pro MPI Analysis of All State ESSA Accountability Plans Finds Fractured Picture of Education Policy for English Learners & Differing Approaches By www.migrationpolicy.org Published On :: Tue, 11 Feb 2020 16:45:31 -0500 WASHINGTON – Four years since the Every Student Succeeds Act (ESSA) was signed into law, all 50 states, the District of Columbia and Puerto Rico have developed accountability plans that include blueprints for serving English Learners (ELs), as well as measuring these students’ progress and being accountable for their outcomes. This marked a significant development, as EL performance was previously not well integrated with factors that determined whether a school was performing well or poorly. Full Article
pro As European policymakers take stock of seasonal worker programmes, MPI Europe brief outlines principles to improve these schemes for all parties By www.migrationpolicy.org Published On :: Tue, 18 Feb 2020 17:46:56 -0500 Findings will be discussed during 25 February MPI Europe – SVR webinar Full Article
pro Immigrant Workers Are Vital to the U.S. Coronavirus Pandemic Response, But Disproportionately Vulnerable By www.migrationpolicy.org Published On :: Fri, 27 Mar 2020 15:29:22 -0400 WASHINGTON — Six million immigrant workers are at the frontlines of keeping U.S. residents healthy, safe and fed during the COVID-19 pandemic, according to a Migration Policy Institute (MPI) analysis of U.S. Census Bureau data issued today. While the foreign born represented 17 percent of the 156 million civilians working in 2018, they account for larger shares in pandemic-response frontline occupations: 29 percent of all physicians in the United States, 38 percent of home health aides and 23 percent of retail-store pharmacists, for example. Full Article
pro Effectively Serving Immigrant and Dual Language Learner Families through Home Visiting Programs By www.migrationpolicy.org Published On :: Tue, 13 Aug 2019 14:43:47 -0400 This MPI webinar marks the release of a policy brief that explores program and policy opportunities to improve home visiting services for immigrant and DLL families currently underparticipating in these programs due to a lack of culturally and linguistically responsive programming and other barriers Full Article
pro Global Demand for Medical Professionals Drives Indians Abroad Despite Acute Domestic Health-Care Worker Shortages By www.migrationpolicy.org Published On :: Tue, 21 Jan 2020 10:02:55 -0500 India is the world's largest source for immigrant physicians, and for Indian-trained doctors and nurses the allure of working abroad is strong despite an acute domestic shortage of health-care workers. Against this pull, the Indian government has enacted a number of policies to limit and regulate the emigration of health-care professionals, though these have been more ad hoc in nature and not part of a fully realized strategy. Full Article
pro An Uneven Landscape: The Differing State Approaches to English Learner Policies under ESSA By www.migrationpolicy.org Published On :: Wed, 29 Jan 2020 13:09:18 -0500 Experts share how states have approached Every Student Succeeds Act (ESSA) implementation, and areas where the law and state efforts to support English Learners can be improved. Full Article
pro Prosciutto and cheese croquettes By www.abc.net.au Published On :: Thu, 30 Jun 2016 10:41:00 +0800 75g butter 75g (1/2 cup) plain flour 500ml (2 cups) milk 75g finely grated parmesan 1 small red onion, finely diced 200g prosciutto, finely chopped 2 tablespoons chopped fresh parsley 3 eggs, lightly whisked 1 cup plain flour 270g (3 cups) dried breadcrumbs Vegetable oil, to deep-fry Full Article ABC Local wheatbelt Lifestyle and Leisure:Recipes:All Australia:WA:Geraldton 6530
pro Brussels Sprout Caesar with Croutons, Borlotti Beans and Sunflower Seeds By www.abc.net.au Published On :: Tue, 06 Sep 2016 12:23:00 +1000 This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by Hetty McKinnon, founder of Surry Hills community kitchen Arthur Street Kitchen and author of 'Neighbourhood'. Full Article ABC Local melbourne Lifestyle and Leisure:Recipes:All Australia:VIC:Melbourne 3000
pro MACADAMIA PESTO POTATO SALAD WITH CRISPY PROSCIUTTO AND MARKET CHERRY TOMATOES By www.abc.net.au Published On :: Tue, 25 Oct 2016 06:24:00 +1100 Love this time of year where our makers are abundant with the sweet aroma of fresh basil . Here is my take on a fancy potato salad of macadamia pesto , crispy prosciutto, sweet cherry tomatoes Full Article ABC Local northcoast Lifestyle and Leisure:Food and Cooking:All Lifestyle and Leisure:Recipes:All Lifestyle and Leisure:Recipes:Main Australia:NSW:Lismore 2480
pro Refugee Sponsorship Programs: A Global State of Play and Opportunities for Investment By www.migrationpolicy.org Published On :: Wed, 11 Dec 2019 12:01:25 -0500 From Argentina to New Zealand and points beyond, a growing number of countries have begun exploring refugee sponsorship as a way to expand protection capacity at a time of rising need, involving individuals and communities more directly in resettlement. This brief takes stock of what both new and well-established programs need to succeed, and outlines opportunities for private philanthropic actors to support them. Full Article
