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When a measure becomes a target, it ceases to be a good measure. (Strathern, 1997)
Our target article set out with an ambitious goal: To provide a unified account of the disparate descriptions of proxy failure across not only social and natural sciences but also engineering and artificial intelligence research. Clearly such a task could only truly be achieved by a broad transdisciplinary community. The wide range of commentaries from a remarkable array of disciplines has not only confirmed our main proposition – that the disparate cases do reflect the same core phenomenon of “proxy failure” – but suggests the viability of a new interdisciplinary undertaking that we might call “proxynomics.” Several comments highlighted key issues and extensions, others provided novel illuminating examples and, perhaps most importantly, quite a few proposed viable solutions or at least mitigation strategies.
As the US population ages, the prevalence of Alzheimer’s disease and related dementias (AD/RD) is on the rise. This is especially true in rural America, where mortality rates due to AD/RD are rising faster than in metropolitan areas. To date, however, people living in rural communities are severely underrepresented in aging research. The Nevada Exploratory Alzheimer’s Disease Research Center (NVeADRC) seeks to address this gap. Here, we present preliminary cognitive data from our rural-dwelling cohort, as well as relevant demographic and clinical characteristics.
Participants and Methods:
Individuals with normal cognition (NC), mild cognitive impairment (MCI), and dementia due to Alzheimer’s disease (AD) living in rural communities, defined as a rural-urban commuting area (RUCA) code of 4 or higher, were enrolled through either clinic or community outreach. Eligibility for the observational cohort required: age >55 years, primarily English-speaking, primary residence in a rural community, and availability of a study partner. Measures included the Uniform Data Set (v3), blood-based biomarkers, structural brain MRI, and portions of the PhenX Social Determinants of Health toolkit. Participants are seen at baseline and followed annually, with interim remote visits every 6 months. A multidisciplinary consensus diagnosis is rendered after each visit. Where feasible, a harmonized urban cohort followed by the Nevada Center for Neurodegeneration and Translational Neuroscience (CNTN) was used for comparison.
Results:
Fifty-six rural-dwelling (age=70.4±7.1 years; edu=15.2±2.6 years; 61% female) and 148 urban-dwelling (age=72.9±6.8 years; edu=15.8±2.7 years; 46% female) older adults were included; age significantly differed between cohorts but education did not. The rural cohort was 46% NC (MoCA=26.8±2.3; CDRsob=0.3±0.6), 32% MCI (MoCA=22.8±3.1; CDRsob=1.2±1.0), and 22% AD (MoCA=16.9±5.5; CDRsob=5.2±3.0). The urban cohort was 39% NC (MoCA=26.4±2.6; CDRsob=0.3±0.8), 44% MCI (MoCA=22.3±3.1; CDRsob=2.0±1.5) and 17% AD (MoCA=18.6±3.9; CDRsob=4.7±2.3). Rural communities were significantly more disadvantaged, as measured by the Area Deprivation Index (ADI), than urban communities (rural ADI=6.3±2.6; urban ADI=3.4±2.3; p<.001). Fifty-percent of the rural cohort lives in a moderate to severely disadvantaged neighborhood (ADI Decile>7) compared to 12% of the urban cohort, and 11% of individuals in the rural cohort reported living more than 30 miles from the nearest medical facility. Across the combined cohort, education was significantly correlated with ADI deciles (r=-.30, p<.001), with people in the areas of highest disadvantage having the lowest education. Verbal memory was also inversely associated with ADI. There were no differences in clinical diagnosis as a function of ADI rank.
Conclusions:
Living in a rural community conveys a multifaceted array of risks and benefits, some of which differ from urban settings. The literature to date suggests that older adults living in rural communities are at significantly increased risk for morbidity and mortality due to AD/RD, though it is unclear why. Preliminary data from the NVeADRC show that increasing levels of neighborhood disadvantage were associated with lower levels of education and worse verbal memory in this convenience sample. The combined effect of low education and increased disadvantage account for some of the urban-rural differences in mortality that have been reported, though additional research on representative samples in this underrepresented population is critical.
