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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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Canadian Study: 40% Would Pay Kidney Donors

Posted By Prucia Buscell, Thursday, October 4, 2012

Researchers at the University of Calgary have found a significant public support for financial incentives for kidney donors.

An online survey was conducted with more than 2,000 members of the Canadian public, 339 health professionals, and 268 people who have or are affected by kidney disease. Forty percent of the respondents thought it was acceptable to pay living donors for kidneys, and 70 percent favored some financial compensation such as payment of funeral expenses for donors whose kidneys were harvested after death. However, few respondents favored payments to a deceased donor’s estate.

Interestingly, only 14 percent of health professionals thought it would be a good idea to pay living donors. The study, "Attitudes Toward Strategies to Increase Organ Donation: : Views of the General Public and Health Professionals,” is published in the Clinical Journal of the American Society of Nephrology.

According to a story by Lindsay Abrams in, people who oppose payment most often said they thought "a kidney should be donated from the goodness of the heart.” At the same time, the authors concluded people might be more willing to donate if they were paid. More than half of the respondents who said they would not be living donors to a stranger indicated they’d reconsider if they were paid $10,000.

A U.S. study by researchers at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center asked 342 participants whether they would be more likely to donate a kidney if they were paid differing amounts, $10,000 and $100,000. Promise of cash nearly doubled the number who said they would donate their organ to a stranger. The study was published in the March 16, 2010 issue of the Annals of Internal Medicine.

It is illegal to buy and sell organs in the U.S. and most western countries. The issues involved are difficult, emotional, ethical and complex. The people who die awaiting transplants greatly outnumber the organs available and advocates for increasing the supply argue that a regulated market could avoid exploitation and save lives. There are periodic international and domestic scandals about a trade in human organs. And the 2002 movie "Dirty Pretty Things" directed by Stephen Frears is memorable for its dark plausibility: the story deftly depicts criminals who profit by selling the organs of poor immigrants in London. A writer in the McGill Journal of Medicine asks whether it’s time for western countries to follow the example of Iran, which has long had a government regulated and funded kidney transplant system with an independent third party association to make arrangements and pay the donors.

But a shortage of donated organs is not the only barrier to life-saving transplants. Kevin Sack in a New York Times story September 19, 2012, reports that while 4,720 people died in the U.S. last year awaiting transplants, more than 2,600 kidneys from deceased donors were discarded. Some of the kidneys were found to be unsuitable, but Sack quotes experts who believe as many as half of them could have been transplanted if the U.S. donated organ allocation system did a better job getting the right organ to the right recipient in the right amount of time. The system needs to be revised, according to these experts, to consider better matching in terms of projected life expectancies of recipients and the very tight time frame for testing, evaluation, decisions and transportation. Surgeons want to transplant kidneys within 24 to 36 hours after removal from the donor.

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The ‘Anternet’—Ancient and Cutting Edge

Posted By Susan Doherty, Thursday, September 27, 2012
Updated: Thursday, September 27, 2012

Harvester ants may increase knowledge about networked systems.

Deborah Gordon, a Stanford biology professor who has studied ants for 20 years, found something extraordinarily sophisticated about the way harvester ants forage for food. She discovered that the ant colonies regulate their foraging activities based on the amount of food available and the amount of time it takes for a round trip between the nest and the food.

Harvester ant foragers waiting inside the nest. – photo by Katherine Decktar, one of the researchers

Gordon recognized that this particular ant behavior approximates the way the Internet works, so she invited Stanford Computer Science Professor Balaji Prabhakar to have a look. Their collaboration is described in a Stanford News story about "the anternet” and their paper is published in Plos Computational Biology.

Individual ants leave the nest looking for the seeds, which they immediately bring back and drop deep into the nest. The more food they find, the faster they return. New foraging trips are initiated based on the rate of return from earlier trips. There’s no central control or boss ant, and no geographic information on where the food is located. Some ants leave pheromone trails in their travels, but these ants don’t. What happens is based on local interactions among the ants in the nest. New foraging trips are signaled by the rate of contact between the antennas of returning ants and the antennas of ants available to leave on the next trip.

Initially skeptical, Prabhakar quickly saw the validity of Gordon’s insight. "The algorithm the ants were using to discover how much food there is available is essentially the same as that used in the (Internet) Transmission Control Protocol,” he told the Stanford News.