pro Ponting takes aim at 'underdone' Proteas By www.abc.net.au Published On :: Tue, 08 Nov 2011 11:31:00 +1100 Ricky Ponting believes South Africa could suffer from a lack of first-class preparation in the opening Test in Cape Town on Wednesday. Full Article
pro Myocardial Ischemic Burden and Differences in Prognosis Among Patients With and Without Diabetes: Results From the Multicenter International REFINE SPECT Registry By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes. RESEARCH DESIGN AND METHODS Of 20,418 individuals who underwent single-photon emission computed tomography myocardial perfusion imaging, 2,951 patients with diabetes were matched to 2,951 patients without diabetes based on risk factors using propensity score. TPD was categorized as TPD = 0%, 0% < TPD < 1%, 1% ≤ TPD < 5%, 5% ≤ TPD ≤ 10%, and TPD >10%. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, unstable angina, or late revascularization. RESULTS MACE risk was increased in patients with diabetes compared with patients without diabetes at each level of TPD above 0 (P < 0.001 for interaction). In patients with TPD >10%, patients with diabetes had greater than twice the MACE risk compared with patients without diabetes (annualized MACE rate 9.4 [95% CI 6.7–11.6] and 3.9 [95% CI 2.8–5.6], respectively, P < 0.001). Patients with diabetes with even very minimal TPD (0% < TPD < 1%) experienced a higher risk for MACE than those with 0% TPD (hazard ratio 2.05 [95% CI 1.21–3.47], P = 0.007). Patients with diabetes with a TPD of 0.5% had a similar MACE risk as patients without diabetes with a TPD of 8%. CONCLUSIONS For every level of TPD >0%, even a very minimal deficit of 0% < TPD < 1%, the MACE risk was higher in the patients with diabetes compared with patients without diabetes. Patients with diabetes with minimal ischemia had comparable MACE risk as patients without diabetes with significant ischemia. Full Article
pro Association of BMI, Fitness, and Mortality in Patients With Diabetes: Evaluating the Obesity Paradox in the Henry Ford Exercise Testing Project (FIT Project) Cohort By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE To determine the effect of fitness on the association between BMI and mortality among patients with diabetes. RESEARCH DESIGN AND METHODS We identified 8,528 patients with diabetes (self-report, medication use, or electronic medical record diagnosis) from the Henry Ford Exercise Testing Project (FIT Project). Patients with a BMI <18.5 kg/m2 or cancer were excluded. Fitness was measured as the METs achieved during a physician-referred treadmill stress test and categorized as low (<6), moderate (6–9.9), or high (≥10). Adjusted hazard ratios for mortality were calculated using standard BMI (kilograms per meter squared) cutoffs of normal (18.5–24.9), overweight (25–29.9), and obese (≥30). Adjusted splines centered at 22.5 kg/m2 were used to examine BMI as a continuous variable. RESULTS Patients had a mean age of 58 ± 11 years (49% women) with 1,319 deaths over a mean follow-up of 10.0 ± 4.1 years. Overall, obese patients had a 30% lower mortality hazard (P < 0.001) compared with normal-weight patients. In adjusted spline modeling, higher BMI as a continuous variable was predominantly associated with a lower mortality risk in the lowest fitness group and among patients with moderate fitness and BMI ≥30 kg/m2. Compared with the lowest fitness group, patients with higher fitness had an ~50% (6–9.9 METs) and 70% (≥10 METs) lower mortality hazard regardless of BMI (P < 0.001). CONCLUSIONS Among patients with diabetes, the obesity paradox was less pronounced for patients with the highest fitness level, and these patients also had the lowest risk of mortality. Full Article
pro Plasma N-Glycans as Emerging Biomarkers of Cardiometabolic Risk: A Prospective Investigation in the EPIC-Potsdam Cohort Study By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE Plasma protein N-glycan profiling integrates information on enzymatic protein glycosylation, which is a highly controlled ubiquitous posttranslational modification. Here we investigate the ability of the plasma N-glycome to predict incidence of type 2 diabetes and cardiovascular diseases (CVDs; i.e., myocardial infarction and stroke). RESEARCH DESIGN AND METHODS Based on the prospective European Prospective Investigation of Cancer (EPIC)-Potsdam cohort (n = 27,548), we constructed case-cohorts including a random subsample of 2,500 participants and all physician-verified incident cases of type 2 diabetes (n = 820; median follow-up time 6.5 years) and CVD (n = 508; median follow-up time 8.2 years). Information on the relative abundance of 39 N-glycan groups in baseline plasma samples was generated by chromatographic profiling. We selected predictive N-glycans for