el Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE Patients with diabetes mellitus (DM) have elevated levels of high-sensitivity cardiac troponin (hs-cTn). We investigated the diagnostic performance of the European Society of Cardiology (ESC) algorithms to rule out or rule in acute myocardial infarction (AMI) without ST-elevation in patients with DM. RESEARCH DESIGN AND METHODS We prospectively enrolled 3,681 patients with suspected AMI and stratified those by the presence of DM. The ESC 0/1-h and 0/3-h algorithms were used to calculate negative and positive predictive values (NPV, PPV). In addition, alternative cutoffs were calculated and externally validated in 2,895 patients. RESULTS In total, 563 patients (15.3%) had DM, and 137 (24.3%) of these had AMI. When the ESC 0/1-h algorithm was used, the NPV was comparable in patients with and without DM (absolute difference [AD] –1.50 [95% CI –5.95, 2.96]). In contrast, the ESC 0/3-h algorithm resulted in a significantly lower NPV in patients with DM (AD –2.27 [95% CI –4.47, –0.07]). The diagnostic performance for rule-in of AMI (PPV) was comparable in both groups: 0/1-h (AD 6.59 [95% CI –19.53, 6.35]) and 0/3-h (AD 1.03 [95% CI –7.63, 9.7]). Alternative cutoffs increased the PPV in both algorithms significantly, while improvements in NPV were only subtle. CONCLUSIONS Application of the ESC 0/1-h algorithm revealed comparable safety to rule out AMI comparing patients with and without DM, while this was not observed with the ESC 0/3-h algorithm. Although alternative cutoffs might be helpful, patients with DM remain a high-risk population in whom identification of AMI is challenging and who require careful clinical evaluation. Full Article
el Microvascular and Cardiovascular Outcomes According to Renal Function in Patients Treated With Once-Weekly Exenatide: Insights From the EXSCEL Trial By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE To evaluate the impact of once-weekly exenatide (EQW) on microvascular and cardiovascular (CV) outcomes by baseline renal function in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL). RESEARCH DESIGN AND METHODS Least squares mean difference (LSMD) in estimated glomerular filtration rate (eGFR) from baseline between the EQW and placebo groups was calculated for 13,844 participants. Cox regression models were used to estimate effects by group on incident macroalbuminuria, retinopathy, and major adverse CV events (MACE). Interval-censored time-to-event models estimated effects on renal composite 1 (40% eGFR decline, renal replacement, or renal death) and renal composite 2 (composite 1 variables plus macroalbuminuria). RESULTS EQW did not change eGFR significantly (LSMD 0.21 mL/min/1.73 m2 [95% CI –0.27 to 0.70]). Macroalbuminuria occurred in 2.2% of patients in the EQW group and in 2.5% of those in the placebo group (hazard ratio [HR] 0.87 [95% CI 0.70–1.07]). Neither renal composite was reduced with EQW in unadjusted analyses, but renal composite 2 was reduced after adjustment (HR 0.85 [95% CI 0.74–0.98]). Retinopathy rates did not differ by treatment group or in the HbA1c-lowering or prior retinopathy subgroups. CV outcomes in those with eGFR <60 mL/min/1.73 m2 did not differ by group. Those with eGFR ≥60 mL/min/1.73 m2 had nominal risk reductions for MACE, all-cause mortality, and CV death, but interactions by renal function group were significant for only stroke (HR 0.74 [95% CI 0.58–0.93]; P for interaction = 0.035) and CV death (HR 1.08 [95% CI 0.85–1.38]; P for interaction = 0.031). CONCLUSIONS EQW had no impact on unadjusted retinopathy or renal outcomes. CV risk was modestly reduced only in those with eGFR ≥60 mL/min/1.73 m2 in analyses unadjusted for multiplicity. Full Article
el Novel Biomarkers for Change in Renal Function in People With Dysglycemia By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE Diabetes is a major risk factor for renal function decline and failure. The availability of multiplex panels of biochemical markers provides the opportunity to identify novel biomarkers that can better predict changes in renal function than routinely available clinical markers. RESEARCH DESIGN AND METHODS The concentration of 239 biochemical markers was measured in stored serum from participants in the biomarker substudy of Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial. Repeated-measures mixed-effects models were used to compute the annual change in eGFR (measured as mL/min/1.73 m2/year) for the 7,482 participants with a recorded baseline and follow-up eGFR. Linear regression models using forward selection were used to identify the independent biomarker determinants of the annual change in eGFR after accounting for baseline HbA1c, baseline eGFR, and routinely measured clinical risk factors. The incidence of the composite renal outcome (i.e., renal replacement therapy, renal death, renal failure, albuminuria progression, doubling of serum creatinine) and death within each fourth of change in eGFR predicted from these models was also estimated. RESULTS During 6.2 years of median follow-up, the median annual change in eGFR was –0.18 mL/min/1.73 m2/year. Fifteen biomarkers independently predicted eGFR decline after accounting for cardiovascular risk factors, as did 12 of these plus 1 additional biomarker after accounting for renal risk factors. Every 0.1 mL/min/1.73 m2 predicted annual fall in eGFR predicted a 13% (95% CI 12, 14%) higher mortality. CONCLUSIONS Adding up to 16 biomarkers to routinely measured clinical risk factors improves the prediction of annual change in eGFR in people with dysglycemia. Full Article
el The Prevalence and Determinants of Cognitive Deficits and Traditional Diabetic Complications in the Severely Obese By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE To determine the prevalence of cognitive deficits and traditional diabetic complications and the association between metabolic factors and these outcomes. RESEARCH DESIGN AND METHODS We performed a cross-sectional study in severely obese individuals before bariatric surgery. Lean control subjects were recruited from a research website. Cognitive deficits were defined by the National Institutes of Health (NIH) Toolbox (<5th percentile for lean control subjects). Cardiovascular autonomic neuropathy (CAN) was defined by an expiration-to-inspiration (E-to-I) ratio of <5th percentile for lean control subjects. Retinopathy was based on retinal photographs and nephropathy on the estimated glomerular filtration rate (<60 mg/dL) and/or the albumin-to-creatinine ratio (ACR) (≥30 mg/g). NIH Toolbox, E-to-I ratio, mean deviation on frequency doubling technology testing, and ACR were used as sensitive measures of these outcomes. We used multivariable linear regression to explore associations between metabolic factors and these outcomes. RESULTS We recruited 138 severely obese individuals and 46 lean control subjects. The prevalence of cognitive deficits, CAN, retinopathy, and nephropathy were 6.5%, 4.4%, 0%, and 6.5% in lean control subjects; 22.2%, 18.2%, 0%, and 6.1% in obese participants with normoglycemia; 17.7%, 21.4%, 1.9%, and 17.9% in obese participants with prediabetes; and 25.6%, 31.9%, 6.1%, and 16.3% in obese participants with diabetes. Waist circumference was significantly associated with cognitive function (–1.48; 95% CI –2.38, –0.57) and E-to-I ratio (–0.007; 95% CI –0.012, –0.002). Prediabetes was significantly associated with retinal function (–1.78; 95% CI –3.56, –0.002). CONCLUSIONS Obesity alone is likely sufficient to cause cognitive deficits but not retinopathy or nephropathy. Central obesity is the key metabolic risk factor. Full Article
