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American College of Emergency Physicians endorses ADA's antibiotics guideline

The American College of Emergency Physicians has endorsed the American Dental Association's clinical practice guideline on the use of antibiotics for the management of pulpal- and periapical-related pain and swelling.




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ADA task force assembles interim guidance toolkit for dentists returning to work

The ADA's Advisory Task Force on Dental Practice Recovery has developed a toolkit to help dentists return to more normal practice operations while taking precautions to protect staff, patients and themselves from COVID-19 as some states reopen.




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Two new dental benefit guides address common hurdles anticipated when reopening practices

In the face of economic challenges, the ADA has released two online guides relating to third-party payment programs available at ADA.org/virus that are intended to help smooth the path of reopening practices: Handling Contract Negotiations and Handling Eligibility Verification




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ADA urges CDC to update guidance for dental personnel

The American Dental Association is urging the Centers for Disease Control and Prevention to “quickly provide guidance” on how to safely reopen dental practices during the deceleration phase of the COVID-19 outbreak.




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ADA tip sheet includes CDC guidance on identifying counterfeit N95 masks

The American Dental Association has created a tip sheet with guidance from the National Institute for Occupational Safety and Health group at the Centers for Disease Control and Prevention to help health care professionals avoid buying or using counterfeit N95 respirators, which are often simply referred to as masks.




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Suicide risk high in first year after brain cancer diagnosis

People with brain cancer are at increased risk for suicide compared to the general population, particularly within the first year following diagnosis, a new analysis has found.




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2017 American Academy of Pediatrics Clinical Practice Guideline: Impact on Prevalence of Arterial Hypertension in Children and Adolescents With Type 1 Diabetes

OBJECTIVE

In 2017, the American Academy of Pediatrics introduced a new guideline (2017 Clinical Practice Guideline of the American Academy of Pediatrics [AAP 2017]) to diagnose arterial hypertension (HTN) in children that included revised, lower normative blood pressure (BP) values and cut points for diagnosing high BP in adolescents. We studied the impact of the new AAP 2017 guideline on prevalence of HTN in children with type 1 diabetes mellitus (T1DM).

RESEARCH DESIGN AND METHODS

Up to September 2018, 1.4 million office BP measurements in 79,849 children and adolescents (aged 5–20 years) with T1DM have been documented in the DPV (Diabetes Prospective Follow-up) registry. BP values of the most recent year were aggregated, and BP values of 74,677 patients without antihypertensive medication were analyzed (median age 16 years and diabetes duration 5.3 years and 52.8% boys). BP values were classified according to AAP 2017 and the references of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (2011) and the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (fourth report) (2004).

RESULTS

Of the patients, 44.1%, 29.5%, and 26.5% were hypertensive according to AAP 2017, KiGGS, and fourth report, respectively. Differences in prevalence of HTN were strongly age dependent: <10 years, AAP 2017 31.4%, KiGGS 30.7%, fourth report 19.6%; 10 to <15 years, AAP 2017 30.9%, KiGGS 31.2%, fourth report 22.4%; and ≥15 years, AAP 2017 53.2%, KiGGS 28.4%, fourth report 30.0%. Among teenagers ≥15 years, 59.1% of boys but only 46.3% of girls were classified as hypertensive by AAP 2017 but only 21.1%/26% of boys and 36.7%/34.4% of girls by KiGGS/fourth report, respectively.

CONCLUSIONS

Classification of BP as hypertension depends strongly on the normative data used. Use of AAP 2017 results in a significant increase in HTN in teenagers ≥15 years with T1DM, particularly in boys. AAP 2017 enhances the awareness of elevated BP in children, particularly in patients with increased risk for cardiovascular disease.




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Clinical and Public Health Implications of 2019 Endocrine Society Guidelines for Diagnosis of Diabetes in Older Adults

OBJECTIVE

Screening for diabetes is typically done using hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG). The 2019 Endocrine Society guidelines recommend further testing using an oral glucose tolerance test (OGTT) in older adults with prediabetic HbA1c or FPG. We evaluated the impact of this recommendation on diabetes prevalence, eligibility for glucose-lowering treatment, and estimated cost of implementation in a nationally representative sample.

