Burst Blood Vessels In The Eye Is Usually Not A Major Medical Condition, And Can Occur Without Any Injury To The Eye.

So, now that we know the hidden biological story behind our tearful eyes, let us make a conscious effort to enhance their expression and beauty. Burst blood vessels in the eye is usually not a major medical condition, and can occur without any injury to the eye. If you have varicose veins, they can cause blood vessels in the leg to burst. This corneal condition is caused by problems related to: Viral infections, for example, herpes. Eye irritation can be a really frustrating problem. However, the term 'blindness' is also used to describe varying levels of vision. Let us take a better look into this... If the swelling is developed as a post-surgery complication, it can be improved by administering eye-drops prescribed by the eye care practitioner.

Disclaimer: This guzzle article is for informative purposes only, and should not be used as a replacement for expert medical advice. It may stay constant, grow over time, or come and go. Viral meningitis is treated with antiviral medications.

subconjunctival hemorrhage


Essay On Archduke Franz Ferdinand

There were three main causes leading up to World War 1, but it wasn't until June 28, 1914 the assassination of Archduke Franz Ferdinand triggered World War 1 which began on July 28, 1914.

The main causes leading to World War 1 were: The Rise of Nationalism, Build-up of Military might, and system of military alliances. Europe avoided major wars in the 100 years before world War 1 began. In the 1800s, nationalism swept across the continent that help bring about the Great War. Nationalism led to the creation of two new powers - Italy and Germany - through the uniting of several small states. On the other hand, nationalism weakened the eastern European empires of Austria-Hungary, Russia, and Ottoman Turkey. Those empires ruled many national groups that wanted independence. Tensions began that threatened to ignite a major war. Rivalry for control of the Balkans added to the tensions that erupted into World War 1.

A build-up of military might occurred among European countries before World War 1 broke out. Nationalism encouraged public support for military build-ups and for a countries use of force to achieve it's goals. By the end of the 1800s, technology enabled countries to fight longer and have greater losses than ever before. A system of military alliances gave European powers a sense of security before World War 1 broke out. They formed alliances with each other for protection and guarantee that other members of the alliance would come to the countries aid if attacked. Although alliances provided protection, the system also created some dangers. If war came, the alliance system meant that a number of nations would fight, not only the two involved in the argument. Alliances could cause a country to go to war against a country it had no argument with. In...

The Assassination of Franz Ferdinand Essay

888 Words4 Pages

While there is never just a single event that has led to the start of a world war, or any other serious war, there is often one thing that triggers long lived tensions and thus war ensues. Such was the case in WWI with the assassination of Archduke Franz Ferdinand. There were many tensions that existed prior to his assassination, but it was his assassination which triggered the war, his assassination that served as an excuse, and perhaps the last straw, so to speak, which led to the First World War. The following paper examines the assassination of Franz Ferdinand and its relationship to the start of WWI.

     Under the rule at the time of the assassination, the old Austrio-Hungarian Empire was built by conquest…show more content…

The European leaders and individuals were perhaps becoming very untrusting of one another, and the tensions were rising as no one would rely on the agreements made by anyone.
     As a result of all this tension and distrust, in combination with the assassination of Ferdinand, many nations came together or attacked certain nations that were a threat. For example, the assassination led Austria to declare war on Serbia and Germany declared war on Russia, and then France and then Belgium (Cox). Great Britain then declared war on Germany and Japan on Germany (Cox). Clearly there were many tensions that were just waiting for the right moment, the breaking of the camel’s back, to push nations to truly act. And, since other nations were acting, each nation took that as a sign to go ahead with plans they had perhaps had for several years.
     In relationship to these tensions were other forces as well. For example, much of the world was suffering from a depression and this led many to worry and blame others for their position. There were also those elements listed below:
          Turmoil in the Ottoman empire,

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Steve Ritchie is Committed to Improving Papa John’s in Every Way

Papa John’s CEO Steve Ritchie reached out to customers in a message that he hopes will keep them as loyal customers. In the apology he reminds the public that Papa John’s is much more than any one person. It is a group of over 200,000 people nationwide who are committed to the customers and the product.

Steve Ritchie Papa John’s went into specifics in his letter. He informed the public that Papa John’s has hired outside individuals to reassess the company’s culture. They hope to become more diverse and inclusive in all of their practices. They hope that this will improve the product and improve the overall customer experience.

He also pledged that the management team will travel to locations throughout the country. In their travels they will listen to employees and franchise owners in the hopes of improving every facet of the company. Above all, Steve Ritchie pledged that the company is committed to transparency in all that they do.

