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Reduction in Global Myocardial Glucose Metabolism in Subjects With 1-Hour Postload Hyperglycemia and Impaired Glucose Tolerance

By care.diabetesjournals.org
Published On :: 2020-02-20T11:55:30-08:00

OBJECTIVE

Impaired insulin-stimulated myocardial glucose uptake has occurred in patients with type 2 diabetes with or without coronary artery disease. Whether cardiac insulin resistance is present remains uncertain in subjects at risk for type 2 diabetes, such as individuals with impaired glucose tolerance (IGT) or those with normal glucose tolerance (NGT) and 1-h postload glucose ≥155 mg/dL during an oral glucose tolerance test (NGT 1-h high). This issue was examined in this study.

RESEARCH DESIGN AND METHODS

The myocardial metabolic rate of glucose (MRGlu) was measured by using dynamic 18F-fluorodeoxyglucose positron emission tomography combined with a euglycemic-hyperinsulinemic clamp in 30 volunteers without coronary artery disease. Three groups were studied: 1) those with 1-h postload glucose <155 mg/dL (NGT 1-h low) (n = 10), 2) those with NGT 1-h high (n = 10), 3) and those with IGT (n = 10).

 RESULTS

After adjusting for age, sex, and BMI, both subjects with NGT 1-h high (23.7 ± 6.4 mmol/min/100 mg; P = 0.024) and those with IGT (16.4 ± 6.0 mmol/min/100 mg; P < 0.0001) exhibited a significant reduction in global myocardial MRGlu; this value was 32.8 ± 9.7 mmol/min/100 mg in subjects with NGT 1-h low. Univariate correlations showed that MRGlu was positively correlated with insulin-stimulated whole-body glucose disposal (r = 0.441; P = 0.019) and negatively correlated with 1-h (r = –0.422; P = 0.025) and 2-h (r = –0.374; P = 0.05) postload glucose levels, but not with fasting glucose.

 CONCLUSIONS

This study shows that myocardial insulin resistance is an early defect that is already detectable in individuals with dysglycemic conditions associated with an increased risk of type 2 diabetes, such as IGT and NGT 1-h high.


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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.


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Risk Factors for First and Subsequent CVD Events in Type 1 Diabetes: The DCCT/EDIC Study

By care.diabetesjournals.org
Published On :: 2020-03-20T11:50:34-07:00

OBJECTIVE

The Diabetes Control and Complications Trial (DCCT) and its observational follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) demonstrated the dominant role of glycemia, second only to age, as a risk factor for a first cardiovascular event in type 1 diabetes (T1D). We now investigate the association between established risk factors and the total cardiovascular disease (CVD) burden, including subsequent (i.e., recurrent) events.

RESEARCH DESIGN AND METHODS

CVD events in the 1,441 DCCT/EDIC participants were analyzed separately by type (CVD death, acute myocardial infarction [MI], stroke, silent MI, angina, percutaneous transluminal coronary angioplasty/coronary artery bypass graft [PTCA/CABG], and congestive heart failure [CHF]) or as composite outcomes (CVD or major adverse cardiovascular events [MACE]). Proportional rate models and conditional models assessed associations between risk factors and CVD outcomes.

 RESULTS

Over a median follow-up of 29 years, 239 participants had 421 CVD events, and 120 individuals had 149 MACE. Age was the strongest risk factor for acute MI, silent MI, stroke, and PTCA/CABG, while glycemia was the strongest risk factor for CVD death, CHF, and angina, second strongest for acute MI and PTCA/CABG, third strongest for stroke, and not associated with silent MI. HbA1c was the strongest modifiable risk factor for a first CVD event (CVD: HR 1.38 [95% CI 1.21, 1.56] per 1% higher HbA1c; MACE: HR 1.54 [1.30, 1.82]) and also for subsequent CVD events (CVD: incidence ratio [IR] 1.28 [95% CI 1.09, 1.51]; MACE: IR 1.89 [1.36, 2.61]).

 CONCLUSIONS

Intensive glycemic management is recommended to lower the risk of initial CVD events in T1D. After a first event, optimal glycemic control may reduce the risk of recurrent CVD events and should be maintained.