RESEARCH DESIGN AND METHODS

We included 2,236 adults aged ≥65 years without known diabetes from the 2005–2016 National Health and Nutrition Examination Survey. Diabetes was defined using: 1) the Endocrine Society approach (HbA1c ≥6.5%, FPG ≥126 mg/dL, or 2-h plasma glucose ≥200 mg/dL among those with HbA1c 5.7–6.4% or FPG 100–125 mg/dL); and 2) a standard approach (HbA1c ≥6.5% or FPG ≥126 mg/dL). Treatment eligibility was defined using HbA1c cut points (≥7 to ≥9%). OGTT screening costs were estimated using Medicare fee schedules.

RESULTS

Diabetes prevalence was 15.7% (~5.0 million) using the Endocrine Society’s approach and 7.3% (~2.3 million) using the standard approach. Treatment eligibility ranged from 5.4 to 0.06% and 11.8–1.3% for diabetes cases identified through the Endocrine Society or standard approach, respectively. By definition, diabetes identified exclusively through the Endocrine Society approach had HbA11c <6.5% and would not be recommended for glucose-lowering treatment. Screening all older adults with prediabetic HbA1c/FPG (~18.3 million) with OGTT could cost between $737 million and $1.7 billion.

CONCLUSIONS

Adopting the 2019 Endocrine Society guidelines would substantially increase the number of older adults classified as having diabetes, require significant financial resources, but likely offer limited benefits.




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UPI News Quiz: Asian baseball, Grimes' baby, scary insects

Asian baseball, Grimes' baby, scary invasive insects -- how well did you follow the news this week? Take the UPI News Quiz for May 8, 2020.




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IRCA in Retrospect: Guideposts for Today’s Immigration Reform

This policy brief traces the successes and failures of the 1986 Immigration Reform and Control Act, which represented the first and most comprehensive legislation to take on the issue of illegal immigration to the United States. The brief makes the case that IRCA's major flaws were rooted in statutory design more than regulatory challenges and implementation by the administrative agencies.




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Leadership Visions: A Discussion with Mexican Foreign Minister Claudia Ruiz-Massieu

An MPI Leadership Visions discussion with the Foreign Minister of Mexico, Claudia Ruiz-Massieu, for her first public appearance in Washington, DC. 




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Rethinking U.S. Immigration Policy: Building a Responsive, Effective Immigration System

This event marks the launch of a major new initiative—Rethinking U.S. Immigration Policy—that aims to generate a big-picture, evidence-driven vision of the role immigration can and should play in America’s future in order to leverage a comparative advantage for the nation.




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Help with a Quick Survey

Hi, this is Dan Ariely, I am trying to understand how people think about the coronavirus. From time to time, I will add surveys here. If you have five minutes, please answer the survey below as truthfully as you can. We don’t...




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[ Cell Phones & Plans ] Open Question : What is the closest android equivalent to the 1st generation iPhone SE?

I am torn, I know it is time to upgrade my phone, but I don't know whether to upgrade to just accept the larger phone size and go with the 2nd gen SE or go with an android. I'd be interested to know what the closest equivalent android device there is to the 1st gen SE. I am open to a bigger screen size, but not a bigger phone. So, if there was an andriod that was all screen on the front, but was similar size to the original SE, I would be open to that.




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[ Politics ] Open Question : Is it true many British and American banks and companies(Bank of England,UIC,Prescott Bush,etc) gave money and goods to Hitler secretly?




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In Search of a New Equilibrium: Immigration Policymaking in the Newest Era of Nativist Populism

In many recent European and U.S. elections, candidates touting nativist populist and anti-immigrant platforms have enjoyed rising support. As populism moves from the fringes into the mainstream, this report takes stock of the economic and social forces driving its rise, the diverse ways populists are influencing immigration policymaking, and what it will take to build a new center around immigration and integration issues.