When a measure becomes a target, it ceases to be a good measure. For example, when standardized test scores in education become targets, teachers may start “teaching to the test,” leading to breakdown of the relationship between the measure – test performance – and the underlying goal – quality education. Similar phenomena have been named and described across a broad range of contexts, such as economics, academia, machine learning, and ecology. Yet it remains unclear whether these phenomena bear only superficial similarities, or if they derive from some fundamental unifying mechanism. Here, we propose such a unifying mechanism, which we label proxy failure. We first review illustrative examples and their labels, such as the “cobra effect,” “Goodhart's law,” and “Campbell's law.” Second, we identify central prerequisites and constraints of proxy failure, noting that it is often only a partial failure or divergence. We argue that whenever incentivization or selection is based on an imperfect proxy measure of the underlying goal, a pressure arises that tends to make the proxy a worse approximation of the goal. Third, we develop this perspective for three concrete contexts, namely neuroscience, economics, and ecology, highlighting similarities and differences. Fourth, we outline consequences of proxy failure, suggesting it is key to understanding the structure and evolution of goal-oriented systems. Our account draws on a broad range of disciplines, but we can only scratch the surface within each. We thus hope the present account elicits a collaborative enterprise, entailing both critical discussion as well as extensions in contexts we have missed.
What is an ‘Oxford composer’? A working definition might be ‘a composer of some distinction associated for much of his or her career with the city or the university’. There are, however, other possible definitions, and our working definition might exclude some composers whose association, though brief, was decisive. Another familiar, but for our purposes less useful, definition is ‘a composer published by Oxford University Press’. As it happens, the Music Department of the Press operated from London, not Oxford, for much of its earlier life, but in any case it has never limited its scope to composers associated with Oxford. I have adopted the working definition above, but with a certain amount of flexibility. Finally, while some composers still living are mentioned, I have avoided all critical comment on their music.
Composition within the orbit of the twentieth-century University, like most of its activities, falls neatly into two almost equal halves divided by World War II, or rather by the end of that war in 1945. Before that date, the study of music was very largely based on composition. The reasons for this are historical. Oxford, with Cambridge, started to offer degrees in Music (B.Mus. and D.Mus.) at the end of the fifteenth century, and apart from a few very early cases they were awarded exclusively for composition. Typ-ically, the requirement at Oxford was for a Mass and an antiphon (a kind of motet) in five parts, together with evidence of the study of music for a period of time, usually ten years for a doctorate. While we know the names of composers who received the degree of Doctor or Bachelor of Music (or at any rate who were given permission to ‘supplicate’ for the degree) we do not know how their submissions were evaluated. It seems, in fact, that the proof of the pudding was in the eating: if the music was performable, it would pass muster.
The requirement for a composition (no longer, it need hardly be said, for a Mass and an antiphon), together with a period of study, was enshrined in the Laudian statutes of 1636, a successful submission entitling the holder to ‘lecture on any book of Boethius's De Musica’. The composition had to be performed in the Sheldonian Theatre, usually as part of the annual ‘Act’, but there is no mention of any examiners.
The ‘long eighteenth century’ (1688–1815) is perhaps not the most obvious time-frame for a survey of Catholic church music in Britain. Beginning with the ignominious flight of the Catholic James II and ending fourteen or so years before the ‘full’ emancipation of Catholics in 1829, it ushers in a period that to begin with is short on information and to all appearances lacking in significant musical activity, whereas the late eighteenth and early nineteenth centuries have already received a considerable amount of attention and might seem to merit little further study. During this time Catholics suffered severe disabilities, both civil and religious. Their civil disabilities, however, were not such as materially to affect religious life, and were similar in any case to those imposed on all women and on other groups including Protestant dissenters and Jews. As for the specifically religious restrictions, for example the embargo on public worship and on Catholic publications, the law was notionally severe but was only exceptionally enforced in all its rigour. The Acts of 1778 and 1791 introduced some elements of relief, but the road to the Act of 1829 was nevertheless beset with difficulties.