Mr. Ritchie admits that they need to earn back the nation’s trust and that it will take a long time. Steve Ritchie has pledged to lead this effort and to be held accountable for their success or failure.

This letter is actually the company’s second such letter. In this edition the CEO and President goes further than he did in the first. This letter overtly apologizes and outlines specific measures that they will take to improve themselves. They more establish themselves as a company that is ready to be dynamic to meet the needs of the future.

Steve Ritchie’s open letter to the public pledged to do better for the loyal Papa John’s customers who he believes deserve better. He took personal responsibility for the company’s failure and pledged that he will improve the culture and promote change, diversity, and transparency in all that they do.

Here’s Steve Ritchie’s executive profile:,-Inc./Steve-M.-Ritchie


Hint: keep it simple, like life twain

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Daily Inspiration - Quotes to Live By

Jacqueline McKenzie Quotes and Sayings

I hope you find great value in these Quotes by Jacqueline McKenzie from my large collection of motivational and inspirational quotes and sayings.

I can't do theatre in the US,' she says,
'because I don't have a green card.
- Jacqueline McKenzie

It's just so fragile.
The growing sense of 'Oh, God, what am I doing? Am
I any good? Will I ever work again?' All those questions of self doubt,
they do creep in.
- Jacqueline McKenzie

You have to have a lifestyle if you live in LA,
otherwise it's deadly.
- Jacqueline McKenzie

It was hysterical going to work.
I would just walk in and think, 'What in hell? Am I
here? What's going on? I'm going to wake up in a minute.
I'm in a dream.'
- Jacqueline McKenzie

No matter how many helicopters there are,
when it comes down to it there is the camera and you.
- Jacqueline McKenzie

You don't choose.
I just go where the work is.
- Jacqueline McKenzie

I love being part of the team.
- Jacqueline McKenzie

Your E-Mail Address:
Your Name:

- Jacqueline McKenzie

Everybody is just at the start of this huge process
of trying to unravel what's going on with the 4,400,
where they've been and why they're back and what they're
trying to do with us in the present.
And we're trying to work out what messages they're sending us.
- Jacqueline McKenzie

And the reason for that I think is that in Australia
our films don't get the exposure,
so the process is foremost.
But anyway, I love being part of the team and hate
being stuck in a corner somewhere.
- Jacqueline McKenzie

that you get really scared before you go on.
actually love getting up there and showing off.
- Jacqueline McKenzie

I was spooked when I first got the role,
as I was afraid I wouldn't have the companionship I need on a shoot,
because I'm so into the process itself,
not so much the end product.
- Jacqueline McKenzie

- Gail Godwin

Movies are not scripts - movies are films;
they're not books,
they're not the theatre.
- Nicolas Roeg

Movies are a complicated collision of literature,
theatre, music and all the visual arts.
- Yahoo Serious

A good film is when the price of the dinner,
the theatre admission and the babysitter were worth it.
- Alfred Hitchcock

Choosing to be in the theatre was a way to put my roots
down somewhere with other people.
It was a way to choose a new family.
- Juliette Binoche

In the theatre, the actor is given immediate feedback.
- Charles Keating

It was progressively more difficult to find work in the theatre,
as well.
- Andrzej Wajda

I like simple things.
I like to sneak in the theatre and watch movies.
I'm a movie buff.
- Justin Timberlake

First there was the theatre of people and animals,
then of people and the devil.
Now we need the theatre of people and people.
- Edward Bond

I think theatre should always be somewhat suspect.
- Vaclav Havel

I did loads of student films and fringe theatre.
I worked for free a lot.
- Christopher Parker

Most of the competition was into bulk popcorn because
of the major increases in the Drive-In Theatre Outlets.
- Orville Redenbacher

You're on stage every night and you have to sustain
your energy level tor several hours.
- Blythe Danner

My plan is to have a theatre in some small town or
something and I'll be manager.
Ill be the crazy old movie guy.
- Quentin Tarantino

You take a plug and put it in a socket,
and that's what the theatre is-it lights up right away.
You speak, and they respond immediately.
- Chita Rivera

The club shows are really intense and powerful,
but for a shorter time, and the audiences are in close
proximity than when I'm performing at The Palace Theatre.
- Deborah Cox

The word theatre comes from the Greeks.
It means the seeing place.
It is the place people come to see the truth about
life and the social situation.
- Stella Adler

Actually, my favourite roles have been in theatre,
but on TV, my faves were Slap Maxwell and Larry Sanders.
- Megan Gallagher

The entrance into Jerusalem has all the elements of
the theatre of the absurd:
the poor king;
truth comes riding on a donkey; symbolic actions -
even parading without a permit!
- David Kirk

