Daily Archives: June 24, 2021

Women have long had successful careers in the technology sector, and as an industry, tech has come a long way to creating a better working environment that supports women from all backgrounds. Despite this, theres still work that needs to be done to ensure that women can continue to thrive balancing their lifestyle with career progression.

We often see women being celebrated externally by businesses, particularly around events such as International Womens Day, however sensationalism often plays a role in enabling organisations to simply talk the talk, not walk the walk. To see more of the latter, we need to see action from businesses that challenge the status quo and show women that their work, contributions and value are seen and appreciated.

The first step for any business wanting to create a more welcoming environment for women is to pause and reflect. Taking the opportunity to look objectively at their organisation, how many women it employs, the recruitment process and the way that it supports diversity in the work force is key. It isnt easy to take this self-critical approach, but its necessary in order to make change. Its impossible to move forward otherwise.

Next comes planning and involvement. Establish a committee dedicated to diversity and inclusion to start welcoming womens voices into the mix and hear about their personal experiences throughout their career and in their current role. This is a useful exercise to find out if people feel supported, where they might need more support, and how they would like to see the organisation operate moving forward. While tacking actionable steps may take time, its better to take a small step forward than make no move at all.

Having a diversity and inclusion committee is a great way of supporting people from underrepresented backgrounds, providing them with the space to explore challenges and offer unique insights into navigating and overcoming difficult situations in the workplace. Finding ways to empower employees and encourage them to use their voice to advocate for change, by creating an atmosphere and work environment that allows these discussions to happen, is crucial.

Additionally, it is important to have a range of networks through different D&I groups that are led by people with the appropriate life experiences to offer guidance to employees from underrepresented backgrounds. If any organisation wants to be more inclusive, then you have to give your employees the tools to make change happen and listen.

Across many industries, the pandemic has aided the levelling out of a gendered work life balance. Childcare is no longer exclusively just a female or male issue, as home schooling has required an all hands on deck approach from families. From a gender perspective, this change in work/life balance has been positive across the technology space.

Previously, women mayhave resisted promotional opportunities thinking it meant longer days or more travelling, encroaching on family life. With everyone working from home there is no need to choose between being home for the family or a two-hour commute each day because working is more accessible. By offering flexible hybrid working environments, companies will find that they are able to attract a wider pool of talented candidates, particularly women, who may have otherwise felt excluded. Similarly, from an internal recruitment perspective, more women will be likely to put themselves forward for promotion.

From a junior and graduate level perspective on gender diversity, the tech industry has come a long way to enabling younger people to feel that they can enter the sector right out of university without fear. At CGI, there have been times when there has been a greater influx of female candidates than male candidates. The challenge the industry as a whole still faces is ensuring that junior hires are getting the appropriate level of experience while working from home. To do this, businesses must ensure that women are encouraged to network among their peers, and offer people the chance to continue to learn and develop at home through online courses.

Looking towards senior hiring, the pool of women is much smaller. The industry simply wasnt where it is today 10 or 20 years ago, so there are a smaller number of female candidates applying for roles that require more than 10 years of experience. Its a sign of times gone by, however businesses can look to counteract this by creating a robust pipeline of women climbing the ladder within their organisation or fast tracking more women to senior positions.

As we look to the future of the technology industry, theres still a lot of work to do to create an environment that embraces the wide range of challenges that women face during their careers. So much great work has been done already, and in time, the entire industry is counting on more and more organisations to keep diversifying, keep listening and keep amplifying the voices of women.

Donna Kelly is CGI Vice President and Business Unit lead for South & Midlands Business Unit in the UK, which includes CGIs Metro markets across the region, HR Solutions & Payroll business and Energy & Petrochemicals business. Kelly has substantial experience in the information technology industry and previously worked as a registered nurse.

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The evolution of women in tech - IDG Connect

This article was originally published here

Acad Med. 2021 Jun 22. doi: 10.1097/ACM.0000000000004214. Online ahead of print.

ABSTRACT

The COVID-19 pandemic interrupted administration of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in March 2020 due to public health concerns. As the scope and magnitude of the pandemic became clearer, the initial plans by the USMLE programs sponsoring organizations (NBME and Federation of State Medical Boards) to resume Step 2 CS in the short-term shifted to long-range plans to relaunch an exam that could harness technology and reduce infection risk. Insights about ongoing changes in undergraduate and graduate medical education and practice environments, coupled with challenges in delivering a transformed examination during a pandemic, led to the January 2021 decision to permanently discontinue Step 2 CS. Despite this, the USMLE program considers assessment of clinical skills to be critically important. The authors believe this decision will facilitate important advances in assessing clinical skills. Factors contributing to the decision included concerns about achieving desired goals within desired timeframes; a review of enhancements to clinical skills training and assessment that have occurred since the launch of Step 2 CS in 2004; an opportunity to address safety and health concerns, including those related to examinee stress and wellness during a pandemic; a review of advances in the education, training, practice, and delivery of medicine; and a commitment to pursuing innovative assessments of clinical skills. USMLE program staff continue to seek input from varied stakeholders to shape and prioritize technological and methodological enhancements to guide development of clinical skills assessment. The USMLE programs continued exploration of constructs and methods by which communication skills, clinical reasoning, and physical examination may be better assessed within the remaining components of the exam provides opportunities for examinees, educators, regulators, the public, and other stakeholders to provide input.

PMID:34166234 | DOI:10.1097/ACM.0000000000004214

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Evolution of Clinical Skills Assessment in the USMLE: Looking to the Future After Step 2 CS Discontinuation - DocWire News

From the bottom of the oceans to the skies above us, natural evolution has filled our planet with a vast and diverse array of lifeforms, with approximately 8 million species adapted to their surroundings in a myriad of ways. Yet 100 years after Karel apek coined the term robot, the functional abilities of many species still surpass the capabilities of current human engineering, which has yet to convincingly develop methods of producing robots that demonstrate human-level intelligence, move and operate seamlessly in challenging environments, and are capable of robust self-reproduction.