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Equipping Immigrant Selection Systems for a Changing World of Work (Transatlantic Council Statement)

As technological developments—from automation to artificial intelligence and machine learning—reshape the world of work, governments face the challenge of updating how they attract, select, and retain economic-stream immigrants. This report, concluding a series on building migration systems for a new age of economic competitiveness, lays out the key considerations for "future-proofing" immigrant selection systems.




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The Multicultural Dilemma: Amid Rising Diversity and Unsettled Equity Issues, New Zealand Seeks to Address Its Past and Present

New Zealand drew global attention for its unity and support for the Muslim community targeted during the horrific Christchurch attacks. Yet the country's road to inclusion has been far from straightforward, and amid rising diversity it is grappling with the best way to achieve inclusion for its multiethnic population, including indigenous Māori peoples and migrants. This article outlines the opportunities and challenges to fostering multiculturalism against a backdrop of bicultural policies.




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One Thing We Can't Build Alone in Iraq

When Columbia University sociologist Peter Bearman dived into the world of the white-gloved workers who open the front doors of expensive New York apartment buildings, he found that most people who applied for jobs as doormen never got one. Most doormen, however, had not applied for their jobs.




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Packing Protection or Packing Suicide Risk?

Seventeen years ago, a couple of criminologists at the University of Maryland published an interesting paper about the 1976 District ban on handguns -- a ban that was recently overturned by the Supreme Court on the grounds it was inimical to the constitutional right of Americans to bear arms to p...




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In Face of Tragedy, 'Whodunit' Question Often Guides Moral Reasoning

When nearly 200 people in India were killed in terrorist attacks late last month, the carnage received saturation media coverage around the globe. When nearly 600 people in Zimbabwe died in a cholera outbreak a week ago, the international response was far more muted.




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Building an Evidence Base to Support Refugee Resettlement

Marking the release of an MPI Europe report commissioned as part of the EU-FRANK project, this webinar examines critical gaps in the research and evaluation of refugee resettlement programs and recommendations for improving evidence gathering and knowledge sharing between resettlement countries. 




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Beyond Transactional Deals: Building Lasting Migration Partnerships in the Mediterranean

Since the 2015–16 refugee crisis, European policymakers have eagerly sought cooperation with origin and transit countries in the hopes of stemming unauthorized migration to Europe. This approach is neither new, nor without its limitations. By examining the evolution of two longstanding Mediterranean partnerships—between Spain and Morocco, and Italy and Tunisia—this report offers insights on what has and has not worked.




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Elementary Guide to Literary Criticism, by Franklin Newton Painter

“As a rule,” urges Franklin Newton Painter in his critically acclaimed classic, Elementary Guide to Literary Criticism,  “we should read only books of recognized excellence, and read them with sympathetic intelligence. Trashy books, whatever pleasure they may give, add but little to knowledge or culture; and immoral books often leave an ineradicable stain upon the soul.”

The ideas of “recognized excellence,” “sympathetic intelligence” and “ineradicable stain upon the soul” make one wonder about the criteria by which Painter determines and advocates such notions. Although the criteria for evaluating literature are as old as Homer, they have undergone massive expansion in the 20th century. Besides, in view of new trends in literary theory and criticism, it is also worth pausing for a moment to reconsider the meaning of "theory" itself. According to the Norton Anthology of Theory and Criticism, today the term "theory" entails a mode of questioning and analysis that goes beyond the earlier criteria of "literariness" of literature.  To an earlier generation, it seems that theory is more of an advocacy rather than a disinterested, objective inquiry into poetics of literature. Because of the effects new social movements, especially the women's and civil rights movements, theory now entails skepticism towards previously taken for granted systems, institutions, and norms. Now theory shows a readiness to take critical stands and to engage in resistance, an interest in blind spots, contradictions, and distortions,  and a habit of linking local and personal practices to the larger economic, political, historical, and ethical forces of culture. How and why did that happen in the world of literature?