el Genetic Susceptibility Determines {beta}-Cell Function and Fasting Glycemia Trajectories Throughout Childhood: A 12-Year Cohort Study (EarlyBird 76) By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE Previous studies suggested that childhood prediabetes may develop prior to obesity and be associated with relative insulin deficiency. We proposed that the insulin-deficient phenotype is genetically determined and tested this hypothesis by longitudinal modeling of insulin and glucose traits with diabetes risk genotypes in the EarlyBird cohort. RESEARCH DESIGN AND METHODS EarlyBird is a nonintervention prospective cohort study that recruited 307 healthy U.K. children at 5 years of age and followed them throughout childhood. We genotyped 121 single nucleotide polymorphisms (SNPs) previously associated with diabetes risk, identified in the adult population. Association of SNPs with fasting insulin and glucose and HOMA indices of insulin resistance and β-cell function, available from 5 to 16 years of age, were tested. Association analysis with hormones was performed on selected SNPs. RESULTS Several candidate loci influenced the course of glycemic and insulin traits, including rs780094 (GCKR), rs4457053 (ZBED3), rs11257655 (CDC123), rs12779790 (CDC123 and CAMK1D), rs1111875 (HHEX), rs7178572 (HMG20A), rs9787485 (NRG3), and rs1535500 (KCNK16). Some of these SNPs interacted with age, the growth hormone–IGF-1 axis, and adrenal and sex steroid activity. CONCLUSIONS The findings that genetic markers influence both elevated and average courses of glycemic traits and β-cell function in children during puberty independently of BMI are a significant step toward early identification of children at risk for diabetes. These findings build on our previous observations that pancreatic β-cell defects predate insulin resistance in the onset of prediabetes. Understanding the mechanisms of interactions among genetic factors, puberty, and weight gain would allow the development of new and earlier disease-management strategies in children. Full Article
el Confirming the Bidirectional Nature of the Association Between Severe Hypoglycemic and Cardiovascular Events in Type 2 Diabetes: Insights From EXSCEL By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE We sought to confirm a bidirectional association between severe hypoglycemic events (SHEs) and cardiovascular (CV) event risk and to characterize individuals at dual risk. RESEARCH DESIGN AND METHODS In a post hoc analysis of 14,752 Exenatide Study of Cardiovascular Event Lowering (EXSCEL) participants, we examined time-dependent associations between SHEs and subsequent major adverse cardiac events (CV death, nonfatal myocardial infarction [MI] or stroke), fatal/nonfatal MI, fatal/nonfatal stroke, hospitalization for acute coronary syndrome (hACS), hospitalization for heart failure (hHF), and all-cause mortality (ACM), as well as time-dependent associations between nonfatal CV events and subsequent SHEs. RESULTS SHEs were uncommon and not associated with once-weekly exenatide therapy (hazard ratio 1.13 [95% CI 0.94–1.36], P = 0.179). In fully adjusted models, SHEs were associated with an increased risk of subsequent ACM (1.83 [1.38–2.42], P < 0.001), CV death (1.60 [1.11–2.30], P = 0.012), and hHF (2.09 [1.37–3.17], P = 0.001), while nonfatal MI (2.02 [1.35–3.01], P = 0.001), nonfatal stroke (2.30 [1.25–4.23], P = 0.007), hACS (2.00 [1.39–2.90], P < 0.001), and hHF (3.24 [1.98–5.30], P < 0.001) were all associated with a subsequent increased risk of SHEs. The elevated bidirectional time-dependent hazards linking SHEs and a composite of all CV events were approximately constant over time, with those individuals at dual risk showing higher comorbidity scores compared with those without. CONCLUSIONS These findings, showing greater risk of SHEs after CV events as well as greater risk of CV events after SHEs, validate a bidirectional relationship between CV events and SHEs in patients with high comorbidity scores. Full Article
el Impact of Glucose Level on Micro- and Macrovascular Disease in the General Population: A Mendelian Randomization Study By care.diabetesjournals.org Published On :: 2020-03-20T11:50:34-07:00 OBJECTIVE To evaluate whether high glucose levels in the normoglycemic range and higher have a causal genetic effect on risk of retinopathy, neuropathy, nephropathy, chronic kidney disease (CKD), peripheral arterial disease (PAD), and myocardial infarction (MI; positive control) in the general population. RESEARCH DESIGN AND METHODS This study applied observational and one-sample Mendelian randomization (MR) analyses to individual-level data from 117,193 Danish individuals, and validation by two-sample MR analyses on summary-level data from 133,010 individuals from the Meta-Analyses of Glucose and Insulin-Related Traits Consortium (MAGIC), 117,165 from the CKDGen Consortium, and 452,264 from the UK Biobank. RESULTS Observationally, glucose levels in the normoglycemic range and higher were associated with high risks of retinopathy, neuropathy, diabetic nephropathy, PAD, and MI (all P for trend <0.001). In genetic causal analyses, the risk ratio for a 1 mmol/L higher glucose level was 2.01 (95% CI 1.18–3.41) for retinopathy, 2.15 (1.38–3.35) for neuropathy, 1.58 (1.04–2.40) for diabetic nephropathy, 0.97 (0.84–1.12) for estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, 1.19 (0.90–1.58) for PAD, and 1.49 (1.02–2.17) for MI. Summary-level data from the MAGIC, the CKDGen Consortium, and the UK Biobank gave a genetic risk ratio of 4.55 (95% CI 2.26–9.15) for retinopathy, 1.48 (0.83–2.66) for peripheral neuropathy, 0.98 (0.94–1.01) for eGFR <60 mL/min/1.73 m2, and 1.23 (0.57–2.67) for PAD per 1 mmol/L higher glucose level. CONCLUSIONS Glucose levels in the normoglycemic range and higher were prospectively associated with a high risk of retinopathy, neuropathy, diabetic nephropathy, eGFR <60 mL/min/1.73 m2, PAD, and MI. These associations were confirmed in genetic causal analyses for retinopathy, neuropathy, diabetic nephropathy, and MI, but they could not be confirmed for PAD and seemed to be refuted for eGFR <60 mL/min/1.73 m2. Full Article