But could robots ever reproduce? This, undoubtedly, forms a pillar of life as shared by all natural organisms. A team of researchers from the UK and the Netherlands have recently demonstrated a fully automated technology to allow physical robots to repeatedly breed, evolving their artificial genetic code over time to better adapt to their environment. Arguably, this amounts to artificial evolution. Child robots are created by mixing the digital DNA from two parent robots on a computer.

The new design is first sent to a 3D printer that fabricates the body of the robot, then a robotic arm attaches a brain loaded with control software inherited from the parents, along with any new components, such as sensors, wheels or joints, selected by this evolutionary process. A digital replica of every new robot is also created in a computer simulation. This enables a novel type of evolution: new generations can be produced from a union of the most successful traits from a virtual mother and a physical father, combining the benefits of fast but potentially unrealistic simulated evolution with the more accurate assessment of robots in a real physical environment. The new robots therefore inherit traits that represent the best of both types of evolution.

While this technology can operate without a human in the loop, it also allows for collaboration with a human breeder: just as humans have been selectively breeding crops since the dawn of farming, the robot breeder could influence selection of robots with particular traits. One might even imagine breeding farms, producing robots adapted to specific conditions and user requirements. They might be bred for qualities such as battery life or carbon footprint, just as we breed plants for drought-resistance or taste.

Such farms should be subject to the same strict controls and ethical considerations as, say, breeding of genetically modified crops, for example enabling an entire facility to be shut down at the touch of a button, or limiting supplies of raw materials. Furthermore, it is also important to consider the possibility that evolution might result in robots exhibiting malicious or harmful behaviours and put appropriate preventive measures in place.

The idea of digital evolution imitating biological evolution in software to successively breed better and better solutions to a problem over time is not new. It can be traced back to the 1960s when engineers in Germany programmed a computer to evolve the optimal design of a jointed plate subject to turbulent airflow. Since then, evolutionary algorithms operating inside a computer have been used to design everything from tables to turbine blades, by simply telling the evolutionary process what metric it should seek to optimise (for example, the power generated by the turbine blade). In 2006, Nasa sent a satellite into space with a communication antenna designed by artificial evolution.

We are now at a breakthrough moment. While scientists have always been confident that digital evolution could be effective as an optimisation tool, its creativity in producing original and unusual designs that would not have been conceived by a human has been more surprising. The creativity of biological evolution is clearly apparent in the natural world. In the Cuban rainforest, vines have evolved leaves shaped like satellite dishes that amplify the signals propagated by echolocating bats to direct them to its flowers, increasing pollination. In the freezing Southern Ocean, fish manufacture their own anti-freeze proteins to survive.

But numerous examples of creativity in digital evolution have also been observed. Asked to find behaviours for a six-legged robot that would enable it to walk even if it had been damaged, digital evolution discovered multiple ways of walking that used only subsets of the legs, even discovering a way for the robot to move if all its legs had been snapped off, by shuffling along on its back. In another case, it evolved an electronic circuit on a chip where elements of the circuit were disconnected, exploiting electromagnetic coupling effects specific to flaws in the silicon on the actual chip.

Digital evolution now finds application in avenues that we might imagine to be uniquely human, for example in creating music and art (even winning an award in a University of Wyoming art competition where judges were unaware the winning picture was created by an algorithm). While this may sound to the uninitiated like artificial intelligence, digital evolution is a specific subset of that wider field.

The idea of harnessing evolution to design robots is particularly appealing, especially in cases where humans have little knowledge of the environment the robot should operate in for example, undersea mining, clean-up of legacy waste inside a nuclear reactor, or using nano robots to deliver drugs inside the human body. Unlike natural evolution which is driven simply by the goals of survival and reproduction, artificial evolution can be driven by specific targets. Once this evolutionary process is set in chain, and with the technology outlined above, of a computer system instructing a 3D printer to create improved models of the robots for these particular environments, we have the beginnings of a theoretical framework for a self-sustaining robot population that is able to reproduce itself, and evolve without too much input from humans.

Which isnt to say that humans would be redundant. Digital evolution will probably be a collaborative process between human and machine, with humans providing descriptions of what is desired while evolution provides the how. So for example a human might demand an energy-efficient robot made from sustainable materials to move heavy waste inside a reactor, leaving evolution to figure out how this can be achieved. Advances in manufacturing technology that facilitate automated and rapid prototyping in a range of materials including flexible soft plastics have played an important role in enhancing our ability to replicate evolution on practical timescales.

If this all might seem to border on science fiction, there is a serious point. Robots clearly have a role to play in our future, whether in revolutionising healthcare or undertaking tasks too dangerous for humans. We are rapidly using up stores of raw materials on our planet, and current manufacturing processes increase carbon emissions and create serious problems with waste disposal. Perhaps the creativity of evolutionary methods will enable the design of new types of robot, unfettered by the constraints that our understanding of engineering, physics and materials science impose on current design processes.

From another perspective, until we discover extraterrestrial life, biologists have only one system on which to study evolution. Just as the Large Hadron Collider provides us with an instrument to study the intricacies of particle physics, perhaps a reproducing system of robots provides a new instrument to study fundamental questions about life itself.

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Robots may soon be able to reproduce - will this change how we think about evolution? - The Guardian

June 21 (UPI) -- For every animal, sperm perform the same function -- egg fertilization. Yet sperm size varies dramatically from species to species.

Most studies on the topic have focused on how sperm compete and win the race to fertilize an egg, but scientists have struggled to explain the dichotomy.

New research, published Monday in the journal Nature Ecology and Evolution, however, suggests sperm evolution is heavily influenced by the competitive environment -- the location where sperm and eggs meet.

"There is a missing piece of the puzzle -- the location where sperm and eggs meet can also influence sperm size," lead study author Ariel Kahrl, researcher and zoologist at Stockholm University in Sweden, said in a press release.

To measure the influence of fertilization location on sperm size, scientists analyzed the sperm size and fertilization dynamics of more than 3,200 animal species.

The researchers divided animals into different groups based on where the sperm meets the egg.

