Complexity Matters

On The Edge Nursing in the Age of Complexity-3rd Annual Conference on Complexity and Nursing

2009-07-12T19:11:00.000-07:00

Marjorie Wiggins, Vice President of Nursing at Maine Medical
Center, a 650-bed hospital, recalls being in the emergency room on a busy night when patients seemed to be arriving by the dozens. The waiting room was filed. Nurses were unable able to move admitted patients. The emergency department might have to be shut down and patients might have to be diverted to another hospital. Yet records were showing 12 empty beds. What happened? All the housekeepers went to dinner at the same time to give a shower for one member of the staff.

Housekeepers returned to work, prepared rooms, and the threatened shut down and diversion were avoided. But the incident illustrates the extraordinary interdependence of all players in complex modern healthcare systems. One principle of complexity is nonlinearity—small things, like an unusual dinner hour, can have very large effects. Ms. Wiggins discussed the challenge of change and new roles for nurses in today's turbulent healthcare environment. She was one of the presenters at the July 12 -14 Plexus Institute conference at St. Joseph's College in Standish, Maine.

While conventional models have emphasized the role of experts, the partnership model adopted by Maine Medical Center emphasizes the strength of all agents and the mutual relationships of all involved in patient care. The idea, she explained, is that while the nurse as professional caregiver is the expert in some clinical information, "You, the patient, are the expert in you, your family, and your resources."

The concept has created many changes in practice. For instance, nurses traditionally prepared patient information reports for the next shift in a small room behind the nurses’ station. Under the partnership model, the shift change information is delivered at bedside, in the presence of patients and family members, and often with contributions from multiple medical providers. Patient safety checks often are done at the same time. The results, said Ms. Wiggins, include improved patient satisfaction and knowledge. In addition, careful and respectful language to patients and among staff is practiced and becomes habitual.

Studies have shown that patients often do not understand their medical conditions and medication, and patients who are not prepared to manage their own care are often readmitted to the hospital, Ms. Wiggins said. Preventable readmissions within 30 days of discharge waste billions of dollars every year. Using a redesigned discharge process, nurses double time spent preparing patients for discharge from eight to 16 minutes. Families are present when possible, and nurses explain medication, provide devices such as a pill box or alarm when necessary, and help uninsured patients find ways to get their medications. Another change allows families to be present, if the patient so desires, during "codes"--the emergencies when patients lives are in danger. "Dying is part of the life process," Ms. Wiggins observes, "but we often don't bring families in." For those fearing litigation, she added, law suits actually decrease when families are present, because they see that providers did all possible for their loved one.

Ms. Wiggins also described the new role of clinical nurse leaders (CNLs), master's degree level nurses who follow the most vulnerable patients through their entire hospital stays, keeping track of care and treatment during their interactions with countless people as they are moved from one department to another in a hospital. She said CNLs have improved patient care by seeing that patients get what they need, and they have saved money by identifying patterns that show some procedures and practices that don't help patients can be eliminated.

Claire Lindberg, professor at The College of New Jersey School of Nursing presented a brief primer on Complexity Science. She emphasized the interdisciplinary nature of the science, which has influenced scholarship in biology, economics physics, the social sciences, anthropology, management and mathematics, as well as nursing. Complexity is not one theory, she said, but many. Dr. Lindberg briefly described complex adaptive systems and complex responsive processes, as well as such central complexity concepts as self organization, emergence, and distributed control. For fuller treatment of this material, see the chapter she wrote with Curt Lindberg in On the Edge, Nursing in the Age of Complexity, edited by Claire Lindberg, Curt Lindberg and Sue Nash.

Bruce West, chief scientist in the Mathematical and Information Directorate of the Army Research Office, talked about the history of ideas, the roots of complexity science, and the vital importance of understanding variability. One of his recent papers, Why Six Sigma Science is Oxymoronic, argues that eliminating variability is counterproductive in research environments and in human systems generally. The mathematician Carl Friedrich Gauss (1777 – 1855) developed the law of averages that became the bedrock of all statistics we learned in school, Dr. West said, “and it is wrong.” At the end of the 19th Century, the economist and philosopher Vilfredo Pareto asked new questions and looked at data in a new way. He discovered the power law distribution of income, and his work introduced a world view more consistent with the principles of complexity science. Mathematical and averages that create a “normal” distribution curve work fairly well with a subject like human height, which has restricted intervals within a fairly small range. An "average" adult of five feet nine inches tall won't meet another adult twice his height, Dr. West explained. But he could easily meet someone with five times his income. (If Bill Gates were in a room with five minimum wage workers, the average of their incomes would be meaningless.) Income distribution, consumer behavior, weather systems and any system where outliers can dominate requires an understanding of power laws.

Dr. West gave several examples of how averages can distort reality. For instance, the “average” scientist has 3.2 published citations a year. But 35 percent of scientists have no citation, and 90 percent publish less than the average. The scientist who has 3.2 citations is actually in the top four percent for published citations.

Sixty years ago scientists began developing revolutionary ideas about the organization of living networks, he explained, and recent advances in complexity science have dealt mathematics of complex networks. He said complex systems are most robust when they are confronting problems they have evolved to solve. He spoke of, habituation, negative entropy, how two complex systems might influence each other, and the need for more scientific exploration of complexity science. The “take home” message, he advised conference goers, is that the best way to influence complex networks is not direct force or dominant authority. The best influence can be delicate and direct, he said, but the influence must match the network in complexity.

Dr. West has written scores of papers, journal articles and books. His book Where Medicine Went Wrong explores how misuse of averages in human physiology have delayed understanding the role of variability in healthy human systems. Lack of variability, he has asserted, leads to the morgue.

When in Rome Do as the Romans--Sage Advice or Doorway to Doom?

2009-06-26T06:55:00.000-07:00

Can conformity lead to mass extinction?

Some scholars think it can, and has. Hal Whitehead of Dalhousie University, Halifax, Nova Scotia, Canada, and Pete Richerson of the University of California, Davis, believe excessive conformity can prevent the adaptability and innovation needed to survive during periods of rapid environmental change. In fact, they think conformity may have contributed to the demise of the Mayan civilization in southern Mexico on the eighth and ninth centuries, and the Norse settlements in Greenland 1,000 years ago.

Their theory is described in the story by Dan Jones ,"Conformist May Kill Civilization" in Nature News. The scholars modeled how different learning strategies fare in different learning environments, and found that under certain circumstances societies can be doomed by conformist social learning. For example, a "red noise environment" is one in which the environment is stable for long periods then undergoes major changes suddenly in unpredictable ways. They say that pattern has characterized many historical periods. And that's when rampant conformity bodes ill. The ability of humans to learn from each other, to imitate and emulate, has helped societies function and keep chaos at bay, and the story explains that social learning is more efficient than having individuals waste time learning what other around them already know. But the story also points out that "Rapid change puts a premium on the capacity of individuals to learn through exploration and experience, and to adapt their behavior accordingly."

"During long periods with only modest amounts of change, conformist social learning is a more successful strategy than costly individual learning," says Richerson, but he adds, "The mix of individual and social learning that evolves during the quiet periods of red noise environments tends to have too little individual learning to cope with the rarer big changes." Luke Rendell, a biologist at the University of St. Andrews in the UK,. thinks it is plausible that excessive conformity can collapse civilizations. "People might find it difficult to believe that humans, in all their complexity, would do something so stupid as to copy themselves to extinction," he says, "but in my view that may rely on an overly rosy view of human omnipotence. What matters to most people is how they are doing as individuals right now, and longer term considerations are very easily pushed down the priority listing."

Whitehead and Richerson argue societies should promote individual learning and innovation over social conformity. They also suggest "prestige bias", meaning that people copy successful role models rather than just indulge in unselective imitation, can be helpful. They say, however, testing their models requires more knowledge about how people really use learning strategies before further testing can be accomplished.

Over the years, scholars have developed many theories about the crash of the Mayan civilization and the demise of Norse settlements in Greenland. Whitehead and Richerson believe entrenched conformity and social inertia may have played a role in the inability of both populations to cope with harsh environmental and ecological changes and societal adversities.

As Ralph Waldo Emerson said, "A man must consider what a rich realm he abdicates when he becomes a conformist." And in the words of a Chinese proverb, one dog barks at something, and a hundred bark at the bark.

But how can we nurture innovation and individuality while still supporting the useful conformity that promotes and order, a body of standard knowledge, and some consensus on manners and values?

The Neurochemistry of Time Influences the Workings of Mind

2009-06-11T14:23:00.000-07:00

The American physicist John Archibald Wheeler observed that time is what prevents everything from happening at once. Researchers are now beginning to suspect that impaired time perception is important in a wide range of psychological ills.

A June 10 New Scientist story by Andy Coghlan reports that children with attention deficit hyperactivity disorder (ADHD) have a hard time with time. He cites a study by Katya Rubia at the Institute of Psychiatry at King’s College London who suspected time perception might influence the short attention spans and impulsive behavior of children with ADHD. Researchers used MRI scans on 12 boys who had ADHD, and discovered below normal activity in the frontal lobe, basal ganglia, and cerebellum, brain areas thought to be critical for time perception. Those boys were also less adept at estimating time than 12 boys without ADHD. Interestingly, their time estimates improved after getting Ritalin, which boosts dopamine levels in the brain and is a drug commonly used to treat ADHD. The research is published in the Philosophical Transactions of the Royal Society.

For a child with ADHD, a few minutes of sitting still can seem like endless torment. Unusual and risky behavior stimulates dopamine, scientists say, and Rubia thinks that when kids with ADHD engage in hyper and disruptive behavior, they may actually be self medicating.

Some scientists have divided our time-keeping abilities into three domains, according to a livecience.com story by Robert Roy Britt, “The Human Brain Seen as a Master of Time.” The circadian clock keeps us in sync with a 24 hour night and day cycle. Another clock operating on a millisecond level controls movement and speech and other vital functions we don’t consciously think about. Neuroscientists think a lesser known middle mode “interval timing” clock helps us manage functions that require seconds, minutes and longer periods of concentration.

Duke University neuroscientists Warren Meck and Catalin Buhusi, who is now with the Medical University of South Carolina, found that interval timing ability seems to be faulty in non-medicated Parkinson’s patients. They note that people who have Huntington’s disease, depression or mania also have been found to have impaired time perception. In addition, researchers have found faulty time perception in persons with schizophrenia. Researchers think drugs to influence the neurochemistry of time have potential to treat many disorders.

But out own thoughts, too, influence our understanding of time. Just think of the old sayings: time flies when you’re having fun and a watched pot never boils. And stress is a factor: One study showed smokers and non smokers were equally accurate in estimating time in an experimental setting. But when the smokers went cold turkey for 24 hours, their estimates deteriorated.

Time is the school in which we learn,

Time is the fire in which we burn.

Delmore Schwartz, "Calmly We Walk Through This April’s Day"

Scientists Probe the Mysteries of Scaling:The Math Applies for Mice, Elephants and Cities

2009-06-05T08:16:00.000-07:00

What does the borough of Manhattan have in common with a mouse? As Steven Srogatz explains it, they are “variations on a single structural theme.”

In a guest column in The New York Times, “Math and the City,”. Strogatz describes similar patterns mathematicians have seen in social and biological systems. Strogatz is a professor of applied mathematics at Cornell University, His books include Sync, The Emerging Science of Spontaneous Order, and The Calculus of Friendship: What a Teacher and Student Learned about Life While Corresponding about Math, to be published in August. Melanie Mitchell, in her book Complexity: A Guided Tour, offers a lucid discussion of power laws, fractals and scaling, and why a tiny mammal and big city can operate on the basis of similar underlying principles.