type 2 diabetes and CVD separately, based on cross-validated machine learning, nonlinear model building, and construction of weighted prediction scores. This workflow for CVD was applied separately in men and women. RESULTS The N-glycan–based type 2 diabetes score was strongly predictive for diabetes risk in an internal validation cohort (weighted C-index 0.83, 95% CI 0.78–0.88), and this finding was externally validated in the Finland Cardiovascular Risk Study (FINRISK) cohort. N-glycans were moderately predictive for CVD incidence (weighted C-indices 0.66, 95% CI 0.60–0.72, for men; 0.64, 95% CI 0.55–0.73, for women). Information on the selected N-glycans improved the accuracy of established and clinically applied risk prediction scores for type 2 diabetes and CVD. CONCLUSIONS Selected N-glycans improve type 2 diabetes and CVD prediction beyond established risk markers. Plasma protein N-glycan profiling may thus be useful for risk stratification in the context of precisely targeted primary prevention of cardiometabolic diseases. Full Article
pro Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study By care.diabetesjournals.org Published On :: 2020-03-20T11:50:34-07:00 OBJECTIVE Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life. RESEARCH DESIGN AND METHODS The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37–60 years with BMI ≥34 kg/m2 (men) or ≥38 kg/m2 (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m2), overweight (BMI 25–29.9 kg/m2), or obesity (BMI ≥30 kg/m2). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers. RESULTS There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction P = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction P = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction P = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction P = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction P = 0.674). Surgical complications were similar in the subgroups. CONCLUSIONS The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age. Full Article
pro Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach By care.diabetesjournals.org Published On :: 2020-03-20T11:50:34-07:00 OBJECTIVE To construct and internally validate prediction models to estimate the risk of long-term end-organ complications and mortality in patients with type 2 diabetes and obesity that can be used to inform treatment decisions for patients and practitioners who are considering metabolic surgery. RESEARCH DESIGN AND METHODS A total of 2,287 patients with type 2 diabetes who underwent metabolic surgery between 1998 and 2017 in the Cleveland Clinic Health System were propensity-matched 1:5 to 11,435 nonsurgical patients with BMI ≥30 kg/m2 and type 2 diabetes who received usual care with follow-up through December 2018. Multivariable time-to-event regression and random forest machine learning models were built and internally validated using fivefold cross-validation to predict the 10-year risk for four outcomes of interest. The prediction models were programmed to construct user-friendly web-based and smartphone applications of Individualized Diabetes Complications (IDC) Risk Scores for clinical use. RESULTS The prediction tools demonstrated the following discrimination ability based on the area under the receiver operating characteristic curve (1 = perfect discrimination and 0.5 = chance) at 10 years in the surgical and nonsurgical groups, respectively: all-cause mortality (0.79 and 0.81), coronary artery events (0.66 and 0.67), heart failure (0.73 and 0.75), and nephropathy (0.73 and 0.76). When a patient’s data are entered into the IDC application, it estimates the individualized 10-year morbidity and mortality risks with and without undergoing metabolic surgery. CONCLUSIONS The IDC Risk Scores can provide personalized evidence-based risk information for patients with type 2 diabetes and obesity about future cardiovascular outcomes and mortality with and without metabolic surgery based on their current status of obesity, diabetes, and related cardiometabolic conditions. Full Article
pro Coronary Artery Disease and Type 2 Diabetes: A Proteomic Study By care.diabetesjournals.org Published On :: 2020-03-20T11:50:34-07:00 OBJECTIVE Coronary artery disease (CAD) is a major challenge in patients with type 2 diabetes (T2D). Coronary computed tomography angiography (CCTA) provides a detailed anatomic map of the coronary circulation. Proteomics are increasingly used to improve diagnostic and therapeutic algorithms. We hypothesized that the protein panel is differentially associated with T2D and CAD. RESEARCH DESIGN AND METHODS In CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation—a cohort of 528 individuals with no previous cardiovascular event undergoing CCTA), participants were grouped into CAD– (clean coronaries) and CAD+ (diffuse lumen narrowing or plaques). Plasma proteins were screened by aptamer analysis. Two-way partial least squares was used to simultaneously rank proteins by diabetes status and CAD. RESULTS