el Send Daily Email Digests to Friends, Colleagues or Even to Yourself By blog.inoreader.com Published On :: Tue, 25 Feb 2020 08:15:13 +0000 When we announced our v13 update, we mentioned a new feature called Email Digests that we’ll explain further in this… Full Article Uncategorized
el Effects of MK-0941, a Novel Glucokinase Activator, on Glycemic Control in Insulin-Treated Patients With Type 2 Diabetes By care.diabetesjournals.org Published On :: 2011-11-21T22:32:39-08:00 OBJECTIVE To assess the efficacy and safety of MK-0941, a glucokinase activator (GKA), when added to stable-dose insulin glargine in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS In this double-blind study, 587 patients taking stable-dose insulin glargine (±metformin ≥1,500 mg/day) were randomized (1:1:1:1:1) to MK-0941 10, 20, 30, or 40 mg or matching placebo t.i.d. before meals (a.c.). This study included an initial 14-week, dose-ranging phase followed by a 40-week treatment phase during which patients were to be uptitrated as tolerated to 40 mg (or placebo) t.i.d. a.c. The primary efficacy end point was change from baseline in A1C at Week 14. RESULTS At Week 14, A1C and 2-h postmeal glucose (PMG) improved significantly versus placebo with all MK-0941 doses. Maximal placebo-adjusted least squares mean changes from baseline in A1C (baseline A1C 9.0%) and 2-h PMG were –0.8% and –37 mg/dL (–2 mmol/L), respectively. No significant effects on fasting plasma glucose were observed at any dose versus placebo. By 30 weeks, the initial glycemic responses noted at 14 weeks were not sustained. MK-0941 at one or more doses was associated with significant increases in the incidence of hypoglycemia, triglycerides, systolic blood pressure, and proportion of patients meeting criteria for predefined limits of change for increased diastolic blood pressure. CONCLUSIONS In patients receiving stable-dose insulin glargine, the GKA MK-0941 led to improvements in glycemic control that were not sustained. MK-0941 was associated with an increased incidence of hypoglycemia and elevations in triglycerides and blood pressure. Full Article
el Effectively Serving Immigrant and Dual Language Learner Families through Home Visiting Programs By www.migrationpolicy.org Published On :: Thu, 29 Aug 2019 12:01:27 -0400 Marking a policy brief's release, this webinar explores the promise of home visiting services that support new parents alongside their infants and toddlers, plus strategies for improving how these programs work with immigrant and linguistically diverse families. Full Article
el The Colombian Response to the Venezuelan Migration Crisis: A Dialogue with Colombia’s Migration Czar By www.migrationpolicy.org Published On :: Mon, 30 Sep 2019 19:29:42 -0400 Felipe Muñoz, Advisor to the President of Colombia for the Colombian-Venezuelan Border, discusses how Colombia is coping with the influx of Venezuelan migrants, plans for future policy decisions surrounding this migration, and developments in regional and international cooperation. Full Article
el Latin American Responses to the Venezuelan and Nicaraguan Migration Crises By www.migrationpolicy.org Published On :: Thu, 31 Oct 2019 12:12:21 -0400 Leading policymakers and key stakeholders from Latin America, as well as representatives of major international institutions, offer their views on the challenges ahead as Latin American governments seek to chart strategies for responding to large-scale forced migration flows, such as those from Venezuela and Nicaragua. Spanish and English versions of the remarks are available. Full Article
el Is the Door Closing? Latin American and Caribbean Responses to Venezuelan Migration By www.migrationpolicy.org Published On :: Thu, 13 Feb 2020 11:40:37 -0500 Fleeing crisis, nearly 4 million Venezuelans have moved to other Latin American and Caribbean countries over the past few years. This webinar marked the launch of a Latin American and Caribbean Migration Portal, and a report examining the migration and integration policy responses in the region. Full Article
el ¿Se Están Cerrando las Puertas? Respuestas a la Migración Venezolana en América Latina y el Caribe By www.migrationpolicy.org Published On :: Thu, 13 Feb 2020 13:08:48 -0500 MPI llevó a cabo un seminario en línea para marcar el lanzamiento de: Un portal sobre Migración en América Latina y el Caribe; y un informe que examina los efectos de las políticas migratorias y de integración en 11 países en América Latina y el Caribe ante el aumento de la migración venezolana y nicaragüense. Full Article
el Immigrant Families and Child Welfare Systems: Emerging Needs and Promising Policies By www.migrationpolicy.org Published On :: Mon, 22 Apr 2019 10:26:23 -0400 With the children of immigrants a growing share of all U.S. children, and federal immigration enforcement and other policies undergoing significant change, some state and local child welfare agencies are developing new ways to improve how they work with immigrant families. This report examines key cultural, linguistic, and legal challenges, and how agencies are adjusting staffing, training, placement, and other policies to tackle them. Full Article
el Millions Will Feel Chilling Effects of U.S. Public-Charge Rule That Is Also Likely to Reshape Legal Immigration By www.migrationpolicy.org Published On :: Thu, 08 Aug 2019 12:09:29 -0400 The public-charge rule issued by the Trump administration in August 2019 will have profound effects on future immigration and on use of public benefits by millions of legal noncitizens and their U.S.-citizen family members. Complex standards for determining when an immigrant is likely to become a public charge could cause a significant share of the nearly 23 million noncitizens and U.S. citizens in benefits-using immigrant families to disenroll, as this commentary explains. Full Article
el Reflections on Business, Leadership, and Branding: Shelly Lazarus ’70 By brandleadership.wordpress.com Published On :: Mon, 22 Feb 2016 15:20:02 +0000 Much has changed in the world of advertising from the picture painted by Mad Men. Shelly Lazarus ’70, Chairman Emeritus, Ogilvy & Mather, was one of the women helping pioneer these changes. Making the journey from ‘the only woman in the room’ to CEO and Chairman of Ogilvy gives Lazarus a lot to reflect on […] Full Article *Matthew Quint Brand Strategy Business Values Leadership Uncategorized BRITE Conference Ogilvy & Mather Shelly Lazarus
el Musculoskeletal Complications of Diabetes Mellitus By clinical.diabetesjournals.org Published On :: 2001-07-01 Rachel Peterson KimJul 1, 2001; 19:Practical Pointers Full Article
el Cutaneous Manifestations of Diabetes Mellitus By clinical.diabetesjournals.org Published On :: 2015-01-01 Michelle DuffJan 1, 2015; 33:40-48Practical Pointers Full Article
el Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics By clinical.diabetesjournals.org Published On :: 2016-04-01 Margaret A. PowersApr 1, 2016; 34:70-80Position Statements Full Article
el Gestational Diabetes Mellitus By clinical.diabetesjournals.org Published On :: 2005-01-01 Tracy L. SetjiJan 1, 2005; 23:17-24Feature Articles Full Article