Fifty years ago, Strogatz writes, George Zipf, a Harvard linguist who had studied word distribution in various pieces of writing, looked at size distribution of cities and found that in any country, the biggest city is always about twice as big as the second largest, and about three times as big as the third, and that the size and rank pattern is one that continues. Strogatz adds that, amazingly, the law has held in different countries, different cultures, and in different time periods. Xavier Gabaix wrote an in depth discussion of Zipf’s law for cities in the August 1999 issue of The Quarterly Journal of Economics.

Scientists don’t agree on why Zipf’s law seems to work, but new research has been done this decade on the mathematics of cities. Mathematicians have been looking at how size affects infrastructure. Studies have been done, for example,. on the number of gas stations, miles of roadways, and length of electrical cable. It turns out that bigger is greener, and that all of these resources decrease, on a per person basis, as city size increases. Strogatz says these resources all grow in proportion to a power of the population that is pretty close to three fourths.

Now comes another amazing fact that Strogatz thinks is not likely to be coincidental. The metabolic needs of animals grow in proportion to body weight raised to the 0.74 power. Mitchell explains in her book how three scientists, James Brown, an ecologist at the University of New Mexico, Brian Enquist, a biology graduate student, and Geoffrey West, a theoretical physicist, collaborated to probe the mystery of ¾ power scaling. They suspected that in living creatures, the answer might lie in the branching networks of blood vessels that carry nutrients to cells and the branching structures of the bronchi in the lungs that carry oxygen to blood vessels. Mitchell explains, with elegance and detail, that fractal structure is one way to generate a power law distribution. She says the three scientists developed a mathematical model of blood vessels and bronchi as “space-filling” fractals, and discovered that, as body mass rises, metabolism decreases, and that the metabolic rate scales with body mass to the 3/4 power. In other words, a mouse will consume more energy, per pound, than a person or an elephant, and there is a mathematical formula that calculates how much more. Further, fractal networks of living creatures and resources in cities may generate similar power law distributions. Mitchell’s stories of decades of biological research andmathematical reasoning are fascinating, and she discussed the intricate math in her chapter notes.

In a cover note for Complexity: A Guided Tour, Strogatz, wrote, “Finally! For years people have been asking me where they can learn the basics of complexity theory. Now I’ve got the answer. Read Melanie Mitchell’s book.”

"Crowdsourcing" and Crisis Mapping: Technological Ingenuity Makes it Happen

2009-05-29T16:18:00.000-07:00

After the disputed election of President Mwai Kibaki in December 2007, violence and looting swept the normally stable country of Kenya, killing hundreds of people and displacing thousands. News from conventional sources was temporarily unavailable. In the midst of the chaos, a small group of tech savvy young Africans created a real-time reporting system that has since been used for relief efforts in other crises and natural disasters.

Erik Hersman, a self-described geek and power networker who grew up in Kenya and Sudan, tells the story in a TED interview. In three days time, Hersman, Ory Okolloh, a Kenyan native with a Harvard law degree, and Juliana Rotich developed free software that allowed anyone with a cell phone to report what was happening on the ground to a website where the collective information was available to aid workers and relief agencies. Ushahidi, which means testimony in Swahili, has simplified technology so that any one can use it, and it takes advantage of what Hersman calls the “default device of Africa”, the mobile phone. Some 59 percent of the world’s cell phones were in the developing world, according to a 2006 Washington Post story, making cell phones the first communications technology in history to have more users in the developing world than in industrially developed countries.

Ushahidi uses crowdsourcing to gather information during unfolding crises. Listen to Jeff Howe, one of those who coined the term, for a discussion of crowdsourcing. Ushahidi can collect information from hundreds of people. A web administrator receives the information, and can call back some contributors seeking verification, send out a blast alert to a large number of people, post the information on a web page with location information from Google maps, or do all three. It has been used to help coordinate relief efforts after earthquakes in Peru and China, to monitor Indian elections, and to track swine flu. Ushahidi has received a $200,000 grant from the John D. and Catherine T. Mac Arthur Foundation.

A team led by Patrick Meier, a doctoral fellow at the Harvard Humanitarian Initiative, posted an analysis of crisis mapping during the post election violence in Kenya. The team found that mainstream media reported actual death counts before citizen journalists, but did not report incidents and early warnings that led to the deaths. Citizens reported early violence before main stream media. Ushahidi reports documented important violent events mainstream and citizen journalists missed, and also covered a wider geographical area.

Hersman’s vision is not only to have real time reporting used for humanitarian aid around the world. His team is working on a “crowdsource filter” that he thinks will be able refine and weigh information and allow system administrators to determine the probability of its accuracy. It’s interesting, he observed, that this innovative technology is coming from Africa, from young smart developers in places one wouldn’t expect.

Sixth Annual Unite For Sight Conference: Insights and Innovations in Public Health

2009-05-15T12:02:00.000-07:00

Goals for a dignified and decent life on our planet have been enunciated three times in the last 60 years, and timetables and accountability are the only hope of achieving them, in the view of Jeffrey Sachs, an economist, professor and director of the Earth Institute at Columbia University.

In 1948, the Universal Declaration of Human Rights had profound significance around the world as people tried to recover from the ravages of World War II, Sachs said. In 1978, the Declaration of Alma-Ata proclaimed health as a fundamental human right. In 2000 the UN Millennium Development Goals constituted an international agreement to reduce extreme poverty, disease and hunger by the year 2015.

The goals have not been met, Sachs said, but the wisdom of the documents is still alive, and like all great documents they need to be renewed and refreshed by each new generation.

“The goals declared at the start of the new millennium were full of hope and renewal,” Sachs said, asserting that security, safety, health, and educational opportunity, as well as freedom from conflict and preventable disease, are basic human rights. Rather than defining poverty in terms of dollars, he added, the document recognizes that extreme deprivation is multi-dimensional and needs to be addressed in a multi-dimensional way.

It is inexcusable that nine million children die before their fifth birthdays, when nearly all of those deaths are caused by extreme poverty, Sachs declared, adding it is a disgrace that children die of malaria for lack of a $5 bed net, that women and infants die because of unsafe childbirth, and that pandemic, parasitic, infectious and controllable diseases cause suffering, blindness and death.

“We need to keep these goals alive, and hold leaders accountable. That is our most important tool,” Sachs said. “We need international leadership. The new world is multi-national, and any solution needs to be cooperative….We are networked. The joy of our time is that we can cooperate in ways we couldn’t even think about in the last century.”

Corporations, businesses, nongovernmental organization, universities, scientists, civil society and individuals can collaborate and create partnerships to find solutions, he said, adding that he sees himself “as a plumber, making connections across these areas, finding ways to make the pipes fit.”

Sachs was a keynote speaker at the Unite For Sight sixth annual Global Health Conference at Yale University April 18-19, 2009. Unite For Sight is a nonprofit organization founded to empower communities worldwide to improve eye health and eliminate preventable blindness. The conference drew more than 2,200 participants from 50 states and 55 countries and a multitude of disciplines, to exchange ideas in all areas of public health and international development. Presenters included physicians, nurses, professors, organizational development practitioners and workers and specialists from dozens of public health-related fields. The following summaries represent just a few of the presentations and discussions at this extraordinary event.

Idealism is Not Enough

Nicholas Kristof tells a cautionary tale about cassava farming in Nigeria.

He recalls that he and his wife worked on a farm where women were raising cassava they ate and sold. Their cassava bed had a low yield, so they welcomed the opportunity for a new variety of the plant that yielded five times more crop. But they didn’t have the time or equipment to harvest it all. Further, the cassava plants absorb mercury and arsenic in areas where it remains in the ground from earlier gold mining operations, and the plant itself has naturally occurring chemicals that trigger production of cyanide. So the increased processing was polluting the ground water. The crop, however, was making money, and men decided they should be in charge of a cash crop. So they took over the operation, and the women were left with nothing.

“Idealism is not enough,” Kristof said. “You need grass roots understanding. There is a danger of making things sound too easy. Ideas are easy. Acting on them is a difficult. And you need to learn form your mistakes.”

Kristof, the Pulitzer Prize winning New York Times columnist who has written stories about human suffering and courage in remote trouble spots all over the world, urges would-be activists, “When you think you know what’s happening, back off. Travel in grass roots areas, find a cause larger than yourself, and get out of your comfort zone. You have to be bewildered.”

Kristof addressed the Unite For Sight conference last month at Yale. People are sometimes dubious about whether aid interventions work, he said, but they are necessary and they can help. See his May 13 column “What A Little Vitamin A Can Do” to combat unnecessary blindness among people in Africa.

Grass roots efforts tend to work best, he said. Great effort has been expended since 1970 to reduce female genital cutting in Afghanistan, he said, but conferences and new laws have had little impact. What helped a great deal was getting girls to school. Politics also may not be helpful. In combating AIDS, he noted, conservatives want abstinence and liberals want condoms, but the most effective approach may be something else. Girls in school who have learned the AIDS rate among middle-aged men are less likely to become involved with “sugar daddies”, despite the economic pressures to find financial help from older men. Kristof was one of several presenters who observed that when girls are educated and women have more social influence, poverty declines. More money is spent on children and small businesses and less on alcohol, prostitution and other vices.

Years ago, Kristof said, a New Yorker donated $100 to educate bright girls in a Chinese village he had written about. The bank erred, and gave the village $10,000. On a return visit 15 years later, Kristof found girls’ education and scholarships continuing, and many more educated young women holding good jobs, starting businesses, and educating their siblings.

Infectious and Chronic Diseases: Today’s Health Threats

Susan Blumenthal, MD, a former US Assistant Surgeon General who is a professor at Georgetown and Tufts University Schools of Medicine, spoke of trends and changes, not all reflecting progress. In 1969, she said, the US Surgeon General declared the battle against infectious disease had been won. Today, she said, the greatest health threats world wide are infectious disease and chronic disease.

Since 1972, she said, more than 32 new infectious diseases have emerged, and 1,500 people die every hour world wide from infectious disease. When people and animals live in close contact, pathogens flourish, and modernization and international travel facilitates dissemination. Climate change and extreme temperatures also foster emergence of new diseases that are water borne, air borne, and carried by rodents and insects. She added massive forest cutting promotes lymes disease in humans.

“We need public health policy that focuses on chronic disease,” she said. “We need to combat childhood obesity: 24 percent of our kids are over weight, and diabetes is becoming epidemic.” Inactivity, which contributes to obesity, impacts every organ system in the body. She added that one fifth of American children are shorter than children of a decade earlier. Published reports have documented that Americans are no longer the tallest people the world.

Disease and “Socioemergence”

A collection of interacting economic, political and environmental processes over several decades may have facilitated the movement of the viruses, Simian Immunodeficiency Virus SIV and Human Immunodeficiency Virus HIV, from nonhumans to humans. Rebecca Hardin, PhD, an assistant professor at University of Michigan’s School of Natural Resources and Environment has studied “socioemergence”, the political and cultural dimensions of emergent viral diseases in Africa’s equatorial rain forest. From 1890 to 1930, she said, the area was under brutal colonial control, with forced labor drawn from small villages for logging and road building. Because the environment does not lend itself to raising cattle, workers were fed wild game. In later decades increased hunting and a growing trade in wild game meat was a threat to African wildlife in the Congo Basin, where the populations of chimpanzees and other primates plunged. Continued road construction from remote areas and human migration increased environmental pressures. Researchers found high HIV prevalence among women in commercial logging areas, and theorized that their vulnerability was related to the social and economic networks created by the industry. The Bushmeat Crisis Task Force website says wild game commercialization is a human as well as natural tragedy: loss of animals means endangered livelihoods and food insecurity for indigenous and rural populations most dependent on wildlife in their diet, and bushmeat consumption is increasingly linked to deadly diseases like HIV/AIDS, Ebola, and Foot and Mouth disease.