Though CAD+ was more prevalent among participants with T2D (HbA1c 6.7 ± 1.1%) than those without diabetes (56 vs. 30%, P < 0.0001), CCTA-based atherosclerosis burden did not differ. Of the 20 top-ranking proteins, 15 were associated with both T2D and CAD, and 3 (osteomodulin, cartilage intermediate-layer protein 15, and HTRA1) were selectively associated with T2D only and 2 (epidermal growth factor receptor and contactin-1) with CAD only. Elevated renin and GDF15, and lower adiponectin, were independently associated with both T2D and CAD. In multivariate analysis adjusting for the Framingham risk panel, patients with T2D were "protected" from CAD if female (P = 0.007), younger (P = 0.021), and with lower renin levels (P = 0.02). CONCLUSIONS We concluded that 1) CAD severity and quality do not differ between participants with T2D and without diabetes; 2) renin, GDF15, and adiponectin are shared markers by T2D and CAD; 3) several proteins are specifically associated with T2D or CAD; and 4) in T2D, lower renin levels may protect against CAD. Full Article
pro Inoreader v13 is Here With Improved Looks and New Features! By blog.inoreader.com Published On :: Wed, 29 Jan 2020 07:54:55 +0000 Since the beginning, Inoreader was meant to be a power-user tool, pushing the boundaries of what RSS readers can do.… Full Article Uncategorized
pro Effectively Serving Immigrant and Dual Language Learner Families through Home Visiting Programs By www.migrationpolicy.org Published On :: Thu, 29 Aug 2019 12:01:27 -0400 Marking a policy brief's release, this webinar explores the promise of home visiting services that support new parents alongside their infants and toddlers, plus strategies for improving how these programs work with immigrant and linguistically diverse families. Full Article
pro 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. Full Article
pro Seasonal Worker Programs in Europe: Lessons Learned and Ways Forward By www.migrationpolicy.org Published On :: Fri, 28 Feb 2020 13:36:08 -0500 As the European Union prepares to review the implementation of its Seasonal Workers Directive, as well as countries such as the United Kingdom continue to explore new approaches to selecting seasonal workers, this webinar features findings from a policy brief on the topic. Full Article
pro Humanitarian Protection in an Era of Pandemic By www.migrationpolicy.org Published On :: Wed, 08 Apr 2020 12:16:51 -0400 MPI and MPI Europe experts discuss the effects of the coronavirus pandemic on asylum systems in Europe and North America, as well as in developing regions, where 85 percent of refugees live. During this freeform conversation, our analysts also assess the implications for the principle of asylum and the future for a post-World War II humanitarian protection system that is under threat. Full Article
pro In the Age of Trump: Populist Backlash and Progressive Resistance Create Divergent State Immigrant Integration Contexts By www.migrationpolicy.org Published On :: Wed, 17 Jan 2018 10:26:51 -0500 As long-simmering passions related to federal immigration policies have come to a full boil, less noted but no less important debates are taking place at state and local levels with regards to policies affecting immigrants and their children. As states are increasingly diverging in their responses, this report examines how some of the key policies and programs that support long-term integration success are faring in this volatile era. Full Article
pro Mitigating the Effects of Trauma among Young Children of Immigrants and Refugees: The Role of Early Childhood Programs By www.migrationpolicy.org Published On :: Mon, 01 Apr 2019 15:12:37 -0400 The first years of a child’s life are a time of immense growth, and exposure to trauma—if left unaddressed—can have significant, lifelong effects. This issue brief examines how young children of refugees and other immigrants may be affected by trauma, and what early childhood education and care programs, health-care providers, and others can do to mitigate its adverse effects. Full Article
pro Addressing Trauma in Young Children in Immigrant and Refugee Families through Early Childhood Programs By www.migrationpolicy.org Published On :: Wed, 03 Apr 2019 18:32:45 -0400 During this webinar, speakers provide an overview of an MPI policy brief that seeks to raise awareness of the intersection of trauma and early childhood development, and how U.S. early childhood programs could more effectively address this trauma in young children in refugee and immigrant households. The participants discuss efforts to integrate trauma-informed approaches into early childhood systems and how home visiting services can effectively address trauma and mental health through a two-generation approach. Full Article