"In species with internal fertilization -- like mammals, birds and insects -- sperm fertilize eggs inside the female's body, while in species with external fertilization -- like sea urchins and many fish species -- sperm and eggs are released into the water and fertilization happens outside of the female's body," said Kahrl.

The data showed animals that practice internal fertilization have developed both bigger, longer sperm and more quickly evolving sperm. Species that practice internal fertilization also possess greater sperm variability.

The findings echo the conclusions of a previous study that identified the female reproductive tract as the primary driver of sperm evolution.

"When sperm are released externally, selection keeps sperm size small to allow males to produce a lot of sperm," study co-author Rhonda Snook said in the release.

"But when sperm are transferred to the females in internal fertilizers, males may compete better with bigger sperm and females may prefer to fertilize eggs with bigger sperm," said Snook, a professor of zoology at Stockholm.

Researchers also analyzed the reproductive dynamics of a third group of animals, invertebrates that practice spermcasting.

Spermcasting sees male invertebrates release their sperm into the water where it is filtered out by females before internally fertilizing the eggs.

"Spermcasting represents a mix of internal and external fertilizations, which gave us the opportunity to see what part of the fertilization process influenced sperm evolution," senior author John Fitzpatrick, an associate professor in zoology at Stockholm, said in the press release.

Spermcasting animals feature relatively small sperm, like external fertilizing animals, but showcase faster sperm evolution, like internal fertilizing species.

"Our results clearly show that interactions between sperm and females help generate the tremendous diversity in sperm size we see in animals today," said Fitzpatrick. "The greater the potential for interactions between sperm and females, the faster sperm evolve."

The authors of the new study acknowledged that not all internal fertilizing animals have large sperm.

Human sperm, for example, is about the same size as the sperm produced by spermcasting species.

"In animals with large bodies, like humans, sperm are diluted inside the female's reproductive tract," Kahrl said.

"From the sperm perspective, it doesn't matter if dilution occurs inside a female or in the ocean -- dilution keeps sperm small. It's only when sperm are confined in small spaces within the female that sperm become supersized," Kahrl said.

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Sperm evolution heavily influenced by location of eggs - UPI News

Dr Sadowsky is a leading historian of psychiatry, and one I am proud to call him my teacher. As a psychiatry resident, I attended his lectures on history of psychiatry as part of our residency didactics and benefitted greatly from them. Sadowsky was previously interviewed for Psychiatric TimesTM in 2017 by Greg Eghigian, PhD, about his book, Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy, an interview that is well worth revisiting. The present interview is about his new book The Empire of Depression: A New History. I admire Sadowsky for his ability to tackle complex and controversial issues with scholarly rigor and fair-minded appraisal, and I am delighted to have him participate in this series.

AFTAB: I suppose some folks, on hearing the title of your new book, may reflexively think, Whatanother book about depression? Dont we have enough of those already? In your opinion, why was a new history of depression needed?

SADOWSKY: Interestingly, not many of the books about depression are histories. Take The Noonday Demon: An Atlas of Depression by Andrew Solomon, PhD.1 I think it is great, but it has only a single chapter on history, and it is a brief account. In addition, with a few exceptions, most of the history books are focused on antidepressants, but many other treatments have important historiespsychodynamic psychotherapy, cognitive behavioral therapy (CBT), electroconvulsive therapy (ECT), and the many approaches that were taken prior to the 20th century, for example.

A couple of long, detailed histories of depression barely mention ECT. This is weird. I know opinions about ECT are dividedmy book about ECT is also about that controversy. However, whatever you think about ECT, many psychiatrists consider it among the best treatments psychiatry has for serious affective disorder. Imagine for a moment a medical historian in another specialty writing a long history of a particular ailment, and then only briefly noting a treatment many doctors say is among the most effective! Previous histories of depression have also been a bit weak on psychoanalysis, which is a strong interest of mine.

Little existing historiography of depression focused on patient experiences and self-representations. This is not an easy area to research, because a lot of depression treatment takes place in private office practice, a confidential setting, and documentation is not really publicly available. I would have liked to do more, but I hope I pushed the field a little in that direction. I want to add immediately that some historical and other critical studies of psychiatry see patient voices as only a way to criticize psychiatry. It is important to document patient complaints, but some critics of psychiatry go to tortuous lengths to deny any therapeutic benefits. Honoring patient voices also means seeing that many feel helped by treatment.

I also wanted to draw attention to the politics of inequality. Like so many other illnesses, depression hits different populations to different extents. Solomon drew attention to this, but most of the historical work on depression restricts inquiry to the gender ratio, which is an important axis, but not the only one. Class, race, and LGBTQ+ status, for example, also matter for depression, and I hope future historians will develop this further.

Finally, I wanted to make the story more global, less focused entirely on the West, and especially the United States, although I do give the United States a lot of attention. Anthropologists and global mental health workers have looked at the wider world, but historians really have not done so for depression. I would like to have gone further here, too, and I hope others will.

AFTAB: What I love about your book is that it does not settle for easy answers. It embraces the uncertainty, ambiguity, contradictions, and flux inherent in the very subject matter. One of the difficulties with studying depression is its a fluid entity, with variations across both time and space. Is depression the same today as it was in the 17th century when Robert Burton wrote The Anatomy of Melancholy? Is depression the same thing in the United States and, say, Nigeria? These are obviously thorny issues. Can you elaborate on the approach you take to address this? How can we tell a coherent history of something if we are having a hard time pinning down what that something is?

SADOWSKY: The various illness categoriesor, as it may be in some contexts, conceptions that are not illness categoriesare already included in a long-running discussion of the comparability of diagnostic categories and sickness experience across time and space. The discussion is a story itself.

Most of the illness states I compare have a core feature, which is excessive sadness or blue mood, in whatever that particular context considers excessive. But some definitions of depressive illness consider this a common, but not necessary, feature for diagnosis. As you know, DSM-5 does not require depressed mood as a necessary criterion for major depressive disorder (MDD), provided there is loss of interest and 4 other symptoms. I draw (lightly) on the concept of family resemblances Ludwig Wittgenstein, PhD: Things do not need precise overlaps to have similarities that justify comparison.2 For all the imperfections of the DSM, I think if you look at the menu of symptoms for MDD, they do form a constellation of related signs of suffering that have been clumped together in disparate contexts.