Mosquitoes and Malaria

Malaria is a preventable and curable disease that kills a million people a year, most of them children in Africa. Marcelo Jacobs-Lorena, PhD, a malaria researcher and professor in the department of Molecular Microbiology and Immunology at the Johns Hopkins School of Public Health, is seeking ways to increase the arsenal of weapons against mosquitoes. Mosquitoes bite an infected person, then pass the malaria germ to the next person they bite. Bed nets offer some protection for people sleeping. Insecticides bring resistance, Dr. Jacobs-Lorena said, and as soon as all the mosquitoes in an environmental niche are killed, more will come to fill the niche. A malaria vaccine does not yet exist. “We will never conquer malaria with a single approach,” he said. “We will have to do multiple things.”

Dr. Jacobs-Lorena’s research involves genetically modifying mosquitoes so that they will be resistant to the pathogen and unable to transmit it. That has been achieved, he said, and the next step, still being researched, is to spread the resistant gene to the rest of the mosquito population.

"Let the people Lead"

Pamela Lynam, MD, is country director for JHPIEGO in Kenya. (That’s pronounced Ja-pie-go-, and its one word, not an acronym.) In her Unite For Sight presentation she stressed letting people lead the way toward health in urban slums. By 2030, she said, three of every five people on earth will be living in cities, and 95 percent of urban growth is in the developing world. One third of all urbanites world wide live in slums, and 72 percent of African urbanites are slum dwellers.

The characteristics of slums, she said, include poor quality health care, lack of access to a hospital, lack of access to public services, good drinking water, and sanitation. “You’ve heard of the flying toilets of Nairobi? People use plastic bags and then throw them,” she said. “Sixty percent of the people live on five percent of the land. And officially, they are not there, so they have no rights where they live. No one has to supply them with water, electricity, or anything else.” Such conditions promote distrust between communities and health services that do exist, she said, with real issues of insecurity and neglect. Breakdown of traditional social structures in urban slums mean large numbers of HIV deaths, children given to neighbors, violence, and very sick patients.

The traditional approach to aid, she said, has been to have experts tell people what they need. The better approach, used by JHPIEGO and many others, is to let people define their needs, and have aid directed towards fulfilling the needs. For example, she said, in one large slum near Nairobi, an aid organization offered to bring people clean water, and was surprised to find what they really wanted. “People said that’s fine, we do want clean water,” Dr. Lynam said, “ but first we’d like covered bus stops, because we get soaked waiting for buses to go to work.”

The community-owned JHPIEGO intervention included anti-rape training, peer education, a village health committee, and a community theater. A community garden is generating small income and better nutrition. A self-defense group made a map of their own community showing places where people can get medical help and counseling, and its members have helped victims of rape and other crimes file police reports so that suspects are charged. They have also traveled to other communities to help others address their local needs.

“Great things happen when people start to respect and appreciate each other,” Dr. Lynam said. “The key is having people come up with their own solutions, and building trust, which takes time and patience, as well as enthusiasm and energy. You have to have a local staff. Consumers do know their own health challenges, and the results are sustainable because they come from all stakeholders.”

Dr. Lynam added that monitoring and evaluating aid programs is a very big challenge that carries with it the need for flexibility from policy makers and donors.

Women as Change Agents

Educated, empowered women are society’s change agents and the key to community health, said Jill Lester, president and CEO of The Hunger Project, a non profit that fights poverty not by direct aid, but by mobilizing women and forming partnerships with government. The organization operates in eight countries, using an “epicenter strategy”, in which clusters of villages that have up to 20,000 people work together to improve health, education, sanitation, or start small businesses. “If a woman can earn enough income so that her family goes from one to two meals a day, it changes her relationship with her husband,” Ms. Lester says. “The whole family changes if the mother has enough money for her family to eat.” She described a group of women in Senegal used a small loan to begin manufacturing a vitamin supplement for children using millet and nuts. In the process they learned skills in nutrition, hygiene, marketing and finance. A women who was illiterate a year ago now takes pride in being able to read her Bible, have soap and water in her house, and handle money without being cheated.

Destruction and Building Back Better

The Chinese got it right, Neil Boothby says: Crisis does represent both danger and opportunity. The aftermath of the devastating Indian Ocean tsunami that struck just before Christmas 2004, killing more than a quarter of a million people, also brought some beneficial legal and social changes.

Boothby is a professor and director of the Program on Forced Migration and Health at Columbia’s Mailman School of Public Health, addressed a session entitled The Epidemiology of Human Rights. He has studied efforts to protect children and families in war and disaster, and described several positive changes that developed from viewing emergency responses through a human rights-based lens. For one thing, he said, the tsunami was a tipping point for cessation at the time of civil war in Sri Lanka and Indonesia In Aceh, an emergency response framework resulted in establishment of family tracing and legal changes to protect children. New laws banned children from leaving the country alone so that child kidnapping and trafficking was greatly reduced. Police patrolled bus stations and created special desks in police stations for women and children. Before the new laws, only eight percent of children accused of crimes had lawyers, so a child who stole a piece of fruit would receive the same treatment as one who committed a felony. After the change, 71 percent of accused youngsters were represented, and the rudiments of a juvenile justice system was begun. In addition, 82 percent of children who were separated from their families in the disaster were placed with families or reconnected with relatives as a result of a family search program. Under the old system, orphanages would recruit and pay families for bright children with good academic records. A large Muslim nonprofit organization that formerly supported orphanages is reexamining its policies.

In Sri Lanka, a proliferation of orphanages came to be viewed as a secondary cause of family separation. Government and non-government agencies have started finding ways to reduce institutionalization of children, and to create safe recreational space where large numbers of children can be reached with basic social supports. Social spending has been increased in Sri Lanka and Indonesia since the tsunami.

Violence Against Women

Marie Skinnider, MD, Health Advisor to Medecins Sans Frontieres/ Doctors Without Borders, Canada, described the “consequences of gender-based violence in Papua New Guinea,” which has one of the world’s highest rates of domestic and sexual violence. One of her patients, in the first trimester of pregnancy, was gang raped while walking across a field in mid-afternoon. She had returned to her parents’ home because of domestic violence, and it appeared her husband had arranged the attack as revenge for her leaving him. Dr. Skinnider cited national survey data showing 67 percent of wives say they have been beaten by their husbands, and 60 percent of men say they have participated in gang rape at least once. The violence, she said, is generated and reinforced by the low standing of women in society: women are regarded as property of their husbands, and there are traditions of bride price and polygamy as well as a history of compensation and retribution attained at the expense of women. These social forces contribute to men being pressured by their peers to control women in their homes. Many women do not feel empowered to seek medical help, Dr. Skinnider said, and lack of transportation also prevents many women from going to health clinics.

Liberation Medicine in Education and Action Toward Health For All

Lanny Smith, MD is Professor of Medicine in the residency program of primary care and social medicine at Montefiore Medical Center, Albert Einstein College of Medicine in The Bronx, New York. He sees patients from the Highbridge and Morrisania sections in the Bronx, communities that are predominantly Hispanic and African American and that have extremely high poverty rates. He is also assistant director of the Human Rights Clinic for Victims of Torture and founder and president of Doctors for Global Health. He explains that liberation medicine has its roots in theology, psychology, ethics, education and liberation movements. The clinic design is inter- and multi-disciplinary, community-oriented and bottom-up, risk-taking, compassionate, and uses a praxis—practice in action—model. Online resources include Social Medicine and the People’s Health Movement. In a discussion after his presentation, he stressed the importance of careful listening and action learning. He cited Daniel Levin, who was acting assistant US Attorney General when he voluntarily endured waterboarding to decide for himself whether it constituted torture. He decided it did and later lost his government job.

Health Disparities and Startling Similarities: Life and Death in Baltimore and Bangladesh

2009-05-15T11:56:00.000-07:00

The United States ranks second out of 177 countries in per capita income—behind Luxembourg—but 34th in the survival of infants to age one. The United States spends $5.2 billion a day on healthcare, more than any other nation in the world, yet ranks 24th among the world’s 30 most affluent nations for life expectancy.

The US infant mortality rate is on a par with that is Croatia, Estonia, Poland and Cuba. If the rate were equal to that of first-ranked Sweden, 21,000 more American babies would have lived to see their first birthdays in 2005.

The US has five percent of the world’s population and 24 percent of the world’s prisoners.

Those numbers come from The Measure of America, 2008-2009, an extraordinary report produced by the American Human Development Project. Sarah-Burd Sharps, co-director of the project, explained the organization’s report maps the level of human development—described by life expectancy, access to knowledge, and a decent standard lf living—in terms of history, geography and congressional district. Ms. Burd-Sharps addressed last month’s Global Health Conference at Yale University sponsored by Unite For Sight.

It’s not only international disparities that are shocking: the report document stunning disparities within ethnic, economic and regional sectors of the US.

For example, Ms. Burd-Sharps said, Asian American women have a life expectancy of 88.6 years, whereas African-American women have a life expectancy of 76.3 years. Asian American men live an average of 83.6 years but the life-expectancy for African American men is 69.4, a difference of 14 years. The average life expectancy in Washington, DC, is 73.8years, whereas a person in Hawaii, where the life expectancy is 81.7 years, can expect to live eight years longer. The infant mortality rate in the nation’s capitol is 11.4 for every 1,000 live births. In Vermont the same rate is 4.7.

Ms. Burd-Sharps said US healthcare spending made up six percent of the gross domestic product in 2006, and 95 percent of that spending went to treatment rather than prevention. We ration care by who can pay rather than who is in need, she said, and the infant mortality rate suggests we do a poor job protecting future generations.

Rebecca Onie, JD, is co-founder and CEO of Project Health, an organization she helped create to break the link between poverty and poor health. The Project maintains family help desks in clinics in Boston, Providence, New York, Baltimore and Chicago, where trained volunteers work with healthcare professionals to identify conditions that impact patients’ health. They have food pantries and offer help, and follow-up, with applications for employment, food stamps or better housing. We tend to think of serious problems existing abroad, she observed, yet some challenges in US healthcare are strikingly similar to those in the developing world. Policymakers need to understand the need for infrastructure changes, she said. “Doctors know they are prescribing inhalers and antibiotics to children when there is no food in the house,” she said, adding that a February 9 article in the McKinsey Quarterly discusses the need for clinical leadership in healthcare.

In comparative terms, she said, “We have one doctor per 20,000 villagers in Sub-Saharan Africa, and domestically we have one social worker for every 16,000 visits to Harlem’s children’s hospital, and on the south side of Chicago 60,000 patients a year get the services of one social worker.”

She offered some dramatic parallels between Bangladesh and Baltimore:

In Bangladesh, life expectancy is 63.1 years. In Baltimore, it’s 62.5. In Bangladesh, there are 20 low-birth-weight babies—those who weigh under five pounds, eight ounces—for every 1,000 life births. In Baltimore, there are 15. In Bangladesh, the adult illiteracy rate is 52 percent, and in Baltimore it is 40 percent.

The Measure of America Report has a section examining the social, economic and environmental reasons for the infant mortality rates and life expectancy in Baltimore. A Baltimore Sun story by Annie Linskey reports a 20 year difference in life expectancy difference between an impoverished Baltimore neighborhood, where it is 63, and a wealthy section of town where it is 83. The Southwest Baltimore Health Profile 2008 published by the city department of health and the Johns Hopkins Bloomberg School of Public has similar analysis. The figures in different reports vary slightly because they are compiled differently, but similar stories emerge.

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

2009-05-07T09:30:00.000-07:00

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 Pannonia in 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, a doctoral 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 scienceblogs.com.

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 the University of Cambridge found 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.

Eating Too Much? You May As Well Be Running a Hummer in Your Kitchen; And Can Pollutants Make Us Fat?