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Declutter Your Inbox. Subscribe to Email Newsletters Straight Into Inoreader

By blog.inoreader.com
Published On :: Thu, 13 Feb 2020 08:07:31 +0000

You have mail! Inoreader now allows you to subscribe to Email Newsletters just as regular RSS feeds. By creating a…


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Inoreader mobile apps updated to support Automatic Night Mode, Microblogs, Sort by Magic and popularity indicators.

By blog.inoreader.com
Published On :: Thu, 20 Feb 2020 09:05:38 +0000

Hey, it’s been quite some time without updates on this front, but our latest updates to our Android and iOS…


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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…


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Get Your Friends Into RSS With Inoreader’s New Invite Feature

By blog.inoreader.com
Published On :: Thu, 19 Mar 2020 07:55:39 +0000

Have you ever tried to convince somebody to start using an RSS reader, only to hear back from them something…


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How we made our Free COVID-19 Alerting System and how you can build your own for any topic

By blog.inoreader.com
Published On :: Mon, 23 Mar 2020 12:32:04 +0000

Ever since we launched our Free COVID-19 Alerting System, we’ve been continuously asked how we made it. In this blog…


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Convert Almost Any Webpage Into RSS Feed With Inoreader’s Web Feeds

By blog.inoreader.com
Published On :: Wed, 08 Apr 2020 05:59:26 +0000

So, you wanted to follow this nice website for new content, but it doesn’t have an RSS feed yet? Don’t…


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Autologous Umbilical Cord Blood Transfusion in Young Children With Type 1 Diabetes Fails to Preserve C-Peptide

By care.diabetesjournals.org
Published On :: 2011-11-21T22:32:39-08:00

OBJECTIVE

We conducted an open-label, phase I study using autologous umbilical cord blood (UCB) infusion to ameliorate type 1 diabetes (T1D). Having previously reported on the first 15 patients reaching 1 year of follow-up, herein we report on the complete cohort after 2 years of follow-up.

RESEARCH DESIGN AND METHODS

A total of 24 T1D patients (median age 5.1 years) received a single intravenous infusion of autologous UCB cells and underwent metabolic and immunologic assessments.

 RESULTS

No infusion-related adverse events were observed. β-Cell function declined after UCB infusion. Area under the curve C-peptide was 24.3% of baseline 1 year postinfusion (P < 0.001) and 2% of baseline 2 years after infusion (P < 0.001). Flow cytometry revealed increased regulatory T cells (Tregs) (P = 0.04) and naive Tregs (P = 0.001) 6 and 9 months after infusion, respectively.

 CONCLUSIONS

Autologous UCB infusion in children with T1D is safe and induces changes in Treg frequency but fails to preserve C-peptide.


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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.


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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.


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Legal Migration Pathways to Europe for Low- and Middle-Skilled Migrants

By www.migrationpolicy.org
Published On :: Thu, 24 Oct 2019 11:17:54 -0400

This event hosted by MPI Europe and the Research Unit of the Expert Council of German Foundations on Integration and Migration featured a discussion on research into legal migration pathways for work and training for low- and middle-skilled migrants.


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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.


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Respuestas latinoamericanas a las crisis migratorias venezolanas y nicaragüenses

By www.migrationpolicy.org
Published On :: Mon, 04 Nov 2019 08:58:25 -0500

Responsables de políticos principales y partes interesadas de América Latina, así como representantes de instituciones internacionales claves, ofrecen sus puntos de vista sobre los desafíos futuros mientras gobiernos latinoamericanos buscan establecer las estrategias para responder a flujos migratorios forzados a gran escala, como los de Venezuela y Nicaragua.


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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. 


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An Uneven Landscape: The Differing State Approaches to English Learner Policies under ESSA

By www.migrationpolicy.org
Published On :: Wed, 19 Feb 2020 10:14:45 -0500

Experts share how states have approached Every Student Succeeds Act (ESSA) implementation, areas where the law and state efforts to support English Learners can be improved, and findings from the compendium, The Patchy Landscape of State English Learner Policies under ESSA. 