Please join us at Brooklyn Book Talk, as we compare Painter’s classical criteria from the beginnings of the 20th century to newer perspectives such as formalism, Marxism,  psychoanalysis, structuralism, post-structuralism, reader-response , feminism, deconstruction, queer theory, cultural studies, new historicism, post-colonial, race, and ethnicity studies, etcetera.

The electronic version of Painter's Elementary Guide to Literary Criticism is in the public domain and can be accessed from Project Gutenberg online at:

 




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Recent Asylum Seeker and Refugee Arrivals to Germany Are Getting into Labor Force More Quickly, Survey Finds

WASHINGTON — Asylum seekers and refugees who arrived in Germany in the leadup to and during the 2015-16 European migration crisis have integrated into the labor market at a slightly faster rate than previous refugee cohorts, a Migration Policy Institute (MPI) report finds.




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Is a U.S. Immigration System Rebuilt after 9/11 Prepared to Tackle Ever-Evolving Security Threats, Including Pandemics? Report Assesses Successes, Gaps

WASHINGTON — The U.S. immigration system was dramatically reshaped by the terrorist attacks of September 11, 2001, which shone a harsh spotlight on weaknesses in visa and immigration screening processes. From the creation of the Department of Homeland Security (DHS) to expanded national security protections in immigration and tourism policies, countless changes in the immigration arena have unfolded over the past 19 years.




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Rebuilding Community after Crisis: Striking a New Social Contract for Diverse Societies (Transatlantic Council Statement)

Addressing the deep-rooted integration challenges unearthed by large-scale migration and rapid social change will require a combination of strategies. Governments in Europe and North America must create a new social contract for increasingly diverse societies that are confronting cycles of disruption. This report sketches a blueprint for an adaptive process oriented by skill needs rather than national origins.





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SLOW-COOKED QUINCES WITH MANDARIN AND ROSEWATER

Once you've peeled and cored the quinces there's really little work to do to make this gorgeous dessert. They just bubble away happily for a few hours while the sugar and long slow cooking cast their spell, transforming the quinces' hard, ivory-coloured flesh until it's meltingly soft and an incredible deep-rose colour.




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Sad Vegetable Ratatouille

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Cassie Duncan from Sustainable Table.




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Mocha-Cappuccino Caramel Biscuit Cheesecake

This indulgent cheesecake is as light as air, with all the ingredients of an afternoon tea rolled into one - coffee, chocolate and caramel biscuits.




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Bouillabaisse

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Tony Twitchett, Taxi Kitchen




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Cres with passionfruit and cottage cheese

Guaranteed to tempt fussy eaters, with lots of hidden nutrients.




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Medallions of Beef, with pan juice sauce, wilted cherry tomatoes, wine and basil

Medallions of Beef, with pan juice sauce, wilted cherry tomatoes, any old wine and basil. Really nice with a potato salad, with fresh spring peas and crispy bacon pieces. Something I do very often is knock up quick tasty dinner utilising your favourite heavy-based frying pan.




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Tash's Passionfruit &Coconut &#55356;&#57140; Slice

Love this tasty slice with the combo of coconut and the passion fruit what's there not to like?




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Sam Gowing's Kiwi fruit & chia breakfast trifle

This is a perfect breakfast on-the-go! Rich in omega-3 and omega-6, the chia balls absorb water and become jelly-like. You can make this a few days head and store it in the fridge.




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

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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Building Therapeutic Relationships: Choosing Words That Put People First

Jane K. Dickinson
Jan 1, 2017; 35:51-54
Commentary




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Heroic Consciousness: What it is and How to Acquire it

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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Baseball and Linguistic Uncertainty

In my youth I played an inordinate amount of baseball, collected baseball cards, and idolized baseball players. I've outgrown all that but when I'm in the States during baseball season I do enjoy watching a few innings on the TV.