All TV can do is capture the spirit of a book because
the medium is so utterly different.
But I'm very grateful for the readers that Masterpiece
Theatre has undoubtedly brought me.
- Joanna Trollope

I've done a lot of costume drama and theatre -
the National Theatre and In fact,
was period.
- Brenda Blethyn

which was quite nearby where I lived.
And I worked there for about six or seven months,
as part of the stage crew.
- Ewan McGregor

Theatre sports is the best improv training period.
- Wayne Brady

but unfortunately, it doesn't pay the bills.
- Kabir Bedi

Theatre to hear Duke Ellington.
- David Amram

I was very interested in theatre, mostly in stage design.
I did a little bit of acting.
- Jim Henson

It's important to move the theatre into the 21st Century.
- David Soul

What theatre started to look at much earlier than any
other form was the internal operations of ordinary people,
sometimes using mythic models in order to tell the story.
- Pete Townshend

- Kim Cattrall

At the same time, television theatre became more visibly active.
- Andrzej Wajda

I never thought of myself in comedy at all...
I loved going to the theatre and seeing people wearing
beautiful clothes come down the staircase and start to dance.
- Imogene Coca

I think I'm a better actress for having friends and
interests outside the theatre.
I wouldn't want to live my life surrounded by other actors all the time.
- Penelope Keith

Theatre has no national identity.
It is something for the world, whether it is Irish,
English, or French.
- Cyril Cusack

People come to the theatre to be excited and uplifted -
I want to inspire my audience.
- Edward Hall

Films take up so much time, and with theatre,
you do have to plan a period of time that you can be free.
- Mike Figgis

I grew up in the theatre.
It's where I got my start.
Writing a television drama with theatrical dialogue
about the theatre is beyond perfection.
- Aaron Sorkin

The theatre only knows what it's doing next week,
to do in five years' time? A completely different attitude.
- Harrison Birtwistle

My operas and my theatre works are very formal pieces.
- Harrison Birtwistle

We are suffocated by writers who want to enlighten us with their truths.
For me, the theatre is beautiful because it is a secret,
and secrets seduce us, we all want to share secrets.
- Howard Barker

Theatre is how I first encountered art on any level.
- Patrick Marber

I sometimes think that theatre is a torture.
- Juliet Stevenson

Because Chicago was to radio what Hollywood was to
films and Broadway was to the theatre:
it was the hub of radio.
- Mel Torme

- Katie Holmes

The people on the business side in the music business
are kind of different from the theatre business.
I think it's partly because there are different pressures on the industries.
- Tim Curry

For me, making films is like being on vacation,
it's a nice walk.
But theatre is like mountaineering.
- Isabelle Huppert

- Boris Spassky

Edinburgh is my favourite city.
We'll be doing a lot of children's theatre and galleries.
- Carol Ann Duffy

The Greeks already understood that there was more interest
in portraying an unusual character than a usual character -
that is the purpose of films and theatre.
- Isabelle Huppert

Fifteen years before I became a screen actor,
I was in the theatre.
A lot of my work was comedy, which I loved doing.
It's harder.
- Ben Kingsley

The first horror film I remember seeing in the theatre
was Halloween and from the first scene when the kid
puts on the mask and it is his POV,
I was hooked.
- David Arquette

without actually introducing myself.
- Bill Forsyth

The money is better in films and television.
But in terms of acting, theatre is more rewarding.
- Christopher Eccleston

Being a film actor is very different from a theatre actor.
- Catherine Deneuve

Musical theatre is something I'm familiar with,
I've been doing that.
- David Naughton

Thirty years ago dinner theatre used to be much more
of a going concern than it is now.
- Ted Shackelford

It's a whole different kind of anxiety.
But the great thing about doing a theatre job is that
it's inexorable.
- Emily Watson

Compromise is its second name.
- Enid Bagnold

Theatre can't be done again and again and again and again -
it's organic.
- Kim Cattrall

My playground was the theatre.
I'd sit and watch my mother pretend for a living.
As a young girl, that's pretty seductive.
- Gwyneth Paltrow

Quotes and Sayings

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- Jonathan Lockwood Huie

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How to Improve your People Management Skills

patienceAt the very basic, any business, be it Platinum Access Limousines or any other,  evolve to be successful because of two main things; figuring out what needs to be done and getting those things done. The main challenge comes when trying to get other people to execute your idea. Managing people is a tough skill because people are different and have varied personalities. However, peoples’ management skill can be learned, and you can perfect it.

To assess your people management skills, you need to ask yourself some basic questions. You need to evaluate how well you relate with others, how well you work with others and your tolerance.  If you are looking forward to improving your people management skills, here are a couple of things you can do.

