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The Complexity Matters blog features the Thursday Complexity Post as well as other complexity inspired news items.

 

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Small Acts Matter

Posted By Prucia Buscell, Friday, February 20, 2015

For the Future of Democracy and the Planet, Small Acts Matter

 

Mass movements and big social changes, whether they are to topple dictators or protect the environment, often start with carefully planned small actions.

 

The huge demonstrations in Egypt’s Tahrir Square that culminated in the ouster of Hosni Mubarak were the result of two years of careful planning and hard work, Tina Rosenberg writes in her New York Times column “Fixes.” They weren’t just a spontaneous happening. Mass demonstrations aren’t the beginning of a movement, she writes, they’re the victory lap.

 

Rosenberg describes the work of Srdja Popovic and Slobodan Djinovic, leaders of Otpor, a Serbian student movement that aided the overthrow of Slobodan Milosevic in 2000. The two founded the Center for Applied Nonviolent Action and Strategies (CANVAS), an organization devoted to training activists committed to nonviolent ways of achieving democracy and human rights. Otpor, Rosenberg writes, began with 11 people and grew to 70,000 in two years, starting with a few activists who staged humorous anti-Milosevic street theater.  Popovic calls that “laughtivism,” and says one of Otpor’s guiding spirits was Monty Python.  Humor can puncture the invincibility of authority.

 

When Turkish officials inveighed against kissing in the Ankara subway,  Popovic has written by way of example,  100 protesters gathered the subway in pairs, kissed mightily, and carried signs advertising free kisses. Police were surprised and lawmakers were prompted to wonder who had the right to ban kissing.

 

Popovic and Djinovic have trained nonviolent activists in 46 countries, and have been invited to lecture and teach at several American colleges, including Grinnell, Harvard, Columbia, NYU and Rutgers. They say nonviolence is not only morally superior to brutality, but it’s really the only tool small groups have against raw power.  Dictators are good at violence, they assert, so advocates for democracy can’t compete in the same way. They have to think strategically and start small.  

 

Burmese who attended a CANVAS workshop knew a big demonstration for political goals would be dangerous. So they organized to get the Yangon government to collect garbage. In a similar vein, Gandhi began a massive civil protest against the British Salt Tax. CANVAS also teaches the value of “tactics of dispersal,” such as coordinated pot banging and traffic in which everyone drives at half speed. They show widespread support, which encourages larger participation.  

 

 The Earth Day Network’s A Million Acts of Green describes individual actions, large and small, that can impact the environment.  And if you think individual acts don’t matter much, watch the FutureEnvironment.Org YouTube presentation on how atmospheric pollutants could be reduced by millions of tons if one percent of the population left some lights burning for five fewer minutes.

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What Makes a Better Team? More Women

Posted By Prucia Buscell, Thursday, February 12, 2015
The teams with the smartest members aren't necessarily the smartest teams.

Researchers who teamed up with Alex Pentland and Nada Hashmi of MIT grouped 697 volunteers into teams with two to five members and studied how they performed several short tasks that required such common skills as logical analysis, brainstorming, planning, coordination and moral reasoning. Volunteers took individual IQ tests, but teams with the highest average IQs weren't necessarily the most successful. Nor were the teams with most extroverts nor the most highly motivated members.

The most successful teams with the best collective intelligence, it turned out, had three characteristics. Their members contributed equally to group discussions rather than having a few members who dominated. Teams with more women outperformed teams with more men. And the most successful teams had members who scored highest on a test called Reading the Mind in the Eyes. That test is designed to measure how well people can read emotional states by looking at facial images that only show the eyes. The study is described in a New York Times story by researchers Anita Woolley, Thomas W. Malone, and Christopher F. Chabris.

An Atlantic story by Derek Thompson stresses the importance empathy and social sensitivity. Generally, the story says, women outperform men on the Eyes test, which helps explain why teams with more women tend to have higher collective intelligence. Elements of that trait include an ability to read complex emotions and skill at interpreting nonverbal clues.

