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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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Surprising Links between Friendships and Genes

Posted By Prucia Buscell, Thursday, July 24, 2014

We tend to choose friends who share our interests and outlooks, but our selections may have less conscious and more ancient roots. Recent research suggests friends share genetic similarities and that resulting social networks play an important role in human evolution.

In their paper "Friendship and Natural Selection," published in the Proceedings of the National Academy of Science, Nicholas Christakis, a physician and social scientist at Yale, and James Fowler, a professor of medical genetics and political science at the University of California at San Diego, write that the number of genetic markers shared by two friends is about what they would have if they were fourth cousins.

That amounts to about one percent of a human's genetic markers. That doesn't sound like much, but Fowler explains in a Washington Post story that has huge implications for human evolution. Researchers found the genes that friends have in common seem to be evolving faster than other genes, so our social environments and social networks could be a key evolutionary force.

There's no gene for friendship, and no way to predict friendship among people because of a particular genetic trait. But the genetic data of two people provides clues to whether they will become friends. The researchers developed a genetic "friendship score" that suggests the likelihood of friendship. Individuals don't consciously recognize these similarities, but they are statistically measurable in huge data sets.

Friends are likely to share genes associated with the sense of smell. Being drawn to the same scent could attract us to certain environments, the authors suggest: people who like the smell of coffee might be drawn to coffee shops where they meet others who like the smell. The authors think our sense of smell may be one of the mechanisms humans use to identify genetically similar friends, though they emphasize more research is needed to discover how that happens.

Christakis and Fowler examined genetic information and details of social relationships documented among nearly 2,000 people who participated in the Framingham Heart Study that began in 1948. They and colleagues analyzed nearly 1.5 million markers of gene variations, and compared the data for pairs of unrelated friends and pairs of unrelated strangers. Because nearly all the people in the study had similar European origins, the findings weren't explainable by the tendency to gravitate to others of similar background.

Interestingly, friends are less likely to share genes associated with immunity to specific diseases, the authors note, and that that could be an evolutionary advantage. We're somewhat less susceptible to the things that sicken our friends.

In their book Connected, Christakis and Fowler write that social networks are in our genes. After studying friendship networks among 1,110 twins drawn from national health data of 90,115 adolescents, they discovered that social network structure was influenced by genes: kids located at the center of their networks had a different genetic makeup than those located at the periphery, and those whose friends were closely connected had different genetic make than those with friends in divergent groups.

In the new paper they discuss the role of genes in a broader social environment where we interact and collaborate with friends and strangers. "Our results support the idea that humans might be seen as metagenomic not just with respect to the microbes within them, but with respect to the humans around them. It may be useful to view a person's genetic landscape as a summation of the genes within the individual and within the people surrounding the individual, just as in certain other organisms."

Tags:  buscell  complexity matters  relationships  research 

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Do Mobile Devices Derail Human Empathy?

Posted By Prucia Buscell, Thursday, July 17, 2014

Networked technologies allow us to be "in a persistent state of absent presence" that can erode empathy and connection, according to Virginia Tech researchers.

In fact, researchers found just having a mobile device within easy reach-even if you're not holding it or using it-can lessen the quality of a face to face conversation, reduce empathy among friends, and deflect our attention from what is happening right before our eyes.

"Mobile phones hold symbolic meaning in advanced technological societies," a research team led by Shalini Misra of Virginia Tech wrote in an article in the journal Environment and Behavior. "In their presence people have the constant urge to seek out information, check for communication and direct their thoughts to other people and words."

In the study, 200 participants were divided into pairs and asked to chat for 10 minutes on either a meaningful topic or a trivial one. Nearby researchers recorded their nonverbal behavior and the presence or use of any mobile device at any time during the conversation. Afterwards, participants were asked about their feelings of personal connectedness and empathy with their conversational partners. When a mobile device was visible, participants rated the encounter less fulfilling and less empathetic. That finding held for trivial and substantial topics, and the negative relationship between the presence of devices and empathy was even more pronounced when the conversation was between people who knew each other. Apparently the mere presence of a mobile device can derail the natural empathy between friends.

