The American Diabetes Association and the European Association for the Study of Diabetes published a 2022 consensus report recommending changes in diabetes care. This Perspective raises three concerns: with how the report summarizes evidence, how it frames the social determinants of health (SDOH), and with its transnational composition and conflicts of interest. The Perspective analyzes three new clinical recommendations that change the role of metformin from first-line therapy to a first-line option, for the inclusion of weight management as a co-primary treatment goal with glycemic control for patients without cardiac or renal complications, and for addition of the SDOH as a universal component of diabetes care together with lifestyle changes and self-management support. The Perspective considers how the poor evidence assessments of the recommendations and the imprecise framing of the SDOH introduce bias. The composition of the panel’s membership poorly represents and accounts for the challenges faced by vulnerable US communities or safety net providers. The report is placed in a historical context for diabetes of organized medicine’s failures to overcome prejudices and promote health equity. The Perspective concludes that the report perpetuates a pattern of prejudice within organized medicine at the expense of scientific precision and health equity.

The chapter reviews key foundations and principles of the burgeoning discipline of executive or leadership coaching and explores how these relate to the practice, profession, and philosophy of engineering. In exploring and comparing objectives, approaches, cognitive preferences and future challenges of coaches and engineers, the authors identify a number of kindred properties between the two disciplines. This common ground would invite us to believe that engineering would naturally draw upon coaching for the development of its students, educators, and practitioners, but evidence shows that this is not the case. Although many late-stage engineers get coached upon reaching the C-suite or other high positions in the public or private sectors, early and mid-career engineers do not have ready access to the coaching support seen elsewhere. Equally, very few initiatives to integrate and tap into this resource are seen in the global engineering education system for academic leaders, educators, or engineering students in ways that would benefit future generations of engineers. This chapter aims at providing a possible explanation for this gap, whilst suggesting why and how coaching could possibly be the untapped resource that engineers may need to successfully meet the challenges and demands of today and tomorrow. The authors call on philosophers to join in the efforts, drawing out some key paths for collaboration and helpful future investigative questions.

Philosopher Pierre-Andre Taguieff, whose earlier work tracked the history of anti-Semitism, indicts contemporary anti-racist critics of the French state as guilty of “anti-white racism.” An assistant attorney general in Australia insisted an anti-racism program should not be funded because “taxpayer funds” were being used “to promote critical race theory”. Like “diversity” over the past decade and “multiculturalism” before that, critical race theory is being made the bag now carrying the load long critical of racism. CRT and more nuanced work in CRS offer an invaluable resource for this work. They take seriously what the conservative attack too readily looks away from. They try to account for what it is in our culture, in the social infrastructure and institutional shaping and the order to which they give rise, that reproduces the undeniable inequality, the lived violence and trauma, that people of color experience in the United States and Europe.

The determinants of health and public mental health frameworks define the factors that shape health, calling for more effective partnerships across organizations and levels of society to address those factors. A consensus exists that it is the combination of risk and protective factors rather than factors taken individually that determines the impact on mental health. A range of cost-effective interventions are described. Nurses and others can also be effective in treating episodes of common mental disorders. It is necessary to recognize the social determinants of health, and work towards a change in health-care and social systems, as well as in the education of doctors. The social determinants of health (SDOH) model posits that genetic endowment interacts with social and physical environments to determine individual biological and behavioural responses that are influenced by access to and quality of health-care services.