The Transmission Control Protocol, or TCP, is the way information transmission among networked computers is regulated. As the Stanford story explains TCP, as a source A sends a file to a destination B, the file is broken up into numbered packets. Each time B gets a packet, it sends an acknowledgment, or ack, back to A. Speed of ack return indicates the amount of bandwidth available. If the ack comes back at a lower speed than it was sent, it means little bandwidth is available, and transmission traffic is slowed accordingly. If it returns quickly, transmission speed can increase. That’s pretty much the same thing the ants do.

The researchers found another similarity: When a data link is disrupted or broken, the source stops sending packets. If forager ants don’t get back to the nest in 20 minutes, no more ants leave to forage.

Each ant is limited, but colonies can achieve some impressively complex computations, and they’ve been evolving for millions of years, probably doing things humans haven’t thought up yet. Read Gordon’s wonderful essay "Colonial Studies."

"Ant algorithms have to be simple, distributed and scalable—the very qualities that we need in engineering distributed systems,” Gordon said. "I think as we start understanding more about how species of ants regulate their behavior, we will find many more useful applications for network algorithms.”

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Social Network Analysis Finds Truth in Myth

Posted By Prucia Buscell, Thursday, September 20, 2012
Beowulf wrestles 
with Grendel 
1933 Lynd Ward


An ancient tale tells us the monster Grendel, annoyed by the noise of warriors drinking and carousing in the great mead hall built by the Danish King Hrothgar, was moved to murder them all in their sleep. No one thinks the monster was real, but there may have been a real mead hall. While evidence is lost and blurred by passing centuries, the story of Beowulf, the mythical hero who slew the monster, may be rooted in actual events and places.


Historians, archeologists and literary scholars have long searched for evidence of reality hidden in ancient myths that have been altered and embellished with every retelling for centuries even before they were committed to writing. Now the science of social network analysis is offering new clues about what’s rooted in reality and what’s totally fictional.


Achilles tending the wounded 
Patroclus from The Iliad

A team of physicists mapped the social networks in three ancient narratives by creating a database of the characters and their interactions and categorizing their relationships as hostile of friendly. Beowulf contained 74 characters, The Iliad 716, and the Irish legend Tain Bo Cuailnge contained 404 characters. Padraig MacCarron and Ralph Kenna, physicists at the Applied Mathematical Research Centre at Coventry University in the United Kingdom, describe their work in "Universal Properties of Mythological Networks" from, a Letters Journal Exploring the Frontiers of Physics, and in the New York Times story "If Achilles Used Facebook...."


Scholars think Beowulf, the heroic epic set in sixth century Scandinavia, has historical inspiration. The Iliad’s Greek gods who intervened in a mythical Trojan War with their supernatural powers come from the realm of art and imagination. But the lives and times described may refer to happenings in the 8th century BCE, and archeologists think Homer, writing some 400 years later, is likely to have incorporated re-told and remembered tales of military conflict around Troy at the end of the Bronze Age.


Slays the Hound of Culain 
1904 Eleanor Hull
The Boys' Cuchulain

Many scholars have considered "Tain Bo Cuailnge" completely fictional. Often translated as the Cattle Raid of Cooley, the story tells how the rulers of Connaught make war on Ulster in order to steal a fabulously potent stud bull. Cu Chulain, a 17-year-old, is Ulster’s sole defender. John Bohannon writing in says recent archeological evidence suggests it could be based on real conflict 3,200 years ago in Ireland. Written manuscripts dating from 12th and 14th centuries tell of a fight between Connaught and Ulster in the north and west of Ireland, and social network analysis lends credence to the historical root.


Kenna and MacCarron found the mythical networks have characteristics of real world networks. All three have structural balance, which the authors explain is related to the real-world idea that the enemy of my enemy is my friend. They are small world networks, meaning connectivity among nodes leads to pathways that link a large number of nodes, and there never are more than a few degrees of separation between two people. They are scale free because their structure and dynamics are independent of the number of nodes in the network, and they were also highly clustered, with groups of people who are well connected. In addition, the networks were assortative, meaning that as in the real world, people connect with people who are similar to them.


The authors examined social networks in several intentionally fictional narratives, such as Harry Potter, and found that none were scale free. In most modern fiction, Bohannon explains, minor characters generally link to the main character. Bohannon quotes Kenna as saying that in deliberate fiction, everyone tends to be linked to everyone else in order to make the story easier to follow. Unlike the real-world and studied mythical networks, the fictional networks were disassortative, indicating many connections between unlike nodes.