Overemphasizing cultural differences has its own risks. I show in chapter 1 the idea that African societies had little or no depression had roots in some frankly racist ideas. Universalizing labels can be a form of cultural imperialism, but overinsistence on difference forecloses possibilities for meaningful comparisons. And some who think depression is a purely modern or Western illness might be surprised at how many cultures, across time and space, have had some conception of excessive sadness as a malady.

Chiara Thuminger, PhD, is a great historian of madness with whom I am collaborating on a new project.

She has set forth 4 principles for comparisons across time and space3:

1. The human mind is biological, a part of a shared evolutionary heritage, so you can expect some measure of universality.

2. The mind and mental life are not confined to the brain, but involve other parts of the body.

3. Mind and brain are situated in and shaped by culture, so universality will always be limited.

4. Every individual has an irreducible quality, uniqueness.

I think these are great principles to keep in mind.

AFTAB: You are clearly dissatisfied with a lot of popular critiques of depression. You write, One thing this book is not is a long lament on the overdiagnosis of depression, and the turning of lifes normal suffering into a medical problem. Tell us more about your dissatisfaction with this line of criticism.

SADOWSKY: Many people look at the high numbers of individuals with a depression diagnosis compared with previous times and take it as self-evident that we are overdiagnosing. It is not. Rising diagnosis rates is a valid reason for concern about overdiagnosis, but it is not proof. In 1950, much of psychiatry was concerned that we were underdiagnosing depression, so from that perspective, we may be finding a lot that we had been missing. We should at least consider the upside: More diagnosis means that more individuals who could use professional help are getting it.

As for medicating the normal pain of living, we should keep in mind that getting treatment for depression, whether in psychotherapy or with antidepressants, does not protect anyone from suffering, although one hopes it is reduced. Life remains hard. And many patients with depression welcome sadness as a relief from feelings of deadness or numbness inside.

In the book, I offer some defense of antidepressants against their most severe critics. But I also think we are probably overreliant on antidepressants. I think the benefits of psychotherapy, particularly long-term insight-oriented therapy, have become underrated in the antidepressant era.

Still, why some advocates of psychotherapy are so adamantly and categorically opposed to any medication use, or to any suggestion of a biological component to depression, is a mystery to me. I have read many hardline critiques of biological and pharmaceutical psychiatry that are focused on whether the evidence for efficacy is robust, or questioning the philosophical underpinnings of the enterprise, or worried about adverse effects, or indicting the pharmaceutical industry. The thoughtful challenges have reinforced my view that we are overreliant on drugs, at least for some populations. Other critiques have struck me as dogma masquerading as critique. But even the smartest of them have not convinced me that antidepressants are worthless, a claim several important voices have made.

The biology of depression is incompletely known, and much of it may remain permanently elusive. However, the idea that depression is purely psychological is, I think, implausible. Yet, so is the view that depression is purely biological. The dichotomy itself is the problem. Mark Solms, PhD, said that mind and brain are 2 ways of looking at the same thing. I find this more helpful. I do not understand how something could affect either the mind or the brain independently of the other. That is not a coherent idea.

I am getting away from your question a little, but it is an important point. Proponents of a life history emphasis in etiology sometimes take it as self-evident that if trauma or neglect is the cause, the better solution must be psychotherapeutic, as opposed to somatic. Psychotherapy might be the better treatment, but it is not self-evident just from the etiology. And the reverse: Individuals who lean toward more organic theories of etiologygenes, brain chemistrysometimes take it as self-evident that the better solution must be something more physical, like a drug or ECT. Again, this could be true, but it is far from self-evident. In any event, I think monocausal approaches to etiology are misguided.

AFTAB: You write at one point, The growing interest in depression led more people, both professional and lay, to learn to label problems as depression, which was a growing idiom of distress before the advent of antidepressants . . . The medications, though, provided new incentives for multiple actorspharmaceutical companies, doctors, patients, and patients familiesto identify cases of depression.4 I suspect you would have been writing a very different history of depression if antidepressant medications had not been developed, or if their use had continued to be severely restricted due to tolerability.

A curious thing, however, is that anxiety disorders are more common in the general community than depressive disorders, and antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are not just antidepressants but also antianxiety medications. We could perhaps imagine an alternative history in which anxiety was the idiom of distress, SSRIs had been marketed as antianxiety rather than antidepressant, and you would perhaps be writing a book about the empire of anxiety, and the continuous historical links between melancholia and anxiety! Is it merely an accident of history that we ended up in the age of depression rather than the age of anxiety?

SADOWSKY: Cross-cultural study has shown that the separation of anxiety and depression is a convention of Western psychiatry (which is rapidly becoming a global or cosmopolitan psychiatry, with both good and bad effects). Many healing systems around the world assume anxiety and depression are aspects of a single thing. And even in the West, the separation is somewhat new, a Kraepelinian innovation.

You present an interesting counterhistory. However, I am not sure the trajectory has been solely drug-driven. When the monoamine oxidase inhibitors and tricyclics were developed, psychiatrists were looking for depression treatments, and they had been doing so for decades. That is partly why these drugs came to be called antidepressants.

One curious thing is that important anxiety medications and antidepressants were introduced around the same time, and yet from a broad cultural point of view, we had first an age of anxietythe immediate postwar periodfollowed by an age of depression, which started sometime in the 1970s and became more visible in the 1980s. In what I consider the most speculative portion of my book, I try to understand those periods as possibly representing wider cultural moods, perhaps rooted in different forms of capitalism. As speculative as that section is, I included it because I thought it was worth thinking about.

AFTAB: You dont spend much time discussing the creation of MDD as a diagnosis in DSM-III. I wonder how different the future course of events would have been in the absence of such a diagnostic category. If you look at DSM-II, depression was fragmented across many different sections under many different diagnoses. In DSM-II, we had diagnoses such as involutional melancholia, manic-depressive illness, depressed type, psychotic depressive reaction, depressive neurosis, and neurasthenic neurosis. I suspect that this DSM-II organization of depression would not have been particularly conducive to the process of empire-building!