So I was watching a baseball game recently and the commentator was talking about the art of pitching. Throwing a baseball, he said, is like shooting a shotgun. You get a spray. As a pitcher, you have to know your spray. You learn to control it, but you know that it is there. The ball won't always go where you want it. And furthermore, where you want the ball depends on the batter's style and strategy, which vary from pitch to pitch for every batter.

That's baseball talk, but it stuck in my mind. Baseball pitchers must manage uncertainty! And it is not enough to reduce it and hope for the best. Suppose you want to throw a strike. It's not a good strategy to aim directly at, say, the lower outside corner of the strike zone, because of the spray of the ball's path and because the batter's stance can shift. Especially if the spray is skewed down and out, you'll want to move up and in a bit.

This is all very similar to the ambiguity of human speech when we pitch words at each other. Words don't have precise meanings; meanings spread out like the pitcher's spray. If we want to communicate precisely we need to be aware of this uncertainty, and manage it, taking account of the listener's propensities.

Take the word "liberal" as it is used in political discussion.

For many decades, "liberals" have tended to support high taxes to provide generous welfare, public medical insurance, and low-cost housing. They advocate liberal (meaning magnanimous or abundant) government involvement for the citizens' benefit.

A "liberal" might also be someone who is open-minded and tolerant, who is not strict in applying rules to other people, or even to him or herself. Such a person might be called "liberal" (meaning advocating individual rights) for opposing extensive government involvement in private decisions. For instance, liberals (in this second sense) might oppose high taxes since they reduce individuals' ability to make independent choices. As another example, John Stuart Mill opposed laws which restricted the rights of women to work (at night, for instance), even though these laws were intended to promote the welfare of women. Women, insisted Mill, are intelligent adults and can judge for themselves what is good for them.

Returning to the first meaning of "liberal" mentioned above, people of that strain may support restrictions of trade to countries which ignore the health and safety of workers. The other type of "liberal" might tend to support unrestricted trade.

Sending out words and pitching baseballs are both like shooting a shotgun: meanings (and baseballs) spray out. You must know what meaning you wish to convey, and what other meanings the word can have. The choice of the word, and the crafting of its context, must manage the uncertainty of where the word will land in the listener's mind.


Let's go back to baseball again.

If there were no uncertainty in the pitcher's pitch and the batter's swing, then baseball would be a dreadfully boring game. If the batter knows exactly where and when the ball will arrive, and can completely control the bat, then every swing will be a homer. Or conversely, if the pitcher always knows exactly how the batter will swing, and if each throw is perfectly controlled, then every batter will strike out. But which is it? Whose certainty dominates? The batter's or the pitcher's? It can't be both. There is some deep philosophical problem here. Clearly there cannot be complete certainty in a world which has some element of free will, or surprise, or discovery. This is not just a tautology, a necessary result of what we mean by "uncertainty" and "surprise". It is an implication of limited human knowledge. Uncertainty - which makes baseball and life interesting - is inevitable in the human world.

How does this carry over to human speech?

It is said of the Wright brothers that they thought so synergistically that one brother could finish an idea or sentence begun by the other. If there is no uncertainty in what I am going to say, then you will be bored with my conversation, or at least, you won't learn anything from me. It is because you don't know what I mean by, for instance, "robustness", that my speech on this topic is enlightening (and maybe interesting). And it is because you disagree with me about what robustness means (and you tell me so), that I can perhaps extend my own understanding.

So, uncertainty is inevitable in a world that is rich enough to have surprise or free will. Furthermore, this uncertainty leads to a process - through speech - of discovery and new understanding. Uncertainty, and the use of language, leads to discovery.

Isn't baseball an interesting game?




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Squirrels and Stock Brokers, Or: Innovation Dilemmas, Robustness and Probability

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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Picking a Theory is Like Building a Boat at Sea


"We are like sailors who on the open sea must reconstruct their ship
 but are never able to start afresh from the bottom." 
Otto Neurath's analogy in the words of Willard V. Quine

Engineers, economists, social planners, security strategists, and others base their plans and decisions on theories. They often argue long and hard over which theory to use. Is it ever right to use a theory that we know is empirically wrong, especially if a true (or truer) theory is available? Why is it so difficult to pick a theory?

