to the changes. He said:

As there’s no point in betting on traffic, many publishers will now focus on engagement. The problem here is that journalism is not primarily intended to generate interactions. Rather, it is primarily a matter of informing. In a journalistic sense, passivity is not a bad thing – quite the opposite of Facebook logic.

Exactly. Years ago when I was the blogs editor at The Guardian, the New York Times’ Sewell Chan met with me as he was launching the paper’s city-focused blog. I put the shift in publication to conversation this way.

A piece of journalism takes reporting and ties together as many threads as possible as quickly and efficiently as possible. A blog post teases out those same threads as the basis of a debate, discussion or conversation.

Slapping a comment box on the bottom of an article or column opened up a return channel, but especially on news articles, there are no calls to action. The intention of the content was to inform. What response did we expect from people?

Now, we need to think about content formats designed to engage.

  • We need a range of products and features that engage people whether they want to lightly engage or more heavily engage. Think of the range of engagement on Facebook itself. For example, news site Rappler in the Philippines has mood reactions on its content, giving people a lightweight way to engage.
  • Think of social media as the top of your engagement funnel and develop strategies that convert people into more durable, direct relationships with you and your journalism.
  • Work to convert users to products like an app, newsletter, podcasts, and events.
  • Develop novel ways to monetise that attention across the range of engagement products.

Successful media organisations have been doing this for years so should take Facebook’s changes in stride. You could never entirely base your business on the someone else’s business, especially one that introduces opaque changes so frequently as Facebook. Facebook is just pushing you to make necessary changes to end your dependence. Embrace it!

The post Creating journalism to engage as well as to inform appeared first on Strange Attractor.

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chrisamico
23 days ago
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