James II had created a full-scale Catholic Royal Chapel, parallel to the Anglican one, but his departure brought overt Catholic practice in England to an abrupt end. Charles II's widow, Catherine of Braganza, had moved to Somerset House in 1671, following the death of Henrietta Maria in 1669, although her chapel in St James's Palace (now part of Marlborough House) seems to have continued for a time in Catholic hands before being converted eventually to Anglican use. The practice of Catholicism, in London at least, then devolved on the chapels of the embassies of Catholic countries. As extra-territorial entities these could be frequented by English Catholics without penalty, although they were subject from time to time to mob violence.
The early history of the Catholic embassy chapels is not altogether clear. At first they will simply have been rooms within the embassy buildings themselves, and several remained so. From 1700 until 1708 the Portuguese had their embassy at Lincoln's Inn Fields. By 1715 a Sicilian embassy was established there, and this became the Sardinian embassy in 1720, when the Duke of Savoy exchanged his kingdom of Sicily (awarded at Utrecht in 1713) for Sardinia; the first reference to a ‘Sardinian’ chapel dates from 1722
The general observance of Salisbury customs throughout the islands of Britain and Ireland means that the occurrence of distinctive Insular Uses is somewhat restricted. The most widespread of the non-Sarum liturgies, observed throughout Europe, was that of the Benedictine monasteries, including in England the cathedral priories; these nevertheless often possessed their own individual customaries, as did other houses such as those of the Augustinian canons. The principal secular Uses, apart from that of Salisbury, were those of Hereford and York, although all dioceses had their local saints and minor differences. A full analysis of everything that was distinctive about diocesan usages in the provinces of Canterbury and York is beyond the scope of this chapter; instead, the focus is on a small range of comparable matter in the major Uses and in the variable customs of some other dioceses.
The psalter is the only book of the bible that survived more or less intact as a constituent part of late medieval breviaries and antiphonals. In the breviary, noted or otherwise, the other biblical books are more widely dispersed and much abbreviated; in the antiphonal, while a psalter usually came to be incorporated, the other books are not represented at all beyond the briefest passages. The integrity of the psalter is explained by the way it was used in the Divine Office, while the details of its arrangement and annotation were the result of an increasing concern for liturgical precision, particularly among the compilers of secular Uses.
The early history of the Latin psalter is a familiar one. It was a translation from the Greek, itself a translation of a Hebrew version that differed in some ways from what became the standard ‘Masoretic’ text. What is referred to as the ‘Hebrew’ numbering of the psalms is a product of the Masoretic arrangement, but it is not the numbering traditionally used in Catholic and Orthodox Christianity. According to Hilary of Poitiers, the Greeks were the first to number the psalms, and theirs is the numbering adopted in Greek and Latin psalters and bibles. Even when St Jerome translated the psalter directly from the Hebrew, he (or the manuscripts representing his translation) retained the Greek numbering.
The division of the psalms into verses is even more significant for performance. Again the Hebrew numbering, or rather the numbering derived from the Masoretic punctuation, differs from the arrangement of verses in the Greek and Latin translations. The Hebrew numbering has gained importance as a means of reference, but it is of no significance for the singing of the psalms in Greek or Latin. It was adopted in the Sixto/Clementine Latin bibles, although these latter retained the liturgical versification in their paragraphing; it is also the numbering found in modern (non-liturgical) editions of the Septuagint. The liturgical verses are not normally (if ever) numbered in medieval psalters, and not often in modern Latin ones. The traditional versification is foreshadowed in the early complete Greek bibles, where a single line was usually sufficient to represent what later became a complete verse, or one half, or one third of a verse.
Rapid identification of esophageal intubations is critical to avoid patient morbidity and mortality. Continuous waveform capnography remains the gold standard for endotracheal tube (ETT) confirmation, but it has limitations. Point-of-care ultrasound (POCUS) may be a useful alternative for confirming ETT placement. The objective of this study was to determine the accuracy of paramedic-performed POCUS identification of esophageal intubations with and without ETT manipulation.
Methods
A prospective, observational study using a cadaver model was conducted. Local paramedics were recruited as subjects and each completed a survey of their demographics, employment history, intubation experience, and prior POCUS training. Subjects participated in a didactic session in which they learned POCUS identification of ETT location. During each study session, investigators randomly placed an ETT in either the trachea or esophagus of four cadavers, confirmed with direct laryngoscopy. Subjects then attempted to determine position using POCUS both without and with manipulation of the ETT. Manipulation of the tube was performed by twisting the tube. Descriptive statistics and logistic regression were used to assess the results and the effects of previous paramedic experience.