Interestingly, another study showed that good collective intelligence was just as important for teams working virtually as it is for teams working face to face. A study by Woolley, Malone, Chabris, David Engel and Lisa X. Jing in PLoS One examined teams that worked together face to face and teams that worked virtually. Emotion reading skill was just as important in the success of online teams. The other characteristics that helped in person teams-frequent good quality conversation and equal participation-also were crucial online.

Henri Lipmanowicz and Keith McCandless wrote the book The Surprising Power of Liberating Structures and created the Liberating Structures website, which describes simple methods to improve the way we meet, interact and collaborate. Lipmanowicz says the use of Liberating Structures (LS) can help people learn the communication, participation and emotion reading skills that create good teamwork. While traditional paths to learning these skills is slow, expensive and unreliable, Lipmanowicz says, people who experience using LS can learn them quickly.

Are you skilled at reading emotions? Take the Reading the Mind in the Eyes test here. Read some thoughts on the test here.

Tags:  buscell  complexity matters  liberating structures  research 

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Collaboration May Improve Medical Diagnoses

Posted By Prucia Buscell, Thursday, February 05, 2015

Doctors working in teams may make more accurate diagnoses than doctors working alone, a recent study suggests.

German researchers recruited 88 fourth year medical student volunteers and showed them videos of simulated patient cases. They then asked the volunteers to select one of 20 possible diagnoses, and order from a menu of 30 possible tests. Twenty eight of the students worked individually and the remaining 60 worked in pairs. Those working in pairs were 18 percent more accurate in their diagnoses. The study also found that pairs were more likely to differ in confidence about the diagnosis when the diagnosis was incorrect.

The researchers said superior accuracy of the pairs could not be explained by differences in knowledge or relevant information. "Collaboration may have helped correct errors, fill knowledge gaps and counteract reasoning flaws," researcher Dr. Wolf E. Hautz and colleagues said. The findings appeared in a research letter in the Journal of the American Medical Association.

A story by Sabriya Rice in Modernhealthcare.com reports that as many as one out of 20 adults in the U.S. may be misdiagnosed in outpatient visits, and about half of those errors could be harmful.

While hospitals have developed systems for monitoring healthcare acquired infections and surgical errors and other patient safety issues, experts say systems for tracking diagnostic mistakes barely exist and causes of diagnostic error have not been thoroughly researched. The 1999 Institute of Medicine Report "To Err is Human" brought medical error into public consciousness but did not focus on diagnostic error. The IOM report due this fall is expected to probe diagnostic error. Complicating the issue, Rice writes, is that there is no universally accepted definition of a diagnostic error.

According to a 2014 study by CRICO Strategies, a Cambridge, Mass.-based risk-management group, about 20 percent of 23,527 medical malpractice cases filed between 2008 and 2012 were related to diagnostic concerns, she reports, and about 73 percent of the 4,705 diagnostic claims alleged lapses in clinical judgment, such as failure to order diagnostic tests, establish a differential diagnoses or give a referral.

Some surveys and research indicate time and scheduling pressures contribute to the potential for error.

At Maine Medical Center, a part of MaineHealth in Portland, began an innovative initiative to get clinicians thinking about diagnoses. The hospital's patient-safety officer and clinical educator started a pilot project that ran from January to July 2011 where doctors voluntarily discussed examples of diagnostic mistakes. During the trial period, doctors found 36 instances where diseases such as cancer, stroke and pneumonia were missed, misdiagnosed or not identified in a timely fashion. "Just about every time you talk to clinicians involved in diagnostic errors, it seems like time and volume is an issue," said Dr. Robert Trowbridge, an internal medicine physician who teaches clinical reasoning at Maine Medical Center.

Dr. Gordon Schiff, a diagnostic error researcher at Brigham and Women's Hospital in Boston, told Modernhealthcare.com that diagnosis is really a team effort. He said the idea that diagnosis is "this heroic, lone ranger thing" that doctors do behind closed doors is romantic and outdated.