pro Immigrant Families and Child Welfare Systems: Emerging Needs and Promising Policies By www.migrationpolicy.org Published On :: Mon, 22 Apr 2019 10:26:23 -0400 With the children of immigrants a growing share of all U.S. children, and federal immigration enforcement and other policies undergoing significant change, some state and local child welfare agencies are developing new ways to improve how they work with immigrant families. This report examines key cultural, linguistic, and legal challenges, and how agencies are adjusting staffing, training, placement, and other policies to tackle them. Full Article
pro 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. Full Article
pro As U.S. Health-Care System Buckles under Pandemic, Immigrant & Refugee Professionals Could Represent a Critical Resource By www.migrationpolicy.org Published On :: Mon, 06 Apr 2020 11:32:00 -0400 In a time of critical shortages of U.S. health-care workers during the COVID-19 pandemic, retired doctors are being called back to work and medical students are graduating on a fast track. There is another important pool that could be tapped: Immigrants and refugees who have college degrees in health fields but are working in low-skilled jobs or out of work. MPI estimates 263,000 immigrants are experiencing skill underutilization and could be a valuable resource. Full Article
pro Can a Company be pro-regulation and pro-commerce? Gregg Renfrew from Beautycounter thinks so By brandleadership.wordpress.com Published On :: Fri, 19 Feb 2016 18:59:09 +0000 It’s the middle of an election year and, according to the Pew Research Center, the country hasn’t been this polarized since the Civil War. In such a climate, it would seem to be an oxymoron for a company to push for both financial growth and tighter regulations. Gregg Renfrew, CEO & Founder of Beautycounter, wouldn’t […] Full Article *Gabriela Torres Patiño Brand Strategy Business Values Customer Experience Event Marketing
pro Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain By clinical.diabetesjournals.org Published On :: 2017-07-01 Lorenzo RinaldoJul 1, 2017; 35:126-131Feature Articles Full Article
pro Therapeutic Inertia is a Problem for All of Us By clinical.diabetesjournals.org Published On :: 2019-04-01 Stephen BruntonApr 1, 2019; 37:105-106Editorials Full Article
pro PROactive: A Sad Tale of Inappropriate Analysis and Unjustified Interpretation By clinical.diabetesjournals.org Published On :: 2006-04-01 Jay S. SkylerApr 1, 2006; 24:63-65Commentary Full Article
pro Insulin Strategies for Primary Care Providers By clinical.diabetesjournals.org Published On :: 2002-01-01 Karen L. HerbstJan 1, 2002; 20:Feature Articles Full Article
pro Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients By clinical.diabetesjournals.org Published On :: 2008-01-01 Daren AndersonJan 1, 2008; 26:22-27Bridges to Excellence Full Article
pro Standards of Medical Care in Diabetes--2019 Abridged for Primary Care Providers By clinical.diabetesjournals.org Published On :: 2019-01-01 American Diabetes AssociationJan 1, 2019; 37:11-34Position Statements Full Article
pro 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. BuseJul 1, 2002; 20:Feature Articles Full Article
pro Standards of Medical Care in Diabetes--2016 Abridged for Primary Care Providers By clinical.diabetesjournals.org Published On :: 2016-01-01 American Diabetes AssociationJan 1, 2016; 34:3-21Position Statements Full Article
pro 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. PolonskyJul 1, 2004; 22:147-150Practical Pointers Full Article
pro A Real-World Approach to Insulin Therapy in Primary Care Practice By clinical.diabetesjournals.org Published On :: 2005-04-01 Irl B. HirschApr 1, 2005; 23:78-86Practical Pointers Full Article
pro Improving Patient Adherence By clinical.diabetesjournals.org Published On :: 2006-04-01 Alan M. DelamaterApr 1, 2006; 24:71-77Feature Articles Full Article
pro Standards of Medical Care in Diabetes--2018 Abridged for Primary Care Providers By clinical.diabetesjournals.org Published On :: 2018-01-01 American Diabetes AssociationJan 1, 2018; 36:14-37Position Statements Full Article
pro Standards of Medical Care in Diabetes--2017 Abridged for Primary Care Providers By clinical.diabetesjournals.org Published On :: 2017-01-01 American Diabetes AssociationJan 1, 2017; 35:5-26Position Statements Full Article
pro Standards of Medical Care in Diabetes--2015 Abridged for Primary Care Providers By clinical.diabetesjournals.org Published On :: 2015-04-01 American Diabetes AssociationApr 1, 2015; 33:97-111Position Statements Full Article