Earlier research by Andrew Przybylski and Netta Weinstein of the University in Essex in the UK produced similar findings. Pairs of strangers conversed while seated facing each other. A nearby table, out of their direct line of vision, held a book and one other item. When the other item was a cell phone, participants reported lower connectedness and a lower quality encounter than when the other item was a notebook.

Research by Sara Konrath and colleagues, reported in Scientific American and at the University of Michigan website, indicates college students of today are less empathetic than they were 30 years, ago, and that empathy has declined the most in the last decade. Konrath conducted meta-analysis combining the results of 72 different studies of American college students between 1979 and 2009. While reasons are uncertain, researchers note the trend has accompanied the rise of social media and mobile communications.

But scientists say those results aren't necessarily discouraging. They show our brains are plastic and subject to experiential influence. And as Konrath writes in a Psychology Today blog, mobile communications can make people feel closer to distant loved ones, and that they have tremendous still fully untapped potential to help people manage physical and mental illnesses. She notes that paradoxically the same technology associated with our being stressed and distracted can be used for people to provide electronic encouragement, kindness and support to each other.

Tags:  buscell  complexity matters  connection  culture  engagement  relationships 

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It’s Not Unusual

Posted By Jeff Cohn, Wednesday, July 9, 2014
Updated: Friday, September 19, 2014

Jasper Palmer died last week. He was a patient transporter at Einstein Medical Center in Philadelphia for more than 20 years. Jasper and I became connected closely in 2005 when Einstein became a participant in the Positive Deviance/MRSA project, facilitated by Plexus Institute. The role of the patient transporter is to do just that: transport patients throughout the medical complex to wherever they need to go. When that patient is identified as harboring the "superbug" MRSA, preventing the bacteria from spreading during that transport is quite a challenge, one that even experts from the CDC hadn’t figured out. We recognized that working with the transporters and asking them how to transport MRSA-positive patients could uncover solutions and barriers of which we weren’t aware.

Jasper emerged as a leader when he pointed out a significant barrier to safe contact with these patients. MRSA-positive patients are placed in "contact isolation,” meaning that staff entering their rooms are required to put on gowns and gloves prior to entry. Jasper noted that trash cans were often overflowing with gowns that had been worn and disposed. This left the next person entering with a dilemma - does one do the right thing by wearing a gown, only to have no reasonable place to dispose it? Or does one avoid the disposal problem, take a risk, and perform the patient task without a gown? Not only did Jasper identify the challenge, he developed a solution that worked for him that could work for others. See him demonstrate his simple solution in the video.

Given a forum to share his concerns and solution, Jasper took it upon himself to help others learn this approach. He would stop physicians facing the disposal dilemma and tell them, "I think I have a method that could help.” He worked with his transport colleagues to develop safer methods of transporting patients, even those connected to ventilators and monitors. Not everyone adopted the Palmer Method. However, it garnered attention to the challenge and ultimately investments were made in different disposal apparatus that could accommodate the large volume of gowns being disposed much more effectively than the small, rigid trash cans in place before.

We wound up referring to Jasper as an "unusual suspect.” By this we meant he wasn't a typical infection prevention expert (i.e., physician, nurse, pharmacist). We learned that we needed to look beyond the usual suspect to those unusual ones, from which diverse perspectives and new innovations would emerge. Instead of asking, "whom do we need to involve?” we asked, "who doesn’t need to be involved?” and then tried to engage everyone else.

Upon learning of Jasper's death, I began to think about the concept of unusual suspects. On reflection, it strikes me as, while well intentioned, a bit demeaning and indicative of our fixation with hierarchy and position. Jasper had served his country in the military, was a family man, had worked at Einstein for many years, had lots of friends, and cared about patients. Why wouldn’t we think someone like him could be beneficial to our improvement efforts? Using this lens, who would qualify as someone unlikely to be a source of new behaviors and ideas, an unusual suspect? Someone wedded to the status quo? No, there are likely many benefits of the current state that deserve preservation. A skeptic? No, their contrary position can help expose blind spots. Maybe a good example is a content expert who is unwilling/unable to see any other perspectives. In the case of our MRSA work, those would typically be clinicians and the same people we initially thought would be our key contacts.