As the authors explain in their Times piece, their approach is not literary or historical, and tells nothing about the human condition. "Instead,” they write, " it promises a new way to analyze old material and find striking new perspective and evidence-in this case, that which we call ‘myths’ may not be as mythical as we thought.”

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IOM Calls for Continuous Learning in Healthcare

Posted By Prucia Buscell, Friday, September 14, 2012

Today’s clinical practice guidelines suggest a 79 year old woman with osteoporosis, osteoarthritis, diabetes, high blood pressure and chronic obstructive pulmonary disease could be taking 19 medications. Guidelines for osteoporosis suggest she should do weight bearing exercises, and guidelines for diabetes say she shouldn’t.

In 2000, some 125 million Americans suffered from chronic ill nesses. By 2020, that number is expected to be 157 million—32 million more people, in part because of an aging population. Right now, 75 million people in the U.S. suffer from multiple chronic diseases.

The new Institute of Medicine report Best Care at Lower Cost: The Path to Continuously Learning Health Care in America cites these figures to illustrate the many sets of circumstances that are increasing and exacerbating the challenges faced by clinicians and patients. It’s daunting enough that treatment guidelines may be contradictory when a patient has multiple conditions. The report also estimates that individual primary care physicians would have to spend 21 hours a day to provide all the care recommended for their patients’ acute, preventive, and chronic disease management needs. Further, the report quotes a study saying that during a single year, the average primary care physician coordinated with 229 other physicians in 117 different practices just for Medicare patients.

Complexity has increased exponentially. The U.S. healthcare system is characterized by more to know, do and manage than at any time in history, the IOM reports. There were, for instance, more than 200,000 research publications in 2000, and in 2010 new biomedical and clinical knowledge filled 750,000 such publications.

Patients may be beleaguered too. Healthcare costs have increased 76 percent during the last decade. For one of every 14 tests performed, patients weren’t told of abnormal results. The report cites a survey that found 25 percent of patients said tests had to be repeated because results hadn’t been shared among providers who cared for them.

Despite enormous increases in biomedical knowledge and therapeutic and procedural innovation, available knowledge is too rarely applied to patient care and information generated by patient care is too rarely gathered to improve existing knowledge, the report says. For instance, the report notes that in 1982 researchers found that the use of beta blockers after a heart attack reduced mortality by 25 percent. Researchers later found 40 percent reductions in mortality, and the practice was included in professional guidelines in the 1990s. But only in the last five years—a quarter century after the initial discovery—have most heart attack patients been receiving this treatment. The cost and quality of care vary enormously from one state to another, and high cost did not correlate with high quality. If the highest quality had been maintained in all states, 75,000 fewer people would have died in 2005.

While Americans spend $2.6 trillion a year in health care—18 percent of the gross domestic product—some $750 million is wasted. The IOM says that amount could pay salaries of all first responders, including police, fire fighters, and emergency medical technicians for 12 years.

Here is the IOM’s breakdown of estimated wasteful spending:

· Unnecessary services - $210 billion

· Inefficiently delivered services - $130 billion

· Excess administrative cost - $190 billion

· Prices that are too high - $105 billion

· Missed prevention opportunities - $55 billion

· Fraud - $75 billion

To address the complex issues of clinical care, individual and public health and overall cost, the IOM calls for a "continuously learning” health care system. Its characteristics would include:

· In science and informatics, real time access to best available knowledge, and the use of information technology to capture and analyze data from the patient experience

· Engaged, empowered patients and families to work with care providers to promote good health and treatment outcomes

· Incentives for continuous improvement and improved transparency

· Culture in which leaders foster and support continuous learning and supportive system competencies with feedback loops created for continuous analysis and improvement

The full report, a summary, and individual chapters, can be accessed here.

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World’s Worst Environments Intensify Innovation

Posted By Prucia Buscell, Thursday, September 6, 2012

A former astronaut who’s also a physician believes extreme and distant environments are "incredible test beds” for technologies that will advance medicine.

Scott Parazynski, MD, a veteran of five Space shuttle flights, is now chief medical officer for the Center for Polar Medical Operations, which supports the National Science Foundation’s U.S. Antarctic Program. Read about the doctor’s extraordinary adventures and observations in a FastCompany story by Neal Ungerleider.