pro The Pains of Progress By decisions-and-info-gaps.blogspot.com Published On :: Fri, 30 Sep 2011 07:04:00 +0000 To measure time by how little we change is to find how little we've lived, but to measure time by how much we've lost is to wish we hadn't changed at all. Andre AcimanThe last frontier is not the Antarctic, or the oceans, or outer space. The last frontier is The Unknown. We mentioned in an earlier essay that uncertainty - which makes baseball and life interesting - is inevitable in the human world. Life will continue to be interesting as long as the world is rich in unknowns, waiting to be discovered. Progress is possible if propitious discoveries can be made. Progress, however, comes with costs.The emblem of my university entwines a billowing smokestack and a cogwheel in the first letter of the institution's name. When this emblem was adopted (probably in 1951) these were optimistic symbols of progress. Cogwheels are no longer 'hi-tech' (though we still need them), and smoke has been banished from polite company. But our emblem is characteristic of industrial society which has seared Progress on our hearts and minds.Progress is accompanied by painful tensions. On the one hand, progress is nurtured by stability, cooperation, and leisure. On the other hand, progress grows out of change, conflict, and stress. A society's progressiveness reflects its balance of each of these three pairs of attributes. In the most general terms, progressiveness reflects social and individual attitudes to uncertainty.Let's consider the three pairs of attributes one at a time.Change and stability. Not all change is progress, but all progress is change. Change is necessary for progress, by definition, and progress can be very disruptive. The disruptiveness sometimes arises from unexpected consequences. J.B.S. Haldane wrote in 1923 that "the late war is only an example of the disruptive result that we may constantly expect from the progress of science." On the other hand, progressives employ and build on existing capabilities. The entrepreneur depends on stable property rights before risking venture capital. The existing legal system is used to remove social injustice. Watt's steam engine extended Newcomen's more primitive model. The new building going up on campus next to my office is very disruptive, but the construction project depends on the continuity of the university despite the drilling and dust. Even revolutionaries exploit and react against the status quo, which must exist for a revolutionary to be able to revolt. (One can't revolt if nothing is revolting.) Progress grows from a patch of opportunity in a broad bed of certainty, and spreads out in unanticipated directions.Conflict and cooperation. Conflict between vested interests and innovators is common. Watt protected his inventions with extensive patents which may have actually retarded the further development and commercialization of steam power. Conflict is also a mechanism for selecting successful ideas. Darwinian evolution and its social analogies proceed by more successful adaptations replacing less successful ones. On the other hand, cooperation enables specialization and expertise which are needed for innovation. The tool-maker cooperates with the farmer so better tools can be made more quickly, enhancing the farmer's productivity and the artisan's welfare. Conflicts arise over what constitutes progress. Stem cell research, genetic engineering, nuclear power technology: progress or plague? Cooperative collective decision making enables the constructive resolution of these value-based conflicts.Stress and leisure. Challenge, necessity and stress all motivate innovation. If you have no problems, you are unlikely to be looking for solutions. On the other hand, the leisure to think and tinker is a great source of innovation. Subsistence societies have no resources for invention. In assessing the implications of industrial efficiency, Bertrand Russell praised idleness in 1932, writing: "In a world where no one is compelled to work more than four hours a day, every person possessed of scientific curiosity will be able to indulge it, and every painter will be able to paint without starving ...." Stress is magnified by the unknown consequences of the stressor, while leisure is possible only in the absence of fear.New replaces Old. Yin and yang are complementary opposites that dynamically interact. In Hegel's dialectic, tension between contradictions is resolved by synthesis. Human history is written by the victors, who sometimes hardly mention those swept into Trotsky's "dustbin of history". "In the evening resides weeping; in the morning: joy." (Psalm 30:6). Change and stability; conflict and cooperation; stress and leisure.No progress without innovation; no innovation without discovery; no discovery without the unknown; no unknown without fear. There is no progress without pain. Full Article change and stability conflict and cooperation costs of progress progress stress and leisure