Jasper, I think you've taught us all a critical lesson. Anyone- no, everyone who cares about a challenge, who wants to be involved in any way, and who is willing to share collaboratively can be a useful contributor. In fact, we depend on the diverse perspectives of many to discover and create the solutions for our big challenges. Thank you, Jasper, for helping us to appreciate the wisdom that lies within our networks. Your legacy will live on through the work we and others you've touched carry forward.

Tags:  catching butterflies  cohn  healthcare  positive deviance  relationships 

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The What and the How

Posted By Jeff Cohn, Wednesday, May 15, 2013
Updated: Friday, September 19, 2014

The Washington Post from April 28, 2013 carried an article by Ezra Klein, "If this was a pill, you’d do anything to get it.” The author describes the recent work of Health Quality Partners (HQP), based in Doylestown, PA, focusing on improving healthcare outcomes and reducing expenses for Medicare patients with at least one chronic illness and one hospitalization in the past year. HQP has been part of a series of demonstration projects that emerged from the 1997 Balanced Budget Act that evaluate methods that aim to "improve the quality of items and services provided to target individuals and reduce expenditures.” Of the 15 funded programs, four improved outcomes but not costs. The HQP program was the only one to improve both. The initiative’s primary intervention has been the use of a nurse to visit enrolled Medicare beneficiaries weekly or monthly, whether they are sick or well. The HQP initiative reduced hospitalizations by 33% and Medicare costs by 22%. And now CMS is planning to eliminate the funding for the program.

Mr. Klein decries this policy decision, which is based on the unwillingness (or inability) of CMS to make the program permanent or to expand it to other populations. CMS plans to "integrate lessons from this experience” into designs for new scalable projects. The article describes how CMS pays for some very expensive, technology-based interventions without much scrutiny on their supporting evidence, while overlooking the successes already achieved through low-cost, non-technical interventions in small initiatives like HQP. He wonders what additional benefits CMS might accrue if they "took the lessons of HQP and used them to seed 15 more programs.” The HQP program has not had much of a budget. What if there were real resources? Couldn’t we get even better clinical and financial benefits?

As I read this I thought about a phrase we’ve used often to describe the effectiveness of the PD approach in improving outcomes: "It’s not the what, it’s the how.” What really are the "lessons of HQP?” Some might look exclusively at the end product and say, "do more of that- send more nurses to elderly, chronically ill patients’ homes in my community at least once a month” and assume that will achieve the same benefits. Others (like me) might look at the path that led to the HQP end product for the lessons. Maybe there are simple rules that are scalable, things like:

· Lead with confidence, curiosity, and humility (HQP’s founder, Ken Coburn, is reportedly this type of adaptive leader)

· Forge strong relationships with the community, and have them as thought partners

· Employ trusted members of the community to build healing relationships with the people being followed

· Ask the people what they need and help them develop skills to play a role in meeting that need

We all seem to be looking for the "solution,” the "magic bullet” that will cure what ails us. But what if it’s the "how” that is really the solution- what if it’s doing important work together, learning and evolving, that really matters?

Tags:  adaptive  catching butterflies  cohn  community  relationships 

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Relationship-Centered Living

Posted By Jeff Cohn, Tuesday, February 19, 2013
Updated: Friday, September 19, 2014

My mom, Natalie, died last week, following a short ending to a lengthy illness. As family and friends came together to remember her and her life, one of the dominant themes that emerged was how critical relationships were to my mom. Several vignettes were particularly impactful to me in describing how skilled she was in forging relationships and what tremendous value emerged from those connections.

