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I offer two interpretations of independence between experts: (i) independence as deciding autonomously, and (ii) independence as having different perspectives. I argue that when experts are grouped together, independence of both kinds is valuable for the same reason: they reduce the likelihood of erroneous consensus by enabling a greater variety of critical viewpoints. In offering this argument, I show that a purported proof from Finnur Dellsén that groups of more autonomous experts are more reliable does not work. It relies on a flawed ceteris paribus assumption, as well as a false equivalence between autonomy and probabilistic independence. A purely formal proof that more autonomous experts are more reliable is in fact not possible – substantive claims about how more autonomous groups reason are required. My alternative argument for the value of autonomy between experts rests on the claim that groups that triangulate a greater range of critical viewpoints will be less likely to accept hypotheses in error. As well as clarifying what makes autonomy between experts valuable, this mechanism of critical triangulation, gives us reason to value groups of experts that cover a wide range of relevant skills and knowledge. This justifies my second interpretation of expert independence.
This paper argues for two propositions. (I) Large asymmetries of power, status and influence exist between economists. These asymmetries constitute a hierarchy that is steeper than it could be and steeper than hierarchies in other disciplines. (II) This situation has potentially significant epistemic consequences. I collect data on the social organization of economics to show (I). I then argue that the hierarchy in economics heightens conservative selection biases, restricts criticism between economists and disincentivizes the development of novel research. These factors together constrain economics’ capacity to develop new beliefs and reduce the likelihood that its outputs will be true.
Patient preferences in schizophrenia (SCZ), including identification of key goals and outcomes for treatment and relative importance of certain treatment goals to patients, have been assessed by several studies. However, there continues to be a lack of sufficient evidence on US patient attitudes and perceptions towards treatment goals and pharmacotherapy options in SCZ, especially taking into context long-acting injectable antipsychotics (LAIs) in this disease area. This lack of evidence is further pronounced in caregivers of individuals with SCZ. The objective of this analysis was to characterize patients with SCZ on LAIs vs patients on oral antipsychotics (OAPs) and evaluate the treatment goals of patients in each group.
Methods
This was a real-world, cross-sectional survey of US psychiatrists, patients =18 years old with a diagnosis of SCZ, and caregivers. Data was collected using the Disease Specific Programme (DSP) methodology, which has been previously published. Psychiatrists (n=120) completed detailed record forms for next 8 consecutive outpatients and 2 inpatients matching inclusion criteria, including non-interventional clinical and subjective assessments. The same patients and their caregivers, if present, were invited by their psychiatrist to voluntarily complete a separate survey.
Results
Of 1135 patients on treatment where the physician provided survey data; 251 were on an LAI, and 884 were on an OAP. Mean (SD) time to SCZ diagnosis for those on an LAI was 10.3 (12.0) years vs 7.8 (10.5) years for those on OAPs. More patients in the LAI vs OAP group were being treated as an inpatient (27.1% vs 15.7%, respectively; p<0.0001). Patients on an LAI reported being on their current medication regimen for less time (mean 1.7 years) vs those on OAPs (mean 2.5 years) (p=0.0093). More patients on LAIs were unemployed due to disability vs those on OAPs (56.1% vs 39.5%, respectively), and less patients on LAIs were able to work part-time or full-time (21.1% or 4.1%) vs those on OAPs (23.2% or 11.4%). More patients on an LAI had a caregiver vs those on OAPs (37.3% vs 26.1%, respectively; p=0.0011). Regarding the most important treatment goals reported by patients, both groups reported similar preferences for decrease in disease symptoms (62% on LAI vs 65% on OAPs) and thinking more clearly (53% on LAI vs 46% on OAPs); however, a numerically higher proportion of LAI patients reported that the current medication helped decrease hospitalizations due to relapse vs those on OAPs (38% vs 32%, respectively).
Discussion
Given the characteristics of patients participating in this real-world survey, those on LAIs exhibited qualities which indicate a higher severity of illness vs those on OAPs. Results suggest that treatment with LAIs is still mainly being provided to patients later in the disease course and/or who have adherence problems, despite a growing body of evidence of utility in younger patients earlier in the course of illness.
Funding
Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck LLC
Objectives for this survey are to determine similarities or differences in treatment goals reported by psychiatrists, patients with schizophrenia (SCZ) and caregivers in the US, as well as whether goals differed by patients currently on an oral antipsychotic (OAP) or long-acting injectable (LAI), and whether goals differed by age.