pro Squirrels and Stock Brokers, Or: Innovation Dilemmas, Robustness and Probability By decisions-and-info-gaps.blogspot.com Published On :: Sun, 09 Oct 2011 11:51:00 +0000 Decisions are made in order to achieve desirable outcomes. An innovation dilemma arises when a seemingly more attractive option is also more uncertain than other options. In this essay we explore the relation between the innovation dilemma and the robustness of a decision, and the relation between robustness and probability. A decision is robust to uncertainty if it achieves required outcomes despite adverse surprises. A robust decision may differ from the seemingly best option. Furthermore, robust decisions are not based on knowledge of probabilities, but can still be the most likely to succeed.Squirrels, Stock-Brokers and Their DilemmasDecision problems.Imagine a squirrel nibbling acorns under an oak tree. They're pretty good acorns, though a bit dry. The good ones have already been taken. Over in the distance is a large stand of fine oaks. The acorns there are probably better. But then, other squirrels can also see those trees, and predators can too. The squirrel doesn't need to get fat, but a critical caloric intake is necessary before moving on to other activities. How long should the squirrel forage at this patch before moving to the more promising patch, if at all?Imagine a hedge fund manager investing in South African diamonds, Australian Uranium, Norwegian Kroners and Singapore semi-conductors. The returns have been steady and good, but not very exciting. A new hi-tech start-up venture has just turned up. It looks promising, has solid backing, and could be very interesting. The manager doesn't need to earn boundless returns, but it is necessary to earn at least a tad more than the competition (who are also prowling around). How long should the manager hold the current portfolio before changing at least some of its components?These are decision problems, and like many other examples, they share three traits: critical needs must be met; the current situation may or may not be adequate; other alternatives look much better but are much more uncertain. To change, or not to change? What strategy to use in making a decision? What choice is the best bet? Betting is a surprising concept, as we have seen before; can we bet without knowing probabilities?Solution strategies.The decision is easy in either of two extreme situations, and their analysis will reveal general conclusions.One extreme is that the status quo is clearly insufficient. For the squirrel this means that these crinkled rotten acorns won't fill anybody's belly even if one nibbled here all day long. Survival requires trying the other patch regardless of the fact that there may be many other squirrels already there and predators just waiting to swoop down. Similarly, for the hedge fund manager, if other funds are making fantastic profits, then something has to change or the competition will attract all the business.The other extreme is that the status quo is just fine, thank you. For the squirrel, just a little more nibbling and these acorns will get us through the night, so why run over to unfamiliar oak trees? For the hedge fund manager, profits are better than those of any credible competitor, so uncertain change is not called for.From these two extremes we draw an important general conclusion: the right answer depends on what you need. To change, or not to change, depends on what is critical for survival. There is no universal answer, like, "Always try to improve" or "If it's working, don't fix it". This is a very general property of decisions under uncertainty, and we will call it preference reversal. The agent's preference between alternatives depends on what the agent needs in order to "survive".The decision strategy that we have described is attuned to the needs of the agent. The strategy attempts to satisfy the agent's critical requirements. If the status quo would reliably do that, then stay put; if not, then move. Following the work of Nobel Laureate Herbert Simon, we will call this a satisficing decision strategy: one which satisfies a critical requirement."Prediction is always difficult, especially of the future." - Robert Storm PetersenNow let's consider a different decision strategy that squirrels and hedge fund managers might be tempted to use. The agent has obtained information about the two alternatives by signals from the environment. (The squirrel sees grand verdant oaks in the distance, the fund manager hears of a new start up.) Given this information, a prediction can be made (though the squirrel may make this prediction based on instincts and without being aware of making it). Given the best available information, the agent predicts which alternative would yield the better outcome. Using this prediction, the decision strategy is to choose the alternative whose predicted outcome is best. We will call this decision strategy best-model optimization. Note that this decision strategy yields a single universal answer to the question facing the agent. This strategy uses the best information to find the choice that - if that information is correct - will yield the best outcome. Best-model optimization (usually) gives a single "best" decision, unlike the satisficing strategy that returns different answers depending on the agent's needs.There is an attractive logic - and even perhaps a moral imperative - to use the best information to make the best choice. One should always try to do one's best. But the catch in the argument for best-model optimization is that the best information may actually be grievously wrong. Those fine oak trees might be swarming with