2009-04-24T13:36:00.000-07:00

Obesity is bad for the planet, according to a study in the April 19 issue of the International Journal of Epidemiology.

The authors, Phil Edwards and Ian Roberts of the London School of Hygiene and Tropical Medicine, say that because food production contributes substantially to global warming, slim individuals and lean populations have lighter carbon footprints than those who are overweight. For instance, the school’s press release on their work says, a slim population, such as is seen in Vietnam, consumes 20 percent less food and produces fewer greenhouse gases than a population in which 40 percent of the people are obese. The researchers estimate that a population of one billion slim people would produce 1,000 million fewer tons of carbon dioxide equivalents in a year than a population of a billion overweight people. Heavy people not only eat more, it takes more energy to transport their weight, and they are likely to drive more. And if they like the burgers and sugary drinks so many US consumers enjoy, their food choices are energy-expensive too.

Obesity may be bad for the environment, but things in the environment may also promote obesity.

Researchers at Mount Sinai Medical Center in New York, have found that exposure to chemicals in plastics may be linked to childhood obesity. In a long term study of 400 girls, aged 9 to 11, in East Harlem, researchers found that the heaviest girls had the highest levels of phthalates in their urine. An April 17 New York Times story by Jennifer 8. Lee explains that phthalates, which are used to make plastic pliable, disrupt endocrines—the bodily chemicals that affect glands and hormones and regulate many bodily functions. Dr. Philip J. Landrigan, a lead researcher in the study, thinks endocrine disrupters may be a more important factor in obesity than has previously been recognized.

Al over the world, Edwards and Roberts write, humans are getting fatter. “When it comes to food consumption,” the authors assert, “moving around in a heavy body is like driving around in a gas guzzler.”

World Water Safety Needs International Cooperation

2009-04-23T16:56:00.000-07:00

Hundreds of millions of people face increased risk of disease and extreme poverty because they lack access to clean water and basic sanitation, a United Nations report warns.

The report, “Water in a Changing World”, estimates that by 2030, nearly half the world’s population—and as many as 250 million people in Africa—will be living in areas of high “water stress”. In addition, between 74 million and 700 million people in arid and semi-arid places will face water shortages.

Wisely managed water supplies are considered vital to the Millennium Development Goals, approved by world leaders who gathered at the United Nations in 2000. The eight goals included cutting extreme poverty in half, providing universal primary education, a universal right to healthcare and ensuring a sustainable environment, all by 2015.

Climate change is causing extreme weather, inevitable flooding and drought, notes Jeffrey Sachs, PhD, the Columbia economist and professor of health policy and management who is also director of Columbia’s Earth Institute and a special advisor to UN Secretary General Ban Ki-Moon. “The poor suffer most from environmental damage”, he said, adding that the millennium environmental goal as been “utterly unmet.” Sachs was among presenters at the Unite for Sight Global Health and Innovation Summit at Yale University April 18-19.

More than one billion people lack access to safe drinking water, and 2.5 billion lack access to basic sanitation. Seth Wayne, MD, an ophthalmologist who heads the eye clinic at a teaching hospital in Ghana, described the ravages of trachoma, an eye infection that causes pain, scarring and ultimately blindness. Of the country’s 22.7 million population, he said, 2.8 million people are at risk for the disease, and a million need antibiotics to treat it. And he explains trachoma is completely preventable: it is a disease of poverty, of poor sanitation, and simply not having enough water to wash.

When water is scarce and has to be hauled long distances to homes, he said, people tend to use it for drinking and cooking rather than washing. Several speakers and UN documents note that because women are usually responsible for managing the household water supply, scarcity is especially hard on them, and the time they spend carrying it long distances takes away from other duties. Further, the UN reports that almost 80 percent of diseases in developing countries are related to water, and three million people die early deaths as a result.

Some progress has been made. Some 1.6 billion people have gained access to clean drinking water since 1990. But the millennium goal for sanitation will not be met. The Trachoma project in Ghana helped with construction of 11,434 latrines, Dr. Wayne said, but pressing need remains.

Lake Chad, once the sixth largest fresh water lake in the world, illustrates just one example of global water trouble. It once covered more than 10,000 square miles, and now it is only one fifth of its original size. Chad, Cameroon, Nigeria and Niger, where the water has already disappeared, share this lake. By 2020, some 35 million people will depend on this lake for survival. The UN stresses that international cooperation is needed for restoration efforts.

Sachs urges people not to abandon long term goals even when they are not met. “Don’t roll back,” he said. “Raise the stakes. Global commitments do achieve…We need to keep these goals alive, and hold leaders accountable. It’s our most important tool.”

Distributed Leadership in the Obama Campaign

2009-04-17T11:52:00.000-07:00

Marshal Ganz, March 19, 2009

The Obama campaign owes its victory not to a single charismatic candidate, but to the efforts of a disciplined and motivated organization whose roots go back to landmark movements of the 1960s. Marshall Ganz, who cut his teeth on civil rights work and with Cesar Chavez’s United Farm Workers, describes how the principles and practices he learned around organizing and leadership played out in the most recent presidential election.

From http://mitworld.mit.edu/video/662

Superbugs and Antibiotics: A Deadly Dance

2009-04-16T13:56:00.001-07:00

Clostridium difficile, a contagious and potentially deadly pathogen, isn’t just increasingly resistant to antibiotics. Its ability to cause serious infection is often triggered by antibiotic treatment.

An article in the Cleveland Clinic Journal of Medicine describes the bacterium, also known as C-diff, as a gram positive, spore forming bacillus that was first linked to disease in 1978 when it was identified as the cause of antibiotic-associated diarrhea and colitis. The February 2006 article, by Rebecca Sunshine, MD and L. Clifford McDonald, MD, says that more than 90 percent of healthcare associated C-diff cases occur after a patient has received antibiotic treatment for some other illness. The story is posted in the website of the federal Centers for Disease Control and Prevention.

Treatments with antibiotics are likely to disturb the bacteria that normally live in the digestive tract and colon. If a person’s exposure to C-diff coincides with that that disruption, the C-diff bacteria flourishes and releases toxins that are harmful to humans.

An April 14 story in The New York Times by Tara Parker Pope reports that health authorities estimate C-diff causes 350,000 infections each year in hospitals alone, with tens of thousands more in nursing homes, and that 15,000 to 20,000 people die annually from the infection. C-diff spores are hardy and live on environmental surfaces and people’s hands and clothing. They are not killed by alcohol based hand sanitizers and hospital cleaning agents. It takes bleach to kill them, which increases the difficulty of eradicating them.

A national prevalence study of C-diff conducted by the Association for Professionals in Infection Control and Epidemiology (APIC) indicated 13 of every 1,000 patients in US healthcare institutions are infected or colonized with C-diff. Based on that rate, on any given day at least 7,178 patients are infected or colonized, at a cost that could range from $17.6 million to $51.5 million. The APIC study, released in November 2008, reported the C-diff incidences rate is between 6.5 and 20 times greater than previous incidence estimates indicated. The Times story notes C-diff now rivals MRSA as one of the top emerging disease threats to humans.

While C-diff has become increasingly virulent and increasingly resistant to antibiotics, recent research findings may lead to better treatment. A March 1, 2009 story in ScienceDaily reports that C-diff manufactures different toxins, and that researchers may have focused on the wrong one. Dr. Dale Gerding, a co-author of the study, published in the journal Nature, explained that while researchers have focused on Toxin A, recent research shows the real culprit is Toxin B. Gerding and colleagues found that the organism was fully virulent and caused disease when Toxin A was knocked out, but did not cause disease when Toxin B was eliminated. Researchers think understanding the relative importance of the two toxins could help pave the way for new methods to combat deadly C-diff infections.

Love and Art Anticipate Neuroscience

2009-04-09T14:14:00.000-07:00

The tragic twelfth century love story of Heloise and Peter Abelard is still irresistibly intriguing. She was a brilliant young student, and he was a famous philosopher and theologian nearly twice her age. They fell in love, had a child and married in secret. Her enraged family had him castrated. They retreated to separate monasteries, and years later continued their love in letters.

Alexander Pope’s poem Eloisa to Abelard published in 1717, tells the tortured tale from Heloise’s perspective. She suffers deeply and begs forgetfulness. The poet imagined her anguished lament:

How happy is the blameless vestal's lot!
The world forgetting, by the world forgot.
Eternal sunshine of the spotless mind!
Each pray'r accepted, and each wish resign'd ...

Nearly three centuries later, in the 2004 film Eternal Sunshine of the Spotless Mind, Pope’s line and Heloise’s desperate desire are revisited by characters played by Jim Carrey and Kate Winslet. It’s a zany, entertaining, touching and profoundly disturbing story about estranged lovers who rediscover their emotional bonds after undergoing treatments by a psychiatrist whose bizarre science fictional techniques obliterate memories of failed romances.

Recent news stories report that neuroscientists actually are getting closer to what Heloise and her cinematic descendants sought, and more. Scientists are discovering things in laboratories that might eventually erase traumas, chronic fear, post traumatic stresses, addictions and the memories that trigger them in humans.

The April 6, 2009 New York Times story “Brain Researchers Open Door to Editing Memory” by Benedict Carey reports that a molecule called PKMzeta is present and active in brain cells at the moment they are connecting to consolidate a memory. As Carey explains it, cells activated by an experience “keep one another on biological speed dial, like a group of people joined in common witness of some striking event.” It seems that the brain retains memories by growing more efficient connections among these cells, and the PKMzeta molecules may be what keeps the “speed dial” turned on.

Researchers at the Weizmann Institute in Israel and SUNY Downstate Medical Center in Brooklyn, NY, found PKMzeta is necessary for long term memory, and that a drug that blocks PKMzeta caused lab animals to forget what they had learned in the past.

Another important factor in memory formation is the set of neurons that make CREB, a protein that spikes in the lateral amygdala when a person experiences a scary event. A Scientific American story by Nikhil Swaminathan explains CREB is believed to be involved in memory formation in living creatures ranging from sea slugs to humans. Researchers at the University of Toronto reported in a paper published in Science that selectively deleting certain CREB-making neurons could wipe out a specific memory in mice. Mice taught to fear a specific tone were no longer afraid after the deletion, but their other memories remained intact.

Marie Monfils, an assistant professor of psychology at the University of Texas at Austin, has studied the importance of timing in formation of a fearful memory. As a ScienceDaily.com story explains it, each time a frightening memory is retrieved, in this case by a tone that reminded rats of having been shocked, the memory is in a labile state and susceptible to change. That means the process of consolidating the memory can be interrupted. Monfils realized that suggested a window of opportunity—a certain period of time during which the fearful memory could be diminished. Rats treated with this method did in fact show lower levels of fear when they heard the sound.

Dutch researchers using pictures of spiders have found that propranolol, drug used to treat high blood pressure, may reduce the intensity of the fear response in people previously known to fear spiders.

While all these findings are promising, researchers say we are still a long way from erasing specific painful memories in humans. Greater understanding of the working of memory, however, offers future hope for the millions of people struggling with Alzheimers, other dementias and age-related memory impairments.

To Heavenly Litterbugs: Take Out The Trash Or Be Fined for Space Pollution

2009-03-25T10:48:00.000-07:00

How dangerous could a bit of litter the size of a corn kernel be? In outer space, very. A minuscule fleck of paint traveling at orbital speed can smash the windshield of a space satellite. And NASA mathematicians say something as small as a grain of sand can have an impact equivalent to the power of a bowling ball moving at 100 miles per hour.

The volume of space junk orbiting 1,000 kilometers—some 621 miles—above the earth is burgeoning and posing a growing risk to millions of dollars worth of orbiting weather, communications and surveillance satellites from countries all over the world. The stuff includes old rocket boosters, derelict space craft and random pieces of technological equipment.