Let's consider two introductory examples.

You are an engineer designing a robot. You must calculate the forces needed to achieve specified motions of the robotic arms. You can base these calculations on either of two theories. One theory assumes that an object comes to rest unless a force acts upon it. Let's call this axiom A. The other theory assumes that an object moves at constant speed unless a force acts upon it. Let's call this axiom G. Axiom A agrees with observation: Nothing moves continuously without the exertion of force; an object will come to rest unless you keep pushing it. Axiom G contradicts all observation; no experiment illustrates the perpetual motion postulated by the axiom. If all else is the same, which theory should you choose?

Axiom A is Aristotle's law of inertia, which contributed little to the development of mechanical dynamics. Axiom G is Galileo's law of inertia: one of the most fruitful scientific ideas of all time. Why is an undemonstrable assertion - axiom G - a good starting point for a theory?

Consider another example.

You are an economist designing a market-based policy to induce firms to reduce pollution. You will use an economic theory to choose between policies. One theory assumes that firms face pure competition, meaning that no single firm can influence market prices. Another theory provides agent-based game-theoretic characterization of how firms interact (without colluding) by observing and responding to price behavior of other firms and of consumers.

Pure competition is a stylized idealization (like axiom G). Game theory is much more realistic (like axiom A), but may obscure essential patterns in its massive detail. Which theory should you use?

We will not address the question of how to choose a theory upon which to base a decision. We will focus on the question: why is theory selection so difficult? We will discuss four trade offs.

"Thanks to the negation sign, there are as many truths as falsehoods;
we just can't always be sure which are which." Willard V. Quine

The tension between right and right. The number of possible theories is infinite, and sometimes it's hard to separate the wheat from the chaff, as suggested by the quote from Quine. As an example, I have a book called A Modern Guide to Macroeconomics: An Introduction to Competing Schools of Thought by Snowdon, Vane and Wynarczyk. It's a wonderful overview of about a dozen theories developed by leading economic scholars, many of them Nobel Prize Laureates. The theories are all fundamentally different. They use different axioms and concepts and they compete for adoption by economists. These theories have been studied and tested upside down and backwards. However, economic processes are very complex and variable, and the various theories succeed in different ways or in different situations, so the jury is still out. The choice of a theory is no simple matter because many different theories can all seem right in one way or another.

"The fox knows many things, but the hedgehog knows one big thing." Archilochus

The fox-hedgehog tension. This aphorism by Archilochus metaphorically describes two types of theories (and two types of people). Fox-like theories are comprehensive and include all relevant aspects of the problem. Hedgehog-like theories, in contrast, skip the details and focus on essentials. Axiom A is fox-like because the complications of friction are acknowledged from the start. Axiom G is hedgehog-like because inertial resistance to change is acknowledged but the complications of friction are left for later. It is difficult to choose between these types of theories because it is difficult to balance comprehensiveness against essentialism. On the one hand, all relevant aspects of the problem should be considered. On the other hand, don't get bogged down in endless details. This fox-hedgehog tension can be managed by weighing the context, goals and implications of the decision. We won't expand on this idea since we're not considering how to choose a theory; we're only examining why it's a difficult choice. However, the idea of resolving this tension by goal-directed choice motivates the third tension.

"Beyond this island of meanings which in their own nature are true or false
lies the ocean of meanings to which truth and falsity are irrelevant." John Dewey

The truth-meaning tension. Theories are collections of statements like axioms A and G in our first example. Statements carry meaning, and statements can be either true or false. Truth and meaning are different. For instance, "Archilochus was a Japanese belly dancer" has meaning, but is not true. The quote from Dewey expresses the idea that "meaning" is a broader description of statements than "truth". All true statements mean something, but not all meaningful statements are true. That does not imply, however, that all untrue meaningful statements are false, as we will see.