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The Nutritional Health of Young Refugee Children Resettling in Washington State

By www.migrationpolicy.org
Published On :: Tue, 01 Nov 2016 12:08:38 -0400

Refugee children are vulnerable to health and nutrition risks that can have long-term consequences for their development and well-being. This report examines the prevalence of malnutrition—from stunting and wasting to overweight and obesity—among refugee children from birth to age 10, using data from an overseas medical screening exam before they were resettled in Washington State between 2012 and 2014.


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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.


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Leveraging the Potential of Home Visiting Programs to Serve Immigrant and Dual Language Learner Families

By www.migrationpolicy.org
Published On :: Thu, 22 Aug 2019 10:48:18 -0400

Home visiting programs for young families are growing in popularity across the United States, and have demonstrated their effectiveness in supporting maternal health and child well-being. At the same time, more infants and toddlers are growing up in immigrant families and households where a language other than English is spoken. Why then are these children under-represented in these programs? This brief explores common barriers, ways to address them, and why it is important to do so.


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Barriers to COVID-19 Testing and Treatment: Immigrants without Health Coverage in the United States

By www.migrationpolicy.org
Published On :: Tue, 05 May 2020 15:58:10 -0400

As millions of U.S. workers lose jobs and the health insurance associated with them, Medicaid and similar programs are increasingly important for people seeking COVID-19 testing and treatment. Yet many low-income uninsured noncitizens, including green-card holders, are excluded from such programs because of their immigration status, as this fact sheet explores.


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Thinking with AND: Insights from KIND’s story

By brandleadership.wordpress.com
Published On :: Fri, 24 Jun 2016 16:29:46 +0000

“I’m a confused Mexican Jew.” So says Daniel Lubetzky, Founder and CEO of KIND Snack, in his very personal interview with Columbia faculty member David Rogers at BRITE ’16. Their discussion touched on the many ideas behind KIND Snacks, from the beginnings of the company, to the strategic thinking that forces Lubetzky to stay away […]


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Medical Nutrition Therapy: A Key to Diabetes Management and Prevention

By clinical.diabetesjournals.org
Published On :: 2010-12-01

Sara F. Morris
Dec 1, 2010; 28:12-18
Feature Articles


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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. Powers
Apr 1, 2016; 34:70-80
Position Statements


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SGLT-2 Inhibitors: A New Mechanism for Glycemic Control

By clinical.diabetesjournals.org
Published On :: 2014-01-01

Edward C. Chao
Jan 1, 2014; 32:4-11
Feature Articles


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Self-Monitoring of Blood Glucose: The Basics

By clinical.diabetesjournals.org
Published On :: 2002-01-01

Evan M. Benjamin
Jan 1, 2002; 20:
Practical Pointers


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Persistence of Continuous Glucose Monitoring Use in a Community Setting 1 Year After Purchase

By clinical.diabetesjournals.org
Published On :: 2013-07-01

James Chamberlain
Jul 1, 2013; 31:106-109
Feature Articles


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Application of Adult-Learning Principles to Patient Instructions: A Usability Study for an Exenatide Once-Weekly Injection Device

By clinical.diabetesjournals.org
Published On :: 2010-09-01

Gayle Lorenzi
Sep 1, 2010; 28:157-162
Bridges to Excellence


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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 Heisler
Oct 1, 2008; 26:161-165
Practical Pointers


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Amylin Replacement With Pramlintide in Type 1 and Type 2 Diabetes: A Physiological Approach to Overcome Barriers With Insulin Therapy

By clinical.diabetesjournals.org
Published On :: 2002-07-01

John B. Buse
Jul 1, 2002; 20:
Feature Articles


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What's So Tough About Taking Insulin? Addressing the Problem of Psychological Insulin Resistance in Type 2 Diabetes

By clinical.diabetesjournals.org
Published On :: 2004-07-01

William H. Polonsky
Jul 1, 2004; 22:147-150
Practical Pointers


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A Real-World Approach to Insulin Therapy in Primary Care Practice

By clinical.diabetesjournals.org
Published On :: 2005-04-01

Irl B. Hirsch
Apr 1, 2005; 23:78-86
Practical Pointers


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Heroic Consciousness: What it is and How to Acquire it

By blog.richmond.edu
Published On :: Thu, 23 Jan 2020 13:03:26 +0000

By Scott T. Allison This blog post is excerpted from: Allison, S. T. (2019). Heroic consciousness. Heroism Science, 4, 1-43.   The philosopher Yuval Noah Harari (2018) recently described consciousness as “the greatest mystery in the universe”. What exactly is heroic consciousness? It is a way of seeing the world, perceiving reality, and making decisions … Continue reading Heroic Consciousness: What it is and How to Acquire it →


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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 Dilemmas




Decision 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 Petersen

Now 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 Probability

Now 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 Up

The 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. 