SADOWSKY: That is a great question, and I could have given this change more attention in my discussion of the DSM. However, I wonder if the creation of the category (if not the precise name) of major depressive disorder was already in process before DSM-III, reflecting the growing research interest in depressive illness in the years preceding the revision of the manual.

AFTAB: When I look back at the evolution of depression, a pair of developments in recent decades appear to me to be notable, although their historical significance is probably yet to be seen. The first is the notion of treatment-resistant depression (TRD). This has led to more aggressive pharmacotherapy, such as augmenting with atypical antipsychotics, and the relatively recently approved medication esketamine.

The second is that bipolar disorder has been steadily encroaching on the territory of depression, such that even in the absence of mania or hypomania, many psychiatrists classify the presentation as being on the bipolar spectrum. Just as the development of antidepressants led to an increase in the diagnoses of depression, development of medications for bipolar depression have led to an increase in the diagnoses of bipolar disorder. Any preliminary thoughts of these developments as a historian?

SADOWSKY: It is, of course, awful that some depressions are so hard to treat. I am not a clinician, but I wonder if many of those that seem resistant to aggressive medication treatment might respond to intensive psychotherapy, which can be expensive, or to ECT, which has risks of adverse effects (risks which are, in my opinion, generally greater than the risks of antidepressants, although I think in some cases, the risks may be worth it).

As a historian, however, I would ask if the whole category of TRD does not actually represent some progress, since it implies the other kind. A 19th-century alienist could not do much about any severe depressions at all. Many of my colleagues in history of medicine, and especially history of psychiatry, get nervous at any hint of a progress narrative, but I do not mind saying I think we have a better repertoire of treatments for depressive illness now than we did in 1850. All the treatments have downsides, but that is true of medical treatments in general.

I am aware of the rise of bipolar diagnosis, but I have not followed it closely. From a practical point of view, of course, what matters about a label is matching the individual in pain to the best treatment possible, and that is a clinical question. My historians take is: The safest prediction is that changes in diagnostic fashions are going to keep happening, and they will not necessarily be driven by genuine scientific advance. The whole enterprise is not worthless, but we should not assume the present trend represents the final or best word. On this point, I do worry about progress narratives.

AFTAB: In a very memorable passage of your most recent book, you compare history with psychoanalysis: [P]atients are locked into repeatedly telling the same story about themselves about their loneliness or their victimization, for example. The therapy helps patients see that they do not have to repeat the same story. They can tell new stories of their lives. History can have a similar role . . . We do not have to live the same story, time after time.4 Later, in the epilogue, you again refer to history as a means of guarding against compulsive repetition. Can you summarize what history tells us we can do differently going forward when it comes to depression?

SADOWSKY: I will name 2 things. First, we do not need to keep having the same arguments about whether depression is fundamentally biological, or really the result of trauma in life, or the result of social forces. I fear that we will continue to do just that, because of the tenacity with which some individuals hold to the insistence that we must choose. It is my hope that by showing historically how insistence on a single approach leads to dead ends, we might be liberated from it. In the epilogue, I used the image of a quarreling couple, stuck in the same fights for decades on end. A good marriage counselor might be able to remind each partner that the other has things to offer.

I also hope we might be liberated from the cycle of hype and disappointment about new treatments. Most of the major treatments for depression over the last century (psychoanalysis, ECT, CBT, and antidepressants) have been overemphasized by some zealous proponents. Then disappointment (dare I say, depression?) comes when the harms or limitations of the treatments become clear. In turn, we rush to condemn the old treatment as worthless and latch on to something new, which is thought to lack the flaws of the earlier ones. But the old treatments still had something to offer, and the new ones prove to have flaws, although we may not see them right away.

New treatments are going to come, as they should. When they do, let us try not to overdo the hype, the radical rejection of the old ones, or the disappointment in the new that follows. In addition to helping patients overcome repetitions, psychotherapy can help patients to see individuals in and things in their complexity. Sometimes we, as professionals or as whole societies, can act like an individual searching for love, and finding partners we initially idealize, only to come to despise them when they inevitably disappoint us. We would do better to tolerate ambiguity. I hope Empire of Depression might help to foster that toleration.

AFTAB: Thank you!

Conversations in Critical Psychiatry is an interview series that explores critical and philosophical perspectives in psychiatry and engages with prominent commentators within and outside the profession who have made meaningful criticisms of the status quo.

The opinions expressed in the interviews are those of the participants and do not necessarily reflect the opinions of Psychiatric TimesTM.

Dr Aftab is a psychiatrist in Cleveland, Ohio, and clinical assistant professor of psychiatry at Case Western Reserve University. He is a member of the executive council of Association for the Advancement of Philosophy and Psychiatry and has been actively involved in initiatives to educate psychiatrists and trainees on the intersection of philosophy and psychiatry. He is also a member of the Psychiatric TimesTM Advisory Board. He can be reached at awaisaftab@gmail.com or on twitter @awaisaftab. Dr Sadowsky is the Theodore J. Castele Professor of the History of Medicine and Associate Director of the Program in Medicine, Society, and Culture at Case Western Reserve University, Cleveland, Ohio. He holds secondary appointments in the Departments of Bioethics and Psychiatry. He earned a PhD in history from Johns Hopkins University and also studied psychiatric epidemiology at Columbia University. He has authored numerous articles and books, most recently The Empire of Depression: A New History (Polity Books; 2020).

Dr Aftab and Dr Sadowsky have no relevant financial disclosures or conflicts of interest.

References

1. Solomon A. The Noonday Demon: An Atlas of Depression. Simon & Schuster; 2001.

2. Wittgenstein L. Philosophical Investigations. Basil Blackwell; 1953.

3. Thumiger C. A History of the Mind and Mental Health in Classical Greek Medical Thought. Cambridge University Press; 2017.

4. Sadowsky J. The Empire of Depression: A New History. Polity; 2020.

Read more from the original source:

Exploring the Evolution of Depression - Psychiatric Times

The App is Back! Dont forget to download the NBC Sports EDGE app to receive real-time player news, mobile alerts and track your favorite players. Plus, now you can check out articles and player cards. Get it here!