Tags:  buscell  collaboration  complexity matters  health  research 

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Our Genes May Know More Than Our Minds

Posted By Prucia Buscell, Thursday, January 29, 2015

Human happiness influences human gene expression, researchers have found, and different kinds of happiness have surprisingly different effects on our physical health.

Researchers at the UCLA Cousins Center for Psychoneuroimmunology and the University of North Carolina note that philosophers since antiquity have distinguished between hedonic wellbeing-the kind of happiness that comes from satisfaction from pleasurable experiences-and eudaimonic wellbeing-the kind that comes from striving toward meaning and noble purpose beyond self gratification. It turns out the molecular mechanics of good health tend to favor people who find happiness striving for higher goals.

Steven Cole, PhD, a professor of medicine, psychiatry and behavioral sciences at UCLA and a member of the Cousins Center, and colleagues including Barbara Frederickson, director of the Positive Emotions and Psychology Lab at the University of North Carolina, have spent a decade studying how stress, fear, loneliness and other miseries impact the human genome. In his paper "Social Regulation of Human Gene Expression: Mechanisms and Implications for Public Health," Cole reported that people who experienced long term loneliness had a gene expression profile showing high inflammation and lower immune function. Inflammation related illnesses include heart disease, neurodegenerative diseases and some types of cancer.

The stress-related gene expression profile characterized by high inflammation and low immunity is known as CTRA, for "conserved transcriptional response to adversity." Cole and colleagues wanted to find whether happiness is just the opposite of misery, or whether it would activate a different kind of gene expression. They took blood samples from 80 healthy adults assessed as having either hedonic or eudaimonic happiness, and used the CTRA gene expression profile to examine potential biological differences. Both groups had high levels of positive emotion. Those in the eudaimonic wellbeing group had favorable gene expression profiles, with low inflammation and functioning immunity, while those in the hedonic wellbeing group showed the opposite gene expression profiles. The study appears in the Proceedings of the National Academy of Sciences.

"What this study shows is that doing good and feeling good have very different effects on the human genome, even though they generate similar levels of positive emotion," Cole, the lead author, said in a UCLA release. "Apparently the human genome is much more sensitive to different ways of achieving happiness than are our conscious minds." The UCLA release says this research, showing specific signals and pathways associated with a positive state of mind and gene expression, is the first of its kind.

In his paper on social regulation of genes, Cole wrote that the human genome is influenced by social environment, and that the "regulatory architecture" of the genome lies outside the cell "in the constraints and affordances present in the social ecology."

Increasing knowledge and technological advances that allow researchers to examine the way genes and environment interact on a molecular level can have profound impact in public health, he suggests. "Social regulation of gene expression implies many aspects of individual health actually constitute a form of public health in the sense that they emerge as properties of an interconnected system of human beings," the paper says.

In an interview, Frederickson suggested our bodies may respond better to happiness related to human connectedness and purpose than to hedonic wellbeing, which she called the emotional equivalent of empty calories.

Tags:  buscell  complexity matters  culture  health  research 

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Lion and Calf, Dog and Cheetah, Tiger and Bear: If They Can Get Along, Can We?

Posted By Prucia Buscell, Wednesday, January 28, 2015

Scientists Examine Interspecies Interactions

The tender togetherness of the 100 year old tortoise and the baby hippo captures the imagination. A Budweiser commercial showing friendship between a Clydesdale horse and a Labrador puppy got more than 55 million views on YouTube. What makes some animals able to form relationships with animals from other species? How can some creatures adopt behavior of other species and even learn to understand  how to communicate with others? Scientists studying interspecies interaction hope to learn more about animal behavior and perhaps find new insights about humans. Read the New York Times story by Erica Goode "Learning from Animal Friendships."

Tags:  news 

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Vaccine Fears and the Return of Old Diseases

Posted By Prucia Buscell, Thursday, January 22, 2015

Measles, whooping cough and other diseases thought to have been eliminated decades ago are reappearing in California and other states and health officials worry that widespread resistance to childhood vaccinations raises potential for dangerous outbreaks of infectious illnesses.