My brother Rich recalled a day when he was 7 or 8 when he accompanied my mom on some routine errands. He observed that what, for some, would have been the onerous tasks of dealing with an ill-tempered postal worker or waiting in a lengthy line in the bank before cashing a check, for my mom were opportunities to meet new people which, hopefully, would lead to ongoing relationships. A cheerful observation of how the weather was beautiful was enough to distract the postal worker from his drudgery and engage him in a brief but meaningful interaction. Both he and my mom remembered that, and her next visit for stamps prompted a smile from him- a sign that they had a real relationship. The wait in the bank line turned into an opportunity to meet the people standing in front and behind her. When she demonstrated she was willing to share with them information about herself, like where she grew up, how long she had lived in the neighborhood, her invitation for them to do the same resulted in a mutually beneficial conversation, where information might emerge that could be the foundation of a future friendship.

While she was in the hospital in her final days, she continued to form new relationships with skill and grace. As new healthcare providers introduced themselves for the first time she asked if they could show her their identification badge. She explained, "By seeing your name in addition to hearing it I’ll be better able to greet you by name when you’re here next time.” This simple request meant that she was interested in truly connecting with them as individuals- not some generic nurse/resident/therapist, but as the person with a name and a story that they really were. The day before she died was Super Bowl Sunday. My dad and I stepped out for a few minutes to grab lunch. When we returned we learned from my mom that the attendant who had delivered her lunch tray (I forget his name, but she named him by name) was a 49ers fan. She shared with him that she was rooting for the Ravens and why (my nephew Dan attends University of Delaware where Joe Flacco, the Ravens quarterback had gone). They mutually agreed they’d continue the conversation the next day, discussing how their teams fared. Think of how easy it would have been for that brief encounter to have come and gone without any real information being shared. Instead, my mom ended her life just as she had lived it: extending herself to another in an effort to begin a relationship that would continue, evolve, and provide joy and meaning for both parties. Of all the lessons I learned from my mom, the value of relationship-based living is probably the most important.

Tags:  catching butterflies  cohn  relationships 

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Good Social Skills May Have Helped Dogs Evolve

Posted By Prucia Buscell, Thursday, February 7, 2013
Updated: Tuesday, February 12, 2013

If you think your dog understands your moods as well as your commands, you’re probably right. No other species has dogs’ capacity to read and respond to our communicative gestures or dogs’ child-like ability to learn word meanings, a canine researcher says.

Brian Hare is an associate professor in the Department of Evolutionary Anthropology and the Center for Cognitive Neuroscience at Duke University. He is also founder of the Duke Canine Cognition Center. Hare and his wife, Vanessa Woods, co-authored a new book, "The Genius of Dogs."

In a Scientific American story by Gareth Cook, Hare explains that dogs’ ability to interpret our gestures to please us and get what they want makes them terrific social partners, whether the activity is hunting or just navigating everyday life. Further, he says, their ability to interpret "helps them solve problems they can’t solve on their own.”

Some veterinarians rate dog intelligence by how easy a breed is to train. Hare dismisses the idea that there are smart and dumb dogs. He says while people think dog intellect differs by breed, and different dogs and good at different things, the genetic differences are miniscule. Are dogs empathetic? Hard to say, because they can’t describe their feelings, Hare says. But he says research has found they get a boost of oxytocin, the love hormone, when humans hug and pet them. What about guilt? Hare says research by Alexandra Horowitz suggests dogs may react to an owner’s distress or disapproval rather than the idea they have sinned. And how did our loveable companions evolve from dangerous predatory wolves? Hare thinks friendliness just may have an evolutionary edge.

While research by Hare and others has found dogs generally are very good at learning meaning of words, they aren’t much good at spacial intelligence. In a Wired Magazine story by Greg Miller, Hare says dogs tend to get befuddled if their leash wraps around a tree, and they have trouble recognizing the physical limits of a leash.

Hare has launched a new company called Dognition. For a fee, you can find games and tasks that will produce a profile of your dog’s strengths and weaknesses. Hare told Wired that at the same time, you’ll be contributing to science because the social skills of dogs, which have in some ways exceeded those of our closest primate relatives, may have much to teach us about how our own social skills evolved. He also thinks research can help train dogs to better help people, such as the blind and disabled. He hopes information from a vast numbers of dogs world wide will further canine science. He conceded to Wired that it’s not conventional for participants in citizens’ science, which relies on collective action and crowdsourcing, to pay. He says people are paying for expertise and technology that provides dog owners a new way to find out about their own pets in their own homes.