Introduction: Observational studies have demonstrated an association between digoxin treatment and lower interstage mortality after Norwood operation for hypoplastic left heart syndrome (HLHS), but the attributable mortality benefit has not been measureable without a clinical trial. Application of an instrumental variable can overcome confounding by indication and unmeasured confounding through pseudo-randomization. Methods: A multicenter retrospective cohort study of neonates with HLHS born 1/1/2007-12/31/2021, undergoing a Norwood operation at Pediatric Health Information Systems Database hospitals, and surviving >14 days post-operatively was performed evaluating the association of digoxin and 1-year transplant-free survival. Traditional multivariable logistic regression models were supplemented with instrumental variable analyses using hospital-specific 60-day likelihood of administering digoxin. Results: The study population included 5,148 subjects treated at 47 hospitals (63% male, 46% non-Hispanic white); 44% (n=2,184) received digoxin. Receipt of digoxin was associated with superior 1-year transplant-free survival in unadjusted analyses (85% vs. 82%, p=0.02). This persisted after adjustment for measurable confounders (OR: 0.66, p<0.001) and in an instrumental variable analysis (OR: 0.71, p=0.01, Figure). Conclusions: This observational study of patients with HLHS after Norwood used instrumental variable techniques to demonstrate a significant benefit in one-year transplant-free survival attributable to digoxin. In the absence of clinical trial data, this should encourage the use of digoxin in this vulnerable population..

The American Diabetes Association 2020 Standards of Care for the treatment of hyperglycemia in type 2 diabetes includes a treatment pathway when "cost is a major issue." This pathway recommends use of 2 generic drug classes, thereby codifying differential treatment for those with financial hardship. This article explores 4 implications of incorporating the cost pathway into clinical recommendations: (1) the presence of a cost pathway might create the appearance of an evidence-based quality difference through activation of implicit bias; (2) screening for financial hardship to guide therapy has potential harms for patients; (3) concern that financial hardship warrants differing care might impact overall quality of care and patient-clinician relationships; and (4) applying the guidelines when caring for patients with financial hardship might demoralize clinicians.

NOTE: The first page of text has been automatically extracted and included below in lieu of an abstract iFoundry: Engineering Curriculum Reform Without Tears Introduction The National Academy of Engineering’s (NAE’s) 2020 reports1,2 have identified the knowledge and skills needed by the engineer of the 21st century and the large-scale curriculum reform necessary to educate these new professionals. Blank-slate curriculum reform efforts,3 innovations from the National Science Foundation’s (NSF’s) curriculum coalitions,4,5 and even a brand new engineering college6 have bootstrapped models for significant and effective curriculum innovation that offer a variety of plausible avenues for change. Yet, despite significant progress in outlining appropriate changes and widespread agreement that change is necessary, many engineering curricula appear to be locked in a cold war time warp with incremental, grudging modifications coming at the margins, if at all.7 This paper suggests that the organizational processes by which curriculum changes are vetted and made are key factors inhibiting effective change. In particular, the normal democratic processes of curriculum approval invoke a kind of educational NIMBY (not in my backyard) problem in which changes are fine with individual professor as long as they are not demanded in courses that particular professor teaches or cares about. The inevitable logrolling results in a coalition favoring the status quo to block changes that many know are needed. The paper discusses efforts to overcome such organizational resistance through the creation of a grassroots interdepartmental collaborative pilot unit of students and faculty to test, implement, and assess needed changes. The pilot called iFoundry, short for the Illinois Foundry for Tech Vision and Leadership, was established in the summer of 2007. This paper discusses the origins of iFoundry, its progress to date, and the theory and practice of its implementation. A key notion is that the usual method of approving untested curriculum changes goes against the engineering grain, and that a pilot unit, especially one that combines the efforts of students and faculty from a number of different departments, is likely to test, implement, and then institutionalize changes more effectively than the traditional approach to curriculum change. The paper starts by reviewing the context of curriculum change in 2008. It continues by discussing the lack of diffusion of tested curriculum reforms that resulted from the NSF coalitions and elsewhere and a number of organizational responses to the problems of change. The paper continues by examining two reasons why curriculum is so hard to change given the organizational processes of vetting and approving curriculum change. It then outlines the iFoundry idea of establishing a collaborative, interdepartmental pilot unit and six key elements of iFoundry’s systems design. The paper continues with a brief report on progress to date and a call for open source curriculum development and the formation of a global xFoundry coalition of pilot units that subscribe to the iFoundry principles. Flat Worlds and the 21st Century Engineering Curriculum The current engineering curriculum was formed in the crucible of the cold war.8 Since that time, radical changes in transportation, communication, and computer technology9 leave us in a very