el Diapression: An Integrated Model for Understanding the Experience of Individuals With Co-Occurring Diabetes and Depression By clinical.diabetesjournals.org Published On :: 2011-04-01 Paul CiechanowskiApr 1, 2011; 29:43-49Feature Articles Full Article
el Self-Monitoring of Blood Glucose: The Basics By clinical.diabetesjournals.org Published On :: 2002-01-01 Evan M. BenjaminJan 1, 2002; 20:Practical Pointers Full Article
el Building Therapeutic Relationships: Choosing Words That Put People First By clinical.diabetesjournals.org Published On :: 2017-01-01 Jane K. DickinsonJan 1, 2017; 35:51-54Commentary Full Article
el Engaging Patients in Education for Self-Management in an Accountable Care Environment By clinical.diabetesjournals.org Published On :: 2011-07-01 Christine A. BeebeJul 1, 2011; 29:123-126Practical Pointers Full Article
el Helping Patients Make and Sustain Healthy Changes: A Brief Introduction to Motivational Interviewing in Clinical Diabetes Care By clinical.diabetesjournals.org Published On :: 2008-10-01 Michele HeislerOct 1, 2008; 26:161-165Practical Pointers Full Article
el Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients By clinical.diabetesjournals.org Published On :: 2008-01-01 Daren AndersonJan 1, 2008; 26:22-27Bridges to Excellence Full Article
el Perspectives in Gestational Diabetes Mellitus: A Review of Screening, Diagnosis, and Treatment By clinical.diabetesjournals.org Published On :: 2007-04-01 Jennifer M. PerkinsApr 1, 2007; 25:57-62Feature Articles Full Article
el Empowerment and Self-Management of Diabetes By clinical.diabetesjournals.org Published On :: 2004-07-01 Martha M. FunnellJul 1, 2004; 22:123-127Feature Articles Full Article
el The Miniseries ‘Devs’ Delivers a Delicious Dose of Heroism and Villainy By blog.richmond.edu Published On :: Mon, 20 Apr 2020 13:06:15 +0000 By Scott T. Allison Devs is the ideal TV mini-series for people to sink their teeth into, for many reasons: (1) It’s both science and science-fiction; (2) it’s brilliant mix of psychology, philosophy, religion, and technology; (3) it tantalizes us with the mysteries of love, life, death, time, and space; and (4) it features a … Continue reading The Miniseries ‘Devs’ Delivers a Delicious Dose of Heroism and Villainy → Full Article Commentary and Analysis
el Squirrels and Stock Brokers, Or: Innovation Dilemmas, Robustness and Probability By decisions-and-info-gaps.blogspot.com Published On :: Sun, 09 Oct 2011 11:51:00 +0000 Decisions are made in order to achieve desirable outcomes. An innovation dilemma arises when a seemingly more attractive option is also more uncertain than other options. In this essay we explore the relation between the innovation dilemma and the robustness of a decision, and the relation between robustness and probability. A decision is robust to uncertainty if it achieves required outcomes despite adverse surprises. A robust decision may differ from the seemingly best option. Furthermore, robust decisions are not based on knowledge of probabilities, but can still be the most likely to succeed.Squirrels, Stock-Brokers and Their DilemmasDecision problems.Imagine a squirrel nibbling acorns under an oak tree. They're pretty good acorns, though a bit dry. The good ones have already been taken. Over in the distance is a large stand of fine oaks. The acorns there are probably better. But then, other squirrels can also see those trees, and predators can too. The squirrel doesn't need to get fat, but a critical caloric intake is necessary before moving on to other activities. How long should the squirrel forage at this patch before moving to the more promising patch, if at all?Imagine a hedge fund manager investing in South African diamonds, Australian Uranium, Norwegian Kroners and Singapore semi-conductors. The returns have been steady and good, but not very exciting. A new hi-tech start-up venture has just turned up. It looks promising, has solid backing, and could be very interesting. The manager doesn't need to earn boundless returns, but it is necessary to earn at least a tad more than the competition (who are also prowling around). How long should the manager hold the current portfolio before changing at least some of its components?These are decision problems, and like many other examples, they share three traits: critical needs must be met; the current situation may or may not be adequate; other alternatives look much better but are much more uncertain. To change, or not to change? What strategy to use in making a decision? What choice is the best bet? Betting is a surprising concept, as we have seen before; can we bet without knowing probabilities?Solution strategies.The decision is easy in either of two extreme situations, and their analysis will reveal general conclusions.One extreme is that the status quo is clearly insufficient. For the squirrel this means that these crinkled rotten acorns won't fill anybody's belly even if one nibbled here all day long. Survival requires trying the other patch regardless of the fact that there may be many other squirrels already there and predators just waiting to swoop down. Similarly, for the hedge fund manager, if other funds are making fantastic profits, then something has to change or the competition will attract all the business.The other extreme is that the status quo is just fine, thank you. For the squirrel, just a little more nibbling and these acorns will get us through the night, so why run over to unfamiliar oak trees? For the hedge fund manager, profits are better than those of any credible competitor, so uncertain change is not called for.From these two extremes we draw an important general conclusion: the right answer depends on what you need. To change, or not to change, depends on what is critical for survival. There is no universal answer, like, "Always try to improve" or "If it's working, don't fix it". This is a very general property of decisions under uncertainty, and we will call it preference reversal. The agent's preference between alternatives depends on what the agent needs in order to "survive".The decision strategy that we have described is attuned to the needs of the agent. The strategy attempts to satisfy the agent's critical requirements. If the status quo would reliably do that, then stay put; if not, then move. Following the work of Nobel Laureate Herbert Simon, we will call this a satisficing decision strategy: one which satisfies a critical requirement."Prediction is always difficult, especially of the future." - Robert Storm PetersenNow let's consider a different decision strategy that squirrels and hedge fund managers might be tempted to use. The agent has obtained information about the two alternatives by signals from the environment. (The squirrel sees grand verdant oaks in the distance, the fund manager hears of a new start up.) Given this information, a prediction can be made (though the squirrel