A New York Times story by Adam Nagourney and Abby Goodnough reports a measles outbreak at Disneyland infected 42 of the 59 people in California whose illnesses were reported to the state this week. The Center for Disease Control and Prevention (CDC) reported 644 cases of measles in 27 states in 2014, the biggest number since 2000. Before common use of measles vaccine in 1963, the story reports, measles infected three to four million Americans a year and 400 to 500 people died.

Stories by Gary Baum of the Hollywood Reporter document childhood immunization rates as low 57 percent and 68 percent in some in some elite preschools in wealthy neighborhoods, numbers that are on a par with immunization in Chad and South Sudan. And nearly 8,000 cases of whooping cough, including 267 that needed hospitalization, had been reported to the state during the first nine months of 2014. Whooping cough, also called pertussis, once killed thousands of people annually, but introduction of the DPT (diptheria, tetanus and pertussis) vaccine nearly eliminated the disease.

During the current measles outbreak, unvaccinated children have been banned from going to public school in Orange County. A Washington Post Wonkblog identifies Orange County as "ground zero in the current epidemic of anti-vaccine hysteria." California allows parents to avoid vaccinating their children by filling out personal belief exemptions, and Baum reports an alarmingly high number of families in many of the wealthiest communities have made that choice. The CDC recommends vaccinations, some of which need multiple doses, against 14 diseases.

Radio station WBUR in Boston reported on a study showing vaccination rates in some states, including Oregon, West Virginia and Colorado, have dropped below the level required for herd immunity. Thresholds differ based on how infectious different illnesses are. The CDC suggests that threshold is crossed for whooping cough and measles when more than six percent of the population is not immunized. Herd immunity means that where a high percentage of the population is immune, the chance of an infected person meeting a susceptible person is low, so disease is unlikely to spread. Diseases spread rapidly among people who are not immunized.

Some parents worry about discredited research linking vaccines to autism, and some have religious or philosophical objections. The National Vaccine Information Center raises concerns about vaccines and the Times story quotes a spokesperson as minimizing the hazard of rejecting vaccination. Why do many resist? A 2014 AP-GfK survey reports only 53 percent of adults are "very confident" that childhood vaccines are safe and effective. The Post Wonkblog notes wryly that's about the same percentage who think houses can be haunted by ghosts.

The World Health Organization, urging universal immunizations, asserts that vaccines save lives and prevent disability, as well as mitigating severity of many diseases, reducing secondary infections. Some vaccines provide protection against related diseases. WHO says, for instance, that measles vaccination protects against multiple complications including dysentery and bacterial pneumonia.

Tags:  buscell  complexity matters  disease  health 

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Community Health Saves Lives and Money

Posted By Prucia Buscell, Thursday, January 15, 2015

A 40 year community-wide effort to promote heart health and healthier habits in a rural low-income county in Maine has resulted in less illness, lower mortality, and millions of dollars in savings according to a study published in the Journal of the American Medical Association. Authors believe the initiative can be widely adapted and that today's new data sources and technologies can make implementation even more feasible than when the program began in the 1970s.

Franklin County Court House

Franklin County Court House

In the late 1960s community groups in Franklin County, which then had a population of about 22,000, identified cardiovascular disease prevention as a priority. A Community Action Agency and Rural Health Associates (RHA), a non profit medical group practice, which were both new at the time, coordinated their efforts with the community hospital. With the hospital's sponsorship, RHA established the Franklin Cardiovascular Health Program (FCHP), which targeted hypertension, cholesterol, smoking, diet and exercise. FCHP used county health data from the past decade as a baseline and compared Franklin with other Maine counties and state averages.

Dr. Daniel Onion, a MaineGeneral Health physician and one of the researchers, told Kaitlin Schroeder of the Kennebec Journal & Morning Sentinel the project was powered by volunteers who worked in the community to help people quit smoking and adopt other healthy behavior. An HPLive story by Gale Scott describes other details. Federal funds were used to start an insurance plan for 3,000 indigent residents. The University of Maine developed a health education degree program and trained local people to be outreach workers. Hundreds of volunteers, including 200 nurses, did health screenings and educated residents. Schools were persuaded to serve healthier meals. A health fitness center with the area's only indoor swimming pool was built with funds raised by the community. Over the years, 150,000 people had an average of five contacts each with a program worker.