In Wall Street Journal piece Hare and Woods write that while cats have twice as many neurons as dogs do in their cerebral cortex, they have nowhere near the social skills. If you’re convinced the special qualities of cats are under-rated, read Pam Belluck’s New York Times story about cats who have found their way home despite distance and hardship. The navigational skills involved have baffled scientists.

Tags:  buscell  complexity matters  connection  learning  relationships 

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Neighborhood Effect Shapes Our Lives

Posted By Prucia Buscell, Thursday, January 10, 2013

The character of a neighborhood-strongly expressed by how much people help and trust each other-may influence its collective health and economic survival even more than such obvious indicators as income levels and foreclosure rates, a long-term study suggests.

Harvard sociologist Robert J. Sampson believes it is vitally necessary to understand the neighborhood environment, not just the characteristics of individual residents. In 1994 he became the scientific director of a 15-year-study based on interviews and surveys in 80 economically diverse Chicago neighborhoods. His new book, The Great American City: Chicago and the Enduring Neighborhood Effect is based on the research.

A New York Times story by Benedict Carey describes the community resilience of Chatham, an African American community on Chicago's South Side that has weathered economic recession and recent violence. Carey describes how the community rallied when Thomas Wortham, a young off-duty police officer, Iraq war veteran, and long time resident was fatally shot after leaving his parents' house one night in May 2011. Family members, friends, and police officers gathered in Cole Park, near the scene of the murder, and stayed, signifying their support of keeping the picnic areas and playgrounds safe for families and out of the hands of the badly-behaved. Crime in the area stopped afterwards, according to analysis by Sampson, though it rose again in 2012, which has been a violent year in Chicago.

In an interview with Marc Parry in the Journal of Higher Education, Sampson explained that his research team followed more than 6,200 children and families wherever they moved in the US, and interviewed 12,000 city residents. Sampson hopes the twenty-first century will be an "era of context." The Chicago study exemplifies "ecometrics," which Sampson calls the new science of context.

The team collected exhaustive data on businesses, civic organizations, clubs, nonprofits, churches, local leaders and officials, networks, and the extent of collaboration among them. Researchers recorded physical and social details they saw in public spaces. In a video, Sampson describes some of the findings and correlations. In areas where homicides were high, child health was poor. Areas most highly segregated in the 1960s had the highest foreclosure rates today, so history matters. People were asked whether they would help an injured stranger on the street. In their "lost letter experiment" researchers scattered stamped, addressed envelopes in neighborhoods across the city and measured the rate of return. High rates of return came from the same areas where people would help an injured person.

What does Chatham have that some similar neighborhoods lack? One thing is a "social efficacy," or social cohesion, which Sampson says seems to protect cities from internal and external adversities. Chatham has more than 100 block groups and citizen volunteers who organize events as well as monitoring neighborhood tidiness and noise. It ranked second among Chicago black communities on how frequently people worked together for common goals such as organizing events or fund-raising for a cause. It ranked first among all neighborhoods on questions about how highly residents valued and enforced respectful behavior by children. The Times story notes it also has small residential and commercial business buildings, few of them more than three stories high. That makes communication easier, and means one abandoned building is less trouble than a partly vacated apartment complex. Nearby neighborhoods with lower social efficacy and cohesion, even though they have newer developments and more young professionals, have been slower to recover from recession and reduce crime.

"The specific neighborhood has a personality that affects all aspects of social life, the choices we make about where to live, about how much disorder we'll tolerate, about how we raise our kids," Sampson told the Times. "Large scale forces like recession of course matter, but they are moderated by local neighborhood factors, whether you're in Chicago or Stockholm or other cities."