Dr. Parazynski says he is drawn to remote and challenging environments, and Antarctica may have the worst the world has to offer. It’s almost completely dark for six months, the temperature hovers around minus 70 degrees F. and conditions make air traffic virtually impossible from February through October. Dr. Parazynski says it’s akin to being on Mars, or the back side of the moon, where every act requires forethought and errors can kill. He finds it a rewarding place to work and study.

"I think the drive toward Apollo and the things we got from the lunar program revolutionized medicine,” Dr. Parazynski told Fast Company. "The miniaturization of technologies, sensors, and microelectronics that are now ubiquitous in our intensive care units...the monitors you see... they’re all ‘space pedigree’.”

He says medicine practiced today in remote and harsh places will lead to advances in telemedicine and point of care diagnostic and therapeutic devices, as well as microelectronics, nanotechnology, genomics, and metabolomics. He thinks they will also advance "MacGyver medicine" named after the TV secret agent who had the skills and ingenuity to rescue almost anyone from almost anywhere, creating tools he needed from materials at hand. As one example, Dr. Parazynski describes how Dr. Jerri Nielsen Fitzgerald diagnosed her own breast cancer during the Austral Winter in 1999 when no plane could land anywhere near the Antarctic outpost. She was the only physician there. She performed her own biopsy, with the help of a resident welder who practiced by sticking needles in apples and yams. Chemotherapy drugs were delivered by a dangerous air drop. Her cancer went into remission, but returned in 2005 and she died in 2009.

Dr. Parazynski recommends breaking up any difficult task into manageable parts rather than trying to achieve the whole goal all at once. He says he applied that principle to mountain climbing, medicine, and his early ambition to become an astronaut. He has climbed mountains all over the world, and is the only person to have flown in space and reached the top of Mount Everest.

Alexander Kumar, a physician and researcher at Concordia, a jointly sponsored French-Italian research station in Antarctica, is conducting scientific experiments for the European Space Agency’s human spaceflight program. His studies include examinations of sleep patterns, dreams and nightmares and behavioral and cognitive changes induced by isolation and perpetual darkness. Read his New York Times blog.

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Landscapes and Liberating Structures

Posted By Jeff Cohn, Thursday, September 6, 2012
Updated: Friday, September 19, 2014

Finding the Peak When the Mountain Moves 

I recently attended a Liberating Structures (LS) workshop in Seattle convened by long-time Plexus partner Keith McCandless. Most of you are likely pretty familiar with LS- methods that can be used with almost any size group and that help create conditions to unleash innovation and new actions. As I describe LS to friends and colleagues who aren’t familiar with them, I’m often asked something like "When would I use these methods? Are there certain types of challenges for which LS are particularly useful?” I’d like to provide my perspective on this by reflecting on other aspects of my few days in Seattle.

Summer in Seattle can be beautiful, a real contrast to the grey and damp climate that dominates the weather there most of the year. The clear blue summer skies allow one to take in the natural beauty that surrounds Seattle. Easily visible from the air as we landed and immediately pointed out to the southeast by the driver taking my wife Marcie and me to the car rental facility was the snow-capped peak of Mt. Rainier. This, with a peak of 14,410 feet above sea level, is the most topographically prominent mountain in the contiguous United States. Locals sometimes just refer to Mt. Rainier as "the mountain.” Looking away from Mt. Rainier to the east and northeast are the rest of the Cascade mountains, a huge range of volcanic mountains that rise and fall for hundreds of miles with hundreds of mountains of varying sizes. Within Seattle proper the topography is marked by significant elevation changes as well. The low points at the waterfront are at sea level. Start walking east towards Capitol Hill and you’ll rise and fall steadily, ultimately climbing more than 400 feet in elevation within a mile or two from the coast.

Coming back to challenges and the uses of LS, some challenges are like Mt. Rainier- the top of the mountain representing the highest point, the clear best solution. As you scale the mountain you can fairly easily tell if you’re closer to the peak than where you were- and for similarly identifiable problems you can also, through experimentation, clearly tell when you’re getting closer to your goal, the one optimal solution. If you’re the first one, you’ll need to create a pathway to the top. If others have gone before, just follow that pathway and you’ll get to the peak. Many industrial, factory floor challenges are Mt. Rainier-like challenges- the best machine for the task at hand. Within healthcare there are some Mt. Rainier challenges too. If a patient presents to the emergency department with severe chest pain and is found to be having a major heart attack, the team should try to get that blood vessel that has become blocked open as soon as possible, in order to prevent heart muscle from being irreparably damaged. The faster you open the vessel, the better.