Patience is a very important skill, that in most cases, everyone thinks they have it until he or she are pushed to the corner. It may be true that some people are born with a higher level of patience than others, but that is not to mean you may not be able to develop your ability to keep a level head in a stressful situation. When you have this feeling like others are losing their cool, you can maintain your patience by closing your eyes, taking a deep breath through your nose and out through your mouth and slowly counting silently in your head up to ten. It is a simple technique that can help you stay patient and calm.

Good Communication

Good communication includes a wide range of issues including your ability to get along with people, your persuasion skills, and your ability to get others to listen to you as well as being clear in what you say. Being clear in what you say is particularly important because in most cases, you will have a limited time when passing your message to others. It can be a bit challenging and overwhelming to pass your message to an audience defined by browsing their phones and paying little attention to what you communicate.

Ability to Relate

peopleBusiness is all about relating with people. You need to be able to relate with other people by accommodating their points of view. When you find that you are struggling to relate to other people’s point of view, all you need is to try putting yourself in their shoes. Ask yourself what caused them to say what they said, or what caused them to feel the way they felt. You will be able to relate with others better if you can view a situation from a perspective that is different from yours.

You need to develop the ability and habit of listening. We are all given two ears and one mouth for a reason. You need to listen more than you speak. Take time to listen to what your employees or team members are saying. Listen keenly without interrupting. Employ active listening and respond to issues at the appropriate time in your conversation. Always have a good judgment. The foundation of good judgment lies in looking at the world around you, listening to what others have to say and learning from the information they have.

How to Increase Productivity at Work

productivityA day has so many hours and therefore making the most out of your time is critical to achieving productivity. Being more productive, whether working in an office setting or at the roads with isn’t rocket science, but it requires deliberation about how you manage your time. Being productive at work can be a bit difficult, but effectively managing your time is key to being productive.

Productivity involves a combination of focused efforts and intelligence planning. Every time the daily work ends, chances are that you are certainly not satisfied with what you have accomplished during the day. The good news is that productivity can be continuously improved, and here are the top ways you can achieve it.

Seek Help

When we talk about seeking help, we mean delegating tasks accordingly. Everyone needs help, and you should not labor to take a massive chunk of functions alone. To get help from others, you need to trust your colleagues in the guidance you get the work done. When delegating your tasks to colleagues, you need to tell them about the deadline to get more serious. When delegating tasks, you should also avail all helpful resources to your colleagues to help them feel comfortable about the task.

Avoid Distractions

Avoid getting stuck into unnecessary things including meeting. It may be very tempting to meet people out of the benefit of networking, but some meetings are not worth it. By the time you get to your desk, know which meetings are necessary to attend, and which ones to skip. In case your senior wants to have a one on one meeting with you, it is obviously going to be very important. Also, ensure meetings are adequately scheduled to avoid last minute rush and inconveniences. Stop getting distracted by the internet including social media.

Have a To-Do List

To-Do ListHave a to-do list of the tasks you need to do, starting from the simplest to the most complex. Put a lot of preference simple tasks to complete them the quickest before moving to complicated ones.  You can get more organized by using google task manager to sync tasks with Google Calendar, Gmail, and Google mobile app among others. If tasks are large, break them into smaller chunks. Put a timer on these tasks so that you do not lose focus on essential details. For your to-do list, review it occasionally to ensure that it is in line with what you want to achieve.

Take Breaks

A study from the Pennington Biomedical Research Center which is in Louisiana shows an exciting lifestyle habit of about 17000 men and women subjected through the research. This study shows that 54% of these people are more likely to die of heart attacks because of sitting all the day long. If you spend more than 8 hours on a desk with a decreased level of physical activities, you are doing your body much harm. Always take a break to engage in some form of physical activities to top up your energy levels.

How to Eat Clean and Healthy Every day

eat cleanAre you looking for a more inspired and principled way to eat? If you change on some of the unhealthy foods you take and start to eat clean, you will become healthier and feel better. You have probably heard about clean eating, but you might not have an idea of what it involves. Eating clean is all about eating more of the best and healthiest foods that can be found on the market. It also consists of eating less of the not so healthy meals on the shelves.

Eating clean means embracing whole foods such as fruits, vegetables, and whole grains. It means you have to take the required proportions of proteins and fat and cut on refined grains, preservatives, and additives. You have to dish out unhealthy fats and unwanted amounts of salt and sugar. If you are looking forward to getting started in clean heating, here are the underlying principles.