Mathematical analysis by two Stanford University researchers suggests if space programs around the world were forced to remove their own trash, the increasing chance that a live satellite would be damaged by passing debris would be vastly reduced.

Lawrence Wein, the Paul E. Holden Professor of Management Science at Stanford Graduate School of Business and Andrew Bradley, a doctoral student at Stanford’s Institute for Computational and Mathematical Engineering, say nations should be required to comply with existing rules against space littering and face fines and taxes if they don’t. Their paper, “Space Debris: Assessing Risk and Responsibility,” was recently published in Advances in Space Research.

The danger was highlighted recently when a derelict Russian satellite and a working American commercial communications satellite collided in outer space, sending clouds of speeding debris into orbits 300 to 800 miles above the earth. It was the first such collision, but not the first danger. Astronauts aboard the International Space Station had to take refuge in their escape capsule March 12 as a piece of flying junk whizzed by. NASA officials explained the astronauts did not have time to maneuver out of the way because the small size of the debris—five inches long—and its elliptical orbit made it hard to track.

The Chinese deliberately blew up one of their own satellites a year ago, adding to the junk. A Wall Street Journal video, with narrative noting there may be millions of pieces of man made litter in space, illustrates the magnitude of the unpredictable risk.

A Stanford Graduate School of Business release says NASA has suggested creating space equipment to lasso some of the junk fragments and drag them closer to the earth’s atmosphere, where friction would burn them up. But Wein says there is no cost effective way to do that. He explains that all satellites are supposed to have enough fuel to propel them downward when their life cycle ends, but international compliance is only about 50 percent. NASA requires junk removed within 25 years of its launch, and the European Union wants more regulation.

“It appears that if full compliance of the 25-year spacecraft de-orbiting guidelines can be achieved within the next few decades and (if) no anti-satellite weapons are used or tested…the lifetime risk of debris…may be sustainable at a tolerable level,” they write in their paper. They suggest fees and fines for violators, but concede “the political and economic issues associated with establishment of such fees are fairly daunting.”

Scientist's Passion and an Engaged Community Restore New Life and Hope to a Ravaged Land

2009-03-24T09:29:00.000-07:00

Willie Smits’s passionate desire to save orangutans from extinction led to an unceasing campaign to transform the scorched earth of Borneo into a new natural habitat—one plot of land and one tree at a time.

Smits is a forestry scientist and microbiologist who emigrated from The Netherlands to Indonesia nearly 30 years ago to help the country grow trees. While advising the Indonesian government on conservation issues, he had witnessed the destruction of rain forests by logging, new roads, and conversion of wild lands to agriculture. In 1989 he saw a caged orangutan in a market place. He still remembers, “She had the saddest eyes I’ve ever seen.” He returned to the place later, and found that the creature was ill and had been thrown in the trash. He took the orangutan home, nursed it back to health, and his life was changed. He coauthored a book, Thinkers of the Jungle, about these intelligent and endangered primates. Hear him tell this inspiring story at TED.com

Borneo, the world’s third largest island, is bisected by the equator and divided into Indonesia, Malaysia, and the small nation of Brunei. It was once a land of lush rain forest and one of the world’s richest sources of biodiversity with thousands of plant and animal species. In the 1970s, loggers came for the hardwood. Oil palm was a profitable crop, and fire was a cheap and traditional way to clear the land plantations. Fires became calamitous. Smits says in his lecture that in 1998 some 5.5 million hectares (that’s nearly 13.6 million acres) were lost, a choking haze darkened the sky, and the area, which has virtually no heavy industry, became the world’s third largest emitter of greenhouse gasses. And he adds that for a year, children gained no weight, and lost twelve IQ points.

Smits was undaunted. He had been researching and experimenting with ways to bring life back to the land. He formed partnerships with people of the Dayak tribe in the Indonesian province of East Kalimantan, buying land from them on behalf of the nonprofit Borneo Orangutan Survival, BOS. He employed them in many projects, such as planting sugar palm trees, which do not burn easily, as a buffer against fire. The trees also yield thatch, medicine and edible fruit, and he has future plans a refining sugar and producing high energy fuel. A Scientific American story by Jane Braxton Little described dozens of specific small steps pursued consistently over the years. Planting fast growing acacia trees supplied shade eventually that killed alang-alang, a grass that secretes cyanide and makes the land toxic. Many cooperated in creating huge amounts of compost to restore the soil, and in planting trees and crops that Smits selected for their benefit to the wildlife and a recreated habitat. He calls the area Samjoba Lestari, which means Everlasting Forest.

Not all scientists endorse Smits’s project. Some biologists are afraid if people get the idea a rain forest can be “recreated”, they will be less afraid of destroying it. Smits hasn’t presented his project for scientific review. But before and after photographs are stunning, and he says in his lecture that the new vegetation has actually increased cloud cover and rain fall. And the habitat now welcomes the return of many species, including birds, as well as a growing community of orangutans. Smits says success has been possible because of the work and cooperation of members of the local community and their commitment to their own environment and economic future. Amory Lovins, chief scientist at the Rocky Mountain Institute in Colorado and an advocate of renewable energy, is quoted on the BOS website. He says Smits’s achievement is “confirmation of Mahatma Gandhi’s philosophy that if you look after the poorest, everything else will take care of itself.”

Money Madness is No Oxymoron

2009-03-21T09:19:00.000-07:00

The very thought or mention of money activates some ancient emotional areas of our brains, some scientists believe.

“Why Money Messes With Your Mind”, an absorbing March 18, 2009 newscientist.com article by physicist Mark Buchanan, describes some of money’s mysterious psychological forces and the odd and unpredictable impact it can have on the things we do.

Barbara Briers and her colleagues at the HEC Business School in Paris, for instance, think people’s desire for money is a modern adaptation of the basic need for food, and their research suggests the interaction between those two urges triggers some pretty primitive instincts. Their paper Hungry for Money reports that hungry research participants were less likely to give to charity than those with full stomachs. People who smelled good food were a little stingier than those in a room without scent, and those whose desire for money was piqued during an experiment ate more candy than those who had other interests. The research suggests our brains process information about money using the same pathways that evolved for food. If that’s correct, Buchanan writes, “It puts a whole new spin on the term ‘greedy banker’.”

His article also cites research that shows our mental accounting is based more on emotion and context than it is on obvious math. There are psychological reasons why we’re more likely to remember an amount we paid in cash than an amount paid with plastic, and why we’ll often take a little money now rather than more later. The reasons just aren’t logical.

Daniel Ariely, a behavioral economist, theorizes that we have two distinct sets of social norms, one for long-term relationships that involve trust and cooperation, and another set of “market norms” that foster money and competition and encourage us to put our own interests first. He notes we get in trouble when we mix them.

Ariely explores contradictory and paradoxical human behavior in economics in his book Predictably Irrational: The Hidden Forces that Shape Our Decisions. He has some provocative thoughts on the Madoff scandal and the possibility that some of the lessons we learn from it may be wrong. While it is important to root out really serious financial miscreants, he worries that we’ll be tempted to pay insufficient attention to other less dramatically egregious financial behavior that could actually have bigger consequences. He says research shows few people cheat a lot, but many will cheat a little. If we ignore small dishonesties by many—fudging financial reports, doctoring documents, little deceptions on mortgage terms and higher pay for cronies—we neglect the real economic sources of the trouble we are in, he says. Listen to Ariely talk about why we think it’s OK to cheat and steal, and the surprising forces and circumstances that encourage and inhibit such behavior.

Pathogens, Pork, and Drinking Water

2009-03-16T08:04:00.001-07:00

“Pathogens in Our Pork”, a March 15 op ed piece by New York Times columnist Nicholas Kristof, raises another alarm about the agricultural use of antibiotics to promote the rapid growth of livestock and control disease in the pens where they are crammed together. Animals raised for food get 70 percent of all the antibiotics dispensed in the US, and scientists say that is a major contributor to the evolution of drug-resistant bacteria. Kristof writes specifically about MRSA, methicillin resistant Staphylopcoccus aureus, and a new strain called ST 398, for which modern hog farms seem to be providing a reservoir. Several studies have identified MRSA and other pathogens in the meat we buy.

Controlled Animal Feeding Operations also produce huge quantities of manure, and Kristof notes that antibiotic resistant bacteria from hog farms has been found in ground water. But don’t get to comfortable just because you don’t live near a hog farm. Scientists have been worrying about antibiotic-resistant pathogens in drinking water for decades, and the presence of antibiotics in water has grown. And it's not surprising. An Associated Press investigative team did a five month study of drinking water supplies in 24 major metropolitan areas and found dozens of pharmaceutical products in the water. Just to get an idea, look at the drugs found in the drinking water in Philadelphia.

It’s sobering to think the water we drink has been has been drunk before, by fellow creatures with two legs and four. It has passed through bodily systems and been excreted, carrying with it a vast assortment of antibiotics and other medicines. We’re assured these are all trace elements below the threshold that would harm human health. But more study might be instructive. The International Dose Response Society studies the concept of hormesis, which holds the warning that a little bit of a bad thing may have a bigger and more unpredictable impact than one might expect.

People, Pigs and MRSA

2009-03-14T05:22:00.000-07:00

When a family physician in a small town in Indiana started seeing scores of patients with MRSA infections, he began to wonder whether nearby hog farms were incubating and spreading the disease.

New York Times columnist Nicholas Kristof, writes about that doctor, Tom Anderson, and the pathogen, in his March 12 Op-Ed page column “Our Pigs, Our Food, Our Health.” Dr. Anderson died of a heart attack or aneurism shortly before his scheduled meeting with Kristof. The columnist notes that Dr. Anderson had three bouts with MRSA himself, and that swine-carried MRSA has been linked to human heart inflammation. Dr. Anderson’s widow says her husband had treated more than 50 people with MRSA infections in a town with a population of about 500.

The most commonly known strain of MRSA, or methicilllin resistant Staphylococcus aureus, kills some 18,000 US hospital patients a year, and sickens thousands more, according to the federal Centers for Disease Control and Prevention. But there’s another strain, ST 398, that has been identified as the predominant strain among swine in Canada and the Netherlands. Researchers say same strain accounts for 30 percent of staphylococcus found in humans in the Netherlands. Now, for the first time, the same strain ST 398 has been found in pigs and humans in the US. Tara Smith, an assistant professor of epidemiology at the University of Iowa, is the lead author of a study published recently in the online Public Library of Science journal, PloS One. She and colleagues sampled nares of 299 swine and 20 workers in hog “production systems” in Iowa and Illinois. They found 49 percent of the sampled swine and 45 percent of the sampled workers were carriers of MRSA ST 398. They conclude MRSA is common among swine, suggesting agricultural animals could become an important reservoir of the bacterium.

A story about the research by Maryn McKenna in The Scientific American notes both the hospital acquired MRSA and ST 398, which is considered a community strain, are potentially deadly. Ms. McKenna’s story quotes a professor of microbiology and infection control from the Netherlands as saying the unpredictability created by adding a novel strain to the evolving US MRSA epidemic is worrisome. “Strains change. They pick up new virulence, new resistance factors,” says the professor, Andreas Voss, who uncovered the first Netherlands MRSA case in 2004. “I believe it is a potential bombshell that it is here.”

A Dutch study has also found MRSA in several meat products. It is not clear that the presence of the bacteria in meat presents a danger of transmissions to humans. Kristof notes there is no proven case of a human getting MRSA from eating pork. “I still offer my kids BLTs,” Kristof writes in his Times column. “but I’ll scrub my hands carefully after handling raw pork.”

Kristof plans to write more on this. Watch for his column in The New York Times Sunday.

MRSA in Pigs and Colony Collapse Disorder: Parables of Unsustainability

2009-03-13T11:14:00.000-07:00

Researchers in Canada and Europe have found Methicillin resistant staphylococcus aureus (MRSA) in pigs and the farmers who care for them, and Michael Pollan suggests that discovery holds an important warning about dangerous modern agricultural practices.