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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 Galilei

Language 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.


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Can We Replay History?

By decisions-and-info-gaps.blogspot.com
Published On :: Thu, 10 Nov 2011 07:15:00 +0000


After the kids' party games and the birthday cake came the action-packed Steve McQueen movie. My friend's parents had rented a movie projector. They hooked up the reel and let it roll. But the high point came later when they ran the movie backwards. Bullets streamed back into guns, blows were retracted and fallen protagonists recoiled into action. The mechanism that pulls the celluloid film forward for normal showing, can pull the film in the reverse direction, rolling it back onto the feeder reel and showing the movie in reverse.

If you chuck a round pebble off a cliff it will fall in a graceful parabolic arch, gradually increasing its speed until it hits the ground. The same pebble, if shot from the point of impact, at the terminating angle and speed, will gracefully and obligingly retrace its path. (I'm ignoring wind and air friction that make things a bit more complicated.)

Deterministic mechanisms, like the movie reel mechanism or the law of gravity, are reversible.

History is different. Peoples' behavior is influenced by what they know. You pack an umbrella on a trip to the UK. Google develops search algorithms not search parties because their knowledge base is information technology not mountain trekking. Knowledge is powerful because it enables rational behavior: matching actions to goals. Knowledge transforms futile fumbling into intelligent behavior.

Knowledge underlies intelligent behavior, but knowledge is continually expanding. We discover new facts and relationships. We discover that things have changed. Therefore tomorrow's knowledge-based behavior will, to some extent, be unpredictable today because tomorrow's discoveries cannot be known today. Human behavior has an inherent element of indeterminism. Intelligent learning behavior cannot be completely predicted.

Personal and collective history does not unfold like a pre-woven rug. Human history is fundamentally different from the trajectory of a pebble tossed from a cliff. History is the process of uncovering the unknown and responding to this new knowledge. The existence of the unknown creates the possibility of free will. The discovery of new knowledge introduces indeterminism and irreversibility into history, as explained by the philosophers G.L.S. Shackle and Karl Popper.

Nonetheless history is not erratic because each increment of new knowledge adds to the store of what was learned before. Memory is not perfect, either of individuals or groups, but it is powerful. History happens in historical context. For instance, one cannot understand the recent revolutions and upheavals in the Arab world from the perspective of 18th century European revolutions; the historical backgrounds are too different, and the outcomes in the Middle East will be different as well. Innovation, even revolution, is spurred by new knowledge laid over the old. A female municipal official slapped a Tunisian street vendor, Mohamed Bouazizi. That slap crystalized Mr Bouazizi's knowledge of his helpless social impotence and lit the match with which he immolated himself and initiated conflagrations around the Mideast. New knowledge acts like thruster engines on the inertial body of memory. What is emerging in the Mideast is Middle Eastern, not European. What is emerging is the result of new knowledge: of the power of networking, of the mortality of dictators, of the limits of coercion, of the power of new knowledge itself and the possibilities embedded in tomorrow's unknowns.

Mistakes are made, even with the best intentions and the best possible knowledge. Even if analysts knew and understood all the actions of all actors on the stage of history, they still cannot know what those people will learn tomorrow and how that new knowledge will alter their behavior. Mistakes are made because history does not unwind like a celluloid reel.

That's not to say that analysts are never ignorant, negligent, stupid or malicious. It's to say that all actions are, in a sense, mistakes. Or, the biggest mistake of all is to think that we can know the full import of our actions. We cannot, because actions are tossed, like pebbles, into the dark pit of unknown possible futures. One cannot know all possible echoes, or whether some echo might be glass-shatteringly cataclysmic.

Mistakes can sometimes be corrected, but never undone. History cannot be run backwards, and you never get a second chance. Conversely, every instant is a new opportunity because the future is always uncertain. Uncertainty is the freedom to err, and the opportunity to create and discover. 