Methods
This was a real-world, cross-sectional survey of US psychiatrists, patients =18 years old diagnosed with SCZ, and caregivers. Data was collected using the Disease Specific Programme (DSP) methodology. Psychiatrists (n=120) completed detailed record forms for next 8 outpatients and 2 inpatients matching inclusion criteria. The same patients and their caregivers, if present, were invited by their psychiatrist to voluntarily complete a separate survey.
Results
Responses on treatment goals were collected from psychiatrists for all patients included in the analysis (n=1161), patients (n= 542) and caregivers (n=130). Among 3 top goals, psychiatrists, patients and caregivers concurred that “decrease in disease symptoms” is most important (63%, 64%, 68% respectively). For psychiatrists and caregivers, second was “decrease in hospitalization for relapse” (41%, and 38% respectively), whereas for patients, it was “thinking clearly” (47%). Of the 3 least important goals, psychiatrists, patients and caregivers agreed with “sexual problems” (59%, 43%, 44%, respectively) and “weight gain” (38%, 44%, 38%, respectively).
When asked which goals were met by current medication, patients responded “decrease in disease symptoms” (68%) and “thinking clearly” (39%). However, caregivers responded “thinking clearly” (30%) was not met by current medication. Caregivers most important goals, “decrease in disease symptom” (70%) and “decrease in hospitalization for relapse” (41%), were met. Additional analyses of patients on OAPs and LAIs, did not show differences in goals. However, “decrease in disease symptoms” was numerically more important for patients on LAIs vs OAPs according to psychiatrists (68% vs 62%) and caregivers (77% vs 70% respectively). Caregivers responded “decrease in hospitalization for relapse” was met for 63% patients currently on an LAI and 35% OAP. No major differences in treatment goals were observed by patient age (18–35 vs 36–65 vs >65 years).
Discussion
There is consensus among US psychiatrists, patients and caregivers on the most important treatment goal “decrease in disease symptoms”, regardless of patients’ current medication or age. For patients, “thinking more clearly” was second, compared with “decrease in hospitalization due to relapse”, for psychiatrists and caregivers. All agreed that least important treatment goals, related to AEs, were “weight gain” and “sexual problems”. More caregivers agreed “decrease in hospitalization for relapse” was met by patients on LAIs vs OAPs. These findings may help with discussions between psychiatrists, patients and caregivers.
Funding
Lundbeck LLC and Otsuka Pharmaceutical Development & Commercialization, Inc.
The Fontan Outcomes Network was created to improve outcomes for children and adults with single ventricle CHD living with Fontan circulation. The network mission is to optimise longevity and quality of life by improving physical health, neurodevelopmental outcomes, resilience, and emotional health for these individuals and their families. This manuscript describes the systematic design of this new learning health network, including the initial steps in development of a national, lifespan registry, and pilot testing of data collection forms at 10 congenital heart centres.
Do increasing, and increasingly diverse, immigration flows lead to declining support for redistributive policy? This concern is pervasive in the literatures on immigration, multiculturalism and redistribution, and in public debate as well. The literature is nevertheless unable to disentangle the degree to which welfare chauvinism is related to (a) immigrant status or (b) ethnic difference. This paper reports on results from a web-based experiment designed to shed light on this issue. Representative samples from the United States, Quebec, and the “Rest-of-Canada” responded to a vignette in which a hypothetical social assistance recipient was presented as some combination of immigrant or not, and Caucasian or not. Results from the randomized manipulation suggest that while ethnic difference matters to welfare attitudes, in these countries it is immigrant status that matters most. These findings are discussed in light of the politics of diversity and recognition, and the capacity of national policies to address inequalities.
A surface-energy/mass-balance model with an explicit calculation of meltwater refreezing and superimposed ice formation is applied to midre Lovénbreen, Spitsbergen, Svalbard. The model is run with meteorological measurements to represent the present climate, and run with scenarios taken from global climate model predictions based on the IS92a emissions scenario to represent future climates. Model results indicate that superimposed ice accounts for on average 37% of the total net accumulation under present conditions. The model is found to be highly sensitive to changes in the mean annual air temperature and much less sensitive to changes in the total annual precipitation. A 0.5˚C decade–1 temperature increase is predicted to cause an average mass-balance change of –0.43 ma–1, while a 2% decade–1 increase in precipitation will result in only a +0.02 ma–1 change in mass balance. An increase in temperature results in a significant decrease in the size of the accumulation area at midre Lovénbreen and hence a similar decrease in the net volume of superimposed ice. The model predicts, however, that the relative importance of superimposed ice will increase to account for >50% of the total accumulation by 2050. The results show that the refreezing of meltwater and in particular the formation of superimposed ice make an important positive contribution to the mass balance of midre Lovénbreen under present conditions and will play a vital future role in slowing down the response of glacier mass balance to climate change.