Michael Pollan wrote The Botany of Desire, The Omnivore’s Dilemma, and his newest book, In Defense of Food: An Eater’s Manifesto. When Pollan writes, it’s worth reading, and his 12-16-07 essay “Our Decrepit Food Factories” in the New York Times, is thoughtful and disturbing. He fears sustainability has become a trendy term that has lost its impact while unrealistic expectations of consumers and the extreme measures of modern industry create destructive practices that foreshadow to systemic breakdowns.

We want cheap meat, Pollan writes, so we raise vast numbers of pigs, chickens and cattle crammed in pens where feed containing antibiotics promotes rapid growth and prevents death from contageous disease. “Without these pharmaceuticals, meat production practiced on the scale and with the intensity we practice it could not be sustained for months, let alone decades,” he writes.

The Union of Concerned Scientists estimated in 2001 that pigs, cows and poultry in the US received more that eight times the amount of antibiotics in their feed and water than humans got for treatment of diseases. No recent data indicates a reduction since then. Dutch researchers found Community Acquired MRSA in pig farmers and their families, Michael Smith writes at MedPage today. It’s not clear how the animals acquired the bacteria, he writes, but it has been shown to be resistant to tetracycline, an antibiotic commonly used in animal feeds.

Much has been written about how over-use of antibiotics creates anti-biotic resistant strains of bacteria. Drugs kill off most of the microbes, but a few with some genetic differences survive, evolve and multiply into a drug-resistant super-race. The MRSA that emerged in hospitals 40 years ago differs from the community acquired MRSA that is afflicting people outside of healthcare environments today. In the Omnivore’s Dilemma Pollan describes how our demand for cheap beef results in a bizarre perversion of bovine digestion. Corn is the cheapest feed to fatten cattle fast. But their stomachs aren’t designed for it. It makes them susceptible to near fatal bloating, liver disease, and it weakens their immune systems so they are vulnerable to a vast array of feedlot diseases, including pneumonia. Activists who oppose using antibiotics to make healthy animals grow faster don’t object to treating sick animals with drugs. But Pollan says that distinction is meaningless with cattle because the way we feed them makes them sick.

The National Pork Producers Council says Dutch research suggests MRSA in food animals is not a food safety hazard. But Pollan argues human health is inextricably linked to the health of animals we eat through the web of relationships that create our environment.

MRSA and colony collapse disorder among bees may both point to systemic breakdowns in modern agriculture. To serve 600,000 acres of almond orchards in California, Pollan writes by way of example, bees are transported from all over the US and Australia. Bees dormant in Minnesota’s frigid winter are perked up with pollen patties that include high fructose corn syrup and flower pollen imported from China.

He says we can’t keep trying to make natural systems and living organisms function like machines. He writes in The Times piece: We’re asking too much of our bees and pigs. By maximizing production and keeping food cheap, we push natural systems and organisms to their limit. When bees or pigs remind us they are not machines we invent ingenious “solutions” such as antibiotics to keep pigs healthy or foreign bees to pollinate the domestic almonds. But this year’s solutions become next year’s problems. That is, they're not “sustainable.”

From this perspective, the Colony Collapse Disorder and drug-resistant staph are both parables about the vulnerabilities monocultures. When we try to rearrange natural systems to operate like machines we lose biological resilience and the brittle systems we create are prone to breaking down. The questions is whether we can learn enough about sustainability to prevent even bigger crises and collapses.

Mathematics, Culture and the Elegance at the Intersection

2009-03-11T08:36:00.000-07:00

When he came across an article about the relationship between housing patterns and women’s autonomy in Tanzania, Ron Eglash was intrigued.

Eglash is a mathematician whose interests are technical, philosophical and cultural. He found that traditional settlements in West and Central Africa are self-organized, bottom-up developments with self-similar structures that seemed to foster greater social influence for women. Modernization brought more rigidly structured Cartesian grids to village and housing design, and social control for women diminished.

That got Eglash thinking about the contrasts between designs based on fractals and those based on Euclidian geometry. He got a Fulbright scholarship to study fractals in African architecture, and by 1988 he was studying aerial photographs of traditional villages. Thatched-roof huts were organized in circular clusters within circular clusters, which Eglash immediately recognized as fractals—self-similar shapes that keep repeating whether the scale is minimized or expanded. He has written a book, African Fractals: Modern Computing and Indigenous Design, and you can hear his wonderfully engaging short presentation on African fractals at TED.com.

Eglash met with village chiefs and elders, and discovered they knew all about rectangles within rectangles and circles within circles. He learned that the patterns were deliberate, not like the unconsciously constructed fractals found in a termite mound. He also discovered that, in his own words, “social scaling was mapped onto geometric scaling.” For instance, one village of rings of rings contained a tiny ring village where ancestral spirits were said to live. Some designs also contained special fractal spaces designated as sacred, approached by pathways imbued with progressively changing behavioral expectations.

Eglash went on to document the use of fractal geometry not only in African architecture, but in art, religion, games, weaving, culture, and hair braids. Eglash even discovers binary code in ancient mystical Bamana sand divination. The intricate designs, deliberate craftsmanship and highly sophisticated patterns are leading scholars to reexamine what must have been conscious knowledge in early African mathematics.

To learn more about African fractal patterns visit Ron Elash’s home page
or follow the link to http://www.rpi.edu/~eglash/eglash.htm

Bankers' Pay and Bull Elephant Seals

2009-03-10T08:49:00.000-07:00

Why have bankers salaries ballooned? Eduardo Porter, an economics writer and member of the editorial board of the New York Times, addresses this issue with an eye on nature and a biting humor. As he puts it, the biggest bull elephant seals beat out lesser bull elephant seals, winning the harems and passing on their genes to future elephant seal generations. Over time the population gets bigger and fatter, and eventually the big bulls become easier dining for the swifter great white sharks, which are among nature’s greatest predators. So as Wall Street views it, humongous pay packages for top bankers grow from competition among big banks and the most enterprising executives. Read Porter’s March 9 column “On the Origins of Bankers’ Giant Bonuses” to learn why he thinks seals and human society would benefit if bull elephant seal blubber and bankers salaries were trimmed. Click here to learn more about the elephant seals. These extraordinary marine mammals spend most of the year in open ocean and migrate thousands of miles. Despite the seals' greater bulk and slower speed, the great white sharks can’t eat them unless they find them in that vast and deep watery expanse. Elephant seals are no longer endangered, although at onetime they were seriously over-hunted for their oil. Great white sharks are endangered. Bankers are not.

Ancient Plagues, Modern Science, and the Double Lives of Locusts

2009-03-09T15:02:00.000-07:00

The brain chemical serotonin triggers one of nature’s most astounding transformations, which happens when solitary placid desert locusts converge into terrifying plant-devouring swarms, scientists have found.

When driven by fluctuating environmental cycles and the compulsion to eat, locusts alter not only their behavior, but their size, strength and color as well. In fact, the change in appearance is so dramatic that until the 1920s scientists thought the two phases of locust existence were actually two separate species.

Researchers led by Michael Anstey of Oxford University in the UK studied changes in locust behavior and tested them with a variety of chemicals. They found that when the insects were swarming, they had three times more serotonin in their systems than when they were living alone.

“Up until now, whilst we knew the stimuli that cause locusts' amazing 'Jekyll and Hyde'-style transformation, nobody had been able to identify the changes in the nervous system that turn antisocial locusts into monstrous swarms,” Dr. Anstey explained in an academic press release. “The question of how locusts transform their behavior in this way has puzzled scientists for almost 90 years, now we finally have the evidence to provide an answer.” The researchers found that drugs that block serotonin made locusts shy, even when other factors suggested they congregate, and drugs that boost serotonin made solitary locusts suddenly gregarious. Serotonin, which carries nerve signals in nearly all animals, plays a role in human moods, emotions and desires.

Dr. Anstey, and colleagues Stephen M. Rogers, of Oxford and Cambridge Universities, Swidbert R. Ott, and Malcolm Burrows, of Cambridge and Stephen J. Simpson of the University of Sydney in Australia, reported their findings in a paper published in the January 30 issue of Science magazine.

Dr. Rogers says locusts are finely tuned to adjust to their dry but changeable desert environment. In dry periods, they are fairly antisocial, existing as harmless green grasshoppers. After the occasional rainstorm, locusts gather to follow the newly increased vegetation, heading out from the driest regions into more fertile adjacent lands. As they see, smell or touch other locusts, their behavior and appearance transforms in a matter of hours. Their darker color scares predators, and their stronger muscles and bigger wings let them make long migratory trips, flying 60 miles in five to eight hours.

It’s one of nature’s cruelest tricks, says Dr. Rogers: Farmers rejoice with rain and then see their crops are devoured. Locust swarms affect 20 percent of the earth’s land mass and have occurred periodically in Africa, Asia, Australia and the western US. The Old Testament, describing the Eighth Plague of Egypt, says locusts shall cover the face of the earth, fill every house and eat everything that grows. The prophet Joel also warned of locusts coming in deadly clouds.
The researchers suggest in their Science article that the discovery could lead to new pest control strategies.

Darwin’s 200th Birthday and the 150th anniversary of The Origin of the Species: The New York Times carried several articles commemorating Charles Darwin, including Olivia Judson’s thoughtful piece, The Origin of Darwin.

Liberating Structures: What They Unleash

2007-12-11T12:41:00.000-08:00

Learn something new, put it to use, continue the conversation!

Join PlexusCalls Friday December 14
1-2 PM Eastern Time
712-432-1100, access code 137251#

Liberating Structures: The Processes that Help People Tap into Their Collective Creativity and Intelligence

Guests: Henri Lipmanowicz, Keith McCandless and Alison Joslyn

Henri Lipmanowicz retired after a distinguished career at Merck, where he was president of the Merck Intercontinental and Japan Division, and a member of the Management Committee. Keith McCandless, principal of the Social Invention Group, is a consultant with expertise in strategic planning, leadership, and organizational development. He has been instrumental in the growth of the Conversation Café movement, which began in Seattle and is spreading internationally as a means of stimulating wide-ranging communication about socially vital issues. Keith helps organizations move forward through uncertainty with innovative approaches including scenario planning, generative dialogue, Chaordic design, communities-of-practice, appreciative inquiry, open space technology, positive deviance, graphic facilitation, and rapid prototyping. Alison Joslyn, the former managing director in Venezuela for Merck, is now vice president and general manager for the Merck/Schering-Plough joint venture for Europe, the Middle East and Africa. She was previously Global Brand Leader responsible globally for all in line products and Phase III development programs within the respiratory franchise, including Merck’s largest product, SINGULAIR. She earned a BS degree in biology from Yale and an MBA from Dartmouth. She has been with Merck in several capacities for 20 years, and has worked with liberating structures. Liberating structures are the processes and methods that help draw out social inventiveness of individuals, groups and communities. Their strength arises from flexibility and structure. They include simple rules, wicked questions, chunking, and many more. To learn how Keith McCandless describes 20 such approaches developed and adapted by complexity-inspired practitioners, visit http://socialinvention.net/liberatingstructures.aspx. Learn more in the e-library at the Plexus Institute web site, http://www.plexusinstitute.org/

Forgetting May Help Us Remember

2007-12-07T13:05:00.000-08:00

Our ability to forget may be just as important as our ability to remember.

We may want to forget woes and traumas, but it may be even more useful to unburden ourselves of the trivial—the mental minutia and impedimenta that accumulates in the course of ordinary existence.

Stanford University researchers using functional magnetic resonance imaging (fMRI) were able to record visual images of people’s brains as they discarded irrelevant memories in order to focus on the task of learning something new.