In this weeks By The Numbers breakdown, the analysis will focus on the shift and how the evolution of this defensive strategy has shaped the game. This will look at the history of the shift, how it has grown into the standard practice of Major League Baseball, and how that has impacted the offensive output of certain players and batted ball profiles.

The goal of this weeks analysis is to identify players who have suffered the most from the aggressive advancement of this defensive alignment and which players approach has left them immune to the effects.

Make no mistake, the modern-day usage of the shift has altered the careers of many players, and in some cases ruined them. Many executives, coaches, players, and fans have called for Major League Baseball to ban the shift in recent seasons. Is this an appropriate course of action, or should major league hitters be forced to adapt?

All of the questions above will be discussed and more in this weeks breakdown, but first lets have a quick overview on the history of the shift.

There are many baseball fans that think the shift was created by new-age Moneyball teams like the mid-2000 Devil Rays and their out-of-the-box manager Joe Maddon. That is a fallacy. The truth is that the shift was created nearly 90 years before Tampa Bay would install this defensive tactic in modern-day baseball.

In the 1920s Phillies outfielder, Cy Williams had such immense pull power that opposing managers positioned their outfielders in right field, and extremely deep. It should be mentioned that a lot of this had to do with the Green Monster-esque wall at the Baker Bowl in Philadelphia, an extremely short porch in right field (see below). Williams was one of the first true power hitters in the game, leading the National Leagues all-time home run list until 1929 when he was unseated by Rogers Hornsby.

Story continues

Baker Bowl

While Cy Williams may have been the first player in the majors to have a modified version of the shift installed against him, it was another Williams that would go on to introduce a closer version of the modern-day shift two decades later.

In 1941, Hall of Famer Ted Williams, who may very well be the greatest hitter of all time, sparked the imagination of White Sox manager Jimmy Dykes. The left-handed Red Sox slugger was hitting .397 with a 1.208 OPS when Dykes came up with the plan to place his shortstop on the right side of second base while moving his second baseman into shallow right field and third baseman over to short. The idea, of course, being that this strategy would somehow slow down the pull-heavy Williams.

TW Shift

In case you were wondering, the strategy was not successful. Ted Williams went 2-for-5 with a double down the left-field line, going 4-for-10 in the two-game series. However, this was not the end of opposing teams trying to tame the Splendid Splinter, as later that season Indians manager Lou Boudreau positioned seven position players on the right side of second base. Three were stationed on the infield dirt, with Jimmy Wasdell positioned directly on the first-base line, while the others were scattered throughout the outfield. Williams went 1-for-2 with a double and two walks.

There are two takeaways from this history lesson. First, Ted Williams was really good. Second, even though the left-handed legend was able to navigate the shift, he ended up seeing his batting average dip around 16 points to a still incredible .340 until the end of his career. The shift works, but elite hitters will still find a way to produce regardless of its presence.

In the years to come, the shift would occasionally be used whenever the league was desperate to neutralize a dangerous left-handed hitter. Orioles legend Boog Powell, famous for both his bat and barbeque stand at Camden Yards, and Hall of Famer Willie McCovey were just a couple of the players that the shift would be utilized against. It was by no means a popular strategy until sabermetrically driven ball clubs, like the Rays, started to look for ways to gain an advantage in the mid-to-late 2000s.

Righties Being Left Out?

You may have noticed that when discussing the shift, the hitters are primarily left-handed. Probably because the vast majority of those impacted by the defensive phenomenon are in fact lefties.

This is not to say that right-handed hitters are immune to the shift, as there are plenty of sluggers that have the shift installed against them. The main issue is logistical. First of all, you need someone to cover first base. There is no way around this. It does not matter if you can find a way to field a baseball if there is no one to throw it to. Secondly, throws are more difficult on the right side of the infield. They require a stronger and more accurate arm while making it impossible to throw someone out from shallow left field. Just think about it, a right-handed shift creates quite a few issues.

That being said, there are several right-handed hitters that are so pull-heavy that a modified shift is still a beneficial strategy against them, such as Miguel Sano. It is also a strategy that has been more and more popular as new age sabermetric thinking continues to take over baseball. In 2016 Major League Baseball only shifted 6.2 percent of the time versus right-handed hitters. In 2021 so far that number has jumped to 17.7 percent.

Its Tough Being A Lefty

If we dive into the traditional Williams shift against left-handed hitters, this is where the game has taken a hard turn into analytics and defensive positioning. In 2016 the league shifted 24.3 percent against hitters from the left side. Fast forward to this season and Major League Baseball is now making defensive shift adjustments on over 53 percent of left-handed hitters.

It is difficult to argue with the success of the strategy, as it may have ended several promising careers such as Chris Davis' and Ryan Howard's (who each saw the shift in over 90 percent of their at-bats). Agent Scott Boras once went as far as to say that shifts are discriminatory against left-handed hitters.

Cardinals infielder Matt Carpenter increased his pull percentage from 31.9 to 48.1 percent from the 2014 season to 2016 and batted .272 with 49 home runs and 182 RBI over that span. However, the left-hander has not hit above .226 since 2018. Granted, Carpenter is now 35-years-old and age and/or injuries have certainly played a role, but the infield shift may have taken this age decline and shoved it off a cliff.

2016: 33.8% (.392 wOBA)

2017: 60.5% (.392 wOBA)

2018: 83.4% (.368 wOBA)

2019: 88.8% (.314 wOBA)

2020: 97.0% (.296 wOBA)

2021: 95.6% (.288 wOBA)

Carp Chart

The obvious impact of the modern-day shift is explained through the tale of Matt Carpenter above. If you are unable to adapt as a pull-heavy major leaguer and/or lack the ability to drive the ball over the fence, you are going to struggle. This situation has been made worse by the introduction of the lower COR baseball that was discussed in last week's By The Numbers breakdown.

Baseball is a game of inches. That is why minor changes like a new baseball can have such a devastating impact. It is no different with the shift. Managers and front office personnel will continue to take every inch they can if it gives them an advantage.