Other challenges are more like hiking through other parts of the Cascades. You may be able to tell when you’re at the top of a peak, though you may have a harder time telling if that peak is higher than another one somewhere else in the range. So local optimums are easy to find, you have to go down first to try and go even higher, and that next peak you climb may not turn out to be higher than the one you left. Given enough exploration, however, you’ll eventually be able to figure out the highest point in the whole area. Experts, like guides, and other help, like technology, can help you get to that highest point. The challenges that are like this are also typically benefited by bringing in expertise and doing lots of designing, planning and experimentation. Staying with the heart attack patient example, howdo you get that patient to the catheterization laboratory to open the vessel in as short a time as possible? That’s like climbing up and down the Cascades, trying to find a higher, better point.

Then imagine a future scenario like this. It’s 1,000 years from now in Seattle. One or more of those volcanic Cascades that nearly abut the city erupts. This triggers a chain reaction and an earthquake of significant proportions. One or more of the hills that populate the city’s landscape has the bottom drop out of it, losing hundreds of feet of elevation. Several days of heavy rains leave areas that were previously hilltops now submerged under inches of water. This "dancing landscape” is related to interdependencies within the system and is associated with surprising changes in conditions. What was once the high point is now something quite different. Things that you were sure were true now are something different. For challenges like this, the quest to get to some higher, "better” point needs to be perpetual, with a focus on constant learning as circumstances evolve and situations change. How do we reduce the risk of our communities needing emergency heart attack services? How do we effectively help patients who have survived heart attacks to modify their lifestyles to reduce future risk? These are examples of dancing landscape challenges.

When your landscape dances you need to dance too. And not just the foxtrot- you may need to cha-cha, or boogie, or twist, or waltz, depending on the situation. Dancing landscape challenges require innovation, diverse perspectives, and the sort of information and feedback that can best be accomplished through connectivity and relationships. These are the results of the use of LS- people think differently, creativity is unleashed, and new relationships are formed that persist and help the system to better deal with its challenges. LS help people to become much better dancers than they ever thought they could be.

I think in healthcare improvement efforts, too many issues are viewed as Mount Rainier or Cascades challenges, and we search for the ultimate highest point, as though there is always some best practice that will be the optimal solution for everyone. That’s fine for some problems- not all landscapes dance. Sometimes implementing the checklist is the way to go. How can we augment those approaches by helping organizations recognize the cues that it’s time to dance --to hear the beat, feel the rhythm emerging, and to see the swirling patterns of color and movement that means we should get up, get together, and, by using methods like LS, join the dance?

Tags:  catching butterflies  cohn  healthcare  liberating structures 

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Social Trust Predicts Better Disaster Recovery

Posted By Prucia Buscell, Thursday, August 30, 2012

When it comes to coping with catastrophe, the density and strength of social networks is more important than wealth, education, or culture, according to a political scientist whose research on the topic was animated by personal experience.

As Gulf Coast residents struggle with flood and destruction from Hurricane Isaac, Daniel P. Aldrich is reminded of the seven year anniversary of Hurricane Katrina’s devastation. He’s an associate professor of pubic policy at Purdue University who was teaching at Tulane in 2005. He and his family evacuated to Houston right before their New Orleans home was destroyed. He decided to study how communities respond to calamity, and he writes about his findings in a New York Times column "How to Weather a Hurricane."

An earthquake struck the region around Kobe, Japan, in 1995, killing 6,400 people and setting more than 200 fires. In Mano, residents self organized a bucket brigade to fight fires. In nearby Mikura, people watched in horror as their homes and businesses burned. Residents of these two urban neighborhoods were similar in age and economic class, but Mano residents had forged social bonds and trust through civic and volunteer activities, including collective efforts to fight pollution. Mikura residents lacked that history.

Aldrich found something similar in the Indian state of Tamil Nadu after the 2004 tsunami in the Indian Ocean that impacted 13 countries, killed a quarter of a million people, and left two million homeless. He learned from people in the city of Nagapattinam that villages where residents had formed and maintained relationships with local officials and foreign aid workers recovered better than equally impoverished villages where residents did not have those relationships. The restorative value of social capital also showed up in the aftermath of earthquake, tsunami and nuclear meltdown around Fukushima, Japan in 2011, he reports.