Fruits and Vegetables

As far as fruits and vegetables are concerned, most people don’t get enough of them. Data from the Center for Disease Control and Prevention shows that 76 percent of Americans do not get enough fruits every day. This data also indicates that 87 percent do not eat enough servings of vegetables.  If you eat more fruits and vegetables, you can significantly reduce the number of risks associated with chronic diseases. These diseases include high blood pressure, heart diseases, type 2 diabetes, cancer, and obesity. Fiber that is found in fruits and vegetables helps to keep micronutrients in check and reduce the risks if autoimmune diseases.

Take Whole Grains

Whole grainsThe cleanest whole grains are those who have not been processed. Think of these whole grains; Quinoa, rice, and oats. Most people avoid these whole grains and instead go for less healthy options such as wheat, pasts, bread among others. Do not be duped by claims of whole grains that are put up in labels. You will need to take a closer look at the ingredients contained in a packaging. Avoid refined carbs such as pasta, white bread, and sugar.

Eat Less Meat

Yes, you read it right; eat less meat.  Research shows that cutting back on meat and working towards becoming a vegan is an important decision you can make. Eating less meat can help you in reducing blood sugar and other risks of heart diseases. Eating more veggies helps in supplying you with the right amounts of fiber that your body needs.  If you have to eat meat, choose the lean cuts. You have to cut down on processed meats such as cold cuts, sausages, and bacon.

Avoid Processed Foods

We are not entirely opposing processed foods because when we cook at home, we are typically processing goods. However, most of the processed foods you can find on the market is processed beyond the recommended levels. Keep a keen eye on anything that has lots of sugar and refined grains as it is among the unhealthiest options. There are clean processed foods such as plain yogurt, whole-wheat pasta, cheese and packaged baby spinach. However, you have to be keen on any other processed foods out there. The main dangers of processed foods are exposure to BPA and other chemicals that are mostly found in plastics.

Lifestyle Habits making you Fat

fatWhen you are running from one business to another or working long hours on the computer, your diet and fitness goals may suffer. If your days are fully packed on a business meeting, you might lack some time for yourself. You may be unintentionally putting your health at risk by adding extra weight. Losing weight and getting in shape is not as easy as it sounds. We are in a busy world, and we do not have much time to do what it takes to lose weight and stay top in shape all the time.

Adding weight from meals we take is simple, and sometimes it happens fast. You could be adding weight without knowing, or even adding and feeling better about it. If you need to lose weight, avoid getting extra weight and stay happily healthy, here are a couple of things you have to observe.

Eating Low-Fat foods

plant based dietWhen you visit the grocery store and supermarkets, you will find many foods labeled low fat or fat-free diets. Yes, these foods might be low-fat ones, but they do so by replacing fat with sugar and other chemicals which are even worse than fat itself. These foods digest more quickly leaving you with a sugar crash and feeling hungry again. When you plan to take any food, have a nutrition discipline in mind.

Eating Too Quickly

How many times have we gone to eat and within 5 minutes we are done with the process? Research from the University of Rhodes found out that people who ate slowly are a third of those who ate fast. The stomach takes 20 minutes to tell the brain that you are full. For every meal that you take, it should last at least 2o minutes for proper digestion to take place. Try to increase the number of chews you subject your food to and pace yourself.

Skipping Meals

One of the worst things you can do to your body and mind is skipping meals. It makes you fat, point blank! When you skip meals, your metabolism slows down making you more likely to overeat later during the day. The American Journal of Epidemiology research showed that people who skip breakfast were 4.5 times more likely to be obese. You need to rev up your metabolism by eating small proportions of food every day. You can also take healthy snacks which can keep you full throughout the day for very few calories.

Watching TV as you Eat

It is awful to watch TV while you eat. When you watch the television while eating, you are not entirely focused on anything else than what you’re doing. Research conducted by the University of Birmingham found that people who get distracted while eating a meal tend to eat more snacks afterward to compensate for not paying attention. Another harm you might be doing to your body is taking big bites. Cut your food into smaller pieces. Cutting the food into smaller pieces increases enjoyment and also takes longer to eat. This will increase your overall satisfaction.

Harmful Effects of Taking Junk Foods

Can Cause Memory and Learning Problems

Increased Risk of Dementia

Lessons One Ability to Control Appetite

Inpatient and Uncontrolled Cravings


Safari displays font differently from other browsers -Set specific font-family for specific browser - How to change font smoothing for Safari [closed]

Tags: javascript,jquery,html,css

Problem :

The font Avenir Next is not displaying/rendering the same on Safari as it is on Google Chrome and Firefox. Is there a way to fix this or to use a separate font for my webpage on Safari? How would I go about this?