The Impact Up The Middle

When most baseball fans think of the shift they think of a pull heavy left-handed batter having a hard-hit ground ball cleanly fielded by a shortstop playing to the right of second base, or by the second baseman in shallow right field. This is certainly a popular outcome. However, what many fans do not realize is that the modern-day shift takes away what many believe to be one of the most fundamentally sound batted balls in the game, a base hit up the middle.

It may seem obvious that the shift was designed to neutralize pull heavy hitters, but it has evolved into a precision defensive tactic that can take away quality batted balls that were once considered automatic base hits. It's amazing how far production on ground balls up the middle has suffered in recent seasons:

2014: .344 avg

2015: .312 avg

2016: .337 avg

2017: .304 avg

2018: .302 avg

2019: .299 avg

2020: .254 avg

2021: .236 avg

The shift has taken off to the point where routine base hits have become routine outs. In past seasons, the video below shows a sure-fire base hit by Jose Ramirez up the middle. However, instead of the baseball reaching the outfield, Reds shortstop Kyle Farmer fields the ball cleanly standing readily several feet to the right of second base.

JRam Middle

Hit It Where They Aint

Hall of Famer Willie Keeler had 13 straight seasons in which he batted over .300 and a lifetime batting average of .345 over 19 seasons. The 5-foot-4 outfielder coined the phrase keep your eye on the ball and hit em where they aint. Simply put, hit the baseball where there are no fielders. This is the complaint of many baseball fans when it comes to the shift, Why cant hitters just go the other way or bunt.

Will Clark, a 15-year veteran who hit .303 during his career is certainly among this crowd. He was quoted as saying As far as the shifts go, its great for the defense because theyre playing the odds and these idiots that are in the batters box dont make any adjustments. Clark went on to add that power hitters like Joey Gallo ...have no pride in (their) craft, you dont work on anything, all you do is go out and try to hit the ball out of the ballpark, thats all you do.

It is certainly a fair question why major league hitters who are left with an entire side of the field left open refuse to take the initiative and learn how to exploit the shift. The shift has been around for a while now and it is safe to say that certain hitters are either not equipped to handle the adjustment or are simply unwilling. However, many (most) pitchers now tailor the way they pitch in order to force a hitter into the defensive shift, making it difficult or impossible to take the ball to the opposite field. This is a compounding problem.

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Success Against The Shift

The chart below demonstrates several players that have had success hitting into the shift this season. In order to make the chart the batter must have at least 200 plate appearances, at least a 50 percent shift rate, and over a .350 wOBA while hitting into the shift:

Good Shift

You will notice that there are quite a few good names on this list, which should not really be surprising. If a hitter is being this successful against the shift then they are unlikely to be struggling.

However, there are a couple of big names such as Freddie Freeman and Juan Soto who have failed to reach expectations this season. Soto has a fairly lofty ground ball rate which is holding him back in 2021, but neither superstar has an egregious pull rate. You can see below that Freeman has a rather impressive spray chart.

Freeman Spray

This is nothing you do not already know. Juan Soto, who was mentioned in last weeks column, has all of the talent to make a quick turnaround this season as everyone is expecting while Freeman is the reigning MVP for the National League.

The interesting standouts on this list are Max Muncy, Matt Olson, and Joey Gallo for the simple fact that they see the shift over 90 percent of the time. The trio's success against the shift to this point is likely due to their ground ball and pull side percentages being held in check so far, at least in terms of batted balls.

Muncy seems to have success almost entirely from the pull side to center (see below), while Olson and Gallo share at least some production to the opposite field.

Mucny Spray

In the end, the x-factor is good old fashion exit velocity. Hit the ball hard and it is far more difficult to field. However, it may be worth monitoring any players drifting too far into the pull side (Mike Yastrzemski) or into the ground (Jared Walsh).

Unsuccessful Against The Shift

The chart below demonstrates several players that have had poor success hitting into the shift this season. In order to make the chart the batter must have at least 200 plate appearances, at least a 50 percent shift rate, and under a .320 wOBA while hitting into the shift:

Bad Shift

Just like the previous chart, there are likely some names you expected to see on this list. For one, Miguel Sano was mentioned by name earlier in the article. It is interesting that only 36.7 percent of Sanos batted balls go to the pull side, but if you notice in the chart below (aside from home runs), most of the sluggers' success comes entirely from left field.

Sanop Spray

Adam Duvall has been on fire lately, collecting multiple two-homer games this past weekend. The Marlins outfielder is one of the few players who is exactly as advertised when it comes to the data you see on the page. Duvall is a power hitter who will struggle to maintain a high batting average. The shift does not impact home runs obviously, but if the ball stays in the field of play, it is almost certainly going to the pull side (see below).

Duvall Spray

Enjoy the home runs from Adam Duvall because that is all you are going to get.

The Modern-Day Shift: Conclusion

This season the offense has been down league-wide, but for multiple reasons. The use of foreign substances has been a popular topic due to the attention Major League Baseball has given it, and since the official ban, there have been improvements in offensive production. The second major issue has been the new baseball, which we discussed last week, but it has more to do with power suppression and production on fly balls.

The shift is something that has skated by, but hasn't been forgotten, as it's probably the most likely culprit for the bulk of MLBs current offensive crater. It has gotten to the point where it is impossible to ignore and many executives have called for its ban, including the team president for the New York Mets, Sandy Alderson. This is significant considering the team from Queens is second in all of baseball with a 55.7 percent shift rate, up from 7.4 percent in 2016.

There have been many theories and compromises, such as keeping the shift but forcing all infielders to be on the infield dirt rather than in the outfield. All of the ideas surround different ways to fix or ban the shift, but there are no current plans by the players or front office personnel to learn how to adjust.

This is the reality we live in and for fantasy baseball, it is an important lesson to learn. The shift impacts certain hitters that fall into certain boxes and it truly changes the kind of hitter that can become on the box score. Fans are interested in foreign substances and the new baseball, but if Major League Baseball were to fix both of those issues there would be a minimal difference compared to what would happen if they decided to ban the shift. We are living in a different world right now due to the shift, which has a massive grip on modern-day baseball.