may make this prediction based on instincts and without being aware of making it). Given the best available information, the agent predicts which alternative would yield the better outcome. Using this prediction, the decision strategy is to choose the alternative whose predicted outcome is best. We will call this decision strategy best-model optimization. Note that this decision strategy yields a single universal answer to the question facing the agent. This strategy uses the best information to find the choice that - if that information is correct - will yield the best outcome. Best-model optimization (usually) gives a single "best" decision, unlike the satisficing strategy that returns different answers depending on the agent's needs.There is an attractive logic - and even perhaps a moral imperative - to use the best information to make the best choice. One should always try to do one's best. But the catch in the argument for best-model optimization is that the best information may actually be grievously wrong. Those fine oak trees might be swarming with insects who've devoured the acorns. Best-model optimization ignores the agent's central dilemma: stay with the relatively well known but modest alternative, or go for the more promising but more uncertain alternative."Tsk, tsk, tsk" says our hedge fund manager. "My information already accounts for the uncertainty. I have used a probabilistic asset pricing model to predict the likelihood that my profits will beat the competition for each of the two alternatives."Probabilistic asset pricing models are good to have. And the squirrel similarly has evolved instincts that reflect likelihoods. But a best-probabilistic-model optimization is simply one type of best-model optimization, and is subject to the same vulnerability to error. The world is full of surprises. The probability functions that are used are quite likely wrong, especially in predicting the rare events that the manager is most concerned to avoid.Robustness and ProbabilityNow we come to the truly amazing part of the story. The satisficing strategy does not use any probabilistic information. Nonetheless, in many situations, the satisficing strategy is actually a better bet (or at least not a worse bet), probabilistically speaking, than any other strategy, including best-probabilistic-model optimization. We have no probabilistic information in these situations, but we can still maximize the probability of success (though we won't know the value of this maximum).When the satisficing decision strategy is the best bet, this is, in part, because it is more robust to uncertainty than another other strategy. A decision is robust to uncertainty if it achieves required outcomes even if adverse surprises occur. In many important situations (though not invariably), more robustness to uncertainty is equivalent to being more likely to succeed or survive. When this is true we say that robustness is a proxy for probability.A thorough analysis of the proxy property is rather technical. However, we can understand the gist of the idea by considering a simple special case.Let's continue with the squirrel and hedge fund examples. Suppose we are completely confident about the future value (in calories or dollars) of not making any change (staying put). In contrast, the future value of moving is apparently better though uncertain. If staying put would satisfy our critical requirement, then we are absolutely certain of survival if we do not change. Staying put is completely robust to surprises so the probability of success equals 1 if we stay put, regardless of what happens with the other option. Likewise, if staying put would not satisfy our critical requirement, then we are absolutely certain of failure if we do not change; the probability of success equals 0 if we stay, and moving cannot be worse. Regardless of what probability distribution describes future outcomes if we move, we can always choose the option whose likelihood of success is greater (or at least not worse). This is because staying put is either sure to succeed or sure to fail, and we know which.This argument can be extended to the more realistic case where the outcome of staying put is uncertain and the outcome of moving, while seemingly better than staying, is much more uncertain. The agent can know which option is more robust to uncertainty, without having to know probability distributions. This implies, in many situations, that the agent can choose the option that is a better bet for survival.Wrapping UpThe skillful decision maker not only knows a lot, but is also able to deal with conflicting information. We have discussed the innovation dilemma: When choosing between two alternatives, the seemingly better one is also more uncertain.Animals, people, organizations and societies have developed mechanisms for dealing with the innovation dilemma. The response hinges on tuning the decision to the agent's needs, and robustifying the choice against uncertainty. This choice may or may not coincide with the putative best choice. But what seems best depends on the available - though uncertain - information.The commendable tendency to do one's best - and to demand the same of others - can lead to putatively optimal decisions that may be more vulnerable to surprise than other decisions that would have been satisfactory. In contrast, the strategy of robustly satisfying critical needs can be a better bet for survival. Consider the design of critical infrastructure: flood protection, nuclear power, communication networks, and so on. The design of such systems is based on vast knowledge and understanding, but also confronts bewildering uncertainties and endless surprises. We must continue to improve our knowledge and understanding, while also improving our ability to manage the uncertainties resulting from the expanding horizon of our efforts. We must identify the critical goals and seek responses that are immune to surprise. Full Article betting innovation dilemma probability proxy property robustness