We know the meanings of words and sentences from experience with language and life. A child learns the meanings of words - chair, mom, love, good, bad - by experience. Meanings are learned by pointing - this is a chair - and also by experiencing what it means to love or to be good or bad.

Truth is a different concept. John Dewey wrote that

"truths are but one class of meanings, namely, those in which a claim to verifiability by their consequences is an intrinsic part of their meaning. Beyond this island of meanings which in their own nature are true or false lies the ocean of meanings to which truth and falsity are irrelevant. We do not inquire whether Greek civilization was true or false, but we are immensely concerned to penetrate its meaning."

A true statement, in Dewey's sense, is one that can be confirmed by experience. Many statements are meaningful, even important and useful, but neither true nor false in this experimental sense. Axiom G is an example.

Our quest is to understand why the selection of a theory is difficult. Part of the challenge derives from the tension between meaning and truth. We select a theory for use in formulating and evaluating a plan or decision. The decision has implications: what would it mean to do this rather than that? Hence it is important that the meaning of the theory fit the context of the decision. Indeed, hedgehogs would say that getting the meaning and implication right is the essence of good decision making.

But what if a relevantly meaningful theory is unprovable or even false? Should we use a theory that is meaningful but not verifiable by experience? Should we use a meaningful theory that is even wrong? This quandary is related to the fox-hedgehog tension because the fox's theory is so full of true statements that its meaning may be obscured, while the hedgehog's bare-bones theory has clear relevance to the decision to be made, but may be either false or too idealized to be tested.

Galileo's axiom of inertia is an idealization that is unsupported by experience because friction can never be avoided. Axiom G assumes conditions that cannot be realized so the axiom can never be tested. Likewise, pure competition is an idealization that is rarely if ever encountered in practice. But these theories capture the essence of many situations. In practical terms, what it means to get the robotic arm from here to there is to apply net forces that overcome Galilean inertia. But actually designing a robot requires considering details of dissipative forces like friction. What it means to be a small business is that the market price of your product is beyond your control. But actually running a business requires following and reacting to prices in the store next door.

It is difficult to choose between a relevantly meaningful but unverifiable theory, and a true theory that is perhaps not quite what we mean.

The knowledge-ignorance tension. Recall that we are discussing theories in the service of decision-making by engineers, social scientists and others. A theory should facilitate the use of our knowledge and understanding. However, in some situations our ignorance is vast and our knowledge will grow. Hence a theory should also account for ignorance and be able to accommodate new knowledge.

Let's take an example from theories of decision. The independence axiom is fundamental in various decision theories, for instance in von Neumann-Morgenstern expected utility theory. It says that one's choices should be independent of irrelevant alternatives. Suppose you are offered the dinner choice between chicken and fish, and you choose chicken. The server returns a few minutes later saying that beef is also available. If you switch your choice from chicken to fish you are violating the independence axiom. You prefer beef less than both chicken and fish, so the beef option shouldn't alter the fish-chicken preference.

But let's suppose that when the server returned and mentioned beef, your physician advised you to reduce your cholesterol intake (so your preference for beef is lowest) which prompted your wife to say that you should eat fish at least twice a week because of vitamins in the oil. So you switch from chicken to fish. Beef is not chosen, but new information that resulted from introducing the irrelevant alternative has altered the chicken-fish preference.

One could argue for the independence axiom by saying that it applies only when all relevant information (like considerations of cholesterol and fish oil) are taken into account. On the other hand, one can argue against the independence axiom by saying that new relevant information quite often surfaces unexpectedly. The difficulty is to judge the extent to which ignorance and the emergence of new knowledge should be central in a decision theory.

Wrapping up. Theories express our knowledge and understanding about the unknown and confusing world. Knowledge begets knowledge. We use knowledge and understanding - that is, theory - in choosing a theory. The process is difficult because it's like building a boat on the open sea as Otto Neurath once said. 




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