The development and survival of spiral ganglion neurons (SGNs) are dependent on multiple trophic factors as well as membrane electrical activity. Semaphorins (Sema) constitute a family of membrane‐associated and secreted proteins that have garnered significant attention as a potential SGN “navigator” during cochlea development. Previous studies using mutant mice demonstrated that Sema3A plays a role in the SGN pathfinding. The mechanisms, however, by which Sema3A shapes SGNs firing behavior are not known. In these studies, we found that Sema3A plays a novel role in regulating SGN resting membrane potential and excitability. Using dissociated SGN from pre‐hearing (P3–P5) and post‐hearing mice (P12–P15), we recorded membrane potentials using whole‐cell patch clamp recording techniques in apical and basal SGN populations. Recombinant Sema3A was applied to examine the effects on intrinsic membrane properties and action potentials evoked by current injections. Apical and basal SGNs from newborn mice treated with recombinant Sema3A (100 ng/ml) displayed a higher resting membrane potential, higher threshold, decreased amplitude, and prolonged latency and duration of spikes. Although a similar phenomenon was observed in SGNs from post‐hearing mice, the resting membrane potential was essentially indistinguishable before and after Sema3A exposure. Sema3A‐mediated changes in membrane excitability were associated with a significant decrease in K+ and Ca2+ currents. Sema3A acts through linopirdine‐sensitive K+ channels in apical, but not in the basal SGNs. Therefore, Sema3A induces differential effects in SGN membrane excitability that are dependent on age and location, and constitutes an additional early and novel effect of Sema3A SGNs in vitro.

The tension between theory, experiment, and practice plays out in genetic and evolutionary computation (GEC) as it plays out in other areas of science and technology. Back in the 80s, 90s, and 00s, I was always compelled to mix theory, experiment, and practical application in vigorous ways to achieve both understanding and effective computation, but my methodology often seemed to irritate more people than it satisfied. Theoreticians didn't think the work was quite "proper theory", and experimentalists/practitioners didn't think the work was sufficiently "real worldly." Although these concerns were always present in my GEC work, I haven't been thinking about them specifically over the last few years. Since resigning my tenure in 2010, I've been on a global quest to improve engineering education, a quest described in the book, A Whole New Engineer (www.wholenewengineer.org), and partially as a result of that journey, I think I can now better articulate some of the intuitions that led to the methodology of my earlier GEC career. I start philosophically by sharing some of Don Schön's thoughts about the epistemology of practice. He asks, how is it, that practitioners, whether they be physicians, architects, engineers, accounts, computer scientists, or even physical scientists, know things in practice? The conventional wisdom, Schön claims, is that practitioners know things by first, mastering a body of well understood and accepted theory, then applying that theory in practice. Schön calls this theory of practical knowing, technical rationality, and he claims that it (1) is the dominant paradigm of epistemology of practice and that (2) it is largely mistaken (or at least, incomplete and misleading). As an alternative, he suggests that practitioners come to know through a process of reflection-in-action, and the talk discusses some of the key ideas behind this model of practice. Thereafter, I revisit two case studies in early GEC work, the idea and use of deception and the idea and use of approximate little models through the lenses of technical rationality and reflection-in-action. The aim of this examination is to better understand the objections to and the intentions of the work, both. These are found to line up nicely along Schön's lines. Thereafter, I introduce Barry Johnson's notion of a polarity, and frame technical rationality and reflection-in-action. Johnson suggests that polarities are often regarded as solutions, but suggests that the appropriate stance is that poles must be managed. Here I suggest that the complexity of GEC demands the development of a population of reflective practitioners who actively manage the polarities of technical rationality and reflection-in-action, both. The talk discusses some of the key practices, particularly conversational practices, that can help do this. The talk concludes with some theoretical and practical observations regarding the education of A Whole New Engineer and what these might offer the educators and education of the next generation of genetic algorithmists and evolutionary computationers.