See the rest here:

Evolution Of The Shift: The Real Issue In MLB - Yahoo Sports

Technology has become a vital part of the financial planning process especially with the business change imposed by covid.

But the advice sector is set for the next tech evolution.

Terry Donohoe, chief executive of Europe at fintech firm Ignition Advice, told International Adviser that the hybrid advice model is what the sector is heading towards.

He said: I think thats the next evolution in this industry. I cant think of many industries where youve gone from a manual process to a fully automated process and not on something in the middle.

Globally that is what the financial advice landscape looks like, you have gone from manual to robo and theres nothing pulling that all together in the middle.

I think its the obvious next step but getting the advisers comfortable is really key. What youre doing is youre giving them more time back to help serve more customers and focus on strategy, not collecting data or collecting facts that can be automated for the most part. Its just the face-to-face contact.

Robo hasnt seen the mass uptake that was probably expected because the adviser isnt in the middle at the important bit. Its critically important.

In February 2021, IA reported that Sydney-headquartered Ignition Advice had moved into the UK market, establishing teams in London and Edinburgh after gaining a European presence in Dublin in 2017.

At the time, the firm said that it looked forward to bringing the UK market live digital advice solutions for insurance, pensions and wealth in 2021.

Donohoe added: We made a strategic pivot about four years ago that focused on how to close the advice gap globally and what was the best way to tackle that rather than trying to do it ourselves as a robo.

What we found was partnering with institutions and providing digital advice solutions through them that this was the best and fastest way to actually provide those services out the back end and hit the mass market.

All jurisdictions are having the same advice gap challenge, its no different in Australia or UK, its all the same.

We had the real benefit of getting to work with a tier-one bank in Ireland. When the guys asked me to come in on board, it allowed us to actually start from scratch, build a platform from the ground up, rather than actually use some legacy systems.

When you design like that, youre actually building for speed of implementation, configuration, things that actually help get you to a point. The very natural next step then is the UK market. Its natural because of the language and the geography. But in actual fact, its probably one of the most advanced financial services marketplaces in the world as well.

This is a good testbed. The opportunity in the UK, the institutions, the advice networks that are going on probably trumps most other jurisdictions globally.

Ignition Advice is looking to take on the likes of Wealth Wizards and Investcloud in the financial planning solution market.

So, what is the UK market missing?

The industry is probably so far ahead of everybody else, its probably not what theyre missing, Donohoe added. They have a lot of what is out there, but theyre not connected.

How do you connect these up? How do you create a seamless experience when you have a separate product engine, fulfilment engine, CRM system, client, portal and bank app?

If were doing it from an engineering perspective, youd use an API or something like that. There is no other advice platform that sits in the middle to pull all of that together and orchestrate how advice is delivered. Its just how you connect it all.

Donohoe said that the firms success in the UK will absolutely determine how successful we are in the rest of the world.

If we want to be the leading advice platform to institutions globally, weve got to do that in the UK, he added. Weve got to be the leading player in the digital advice marketplace.

Its still relatively new. We would hope to be in some way supporting most of the leading advice firms within the UK within the next few years.

Link:

Hybrid advice is 'next evolution' for the industry - International Adviser

Under the sea isnt dancing crabs with faux Jamaican accents, cute flounders, and mermaids looking for love. Its not even a secret city of dwellers with a very handsome man who rules all. Yes, there are certainly beautiful parts of the ocean, some of which we get to see at the beach. However, the depths of our oceans have a lot of downright scary creatures and a history that we are still trying to piece together. New discoveries of animals, past and present, happen all the time. The latest find is the Ophiojura, a starfish-like creature with eight sets of jaws and hooks all over its arms. It looks like something out of the Jurassic era or an H.P. Lovecraft novel and I am terrified of it.

According to NewAtlas, the specimen came to scientists attention back in 2011 near New Caledonia in the Pacific Ocean. French scientists were baffled by the creature and its been the subject of study since then. A new recent breakthrough reveals that although it looks like a very long starfish, it is a completely new genus and family with loose relation to brittle stars. In fact, the Ophiojuras last common ancestor is from the Jurassic era about 180 million years ago.

The Royal Society Publishing

There are also fossils from that era that look a lot like this species, which is how it earns the label of a relict species. This means it has existed with little to no evolution for millions of years. Right now, this specimen is the only known one in the world so their actual numbers are unclear.

It wouldnt be surprising if theres an entire army out there somewhere. If they have been around for all this time with virtually zero evolution, then they must be great at surviving, right? Or, maybe the lack of evolution isnt a great thing if the ocean is changing. Either way, it has a lot of teeth so that must help it in some way.

This information is leading a team of researchers to embark on a new mission in July 2021. They will travel to novel underwater mountains similar to where they found the Ophiojura. Only this time it will be in the Indian Ocean in hopes of finding more new groundbreaking creatures. Theres so much to discover in the depths of our oceans that surely they will come back with yet another fascinating find.

Featured Image: The Royal Society Publishing

See more here:

Deep-Sea Creature with Eight Jaws Is an Evolutionary Wonder - Nerdist

As the theater world is slowly coming back to life after widespread pandemic shutdowns, the Eugene ONeill Theater Center is hosting a series of talks about theater.

The Saturday Spotlight boasts storytelling, interviews and demonstrations as it highlights artists who have participated in the ONeills conferences discussing various aspects of stage work.

For this Saturdays opening session, the subject is The Evolution of a Song. The featured artists are Alexander Gemignani, who is the artistic director of the ONeills National Music Theater Conference, along with writer Amy Jo Jackson, who is part of this years NMTC, and arranger Pearl Rhein.

Coming up are

Saturday Spotlight, 6 p.m. June 26, July 10 and 24, and Aug. 7, Eugene ONeill Theater Center, outdoor amphitheater, 305 Great Neck Road, Waterford; free admission, but people must RSVP by the Thursday before the event; masks and social distancing are required; http://www.theoneill.org.

More here:

'The Evolution of a Song' starts new series at O'Neill Center - theday.com