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Mind or Stomach? Imagination or Necessity?

By decisions-and-info-gaps.blogspot.com
Published On :: Wed, 04 Jan 2012 06:12:00 +0000

"An army marches on its stomach" said Napoleon, who is also credited with saying "Imagination rules the world". Is history driven by raw necessity and elementary needs? Or is history hewn by people from their imagination, dreams and ideas?

The answer is simple: 'Both'. The challenge is to untangle imagination from necessity. Consider these examples:

An ancient Jewish saying is "Without flour, there is no Torah. Without Torah there is no flour." (Avot 3:17) Scholars don't eat much, but they do need to eat. And if you feed them, they produce wonders.

Give a typewriter to a monkey and he might eventually tap out Shakespeare's sonnets, but it's not very likely. Give that monkey an inventive mind and he will produce poetry, a vaccine against polio, and the atom bomb. Why the bomb? He needed it.

Necessity is the mother of invention, they say, but it's actually a two-way street. For instance, human inventiveness includes dreams of cosmic domination, leading to war. Hence the need for that bomb. Satisfying a need, like the need for flour, induces inventiveness. And this inventiveness, like the discovery of genetically modified organisms, creates new needs. Necessity induces inventiveness, and inventiveness creates new dangers, challenges and needs. This cycle is endless because the realm of imagination is boundless, far greater than prosaic reality, as we discussed elsewhere.

Imagination and necessity are intertwined, but still are quite different. Necessity focusses primarily on what we know, while imagination focusses on the unknown.

We know from experience that we need food, shelter, warmth, love, and so on. These requirements force themselves on our awareness. Even the need for protection against surprise is known, though the surprise is not.

Imagination operates in the realm of the unknown. We seek the new, the interesting, or the frightful. Imagination feeds our fears of the unknown and nurtures our hopes for the unimaginable. We explore the bounds of the possible and try breaking through to the impossible.

Mind or stomach? Imagination or necessity? Every 'known' has an 'unknown' lurking behind it, and every 'unknown' may some day be discovered or dreamed into existence. Every mind has a stomach, and a stomach with no mind is not human.


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We're Just Getting Started: A Glimpse at the History of Uncertainty

By decisions-and-info-gaps.blogspot.com
Published On :: Thu, 22 Mar 2012 19:12:00 +0000


We've had our cerebral cortex for several tens of thousands of years. We've lived in more or less sedentary settlements and produced excess food for 7 or 8 thousand years. We've written down our thoughts for roughly 5 thousand years. And Science? The ancient Greeks had some, but science and its systematic application are overwhelmingly a European invention of the past 500 years. We can be proud of our accomplishments (quantum theory, polio vaccine, powered machines), and we should worry about our destructive capabilities (atomic, biological and chemical weapons). But it is quite plausible, as Koestler suggests, that we've only just begun to discover our cerebral capabilities. It is more than just plausible that the mysteries of the universe are still largely hidden from us. As evidence, consider the fact that the main theories of physics - general relativity, quantum mechanics, statistical mechanics, thermodynamics - are still not unified. And it goes without say that the consilient unity of science is still far from us.

What holds for science in general, holds also for the study of uncertainty. The ancient Greeks invented the axiomatic method and used it in the study of mathematics. Some medieval thinkers explored the mathematics of uncertainty, but it wasn't until around 1600 that serious thought was directed to the systematic study of uncertainty, and statistics as a separate and mature discipline emerged only in the 19th century. The 20th century saw a florescence of uncertainty models. Lukaczewicz discovered 3-valued logic in 1917, and in 1965 Zadeh introduced his work on fuzzy logic. In between, Wald formulated a modern version of min-max in 1945. A plethora of other theories, including P-boxes, lower previsions, Dempster-Shafer theory, generalized information theory and info-gap theory all suggest that the study of uncertainty will continue to grow and diversify.

In short, we have learned many facts and begun to understand our world and its uncertainties, but the disputes and open questions are still rampant and the yet-unformulated questions are endless. This means that innovations, discoveries, inventions, surprises, errors, and misunderstandings are to be expected in the study or management of uncertainty. We are just getting started. 