We argue that widely accepted elitist and “clientelist” models of immigration policy in the United States unduly minimize popular pressure on policy-making. These models portray majority opinion in ways that fail to recognize divergence between the public’s abstract goals for immigration policy and its support for the concrete policy changes needed to achieve them. As a result, they obscure many important instances in which immigration policy accords with public preferences despite counter-pressure from elites and organized lobbies. We demonstrate this point by identifying and explaining gaps between generalized attitudes and beliefs about specific policies in the domains of both legal and illegal immigration, showing that status quo legal admissions policies are not starkly at odds with majority preferences and that, contrary to interpretations of most commercial polling on the topic, majorities reject specific aspects of legalization programs that organized lobbies insist on as components of a “grand bargain” to overhaul an immigration system widely viewed as “broken.” Appreciating the nuance in mass opinion toward immigration policy helps explain policy stagnation that confounds elitist models and suggests that forging ahead with immigration reform will require persuading the public and not only successful bargaining among elites and interest groups.
FRANCE IS A COUNTRY IN WHICH PAST POLITICAL BATTLES ARE IN the forefront of the minds of those who are engaged in contemporary conflicts. The March 1977 elections in the 36,383 communes of metropolitan France could evoke memories of 1877 and 1947. The thirtieth anniversary of the Gaullist landslide of 1947 was directly concerned with local elections as such, while 1877 recalled the defeat of President MacMahon's attempt to impose his choice of government a century ago, which finally settled the struggle between Left and Right over the regime of the Third Republic. Anticipation that the regime established by General de Gaulle would be put to the searching test of a clash between the President and a Left-wing Assembly majority converted in some people's minds the March 1977 local clections into a prologue to this decisive national confrontation.
Abstract. The relationship of national identifications to preferences about immigration is a subject of empirical controversy. The hypothesis we explore here through a comparison of Canada and the United States is that the normative content of national identity—how people define the meaning of patriotism in their country—mediates the relationship between national pride and sentiment about immigration and multiculturalism. How political elites construct what citizens should be proud of matters. In comparisons based on the 2003 International Social Survey Program's “National Identity Module,” Canadians seem more divided than Americans over their nationality and generally less chauvinist. Canadians are more receptive to maintaining the current level of immigration and see newcomers as less threatening to economic and cultural values. The relationship between identification with the country and support for immigration and multiculturalism diverges sharply between the countries: where in Canada the relationship is positive, in the US it is negative.
Résumé. Le lien entre l'identification à la nation et les préférences quant à l'immigration est un sujet de controverse. À travers une comparaison du Canada et des Etats-Unis, l'hypothèse que nous explorons ici est que le contenu normatif de l'identité nationale, c'est-à-dire le sens donné par la population au patriotisme envers leur pays, joue un rôle intermédiaire dans la relation entre la fierté nationale et les sentiments vis-à-vis l'immigration et le multiculturalisme. La façon dont les élites politiques construisent ce en quoi les citoyens devraient être fiers revêt donc une importance particulière. À titre comparatif, en se basant sur le « Module Identité Nationale » du International Social Survey Programme de 2003, les Canadiens semblent plus divisés que les Américains sur la signification de leur identité nationale et, de façon générale, sont moins chauvins. Les Canadiens sont également plus réceptifs à l'idée de maintenir l'immigration à son niveau actuel et voient les nouveaux arrivants comme étant moins menaçants pour leurs valeurs économiques et culturelles. La relation entre l'identification au pays et le support pour l'immigration et le multiculturalisme diverge nettement entre les deux pays. Alors qu'au Canada la relation est positive, aux Etats-Unis elle est négative.
The Farming Game is the agricultural management text for the twenty-first century. The central theme underpinning this text is that the farm management context is most usefully and reliably managed by the application of economic ways of thinking. In this text, the practice of farm management is approached in an integrated way, leaving no significant issues about management uncovered. Finance, investment, decision analysis, management, economic thinking, growth, risk and marketing are critical and exciting domains of interest that are brought together to give the reader a thorough and comprehensive understanding of how the farming situation is best analysed and managed. The text is essential reading for those who seek to manage agricultural businesses well and for those with interest throughout agricultural supply chains who need to understand the character of farms as the core of agribusiness systems.