insects who've devoured the acorns. Best-model optimization ignores the agent's central dilemma: stay with the relatively well known but modest alternative, or go for the more promising but more uncertain alternative."Tsk, tsk, tsk" says our hedge fund manager. "My information already accounts for the uncertainty. I have used a probabilistic asset pricing model to predict the likelihood that my profits will beat the competition for each of the two alternatives."Probabilistic asset pricing models are good to have. And the squirrel similarly has evolved instincts that reflect likelihoods. But a best-probabilistic-model optimization is simply one type of best-model optimization, and is subject to the same vulnerability to error. The world is full of surprises. The probability functions that are used are quite likely wrong, especially in predicting the rare events that the manager is most concerned to avoid.Robustness and ProbabilityNow we come to the truly amazing part of the story. The satisficing strategy does not use any probabilistic information. Nonetheless, in many situations, the satisficing strategy is actually a better bet (or at least not a worse bet), probabilistically speaking, than any other strategy, including best-probabilistic-model optimization. We have no probabilistic information in these situations, but we can still maximize the probability of success (though we won't know the value of this maximum).When the satisficing decision strategy is the best bet, this is, in part, because it is more robust to uncertainty than another other strategy. A decision is robust to uncertainty if it achieves required outcomes even if adverse surprises occur. In many important situations (though not invariably), more robustness to uncertainty is equivalent to being more likely to succeed or survive. When this is true we say that robustness is a proxy for probability.A thorough analysis of the proxy property is rather technical. However, we can understand the gist of the idea by considering a simple special case.Let's continue with the squirrel and hedge fund examples. Suppose we are completely confident about the future value (in calories or dollars) of not making any change (staying put). In contrast, the future value of moving is apparently better though uncertain. If staying put would satisfy our critical requirement, then we are absolutely certain of survival if we do not change. Staying put is completely robust to surprises so the probability of success equals 1 if we stay put, regardless of what happens with the other option. Likewise, if staying put would not satisfy our critical requirement, then we are absolutely certain of failure if we do not change; the probability of success equals 0 if we stay, and moving cannot be worse. Regardless of what probability distribution describes future outcomes if we move, we can always choose the option whose likelihood of success is greater (or at least not worse). This is because staying put is either sure to succeed or sure to fail, and we know which.This argument can be extended to the more realistic case where the outcome of staying put is uncertain and the outcome of moving, while seemingly better than staying, is much more uncertain. The agent can know which option is more robust to uncertainty, without having to know probability distributions. This implies, in many situations, that the agent can choose the option that is a better bet for survival.Wrapping UpThe skillful decision maker not only knows a lot, but is also able to deal with conflicting information. We have discussed the innovation dilemma: When choosing between two alternatives, the seemingly better one is also more uncertain.Animals, people, organizations and societies have developed mechanisms for dealing with the innovation dilemma. The response hinges on tuning the decision to the agent's needs, and robustifying the choice against uncertainty. This choice may or may not coincide with the putative best choice. But what seems best depends on the available - though uncertain - information.The commendable tendency to do one's best - and to demand the same of others - can lead to putatively optimal decisions that may be more vulnerable to surprise than other decisions that would have been satisfactory. In contrast, the strategy of robustly satisfying critical needs can be a better bet for survival. Consider the design of critical infrastructure: flood protection, nuclear power, communication networks, and so on. The design of such systems is based on vast knowledge and understanding, but also confronts bewildering uncertainties and endless surprises. We must continue to improve our knowledge and understanding, while also improving our ability to manage the uncertainties resulting from the expanding horizon of our efforts. We must identify the critical goals and seek responses that are immune to surprise. Full Article betting innovation dilemma probability proxy property robustness
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