el The Language of Science and the Tower of Babel By decisions-and-info-gaps.blogspot.com Published On :: Mon, 31 Oct 2011 06:23:00 +0000 And God said: Behold one people with one language for them all ... and now nothing that they venture will be kept from them. ... [And] there God mixed up the language of all the land. (Genesis, 11:6-9)"Philosophy is written in this grand book the universe, which stands continually open to our gaze. But the book cannot be understood unless one first learns to comprehend the language and to read the alphabet in which it is composed. It is written in the language of mathematics." Galileo GalileiLanguage is power over the unknown. Mathematics is the language of science, and computation is the modern voice in which this language is spoken. Scientists and engineers explore the book of nature with computer simulations of swirling galaxies and colliding atoms, crashing cars and wind-swept buildings. The wonders of nature and the powers of technological innovation are displayed on computer screens, "continually open to our gaze." The language of science empowers us to dispel confusion and uncertainty, but only with great effort do we change the babble of sounds and symbols into useful, meaningful and reliable communication. How we do that depends on the type of uncertainty against which the language struggles.Mathematical equations encode our understanding of nature, and Galileo exhorts us to learn this code. One challenge here is that a single equation represents an infinity of situations. For instance, the equation describing a flowing liquid captures water gushing from a pipe, blood coursing in our veins, and a droplet splashing from a puddle. Gazing at the equation is not at all like gazing at the droplet. Understanding grows by exposure to pictures and examples. Computations provide numerical examples of equations that can be realized as pictures. Computations can simulate nature, allowing us to explore at our leisure.Two questions face the user of computations: Are we calculating the correct equations? Are we calculating the equations correctly? The first question expresses the scientist's ignorance - or at least uncertainty - about how the world works. The second question reflects the programmer's ignorance or uncertainty about the faithfulness of the computer program to the equations. Both questions deal with the fidelity between two entities. However, the entities involved are very different and the uncertainties are very different as well.The scientist's uncertainty is reduced by the ingenuity of the experimenter. Equations make predictions that can be tested by experiment. For instance, Galileo predicted that small and large balls will fall at the same rate, as he is reported to have tested from the tower of Pisa. Equations are rejected or modified when their predictions don't match the experimenter's observation. The scientist's uncertainty and ignorance are whittled away by testing equations against observation of the real world. Experiments may be extraordinarily subtle or difficult or costly because nature's unknown is so endlessly rich in possibilities. Nonetheless, observation of nature remorselessly cuts false equations from the body of scientific doctrine. God speaks through nature, as it were, and "the Eternal of Israel does not deceive or console." (1 Samuel, 15:29). When this observational cutting and chopping is (temporarily) halted, the remaining equations are said to be "validated" (but they remain on the chopping block for further testing).The programmer's life is, in one sense, more difficult than the experimenter's. Imagine a huge computer program containing millions of lines of code, the accumulated fruit of thousands of hours of effort by many people. How do we verify that this computation faithfully reflects the equations that have ostensibly been programmed? Of course they've been checked again and again for typos or logical faults or syntactic errors. Very clever methods are available for code verification. Nonetheless, programmers are only human, and some infidelity may slip through. What remorseless knife does the programmer have with which to verify that the equations are correctly calculated? Testing computation against observation does not allow us to distinguish between errors in the equations, errors in the program, and compensatory errors in both.The experimenter compares an equation's prediction against an observation of nature. Like the experimenter, the programmer compares the computation against something. However, for the programmer, the sharp knife of nature is not available. In special cases the programmer can compare against a known answer. More frequently the programmer must compare against other computations which have already been verified (by some earlier comparison). The verification of a computation - as distinct from the validation of an equation - can only use other high-level human-made results. The programmer's comparisons can only be traced back to other comparisons. It is true that the experimenter's tests are intermediated by human artifacts like calipers or cyclotrons. Nonetheless, bedrock for the experimenter is the "reality out there". The experimenter's tests can be traced back to observations of elementary real events. The programmer does not have that recourse. One might say that God speaks to the experimenter through nature, but the programmer has no such Voice upon which to rely.The tower built of old would have reached the heavens because of the power of language. That tower was never completed because God turned talk into babble and dispersed the people across the land. Scholars have argued whether the story prescribes a moral norm, or simply describes the way things are, but the power of language has never been disputed.The tower was never completed, just as science, it seems, has a long way to go. Genius, said Edison, is 1 percent inspiration and 99 percent perspiration. A good part of the sweat comes from getting the language right, whether mathematical equations or computer programs.Part of the challenge is finding order in nature's bubbling variety. Each equation captures a glimpse of that order, adding one block to the structure of science. Furthermore, equations must be validated, which is only a stop-gap. All blocks crumble eventually, and all equations are fallible and likely to be falsified.Another challenge in science and engineering is grasping the myriad implications that are distilled into an equation. An equation compresses and summarizes, while computer simulations go the other way, restoring detail and specificity. The fidelity of a simulation to the equation is usually verified by comparing against other simulations. This is like the dictionary paradox: using words to define words.It is by inventing and exploiting symbols that humans have constructed an orderly world out of the confusing tumult of experience. With symbols, like with blocks in the tower, the sky is the limit. Full Article