I would prefer the solution to be pure html/css (perhaps there is an @media for browsers?). If not possible I could use javascript or jQuery.

EDIT: Solved, the problem is Safari font-smoothing. See my own answer below

Solution :

Safari has its own separate font-smoothing (that is, an automatic function adjusting the font to render nice and proper)from other browsers like Chrome or Firefox. In the case of discrepancies such as those I encountered, we can manually alter the automatic font-smoothing in our CSS with

In my case, font-smoothing on Safari was automatically set on antialiased, while the standard (font-smoothing used on Chrome and Firefox) was subpixel-antialiased.

Simply added:

And the font now displays the same as in Chrome and other browsers.

For more on Safari font-smoothing:

    CSS Howto..

    How to achieve a lightbox effect with css only? Example available

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    after every

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Lygia Pape

‘Fragments of improvized poetry came together and devoured one another’

Anna Maria Maiolino, É o que Sobra (What Is Left Over), from the series ‘Fotopoemação’ (Photopoemaction), 1974, digital print, 62 × 153 cm. Courtesy: the artist and Galleria Raffaella Cortese, Milan

How the radical practices of female artists drove the Modernist movement in Brazil

Gagosian Gallery at Frieze New York 2017. Courtesy: Mark Blower/Frieze

The first day of the weekend is the second public day of Frieze New York 2017. Plan your day around the city and the fair

Bas Jan Ader, Primary Time (1974), DVD still

The Museum of Modern Art, New York, USA


StartupTAP is hiring a

Product Manager

Santa Monica, United States

This is an exciting opportunity to join an agile, entrepreneurial team and have a real impact. The product manager will drive customer-focused solutions. S/he will take business objectives and combine them with customer and user experience insights. This role will collaborate with all areas of the business to drive the product strategy through to execution and customer adoption of features by guest community. The right candidate has a strong ownership mentality, bias towards action and a tenacious results focus.

What we're looking for
·         It’s not your first rodeo. You have 5+ years product management experience building customer focused and intuitive products. Prior startup experience is an advantage
·         You get the customer and the business. You have an insatiable need to understand the customer. You translate customer needs and analytical insights into a strong creative vision, aligned with the company strategy
·         You’re hands on. You never hesitate to roll up your sleeves and tackle something hands-on, you persevere when others fall away even if it’s not your area
·         You have a “driver” personality. You’re biased towards action, a great collaborator and master disambiguator/simplifier. You never stop pushing towards clarity and delivery
·         A test-and-learn personality. You just go get the data you need with no muss/fuss and can whip it into an insightful story with no help. You know how to leverage data to make decisions and drive growth
·         Data-driven mindset. Ability to leverage data to make decisions without getting stuck in analysis paralysis

Other jobs at StartupTAP


Tuesday, October 23, 2018

Sexual harassment in academic contexts

Sexual harassment of women in academic settings is regrettably common and pervasive, and its consequences are grave. At the same time, it is a remarkably difficult problem to solve. The "me-too" movement has shed welcome light on specific individual offenders and has generated more awareness of some aspects of the problem of sexual harassment and misconduct. But we have not yet come to a public awareness of the changes needed to create a genuinely inclusive and non-harassing environment for women across the spectrum of mistreatment that has been documented. The most common institutional response following an incident is to create a program of training and reporting, with a public commitment to investigating complaints and enforcing university or institutional policies rigorously and transparently. These efforts are often well intentioned, but by themselves they are insufficient. They do not address the underlying institutional and cultural features that make sexual harassment so prevalent.

The problem of sexual harassment in institutional contexts is a difficult one because it derives from multiple features of the organization. The ambient culture of the organization is often an important facilitator of harassing behavior -- often enough a patriarchal culture that is deferential to the status of higher-powered individuals at the expense of lower-powered targets. There is the fact that executive leadership in many institutions continues to be predominantly male, who bring with them a set of gendered assumptions that they often fail to recognize. The hierarchical nature of the power relations of an academic institution is conducive to mistreatment of many kinds, including sexual harassment. Bosses to administrative assistants, research directors to post-docs, thesis advisors to PhD candidates -- these unequal relations of power create a conducive environment for sexual harassment in many varieties. In each case the superior actor has enormous power and influence over the career prospects and work lives of the women over whom they exercise power. And then there are the habits of behavior that individuals bring to the workplace and the learning environment -- sometimes habits of masculine entitlement, sometimes disdainful attitudes towards female scholars or scientists, sometimes an underlying willingness to bully others that finds expression in an academic environment. (A recent issue of the Journal of Social Issues (link) devotes substantial research to the topic of toxic leadership in the tech sector and the "masculinity contest culture" that this group of researchers finds to be a root cause of the toxicity this sector displays for women professionals. Research by Jennifer Berdahl, Peter Glick, Natalya Alonso, and more than a dozen other scholars provides in-depth analysis of this common feature of work environments.)