He argues that social doesn’t always happen naturally, but it can be built. The Japanese government sponsors Matsuris, or local festivals, where people gather and meet one another. He says some US cities have sponsored such local events as part of disaster preparedness. A "Sister Cities" initiative in Seattle and San Francisco is enabling local officials to share disaster preparedness ideas and experiences with officials in similar cities in China, Korea and Vietnam. Aldrich also asserts that "community currency" programs, which reward volunteers with tokens that can be traded for goods and services, have been shown to strengthen social networks.

A successful form of community currency, also called complementary currency, was used in the impoverished city of Curitiba, Brazil. In the 1970s, garbage piled up in shantytowns where the streets were too narrow for trash trucks. There was no money for a physical fix, so officials offered residents bus tokens and plastic chits exchangeable for food and other goods if they brought garbage to bins placed outside the neighborhoods. Eventually, more than 70 percent of households participated, an under-used bus system prospered, improved transportation increased employment, the neighborhood was clean, recycling increased, children had school supplies and improved nutrition, and general health and quality of live got better, all with minimal cash outlay.

Aldrich is the author of Building Resilience: Social Capital in Post-Disaster RecoveryListen to his lecture here and learn what voter turnout says about social capital and coping in disaster.

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Language Ripens, Dies and Springs Forth Anew

Posted By Prucia Buscell, Thursday, August 23, 2012

Despite globalization of film and television, the Internet, world-wide telephone capabilities, and continual travel, we aren't losing distinct regional speech. In fact, linguists say American dialects are actually diverging and thriving.

In a story at Slate, Rob Mifsud writes that 34 million people in cities that ring the Great Lakes are revolutionizing the sounds of the English language. Linguists began noticing a change in the articulation of vowel sounds in those cities in the 1960s, Mifsud writes, and in 1972, three linguists led by William Labov of the University of Pennsylvania called the phenomenon the Northern Cities Shift (NCS). Lebov thinks it may be the most important change in the last thousand years. Think you know how to say caught, cot, cat, bet and but? There's no right or wrong, but it will sound different depending on where you live. Linguists aren't sure about reasons for the changes, and no one is sure how they will evolve.

Labov thinks the new trend may be rooted in the multiply accented versions of English that immigrants brought to the region when they came to build the Erie Canal in the late 1800s. Linguists think NCS began with a change in the way people move their tongues to produce a short "a" sound. As Labov explains, "language is a set of connected items," and that causes all the other vowels to move around "something like a game of musical chairs." So people in Detroit work at a jab, not a job, they roll out the cat, not the cot, for a guest to sleep on, and ride home on a boss rather than a bus. And some flat As, as in flat, grow another syllable, as in "fleaht."

Today's English speakers would need extensive study to comprehend the language of Chaucer. The larger Great Vowel Shift that brought about the modern pronunciations of A, E, I, O and U, began about 1400, and the sounds remained pretty stable for centuries. Until now. In his writing and lectures, the linguist John McWhorter talks about the how language continually changes-eroding, re-growing and emerging, as words shift in meaning, structure, usage and sound, in ways we rarely realize at the time.

Dennis Preston, a linguistics professor from Oklahoma State University noticed when he was teaching in Michigan that NCS speakers there were oblivious to their own distinctions of speech. Mifsud describes an experiment in which NCS speakers hearing a list of words spoken by a person with NCS accent could not distinguish between cat and cot. His story explains that to Preston, the reasons are that people think their own speech is standard and normal, and they reject evidence to the contrary: "They reject it in their daily lives, and they reject it experimentally. They don't even understand themselves."

Allan Metcalf writes in the Chronicle of Higher Education that a traditional eastern New England accent, in which the "r" after a vowel is dropped, as in "New Hampsha," is becoming less common. In New Jersey, some people have "cawfee before wawking the dawg," but some listeners say there the line between a south Jersey and north Jersey accent is shifting. Visit the International Dialects of English Archives to hear samples of speech from each state. Listen to Lebov here.

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Sloth Kills: Should Doctors Prescribe Exercise?

Posted By Prucia Buscell, Thursday, August 16, 2012

Physical inertia is unnatural and unhealthy, a Mayo Clinic physiologist asserts, and physicians need to combat what The Lancet recently called an "inactivity pandemic.”

Mayo Physiologist Michael Joyner writing in this month’s Journal of Physiology suggests physical inactivity should be recognized as a mainstream medical diagnosis and doctors should prescribe exercise.