A ScienceDaily story reports that between 1994 and 2006 lower than expected hospitalizations saved an estimated $5.4 million per year in hospital charges for Franklin County residents. The program, which continued through 2010, had many successes. Among people with hypertension there was a 24.7 increase in the portion of people in control of their blood pressure. Control of cholesterol increased 28.5 percent. The quit rate for smoking improved from 48.5 percent to 69.5 percent. The overall death rate and the cardiovascular death rate dropped below state levels during most of the study period.

Darwin R. Labarthe, MD, MPH, PhD, and Jerome Stamler, MD, of the Northwestern University Feinberg School of Medicine in Chicago say in a JAMA editorial that the Franklin County experience deserves to be examined and copied. They say the results reinforce importance of disease prevention at the local level. They call on communities to document and publish past experiences in community health to "inform ongoing work and foster wider application of program evaluation and implementation research, exploiting new data sources and technologies to accelerate replication and scaling up of community-based prevention. Intervening developments-not least among them the Affordable Care Act-have made this task clearly more achievable today."

Tags:  buscell  community  complexity matters  health 

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Nature Editorial: Science and Satire Flourish Together

Posted By Prucia Buscell, Wednesday, January 14, 2015

Fanaticism Stifles Satire, Free Speech and Science

The heritage of the eighteenth century French writer Voltaire and the Enlightenment help explain why four million people poured into the streets of France after terrorists murdered 17 people, including eight staff members of the weekly satirical magazine Charlie Hebdo, an editorial in Nature asserts. Crowds in Paris surpassed the size of the demonstrations welcoming allied troops that liberated the city in World War II. The Nature editorial says freedom of speech and satire are crucial in challenging the authoritarianism and dogma that undermine science and scientific inquiry. The editorial also calls for social science research to understand origins of violent fanaticism so that terrorism can be addressed by long term policies and initiatives without relying solely on repressive measures. Read the editorial here. Huffington Post writer Lex Paulson summarizes Voltaire’s message: Tolerate others, think for yourself.

Tags:  news 

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Risk, Randomness and Cancer

Posted By Prucia Buscell, Thursday, January 08, 2015

The risk of developing many kinds of cancer may rely on random luck.

Cristian Tomasetti, PhD, and Bert Vogelstein, MD, cancer scientists at Johns Hopkins University School of Medicine, report in a Science magazine article that many cancers are caused by random mutations that happen when healthy stem cells divide. Cancers are known to result from life styles, inherited proclivities, and environmental exposures, as well as causes that can't be identified. A New York Times story by Denise Grady reports that the authors found chance was a bigger factor than they'd expected. "It was about double what I would have thought," Dr. Tomasetti, a biostatistician and professor told the Times. Basically, the risk of cancer is highly correlated with the number of stem cell divisions over time.

A Johns Hopkins press release explains that Tomasetti and Vogelstein charted the number of stem cell divisions likely to occur in 31 tissue types during an average life span, and compared these rates with the lifetime risk of cancer in the same tissues among adult Americans. Adult stem cells are a specialized population of cells in each organ or tissue that divide or self-renew indefinitely to generate replacement parts as other cells wear out.

The researchers report, for example, that the large intestines have more stem cells than small intestines, and those cells divide 73 times a year, compared with cells in the small intestines that divide 24 times a year. The lifetime risk of cancer in the large intestine is 4.8 percent, which is 24 times higher than the risk of a small intestine cancer. Their calculations show that about two thirds of the variation in cancer risk was explained by the number of stem cell divisions, and about one third is explained by heredity and environment.