After volunteering at the Oceti Sakowin encampment at Standing Rock, a doctor returns to the Navajo community where he works better able to engage with his patients. Cultural immersion and acts of solidarity may be challenging, but they build trust and understanding.

This chapter discusses how the FDNY’s cultural of insularity evolved during the 19th Century as the department shifted from volunteerism and became professionalized. The chapter also chronicles how Irish Americans came to dominate the FDNY and used this workplace culture to consolidate and maintain an ethnic niche within the department.

Because engineering faculty seldom use research-based instructional strategies, the engineering education community hasbecome increasingly concerned with how to help faculty sustainably integrate education research into their teachingpractices. We developed the Intrinsic-Motivation (IM) Course Design Method to make motivation theory accessible tofaculty and to help faculty think more concretely about the costs that demotivate them and make their course designsuntenable. Our course design method complements existing course design methods by providing an approach to designingfor motivational outcomes. In this paper, we describe the IM Course Design Method and then illustrate how this methodwas used to refine the design of a sophomore-level engineering course that enrolled over 200 students. We then presentevaluation evidencefrom this course to suggestthat applicationof the method canincrease students’intrinsic motivationinengineering courses.

Tolerance is portrayed usually as powerful in so far as it engenders, in the face of possibly aggressive and violent responses, a wide variety of viewpoints and behaviour. Tolerance accordingly is taken to promote, it is even considered the behavioural analogue of, open-mindedness and patience, ultimately enabling the emergence of the truth. Tolerance thus articulated is a virtue, a habit of the heart to be inculcated and cultivated. Modern liberal moral theory relies heavily on tolerance in mediating the recognition of increasing pluralism or diversity, heterogeneity and multiculturalism. For liberalism socially defined identities such as race and gender are morally irrelevant categories, those on the basis of which moral judgments about persons, pernicious or affirmative, are supposed not to be made. The elevation of the category 'hate crimes' in the past twenty years is embraced as evidence of the state's tolerance in the face of multicultural diversity.

Chapter 3 examines the political strategies white business owners and marketing agents employed in response to the black consumer activism of the late 1880s and early 1890s. Beginning in 1893, white authorities developed a Jim Crow strategy built around a defense of market values and public propriety, necessary regulations that they believed would prevent a wholesale disintegration of core capitalist principles and Victorian assumptions of respectability. In doing so, they attempted to make the segregation debate about political economy instead of race, castigating black consumer activism as a disruptive social act that threatened the popularity and financial growth of the region.

Chapter 4 explains how black entrepreneurs used the creation and promotion of black-owned leisure venues to boycott segregation and protect their right to consume. Recognizing the need for economic growth and social autonomy, black ministers and entrepreneurs argued that the right to consume should be greater than the right to integration. In building modestly profitable and popular businesses and recreational spaces, the region’s black merchant class succeeded in helping make separate more equal, even though they lost the larger fight over integrated leisure.

Chapter 2 details how black workers responded to the resistance of white tourists and the ambiguous state of segregation in the late 1880s and early 1890s. In their campaigns to desegregate public and commercial leisure space, black activists used violent and non-violent resistance to manipulate class divisions among whites and fight against discrimination by claiming full rights as citizens and free choice as consumers. By claiming that the right to consume was equal to the right to work, black workers helped refute free labor ideology as the basis of economic freedom.

Complexity science pioneer John H. Holland passed away on Sunday, 9 August 2015 (here). Those of us who got to work with him were blessed, and, like so many of his other students, my life was irrevocably altered by working with him. To remember John, I'd simply like to tell the story of how I met him, and three things I learned from him that had roots in that first encounter.