el I am a Believer By decisions-and-info-gaps.blogspot.com Published On :: Mon, 23 Apr 2012 05:11:00 +0000 There are many things that I don't know. About the past: how my great-great-grandfather supported his family, how Charlemagne consolidated his imperial power, or how Rabbi Akiva became a scholar. About the future: whether I'll get that contract, how much the climate will change in the next 100 years, or when the next war will erupt. About why things are as they are: why stones fall and water freezes, or why people love or hate or don't give a damn, or why we are, period.We reflect about questions like these, trying to answer them and to learn from them. For instance, we are interested in the relations between Charlemagne and his co-ruling brother Carloman. This can tell us about brothers, about emperors, and about power. We are interested in Akiva because he purportedly started studying at the age of 40, which tells us something about the indomitable human spirit.We sometimes get to the bottom of things and understand the whys and ways of our world. We see patterns and discover laws of nature, or at least we tell stories of how things happen. Stones fall because it's their nature to seek the center of the world (Aristotle), or due to gravitational attraction (Newton), or because of mass-induced space warp (Einstein). Human history has its patterns, driven by the will to power of heroic leaders, or by the unfolding of truth and justice, or by God's hand in history.We also think about thinking itself, as suggested by Rodin's Thinker. What is thinking (or what do we think it is)? Is thinking a physical process, like electrons whirling in our brain? Or does thinking involve something transcendental; maybe the soul whirling in the spheres? Each age has its answers.We sometimes get stuck, and can't figure things out or get to the bottom of things. Sometimes we even realize that there is no "bottom", that each answer brings its own questions. As John Wheeler said, "We live on an island of knowledge surrounded by a sea of ignorance. As our island of knowledge grows, so does the shore of our ignorance."Sometimes we get stuck in an even subtler way that is very puzzling, and even disturbing. Any rational chain of thought must have a starting point. Any rational justification of that starting point must have its own starting point. In other words, any attempt to rationally justify rational thought can never be completed. Rational thought cannot justify itself, which is almost the same as saying that rational thought is not justified. Any specific rational argument - Einstein's cosmology or Piaget's psychology - is justified based on its premises (and evidence, and many other things). But Rational Thought, as a method, as a way of life and a core of civilization, cannot ultimately and unequivocally justify itself.I believe that experience reflects reality, and that thought organizes experience to reveal the patterns of reality. The truth of this belief is, I believe, self evident and unavoidable. Just look around you. Flowers bloom anew each year. Planets swoop around with great regularity. We have learned enough about the world to change it, to control it, to benefit from it, even to greatly endanger our small planetary corner of it. I believe that rational thought is justified, but that's a belief, not a rational argument.Rational thought, in its many different forms, is not only justified; it is unavoidable. We can't resist it. Moses saw the flaming bush and was both frightened and curious because it was not consumed (Exodus 3:1-3). He was drawn towards it despite his fear. The Unknown draws us irresistibly on an endless search for order and understanding. The Unknown drives us to search for knowledge, and the search is not fruitless. This I believe. Full Article
el When Lead Generation Trumps Helping Customers | #FrictionHunter By feeds.feedblitz.com Published On :: Thu, 26 Dec 2019 17:54:40 +0000 Turning a chat request into a lead generation process adds friction and annoys customers. The post When Lead Generation Trumps Helping Customers | #FrictionHunter appeared first on Neuromarketing. Full Article Friction chat help chatbots conversion cro customer experience cx friction lead generation leadgen user experience ux
el New History of Psychiatry: Melancholy, Madness, Chinese Psychiatry, Psychedelic Therapy, and More By ahp.apps01.yorku.ca Published On :: Tue, 21 Apr 2020 12:59:00 +0000 The June 2020 issue of History of Psychiatry is now online. Full details follow below: “Wild melancholy. On the historical plausibility of a black bile theory of blood madness, or hæmatomania,” Jan Verplaetse. Abstract: Nineteenth-century art historian John Addington Symonds coined the term hæmatomania (blood madness) for the extremely bloodthirsty behaviour of a number of … Continue reading New History of Psychiatry: Melancholy, Madness, Chinese Psychiatry, Psychedelic Therapy, and More → Full Article General
el Forthcoming in JHBS: Quêtelet on Deviance, McClelland on Leadership, Psychological Warfare, and More By ahp.apps01.yorku.ca Published On :: Fri, 01 May 2020 14:43:00 +0000 A number of articles now in press at the Journal of the History of the Behavioral Sciences will be of interest to AHP readers. Full details below. “Uncovering the metaphysics of psychological warfare: The social science behind the Psychological Strategy Board’s operations planning, 1951–1953,” Gabrielle Kemmis. Abstract: In April 1951 president Harry S. Truman established … Continue reading Forthcoming in JHBS: Quêtelet on Deviance, McClelland on Leadership, Psychological Warfare, and More → Full Article General
el CfP: Shaping the ‘Socialist Self’? The Role of Psy-Sciences in Communist States of the Eastern Bloc (1948–1989) By ahp.apps01.yorku.ca Published On :: Wed, 06 May 2020 01:10:00 +0000 CALL FOR PAPERSINTERNATIONAL WORKSHOP Shaping the ‘Socialist Self’? The Role of Psy-Sciences in Communist States of the Eastern Bloc (1948–1989) Date: 6 November 2020 Venue: Prague, Czech Republic Deadline for applications: 30 June 2020 Organizing institutions: CEFRES (French Research Center in Humanities and Social Sciences in Prague) Institute of Contemporary History of the Czech Academy of Sciences Collegium Carolinum … Continue reading CfP: Shaping the ‘Socialist Self’? The Role of Psy-Sciences in Communist States of the Eastern Bloc (1948–1989) → Full Article General
el Forthcoming in HHS: Homosexual Aversion Therapy, Comte on Organism-Environment Relationships By ahp.apps01.yorku.ca Published On :: Fri, 08 May 2020 19:47:00 +0000 Two forthcoming pieces in History of the Human Sciences may be of interest to AHP readers. Full details below. “Cold War Pavlov: Homosexual aversion therapy in the 1960s,” by Kate Davison. Abstract: Homosexual aversion therapy enjoyed two brief but intense periods of clinical experimentation: between 1950 and 1962 in Czechoslovakia, and between 1962 and 1975 … Continue reading Forthcoming in HHS: Homosexual Aversion Therapy, Comte on Organism-Environment Relationships → Full Article General
el What Loneliness Does To Your Immune System (M) By www.spring.org.uk Published On :: Wed, 06 May 2020 15:30:08 +0000 Five natural ways to boost the immune system. → Support PsyBlog for just $5 per month. Enables access to articles marked (M) and removes ads. → Explore PsyBlog's ebooks, all written by Dr Jeremy Dean: Accept Yourself: How to feel a profound sense of warmth and self-compassion The Anxiety Plan: 42 Strategies For Worry, Phobias, OCD and Panic Spark: 17 Steps That Will Boost Your Motivation For Anything Activate: How To Find Joy Again By Changing What You Do Full Article Loneliness subscribers-only