Results
During 12 study sessions, from March 2014 through December 2015, 57 subjects participated, evaluating a total of 228 intubations: 113 tracheal and 115 esophageal. Subjects were 84.0% male, mean age of 39 years (range: 22 - 62 years), with median experience of seven years (range: 0.6 - 39 years). Paramedics correctly identified ETT location in 158 (69.3%) cases without and 194 (85.1%) with ETT manipulation. The sensitivity and specificity of identifying esophageal location without ETT manipulation increased from 52.2% (95% confidence interval [CI], 43.0-61.0) and 86.7% (95% CI, 81.0-93.0) to 87.0% (95% CI, 81.0-93.0) and 83.2% (95% CI, 0.76-0.90) after manipulation (P<.0001), without affecting specificity (P=.45). Subjects correctly identified 41 previously incorrectly identified esophageal intubations. Paramedic experience, previous intubations, and POCUS experience did not correlate with ability to identify tube location.
Conclusion:
Paramedics can accurately identify esophageal intubations with POCUS, and manipulation improves identification. Further studies of paramedic use of dynamic POCUS to identify inadvertent esophageal intubations are needed.
LemaPC, O’BrienM, WilsonJ, St. JamesE, LindstromH, DeAngelisJ, CaldwellJ, MayP, ClemencyB.Avoid the Goose! Paramedic Identification of Esophageal Intubation by Ultrasound. Prehosp Disaster Med.2018;33(4):406–410
In New Zealand, the relationship property and adult maintenance regimes on the breakdown of a marriage, civil union, or de facto relationship have long been dealt with under two discrete legislative regimes. Relationship property assets of the parties are divided pursuant to the detailed provisions of the Property (Relationships) Act 1976 (NZ) (‘PRA’), whereas the adult maintenance and future income needs of any one party are governed by the essentially discretionary provisions found in Part 6 of the Family Proceedings Act 1980 (NZ) (‘FPA’). While the two regimes are clearly distinct, there is nevertheless an acknowledged complementarity in their policies. After all, both share the common goal of facilitating a fair resolution of financial problems ensuing from a failed relationship, and the legislative amendments in 2001 to both the PRA and the FPA were designed to'sit alongside ‘each other.
In 2016 the New Zealand Law Commission commenced a review of the PRA. This review provides an ideal opportunity to reflect on whether there could now be further integration of the two regimes and, indeed, whether the concept of separate adult maintenance even remains justifiable in principle at all. In particular, given the regime for property division in New Zealand encompasses compensation for relationship-derived economic disparities (though admittedly a little incongruously), it may be timely to reconsider the purpose and future of our so-called rehabilitative, needs-based maintenance. It may be time to think about fortifying the ‘clean break‘ principle.
The clean break principle is premised on the notion that the parties will use their respective shares of the relationship property to start afresh. Its purpose is to achieve financial finality and to assist the parties to self-determine and become self-sufficient. While no overt or implicit reference to this principle can be found in any of the specific provisions of the PRA, including in sections 1M and 1N which set out the purposes and principles of the PRA, there can be no doubt that the statutory regime as a whole is firmly grounded on the philosophy that ‘there should be a clean break between the parties as soon as practicable, with each able to take up their future life independently of the other’.
The changing total luminosity of SN 1987A between 2 and 1200 days after core collapse is illustrated and discussed. From about four weeks after outburst the supernova light curve was dominated by the release of radioactive decay energy; the major contributor being 0.078M⊙ of 56Co. Recently an additional contribution probably from the decay of 57Co and 44Ti appears to be manifesting itself in the light curve. A gradually increasing fraction of the radioactive decay energy has probably been emitted at X- and γ-ray wavelengths; the fluxes are low and no recent measurements have been published. Most of the remaining radioactive decay energy appears to be emitted in the IR and is very difficult to measure. Other factors influencing the interpretation of the recent light curve are the uncertain contribution from long-lived radioactive isotopes and light-echoes. It is therefore premature to make any definitive statements on the contribution from the neutron star, although it is probably less than a few times 1037 erg s−1.