The scope and urgency of the problem of sexual harassment in academic contexts is documented in excellent and expert detail in a recent study report by the National Academies of Sciences, Engineering, and Medicine (link). This report deserves prominent discussion at every university.

The study documents the frequency of sexual harassment in academic and scientific research contexts, and the data are sobering. Here are the results of two indicative studies at Penn State University System and the University of Texas System:

The Penn State survey indicates that 43.4% of undergraduates, 58.9% of graduate students, and 72.8% of medical students have experienced gender harassment, while 5.1% of undergraduates, 6.0% of graduate students, and 5.7% of medical students report having experienced unwanted sexual attention and sexual coercion. These are staggering results, both in terms of the absolute number of students who were affected and the negative effects that these  experiences had on their ability to fulfill their educational potential. The University of Texas study shows a similar pattern, but also permits us to see meaningful differences across fields of study. Engineering and medicine provide significantly more harmful environments for female students than non-STEM and science disciplines. The authors make a particularly worrisome observation about medicine in this context:
The interviews conducted by RTI International revealed that unique settings such as medical residencies were described as breeding grounds for abusive behavior by superiors. Respondents expressed that this was largely because at this stage of the medical career, expectation of this behavior was widely accepted. The expectations of abusive, grueling conditions in training settings caused several respondents to view sexual harassment as a part of the continuum of what they were expected to endure. (63-64)
The report also does an excellent job of defining the scope of sexual harassment. Media discussion of sexual harassment and misconduct focuses primarily on egregious acts of sexual coercion. However, the  authors of the NAS study note that experts currently encompass sexual coercion, unwanted sexual attention, and gender harassment under this category of harmful interpersonal behavior. The largest sub-category is gender harassment:
"a broad range of verbal and nonverbal behaviors not aimed at sexual cooperation but that convey insulting, hostile, and degrading attitudes about" members of one gender (Fitzgerald, Gelfand, and Drasgow 1995, 430). (25)
The "iceberg" diagram (p. 32) captures the range of behaviors encompassed by the concept of sexual harassment. (See Leskinen, Cortina, and Kabat 2011 for extensive discussion of the varieties of sexual harassment and the harms associated with gender harassment.)

The report emphasizes organizational features as a root cause of a harassment-friendly environment.
By far, the greatest predictors of the occurrence of sexual harassment are organizational. Individual-level factors (e.g., sexist attitudes, beliefs that rationalize or justify harassment, etc.) that might make someone decide to harass a work colleague, student, or peer are surely important. However, a person that has proclivities for sexual harassment will have those behaviors greatly inhibited when exposed to role models who behave in a professional way as compared with role models who behave in a harassing way, or when in an environment that does not support harassing behaviors and/or has strong consequences for these behaviors. Thus, this section considers some of the organizational and environmental variables that increase the risk of sexual harassment perpetration. (46)
Some of the organizational factors that they refer to include the extreme gender imbalance that exists in many professional work environments, the perceived absence of organizational sanctions for harassing behavior, work environments where sexist views and sexually harassing behavior are modeled, and power differentials (47-49). The authors make the point that gender harassment is chiefly aimed at indicating disrespect towards the target rather than sexual exploitation. This has an important implication for institutional change. An institution that creates a strong core set of values emphasizing civility and respect is less conducive to gender harassment. They summarize this analysis in the statement of findings as well:
Organizational climate is, by far, the greatest predictor of the occurrence of sexual harassment, and ameliorating it can prevent people from sexually harassing others. A person more likely to engage in harassing behaviors is significantly less likely to do so in an environment that does not support harassing behaviors and/or has strong, clear, transparent consequences for these behaviors. (50)
So what can a university or research institution do to reduce and eliminate the likelihood of sexual harassment for women within the institution? Several remedies seem fairly obvious, though difficult.
  • Establish a pervasive expectation of civility and respect in the workplace and the learning environment
  • Diffuse the concentrations of power that give potential harassers the opportunity to harass women within their domains
  • Ensure that the institution honors its values by refusing the "star culture" common in universities that makes high-prestige university members untouchable
  • Be vigilant and transparent about the processes of investigation and adjudication through which complaints are considered
  • Create effective processes that ensure that complainants do not suffer retaliation
  • Consider candidates' receptivity to the values of a respectful, civil, and non-harassing environment during the hiring and appointment process (including research directors, department and program chairs, and other positions of authority)
  • Address the gender imbalance that may exist in leadership circles
As the authors put the point in the final chapter of the report:
Preventing and effectively addressing sexual harassment of women in colleges and universities is a significant challenge, but we are optimistic that academic institutions can meet that challenge--if they demonstrate the will to do so. This is because the research shows what will work to prevent sexual harassment and why it will work. A systemwide change to the culture and climate in our nation's colleges and universities can stop the pattern of harassing behavior from impacting the next generation of women entering science, engineering, and medicine. (169)