el Can CBD Help Your Mental Health? By feedproxy.google.com Published On :: Wed, 12 Feb 2020 21:42:36 +0000 These days, there is huge hype around cannabidiol (also known as CBD), and for good reason. There are numerous health benefits that are linked to this non-psychoactive all-natural substance. Many people report that CBD has helped them to manage mental and emotional distress. But are those reports true? Can CBD help your mental health? In […] Full Article Abnormal Psychology Biopsychology CBD for anxiety CBD for depression CBD for mental health natural anxiety treatment natural depression treatment newsnow
el Intimacy vs Isolation: Why Do Some People Struggle to Form Intimate Relationships? By feedproxy.google.com Published On :: Wed, 29 Apr 2020 21:24:32 +0000 Loneliness is a surprisingly common phenomenon in the 21st century. In 2018, a survey conducted by The Economist and the Kaiser Family Foundation revealed that 22% of adults in the United States and 23% of adults in the United Kingdom often or always feel lonely or left out. Interestingly, many people who describe themselves as […] Full Article Developmental Psychology Love And Relationships Social Psychology intimacy versus isolation intimacy vs isolation newsnow relationship issues
el How Phone Counseling May Help Save Lives During the Covid-19 Lockdown By feedproxy.google.com Published On :: Thu, 30 Apr 2020 21:33:32 +0000 With the covid-19 pandemic now affecting virtually every country on earth, it is understandable that much of the world’s focus has been on protecting people’s physical health. Hand washing and social distancing is important in the fight against the coronavirus. However, it is important to remember that mental health issues may lead to loss of […] Full Article Abnormal Psychology Psychology News covid-19 newsnow over the phone therapy phone counseling
el Charles Barkley believes in the hot hand fallacy – when it comes to poker, anyway By nudges.org Published On :: Mon, 29 Aug 2011 22:43:33 +0000 NBA legend and recreational gambler Charles Barkley is presented with the following hypothetical on ESPN radio: You are winning big at the poker table when a beautiful woman sits down next to you. “Do you stay with the hands or do you leave?” Barkley: “Bro, gambling is so fickle, I love to gamble, when you [...] Full Article Blog posts hot hand fallacy
el Seeking Participants for a Study on How COVID-19 is Affecting Sex and Relationships By feedproxy.google.com Published On :: Wed, 25 Mar 2020 14:45:00 +0000 The COVID-19 coronavirus pandemic is causing a number of societal changes that are new to nearly all of us, with governments around the world locking down cities and countries in an attempt to slow the spread of the virus. This situation is pushing some people together, but pulling others apart—and we’ve never seen anything quite like it in the modern era. Countless media articles have been written about the ways in which this is affecting people’s sex lives and relationships; however, most of them are purely speculative. This led some of my colleagues at the Kinsey Institute and I to wonder what’s really happening—and we’ve designed a study to help us better understand how emergency situations like this affect people’s sexual and romantic lives, which may help us to better plan and prepare for similar events in the future. Full Article Professional Issues in Psychology
el The Paradox of Online Dating: Too Many Options Makes It Harder to Invest in a Relationship By feedproxy.google.com Published On :: Fri, 27 Mar 2020 14:00:00 +0000 In any relationship, you’re bound to discover that your partner has one or two (or maybe ten or twenty) quirks that eventually come to annoy you. In these situations, it's tempting to think that you might be happier with someone else—someone who doesn’t have the same set of peccadillos. However, according to behavioral economist Dr. Dan Ariely, this kind of thinking can set you up for a lifetime of disappointment. Full Article Videos
el How Do You Help a Partner Who is Depressed? Advice From a Sex Therapist By feedproxy.google.com Published On :: Wed, 08 Apr 2020 14:00:00 +0000 Depression is one of the most common mental health issues in the United States. In fact, according to the National Institutes of Mental Health, 1 in 14 Americans experienced an episode of major depression in the last year alone. Given the circumstances surrounding the current COVID-19 coronavirus pandemic, many in the mental health community predict that the number will be even higher this year because these circumstances are creating a “perfect storm” of depression risks. The widespread prevalence of depression has a lot of implications for our lives, even if we don’t personally have depression ourselves. Many of us will have loved ones, such as a romantic partner, who develops depression at some point. In these situations, it’s common for people to wonder how they can help their partner most effectively. So what should they do? Full Article Videos
el Why it's so hard to talk about the N-word | Elizabeth Stordeur Pryor By feedproxy.google.com Published On :: Thu, 12 Mar 2020 15:19:08 +0000 Historian Elizabeth Stordeur Pryor leads a thoughtful and history-backed examination of one of the most divisive words in the English language: the N-word. Drawing from personal experience, she explains how reflecting on our points of encounter with the word can help promote productive discussions and, ultimately, create a framework that reshapes education around the complicated history of racism in the US. Full Article Higher Education
el How we could change the planet's climate future | David Wallace-Wells By feedproxy.google.com Published On :: Fri, 13 Mar 2020 19:09:40 +0000 The climate crisis is too vast and complicated to solve with a silver bullet, says author David Wallace-Wells. What we need is a shift in how we live. Follow along as he lays out some of the dramatic actions we could take to build a livable, prosperous world in the age of global warming. Full Article Higher Education
el A fascinating time capsule of human feelings toward AI | Lucy Farey-Jones By feedproxy.google.com Published On :: Tue, 17 Mar 2020 14:59:28 +0000 How comfortable are you with robots taking over your life? Covering a wide range of potential applications -- from the mundane (robot house cleaner) to the mischievous (robot sex partner) to the downright macabre (uploading your brain to live on after death) -- technology strategist Lucy Farey-Jones shares data-backed evidence of how our willingness to accept AI may be radically changing. Full Article Higher Education
el A camera that can see around corners | David Lindell By feedproxy.google.com Published On :: Tue, 24 Mar 2020 15:14:45 +0000 To work safely, self-driving cars must avoid obstacles -- including those just out of sight. And for this to happen, we need technology that sees better than humans can, says electrical engineer David Lindell. Buckle up for a quick, groundbreaking tech demo as Lindell explains the significant and versatile potential of a high-speed camera that can detect objects hidden around corners. Full Article Higher Education