Brice Kuhl, a doctoral student working in the Stanford Memory Lab run by Associate Professor Anthony Wagner explains that the brain is very plastic and adaptive and that means that it suppresses or weakens some memories at the same time it strengthens others. “Remembering something actually has a cost for memories that are related but irrelevant,” he explains in a Stanford Report.

Kuhl and Wagner, both neuroscientists, gathered 20 Stanford students between the ages of 18 and 32 and had them view 240 pairs of words in rapid succession while their brains were being scanned. The word list included 40 words printed in capitals. Each of the 40 capitalized word was paired separately with six words printed in lower case letters—for instance ATTIC-junk and ATTIC-dust. So there were six memories created for each main word. After viewing all words, subjects were asked to try to remember selected pairs. The first time they practiced a pair, the story explains, the prefrontal cortex “lit up” as the brain worked to forge a new memory from among the competing pairs. In their second and third memory practices, the frontal lobes became less active. The more the frontal lobe activity decreased, the more likely it was that in later testing the participant would remember the selected pairs and not the irrelevant ones.

Wagner says the prefrontal cortex is the “CEO of the brain”, governing cognition and the purposeful uses of memories. When unimportant memories are suppressed, he says, the brain can devote more of its computational resources to recalling what’s important.

The findings by Kuhl and Wagner were published in the June 3 issue of Nature Neuroscience and are also the subject of a New York Times story by Benedict Carey. Their work may have implication for treating difficulties associated with aging and neurological diseases.

In similar research last year at the University of California at Berkeley, neuroscientists Adam Gazzaley and Mark D’Esposito found that memory losses associated with aging resulted more from distractions than from an inability to focus. These researchers, who also tested their subjects while their heads were in an fMRI scanner, discovered that many older people are able to focus on pertinent information, but that their reduced ability to screen out the distractions and irrelevant information resulted in impaired memory. Their work suggests people with Alzheimer’s disease and other age-related memory problems may benefit more from drugs targeting the suppression of distraction than from drugs that enhance focus.

The poet Robert Pinsky, who has reflected philosophically and lyrically on the power of things lost, remembered and disregarded, reminds us “Forgetting is never perfect, just as recall is never total: the list or the person’s name, or the poem or the phone number may be recalled in every detail, but never with the exact feeling it had. And conversely, the details may be obliterated, but a feeling lingers on. .…memory and forgetting are willful and involuntary, helpless and desperate in mysterious measures. Forgetting is not mere absence. The repressed does not merely return, it transforms and abrogates, rising and plunging like a dolphin or Proteus.” And what about the colorless memories that are merely suppressed? The Times story suggests they may just get lost in a sensory crowd.

Bees and Hornets: Decapitations and Death Balls

2007-09-21T16:19:00.000-07:00

Hornets are nasty predators that chop off the heads of honey bees before devouring them. They also feast on honey bee larvae. Bee stingers can’t penetrate the hornet’s body armor. But don’t think honeybees are defenseless.

Cyprian honeybees will swarm around a threatening hornet and form a tightly packed ball that kills the invader, according to a story in New Scientist by Roxanne Khamsi. Scientists used to think the bee ball generated enough heat to kill the hornet. But a new study suggests the hornet inside the ball is suffocated. The hornet-destruction balls may be composed of as many as 300 bees, the story says, and pity the hornet—the execution by oxygen deprivation takes about an hour. It’s not clear how the bees coordinate their behavior to form the death ball, but bee researcher Alexandros Papachristoforou of Aristotle University of Thessaloniki in Greece thinks the bees might use chemical signals known as alarm pheromones to convene a gathering.

A National Geographic article “Hornets from Hell” tells how just one Japanese giant hornet can dispatch 40 European honeybees in one minute, and a handful of them can slaughter 30,000 honeybees in a matter of hours. The Japanese giant hornet has venom powerful enough to “disintegrate human flesh”, the story says. But we also learn that hornets are extraordinarily good parents, who chew their prey into baby food for their larvae. And high-powered hornet saliva has been synthetically replicated in an energy drink popular in Japan. We say a dangerously angry person is "mad as a hornet". We say bees are industrious, but so are hornets. Do bees and hornets experience some mysterious elements of fear, glee or revenge in these life and death encounters? Will we ever know? We can only marvel at what scientists discover on how these amazing creatures with minuscule brains organize their lives, protect their own, coordinate their behavior, and survive in spite of relentless duties and random danger.

Extemporaneous Exchanges Play Well in Jazz and Medicine

2007-09-17T12:19:00.000-07:00

Join the PlexusCalls discussion October 4. Details below.

“Man you don’t have to play a whole lot of notes. You just have to play the pretty notes”.
Trumpeter Miles Davis

Paul Haidet, a physician, former disc jockey and amateur jazz historian who has studied doctor-patient communication, marvels at the parallels between jazz and medicine. Gary Onady, a physician and jazz trumpeter who composes and arranges music, uses musical metaphor to describe patient-clinician interactions.

In his article Jazz and the ‘Art’ of Medicine: Improvisation in the Medical Encounter, Dr. Haidet writes that good communication results in fewer medical errors and a variety of good social, psychological, and biological outcomes. Further, he suggests jazz improvisation is a guide to the kinds of moment-to-moment decisions a doctor must make—what to say next, how to structure a question, when to let the patient keep talking, when to move on—that bring about high quality communication. Dr. Haidet’s story is instructive because he cites the artists and musical selections with the sounds that open new ways of examining the subtle, contextual and subjective experiences that are woven together when people try to share knowledge and meaning.

Dr. Onady, who has an academic career in medicine and pediatrics, is a member of the Eddie Brookshire Quintet, which just released the CD Base Notes: The Heart Beat of Jazz. He has developed a workshop that includes an introductory lecture on Jazz Improvisation and Physician-Patient Communication. He uses the “minimal structure theory” of jazz along with jazz improvisational tools for solving patient problems in a turbulent medical environment.

Consider what Dr. Haidet calls the communicative act of creating space. “I have found the act of providing communicative space to the patient to be one of the one of the most powerful yet underused skills by physicians,” he writes. We have a cultural inclination to be uncomfortable with silence and pauses, he observes, so the ability to create space in our encounters takes discipline and practice. Dr. Haidet, an internist at the Michael DeBakey VA Medical Center who also teaches at Baylor College of Medicine in Houston, TX, says when he is with a patient, he often thinks of how Miles Davis used his intuitive sense of space and time in his music. Davis was also exquisitely attuned to his surroundings. “We play what the day recommends,” he once remarked.

“He conserves notes, plays at a relaxed pace, plays on the ‘back end’ of the beat, and drops musical hints that allow listeners to use their imaginations to fill in the phrases,” Dr. Haidet writes of Davis. The result, he continues, is that the listener hears not only the solo, but what the rest of the band is playing. If you listen to a piece like his All Blues, you will see what he means.

Dr. Onady, in a written response to Dr. Haidet’s article, recalls using the concept of musical space in his own medical practice to help evaluate a patient who had received several conflicting diagnoses. “Giving the patient space to provide her own descriptive phrases, accented by arm and hand gestures much as a conductor uses to conduct an orchestra, the cause of her illness became obvious…”he wrote.

Like jazz musicians, Dr. Haidet writes, doctors need to develop their own improvisational voice. He notes the evolution of saxophonist John Coltrane’s “sheets of sound”, the high speed arpeggios so wide ranging and densely packed that the notes run together. In similar fashion, physicians need to master the basics of patient-centered interviewing to develop a personal style that honors their own humanity as well as that of their patients. It’s the kind of skill, he says, that enables the physician to “show up” in encounters where bad news is delivered. For the kind of respect and sharing that is critical for physician understanding of a patient’s illness perspective and the patient’s understanding of the biomedical processes the illness involves, Dr.Haidet turns to ensemble improvisation. As an example, he suggests Waltz for Debbie, by pianist Bill Evans and bassist Scott LeFaro, an intricate flowing musical conversation. Just as musicians “talk to” each other with their instrumental skill and personal style, cultivating ensemble in medicine means doctors need to go far beyond collecting data when they encounter patients.

Dr. Haidet’s article appeared in the March/April 2007 issue of the Annals of Family Medicine. Click here for the supplemental appendix where you can hear the music Dr. Haidet suggests. The Eddie Brookshire Quintet’s new CD, soon available for purchase on CD Baby, contains song Surrendered Life, written by Eddie Brookshire with Dr. Onady on flugelhorn.

Don’t Forget PlexusCalls
Thursday Communication Series
1-2 PM Eastern Time, October 4, 2007
Note New Call-In Number:
712-432-1100, access code 137251#

Improvisation in Medical Communication and Jazz
Guests: Dr. Paul Haidet and Dr. Gary Onady

The Starfish and the Spider

2007-09-06T08:53:00.000-07:00

Read about the book and join the author in a PlexusCall. Details below.

Of Apaches and e-Bay, Mary Poppins and Bill W.

It would be easy to miss the metaphysical connection between Napster, the pioneer of electronic file sharing, and the Apache Indians of the American West.

For Ori Brafman and Rod Beckstrom, the kinship between peer to peer internet services and the relational structures among Apache tribes is a central insight into the extraordinary power of open systems. Their book, The Starfish and the Spider: The Unstoppable Power of Leaderless Organizations, is the result of five years of research on decentralized organizations that achieved dramatic successes without rigid hierarchies or control by bosses and managers. Every major organ of a starfish is replicated in each of its five arms, so if an arm of starfish is severed, the arm grows a new starfish. By contrast, a spider that loses a leg is impaired and a spider that loses its head is dead. And an organization committed to strict top-down management, even when it is big and powerful, is increasingly vulnerable to the vicissitudes of cultural climate change and roiling waves of innovative competition.

Starfish-like organizations can wreak havoc on rivals The authors see common elements that helped Wikipedia, the Internet, e-Bay, Alcoholic Anonymous and al Qaeda flourish. And they see common challenges that have beset Fortune 500 companies, and 16^th Century Aztec capital of Tenochtitlan and the modern entertainment industry. What is the difference between Montezuma and Geronimo? Montezuma II was the Aztec leader who presided over an advanced civilization of 15 million people from a grand palace in the capital city of Tenochtitlan in what is now Mexico. When the Spanish explorer Hernando Cortes attacked, Montezuma was killed, and Cortes’s armies swarmed over roads and aqueducts. Not long afterwards, the city’s 240,000 inhabitants were wiped out by disease and starvation, and within two years the Aztec empire collapsed. The Incas of Peru met the same fate when another Spanish army invaded a decade later, beginning Spanish dominance over South America.

While the Spanish overwhelmed centralized civilizations, Brafman and Beckstrom argue, they were never able to conquer the decentralized Apaches, who had no palaces, temples, cities, or accumulated wealth. The authors learned from an anthropologist who studied them that instead of a chief the Apaches had a Nant’an, a spiritual leader who led by example rather than force. The most famous Nant’an, they write, was Geronimo, whose people followed him because they wanted to, and who fended off adversaries for decades.

People used Napster, the brainchild of an 18-year-old college freshman, by logging into a central server and sharing music files with people all over the world. The big music labels sued, and Napster closed. But people like free music, and Napster had increasingly decentralized successors—Kazaa, Grokster, e-Donkey—with elusive owners who avoided central servers and obvious business addresses. Every time the labels conquered one such company, another emerged. Even though court rulings favored the big companies, E-Mule and other little per-to-peer file sharing ventures are beyond lawyers’ reach. As the authors explain it, their decentralization is unlike anything the entertainment industry has ever seen. “The software is a completely open source solution. No owner. No Montezuma. Who started e-Mule? No one knows,” Brafman and Beckstrom write. “They simply can’t be found.”