Tags:  buscell  community  complexity matters  relationships 

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Vital Signs: Taking the Measure of Clinical Teams

Posted By Jeff Cohn, Wednesday, October 17, 2012
Updated: Friday, September 19, 2014

Last month I attended the 11th International Conference on Complexity in Acute Illness in Ottawa along with former Plexus President Curt Lindberg. The conference was primarily focused on developing applications of the theories of Plexus Advisor Ary Goldberger, who has described the complexity of normal heart and lung physiology, and how a loss in that complexity could indicate emerging illness. Numerous speakers, representing disciplines of critical care medicine, surgery, informatics, mathematical modeling, and physics, described how these concepts could potentially lead to earlier recognition of potentially reversible illness. Patient populations described included critically ill infants, burn patients, major trauma patients, and adult patients on ventilators, just to name a few.

At the same conference we heard a presentation from Curt Lindberg about Billings Clinic and how focusing on changing and improving relationships is leading to healthcare delivery innovations. John Scott, MD, described his research on what patients and physicians have mutually agreed are "healing relationships” that involve factors such as mindfulness, valuing, appreciating power, and abiding. And Heather Mattila, PhD, from Wellesley, presented some of her research regarding the role of diversity in ensuring the health of honeybee colonies.

This caused me to think about the convergence of factors associated with restoring seriously ill patients to health. These patients are connected to numerous monitors that give important information to the group of clinicians providing care. Soon we may have additional monitoring capabilities to identify loss of complexity, which could enable caregivers to respond earlier and provide more effective rescue care. But then what? Once team members have the information, they need to go into action to provide the care the patient needs. And how do we know whether, at that moment, the team is "healthy” enough to provide that care? What is the status of the relational coordination (the subject of a recent Plexus call) of the team providing care? What is staffing like? Fatigue? How quickly are clinicians responding to their patients’ changes in condition? What if we had the ability to stream this kind of information together and have that displayed on monitors, reflecting the unit’s "health?” Maybe the unit’s vital signs are as important in determining the outcomes of care as the vital signs of the patients for whom they’re providing care. Please share any thoughts or ideas you have below, or email me at

Tags:  catching butterflies  cohn  complexity  health  healthcare  relationships 

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Got a Problem? Get a Group! For People and Birds, Diversity Aids Solutions

Posted By Prucia Buscell, Thursday, May 7, 2009
Updated: Tuesday, February 15, 2011

People in groups have been shown to solve problems faster than individuals. Now researchers have found the same is true of house sparrows, and for birds too, diversity is key.

Andras Liker and Veronika Bokony of the University of Pannoniain Hungary tested the theory experimentally by presenting the sparrows with a bird feeder that had been modified with lids covering the food wells.The birds were familiar with the feeder, but had to figure out how to open the newly placed lids to get at the food. Liker, an evolutionary biologist, and Bokony,adoctoral student, observed the birds, in groups of six and in pairs,trying to get at the food. The groups of six opened four times as many lids, and did it 11 times faster than the birds in pairs.Their findings are described in an article in The Proceedings of the National Academy of Sciences and featured in a New York Times story and

They report that the greater success of groups was not only a result of a greater number of tries, but related to higher effectiveness of a group. House sparrows are very social birds, and like many social creatures they have a range of differing abilities and personalities. Liker and Bokony concluded that diversity accounted for the greater success of the group—a group of six is more likely to have members with differing skills and experiences, which increases the chance of bringing more approaches to the problem at hand.

Several studies have shown that group living benefits animals because they are better able to avoid predators and more successful finding food. Fish in shoals forage more efficiently than a few stragglers. Cooperation has been documented in many animals. Researchers from theUniversityofCambridgefound two rooks could team up to pull strings to reach as tray of food that was inaccessible to a lone bird.Less research has been done on problem solving by animals in larger groups, though even small groups of people have been shown to solve problems better than individuals.

Researchers from the University of Illinois found that three or more people solve intellectual puzzles faster than individuals or pairs. The pairs performed at the level of the more capable of the two individuals, but all groups of three or more performed better than any of the pairs, and all the groups performed better than their best member would have performed alone.Liker’s and Bokony’s research shows house sparrows in groups perform better than pairs in tackling new problems that require inventing new strategies.

Tags:  buscell  complexity matters  diversity  nature  relationships 

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