Tall fescue toxicosis adversely affects calving rate and weight gainsreducing returns to cow-calf producers in the south–central United States.This grazing study estimated animal and economic performance implications ofendophyte-infected fescue and calving season. Establishing novelendophyte-infected tall fescue on 25% of pasture acres resulted in improvedcalving rates (87% vs. 70%), weaning weights (532 lbs vs. 513 lbs), andpartial returns per acre ($257 vs. $217). Additionally, fall-calving cowshad higher calving rates (91% vs. 67%), weaning weights (550 lbs vs. 496lbs), and partial returns per acre ($269 vs. $199) than spring calvingcows.
Discovery of ultra-compact dwarfs (UCDs) in the past 15 years blurs the once thought clear division between classic globular clusters (GCs) and early-type galaxies. The intermediate nature of UCDs, which are larger and more massive than typical GCs but more compact than typical dwarf galaxies, has triggered hot debate on whether UCDs should be considered galactic in origin or merely the most extreme GCs. Previous studies of various scaling relations, stellar populations and internal dynamics did not give an unambiguous answer to the primary origin of UCDs. In this contribution, we present the first ever detailed study of global dynamics of 97 UCDs (rh ≳ 10 pc) associated with the central cD galaxy of the Virgo cluster, M87. We found that UCDs follow a different radial number density profile and different rotational properties from GCs. The orbital anisotropies of UCDs are tangentially-biased within ~ 40 kpc of M87 and become radially-biased with radius further out. In contrast, the blue GCs, which have similar median colors to our sample of UCDs, become more tangentially-biased at larger radii beyond ~ 40 kpc. Our analysis suggests that most UCDs in M87 are not consistent with being merely the most luminous and extended examples of otherwise normal GCs. The radially-biased orbital structure of UCDs at large radii is in general agreement with the scenario that most UCDs originated from the tidally threshed dwarf galaxies.
Background: We evaluated whether quality of life correlates to age and activity in children following heart transplantation. In addition, quality of life in children following heart transplantation was compared with previously reported values in children with congenital heart disease. Quality of life remains an important aspect of therapy. Methods: The Pediatric Quality of Life Inventory Generic Core Scales and Cardiac Module were administered to 14 children who had previously undergone heart transplantation. Patients wore a pedometer for 7 days to assess daily activity. Results: The age at assessment was 13.1±1.9 years. The patients were 7.1±5.7 years post heart transplantation. There was a negative correlation between age at first heart transplantation and emotional (r=−0.64; p<0.05) and school function (r=−0.57; p<0.05). A negative correlation between patient’s age at assessment and perceived physical appearance existed (r=−0.53; p<0.05). Daily steps negatively correlated with cognitive (r=−0.58; p<0.05), physical (r=−0.63; p<0.05), emotional (r=−0.62; p<0.05), and school function (r=−0.66; p<0.01). Heart transplantation patients reported better scores for treatment and symptoms (p<0.05) but lower physical health scores (p<0.01) than those with moderate congenital heart disease. Conclusions: Paediatric heart transplantation patients reported overall similar quality of life as patients with moderate congenital heart disease. Children receiving heart transplants at an older age may require additional emotional and educational support. Heart transplantation patients with higher activity levels may be more aware of their physical, emotional, and cognitive limitations, and thus score lower on these quality of life indicators.
The following dexriptions are based on specimens collected by Mr. E. H. Strickland in Alberta, Canada. All holotypes and allotypes are deposited in the Canadian National Collection at Ottawa, Ontario. Paratypes are in the collection at the University of Alberta, Edmonton, and in the Caldwell collection at Ohio State University, Columbus.
Modifications to the p-type semiconductor TIPS-Pentacene can result in elimination of the solid-solid thermal transition at 124 °C. This new material has shown mobility higher than 1 cm2/Vs. Elimination of the solid-solid thermal transition leaves the melting point as the lowest temperature transition at 199 °C.