"The entire medical research industrial complex is oriented towards inactivity,” Dr. Joyner told NPR. "Physicians really need to start defining the physically active state as normal.”

In an NPR health blog Eliza Barclay notes that insurance companies will reimburse patients for medicines for diseases related to inactivity, but rarely for gym membership. Barclay says Joyner figures about 30 percent of the responsibility to fight inactivity should fall on the medical community. He says the two greatest public health triumphs of the last century were improved traffic safety and reduced smoking. Doctors and the public health community influenced those achievements, he argues, and the same model could be used for widespread behavior change to reduce destructive sedentary habits.

The World Health Organization estimates that 3.2 million people die each year, including 2.6 million in low and middle income countries, because of physical inactivity.

I-Min Lee, a professor of medicine at Harvard Medical School, says inactivity will contribute to 5.3 million premature deaths this year, about the same number of premature deaths caused by smoking. Dr. Lee is the lead author of a study on physical activity, non-communicable disease and life expectancy published in The Lancet. The article reports that worldwide, inactivity causes from six to eight percent of the burden of disease from coronary heart disease; seven percent of type 2 diabetes, 10 percent of breast cancer, 10 percent of colon cancer, and nine percent of deaths before age 60. A MedicalDaily story by Nikki Tucker notes inactivity also increases susceptibility for fibromyalgia, chronic fatigue syndrome, and postural orthostatic tachycardia syndrome, also known as POTS, in which a person experiences dizziness or flu-like symptoms when standing or exercising. Joyner says in his article that exercise training has been shown to reduce or reverse POTS.

A NewScientist story by Andy Coghlin cites a study by Gregory Heath of the University of Tennessee who examined interventions around the work that worked to promote physical activity. Among them are more than 100 cities in South America and some in the U.S. that periodically close certain roads to vehicular traffic to make way for bikers, skaters, runners and pedestrians. The movement, called Ciclovia, which translates as bike path, started 30 years ago in Bogota, Colombia, where traffic is banned on certain streets 72 days out of the year.

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A New Way to Predict Financial Network Collapse?

Posted By Prucia Buscell, Thursday, August 9, 2012

Scholars who have studied global financial institutions say it’s more important for policy makers to figure out which ones are too connected to fail than ponder whether some are too big to fail. Their findings also suggest those with the potentially riskiest interconnections aren’t necessarily the biggest.

The risk of default of a large segment of the financial system depends on the network of exposure among financial institutions, the scholars say, but to date no widely accepted way of identifying the most important nodes in the financial network has been established. In a paper in Nature’s Scientific Reports, Stefano Battistan, Michelangelo Puliga, Rahul Kaushik, Paolo Tasca and Guido Caldarellui, who are economists and physicists, describe a method they have devised to figure out which banks and institutions are the most connected and therefore the most dangerous if they fail.

Josh Rothman, in the Brainiac blog at, explains that the financial system is deeply interconnected, because banks borrow from, lend to, and own pieces of one another. In the complex financial network, the nodes are the institutions and the links are financial dependencies. The scholars created a measure called DebtRank, loosely inspired by Google’s PageRank algorithm, to analyze a huge amount of data gathered by the Federal Reserve from the $1.2 trillion FED emergency loan program to global financial institutions during 2008 -2010. The scholars found that 22 institutions, which received the bulk of the funds, formed a strongly interconnected network in which each node was systemically important. As a result, they say, a systemic default could have been triggered by small dispersed shocks. Read their paper, "DebtRank: Too Central to Fail? Financial Networks, the FED and Systemic Risk." The paper and blog show network maps of the top borrowers.

The authors note that more data would be needed to establish a fully accurate DebtRank, and much information is unavailable because of confidentiality in banking transactions. Rothman notes greater transparency in the financial system would help. The authors say their work and the DebtRank measure contributes to understanding financial networks and is also relevant to regulators and risk management practitioners. In addition, they say the work is relevant to the field of complex networks in general, and can be used to "detect systemically important nodes in any directed and weighted network.”

The Financial Stability Oversight Council, the nation’s largest financial regulatory agency created by the Dodd Frank Act, is not mentioned in the blog or the article. But it is mandated to evaluate "interconnectedness” among other characteristics such as size, scope, concentration and mix of activities in determining whether certain nonbank financial institutions could pose a threat to U.S. financial stability and therefore require enhanced supervision. Risk identifiers and measurements continue to be a work in progress.

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