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Habit: A Response to the Unknown

By decisions-and-info-gaps.blogspot.com
Published On :: Sat, 10 Nov 2012 15:06:00 +0000


David Hume explained that we believe by habit that logs will burn, stones will fall, and endless other past patterns will recur. No experiment can prove the future recurrence of past events. An experiment belongs to the future only until it is implemented; once completed, it becomes part of the past. In order for past experiments to prove something about the future, we must assume that the past will recur in the future. That's as circular as it gets.

But without the habit of believing that past patterns will recur, we would be incapacitated and ineffectual (and probably reduced to moping and sobbing). Who would dare climb stairs or fly planes or eat bread and drink wine, without the belief that, like in the past, the stairs will bear our weight, the wings will carry us aloft, and the bread and wine will nourish our body and soul. Without such habits we would become a jittering jelly of indecision in the face of the unknown.

But you can't just pull a habit out of a hat. We spend great effort instilling good habits in our children: to brush their teeth, tell the truth, and not pick on their little sister even if she deserves it.

As we get older, and I mean really older, we begin to worry that our habits become frozen, stodgy, closed-minded and constraining. Younger folks smile at our rigid ways, and try to loosen us up to the new wonders of the world: technological, culinary or musical. Changing your habits, or staying young when you aren't, isn't always easy. Without habits we're lost in an unknowable world.

And yet, openness to new ideas, tastes, sounds and other experiences of many sorts can itself be a habit, and perhaps a good one. It is the habit of testing the unknown, of acknowledging the great gap between what we do know and what we can know. That gap is an invitation to growth and awe, as well as to fear and danger.

The habit of openness to change is not a contradiction. It is simply a recognition that habits are a response to the unknown. Not everything changes all the time (or so we're in the habit of thinking), and some things are new under the sun (as newspapers and Nobel prize committees periodically remind us).

Habits, including the habit of open-mindedness, are a good thing precisely because we can never know for sure how good or bad they really are.


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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 →


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History of Spanish Psychology, 1800–2000

By ahp.apps01.yorku.ca
Published On :: Thu, 30 Apr 2020 14:11:00 +0000

AHP readers may be interested in a recent piece on “History of Spanish Psychology, 1800–2000” in the Oxford Research Encyclopedia of Psychology. Full details below. “History of Spanish Psychology, 1800–2000,” by Javier Bandrés. Abstract: In the history of Spanish psychology in the 19th century, three stages can be distinguished. An eclectic first stage was defined … Continue reading History of Spanish Psychology, 1800–2000 →


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May HoP, including a Special Section: Who Was Little Albert? The Historical Controversy

By ahp.apps01.yorku.ca
Published On :: Fri, 08 May 2020 19:25:00 +0000

Photographs of John Watson (left) and Rosalie Rayner (right) via Ben Harris. The May 2020 issue of History of Psychology is now online. The issue includes a special section on “Who Was Little Albert? The Historical Controversy.” Full details follow below. Special Section: Who Was Little Albert? The Historical Controversy“Journals, referees, and gatekeepers in the … Continue reading May HoP, including a Special Section: Who Was Little Albert? The Historical Controversy →


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This Essential Mineral Linked To COVID-19 Recovery

By www.spring.org.uk
Published On :: Tue, 05 May 2020 15:00:39 +0000

An essential mineral in the body have been linked to recovery of COVID-19 patients.

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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.

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How to Mentally Prepare for a Synchro Swimming Competition

By feedproxy.google.com
Published On :: Fri, 21 Feb 2020 03:23:42 +0000

Some people have the misguided belief that synchronized swimming is just an easy sport performed in beautiful swim team suits. That it’s merely dancing in the water that you can tune in to watch during the Olympic Games. But that is far from true; there is much more to the sport.  Synchro is a dominant […]


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Online Therapy: A Powerful Tool in the Fight Against Covid 19

By feedproxy.google.com
Published On :: Sat, 28 Mar 2020 13:19:21 +0000

The coronavirus pandemic is affecting billions of people around the world today. Coronavirus, now called covid 19, is a type of virus that is usually found in animals and is rarely transmitted to humans. According to reports from the World Health Organization, covid 19 likely originated from a seafood and meat market in Wuhan, China, […]


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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 […]


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