Alcoholics Anonymous has a purpose and ideology that has drawn massive membership distributed in small geographically separate circles. Its catalyst Bill W. let go when he saw AA was growing. Consider al Qaeda, with its rapid succession of mercurial leaders. How can governments fight terrorist organizations, and how can businesses compete with energetic nontraditional rivals?

Brafman and Beckstrom return to the starfish. In the late 1990s, they write, the coral of the Great Barrier Reef in Australia was threatened by an explosion of starfish. Divers with knives cut the starfish in half to kill them. But the starfish just multiplied. Scientists then realized pollution and rising water temperature were spurring the burgeoning starfish population. So only environmental change would stop them. To tame the power of decentralized organizations, ideology has to change. Micro loans and small businesses help change ideologies in slums, where hopelessness helps attracts recruits to terrorist cells. The authors also describe a brick-by-brick community rebuilding effort in Afghanistan, with no money or outside support, where people worked together to recover from the harsh rule and destruction of the Taliban.

Some organizations, they say, succeed by becoming hybrids. E-Bay for instance, is pure starfish. It hosts sellers and buyers who deal with each other directly and safeguard trust through a user rating system. But e-Bay’s PayPal subsidiary is based on rigid controls and secure transactions and “trust” isn’t a philosophical value. IBM bowed to decentralization by supporting Linux, the open source operating system, and designed Linux-compatible hardware and software. By doing so, the authors observe, “IBM is harnessing the collective skill of thousands of engineers working collaboratively world wide, and at no cost to IBM.” Oprah Winfrey’s production company is centralized, but she added a decentralized element with her book club, which has grown exponentially.

This is a collection of provocative, surprising and well-told stories about the social and organizational revolutions going on around us and some of the powerful forces driving the change. The examples are consistently engaging and memorable. In discussing the differences between traditional business leaders and catalysts who spark creation of organizational starfish, the authors cite the lead characters in The Sound of Music and Mary Poppins. In Sound of Music, Maria enters a dysfunctional family and helps everyone get along better. But when the movie ends, it’s clear she will stay and remain in charge. Mary Poppins, however, comes to smooth out family turbulence so its members can thrive on their own. A CEO settles in, a catalyst knows when it’s time to move on. “Once she accomplishes her goal,” Brafman and Beckstrom write, “(Mary Poppins) rides her umbrella into the sunset.”

Don’t forget PlexusCalls

Friday September 7

1-2 PM Eastern Time

Call 605-990-0300, access code 716551 followed by#

The Starfish and the Spider

Guest: Ori Brafman, Jane Wei-Skillern, and June Holley

Ori Brafman is the coauthor, along with Rod A. Beckstrom, of The Starfish and the Spider: The Unstoppable Power of Leaderless Organizations, a book that has been hailed as a must read by theoreticians and business executives. Paul Saffo, director of the Institute for the Future, says this book “lifts a lid on a massive revolution in the making, a revolution certain to reshape every organization on the planet from bridge clubs to global government.” Brafman is a life-long entrepreneur whose projects include a wireless start up, a health food advocacy group, and a network of CEOs working on public benefit initiatives, which he co-founded with Rod Beckstrom. He holds BA in peace and conflict studies from the University of California at Berkeley, and an MBA from the Stanford Business School. Jane Wei-Skillern is as assistant professor of business administration in the General Management Unit and Social Enterprise Group of Harvard Business School. Her research examines creation of social value in commercial and nonprofit organizations and she is currently studying how building a range of strategic networks can be a powerful lever for nonprofits to achieve greater social impact. June Holley provides consulting, training and mentoring to a wide range of organizations seeking to create healthier communities around the world through a better understanding of networks collaboration, innovation and learning. For more than 20 yeas she was president and CEO of the Appalachian Center for Economic Networks (ACEnet) a regional entrepreneurship organization in southeastern Ohio devoted to building a healthy, sustainable regional economy based on economic justice, self determination and diversity

Do you believe your lying eyes?

2007-08-27T12:38:00.000-07:00

What You See Isn’t Always What You Just Saw

Nearly 175 years ago a Swiss crystallographer named Albert Louis Necker discovered that the line drawing of a cube could jump back and forth in our vision depending on how we look at it. In other words, our brains can suddenly discover a new way of seeing the same thing.

Mark Newbold’s Animated Necker Cube is an entertaining example of how this works. Optical illusions are fun, and if you want to see the case of the mysterious disappearing purple dots, go to the Sandlot Science Illusion of the Month. The Sandlot Science website has a collection of engaging illusions presented in a “guided tour”, and students of complexity science will especially enjoy the graphic that shows dramatically how a minor movement makes a major difference.

There is even an interesting personality experiment developed by Dr. Peter Naish, a lecturer in psychology at the Open University, the largest university in the United Kingdom, presented in conjunction with the BBC. The test, which takes about five minutes, relates certain personality traits to the way the observer sees and interprets the ambiguous and illusive Necker Cube. The results may surprise you.

For a more in-depth consideration of optical puzzles and cognitive response, an article on “Inconsistent Images” by Peter Quigley, of the philosophy department of the University of Adelaide, offers analysis of Necker cubes, Escher drawings and the challenging idea of “impossible pictures” and pictures that are oddly incomplete. He uses still and animated illustrations in his discussion. Impossible pictures can be described mathematically only when using the tools of inconsistent mathematics and paraconsistent logic, he writes. That means advanced math and advanced logic that is tolerant of inconsistencies is needed to describe such pictures. Our brains, however, can find ways to reconcile inconsistent images. Basically, we find ways to impose consistency on our world even when our imposition isn’t completely justified by the evidence.

For more explanations, Michael Bach, a professor at the University of Frieberg in Germany, has written a brief primer on Optical Illusions. The professor has also assembled an interesting collection of 72 Optical Illusions and Visual Phenomena

You think communication is complex? Try Taarof

2007-08-27T08:14:00.001-07:00

Finely Crafted Discourse, or Yo Dude?
Linguistic Form Anticipates Substance

In an ancient culture where poetry is revered and people have resisted centuries of oppression, artfully selected words and phrases come with invisible webs of mysteriously moored strings.

The persianmirror.com, a site devoted to Persian culture and community explains, “Taarof has deep roots in the Iranian tradition of treating your guests better than your own family, and being gracious hosts. Taarof is a verbal dance between an offerer and an acceptor until one of them agrees. It is a cultural phenomenon that consists of refusing something even though you might want it, out of politeness. On the giving end, it is offering something…to be polite…but not really wanting to give it away.”

An August 6, 2006 New York Times story by Michael Slackman describes the Iranian social principle of taarof, a complex interactive ritual of manners, pretense, and polite expectations. Americans accustomed to short declarative sentences and no frill facts might consider it lying. But taarof is a time-honored element of Iranian communication that linguists and diplomats say Americans need to learn.

As Nasser Hadian, a political science professor at the University of Tehran tells the Times, “You have to guess if people are sincere, and you are never sure. Symbolism and vagueness are inherent in our language.”

Kian Tajbakhsh, an Iranian social scientist who lived in England and the US for many years before returning home a decade ago, explains in the same story, “Speech has a different function than it does in the West. In the West, 80 percent of language is denotive. In Iran, 80 percent is connotative.” Even Iranians are kept guessing, but perpetually ambiguity is indelibly worked into the texture of life. Says Tajbakhsh, “This creates a rich, poetic linguistic culture. It creates a multidimensional culture where people are adept at picking up on nuances.”

As the Persian Mirror advises, even if you would like a second helping of a tasty dish, you can’t accept unless it has been urged upon you several times. If your host says don’t taarof, that can be dicey too, because the host herself may be taarofing. Should you eat and appear gluttonous, or refuse and risk insulting her cooking? This custom is perilous for foreigners. If you ask a shopkeeper the price of an item, he may say it’s nothing, be my guest. If you take him literally, you’ll be in trouble and you'll be pursued as a thief. The shopkeeper’s elocution is really a polite way of approaching the indelicate matter of price. The same principle applies in other interactions. An invitation to someone’s home may be a courteous expression, not an actual desire for a visit. Body language and signs need to be considered as well. The bilakh is a one-thumb up gesture that has a terribly rude meaning in Iran. To Westerners, thumbs up has positive connotations, so misinterpretations are inevitable.

If taarof challenges the social skills of individuals, imagine how it can confound foreign diplomats and politicians. What did President Mahmoud Ahmadinejad really mean in the 18-page letter about religion, values and history that he sent to President Bush? In centuries of occupation by Arab, Mongol, French and British forces, Iranians learned to express themselves with elaborate caution. In fact, an ancient practice called takiya, or al-takeyya, allowed Muslims minorities to avoid persecution and preserve their lives and and honor by holding their true beliefs in private while using subterfuge to disguise them in public.

And then there is the cultural love art, literature and poetry. The beautiful Rubaiyat of Omar Khayyam was written more than a thousand year ago by a Persian who was both scientist and poet. It is still read throughout the world. Americans who have traveled to neighboring Afghanistan report that there too, poetic expression infuses commerce and social transactions. Trying to hurry a negotiation risks failure. A Wall Street Journal piece Afghan Poetry Groups in DC Fight a War of Words on Their Art by Masood Favirar tells the captivating story of two Afghan cab drivers in Washington whose poetry clubs have differing commitments to their traditions. As the story point out, the passion for poetry extends to everyday modern life: “Afghans pepper their conversation with snippets of poetry and engage in poetic duels in which each side recites a line of verse that begins with a letter than ends the opposing side’s line.”

Hormesis

2007-08-23T12:52:00.000-07:00

If it doesn’t kill you, it might help

Is it possible to have too little of a bad thing? Maybe, if that means none.

The concept is hormesis, and the term comes from the Greek word horme, which means to excite. A German pharmacologist named Hugo Schultz noticed in 1888 that a small mount of poison seemed to stimulate the growth of yeast. Some 60 years ago, Chester Southam, a graduate student in the University of Idaho School of Forestry and his advisor John Ehrlich used to term hormesis to describe another unexpected phenomenon: a toxic red cedar extract stimulated the growth of various species of fungus.

In recent years scientists have recognized that living things do not respond to stimuli, good or bad, in a linear way. Many types of stress—chemical, environmental and behavioral—can actually stimulate cellular repair and maintenance. Some toxins that do harm in large or moderate quantity, the theory goes, can actually be helpful in small amounts.

The International Hormesis Society based at the University of Massachusetts at Amherst is dedicated to research on biological dose-response relationships. Its members want to understand the nature, mechanisms and implications of how living organisms respond to varying low doses of substances that are known to be toxic in quantity. The research is important in dozens of fields—pharmacology, medicine, ecology, biology, environmental science, risk assessment, public policy, neuroscience and immunology, to name a few. The BELLE (Biological Effects of Low Level Exposures) newsletter covers a wide range of articles on current research. For instance, Mark P. Mattson, in his article Hormesis and Disease Resistance, writes that knowledge of hormesis mechanisms will lead to novel approaches in preventing and treating disease. He explains that the proven beneficial effects of exercise and calorie-restricted diets may actually result from hormesis mechanisms. Both are stresses, which can stimulate bodily responses that improve immunity and promote cellular health. When rodents are subjected to calorie restrictions or intermittent fasting, he writes, they increase their resistance to several types of stress, including toxins, heat, cardiovascular stresses, and diseases. Perhaps, he suggests, hormesis research will be the “impetus for reemergence of a Spartan lifestyle.” Other papers review research on possible beneficial effects of very low doses of radiation and toxic chemicals and environmental poisons.

A page for historical figures describes the work of the pharmacologist Hugo Schulz, Chester Southam, an early user of the term, and Fernando Hueppe, another pioneer of hormeses study. The survival or all organisms depends on their ability to adapt to stressful change, and researchers contributing to this society are trying to discover how much of a role hormesis plays in the continuing evolution of viable organisms.