They compare cancer with a car accident. The longer the trip, the higher the risk of accident. They say the mechanical condition of the car is a metaphor for inherited genetic factors and road conditions are like environmental factors. We may not know which of these three conditions contributed most to a particular wreck, but well maintained roads and vehicles can reduce overall risks. Knowledge that some factors are beyond our control may reduce stigma and comfort some cancer patients who blame themselves for their illness. Findings also suggest more cancers will appear simply because aging increases the number of stem cell divisions, the authors say in the release, so research on early detection, treatment and the biology of the disease is more important than ever.

Breast and prostate cancers were not included in the study because researchers lacked data on breast and prostate stem cell division rates. Lung cancer cases were divided between smokers and non-smokers, leading some readers to note that smoking also contributes to many other cancers. The American Lung Association reports that smoking causes nearly 90 percent of all lung cancer cases.

In a lengthy blog post on the article, oncologist David Gorski, MD, cites research suggesting one third to one half of all cancers are "potentially preventable," meaning they come from environmental factors that could be altered, such as smoking, alcohol use and weight control. He has some quibbles with the article, and wishes the discussion of it had been more nuanced. Bob O'Hara and GirrlScientist writing in The Guardian complain that too many news stories about the research confuse the variation in cancer risk with absolute risk of cancer, thereby blurring what constitutes bad luck.

Sometimes luck is randomly good. In the press release, Dr. Vogelstein observes cancer free longevity in people exposed to tobacco smoke and other carcinogens, often attributed to good genes, is likely to be good luck.

Tags:  buscell  complexity matters  culture  disease  health  luck  research 

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Some Gene Mutations Are Good

Posted By Prucia Buscell, Thursday, January 01, 2015
Updated: Monday, January 05, 2015

For years, researchers have looked for gene mutations that cause disease. Two scientists who started The Resilience Project have flipped that effort upside down and started looking for gene mutations that protect against disease. Discovery of such positively deviant genes paves the way for drugs that mimic the protective qualities.

A New York Times story by Gina Kolata tells the story of a Port Orchard, Washington, man who has a gene for early onset Alzheimer's. The man's older brother, mother, nine of his mother's siblings, and six cousins began showing symptoms in their 40s, and most died in their 50s. The man, now 65, has no signs of the illness, and researchers are trying to learn whether he has a genetic mutation that is counteracting or substantially delaying the horrifying impact of the Alzheimer's gene that he has.

"Instead of trying to fix things that are broken, let's look at people where things are broken but nature finds a way around it," Dr. Eric E. Schadt, director of the Icahn Institute, a medical research institute at Mount Sinai Hospital in New York, said in an interview with the Times.

Researchers have found many gene mutations that cause disease or predispose a person to an illness, and those seem to be considerably more common than the beneficial mutations. However, with today's fast and relatively inexpensive methods of sequencing DNA, and the ever-growing databases of study subjects whose genomes have been sequenced, scientists can begin to look for the positive mutations. Dr. Schadt and Dr. Stephen H. Friend, director of Sage Bionetworks, a nonprofit research organization in Seattle, are searching databases that hold clinical and genetic information. They are looking for people who, despite having mutations for fatal diseases that strike early in life, have remained healthy far past the age when the illness should have appeared. They have analyzed data from more than 500,000 people, and found only 20 in which a good gene mutation appears to have blocked a bad one. But because no names are attached to the data, the scientists can't contact those people. So they contacted researchers studying extended families with severe genetic illnesses, and they found the Washington man.

Some amazing beneficial gene mutations have already been discovered. One prevents HIV from entering cells and causing AIDS, and that discovery has enabled scientists to treat HIV positive patients by directly editing their cells. Discovery of another gene alteration that prevents build up of LDL cholesterol led to discovery of a drug that is now in the final stage of testing. Researchers using genetic databases have also found mutations in some genes that confer partial protection against heart disease, osteoporosis and Type 2 diabetes.

The Washington man who seems to have defied his dangerous Alzheimer's gene retired recently. He told the Times his life's work now is to help scientists understand the treacherous disease that claimed the lives of so many members of his family.

Tags:  buscell  complexity matters  health  positive deviance  research 

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