Sunday, October 21, 2018

System effects

What are some examples of system effects? Consider these phenomena:
  • Flash crashes in stock markets as a result of automated trading
  • Under-reporting of land values in agrarian fiscal regimes
  • Grade inflation in elite universities
  • Increase in product defect frequency following a reduction in inspections
  • Rising frequency of industrial errors at the end of work shifts

Friday, October 5, 2018

Social mobility disaggregated

There is a new exciting and valuable contribution from the research group around Raj Chetty, Nathan Hendren, and John Friedman, this time on the topic of neighborhood-level social mobility. (Earlier work highlighted measures of the impact on social mobility contributed by university education across the country. This work is presented on the Opportunity Insights website; link, link. Here is an earlier post on that work; link.) In the recently released work Chetty and his colleagues have used census data to compare incomes of parents and children across the country by neighborhood of birth, with the ability to disaggregate by race and gender, and the results are genuinely staggering. Here is a report on the project on the US Census website; link. The interactive dataset and mapping app are provided here (link). The study identifies neighborhoods of origin; characteristics of parents and neighborhoods; and characteristics of children.

Here are screenshots of metropolitan Detroit representing the individual incomes of the children (as adults) based on their neighborhoods of origin for all children, black children, and white children. (Of course a percentage of these individuals no longer live in the original neighborhood.) There are 24 outcome variables included as well as 13 neighborhood characteristics, and it is possible to create maps based on multiple combinations of these variables. It is also possible to download the data.

Children born in Highland Park, Michigan earned an average individual income as adults in 2014-15 of $18K; children born in Plymouth, Michigan earned an average individual income as adults of $42K. It is evident that these differences in economic outcomes are highly racialized; in many of the tracts in the Detroit area there are "insufficient data" for either black or white individuals to provide average data for these sub-populations in the given areas. This reflects the substantial degree of racial segregation that exists in the Detroit metropolitan area. (The project provides a special study of opportunity in Detroit, "Finding Opportunity in Detroit".)

This dataset is genuinely eye-opening for anyone interested in the workings of economic opportunity in the United States. It is also valuable for public policy makers at the local and higher levels who have an interest in improving outcomes for children in poverty. It is possible to use the many parameters included in the data to probe for obstacles to socioeconomic progress that might be addressed through targeted programs of opportunity enhancement.

(Here is a Brookings description of the social mobility project's central discoveries; link.)

Wednesday, October 3, 2018

Emotions as neurophysiological constructs

Are emotions real? Are they hardwired to our physiology? Are they pre-cognitive and purely affective? Was Darwin right in speculating that facial expressions are human universals that accurately represent a small repertoire of emotional experiences (The Expression of the Emotions in Man and Animals)? Or instead are emotions a part of the cognitive output of the brain, influenced by context, experience, expectation, and mental framework? Lisa Feldman Barrett is an accomplished neuroscientist who addresses all of these questions in her recent book How Emotions Are Made: The Secret Life of the Brain, based on several decades of research on the emotions. The book is highly interesting, and has important implications for the social sciences more broadly.

Barrett's core view is that the received theory of the emotions -- that they are hardwired and correspond to specific if unknown neurological groups, connected to specific physiological and motor responses -- is fundamentally wrong. She marshals a great deal of experimental evidence to the incorrectness of that theory. In its place she argues that emotional responses and experiences are the result of mental, conceptual, and cognitive construction by our central nervous system, entirely analogous to our ability to find meaning in a visual field of light and dark areas in order to resolve it as a bee (her example). The emotions are like perception more generally -- they result from an active process in which the brain attempts to impose order and pattern on sensory stimulation, a process she refers to as "simulation". She refers to this as the theory of constructed emotion (30). In brief:
Emotions are not reactions to the world. You are not a passive receiver of sensory input but an active constructor of your emotions. From sensory input and past experience, your brain constructs meaning and prescribes action. If you didn't have concepts that represent your past experience, all your sensory inputs would just be noise. (31)
And further:
Particular concepts like "Anger" and "Distrust" are not genetically determined. Your familiar emotion concepts are built-in only because you grew up in a particular social context where those emotion concepts are meaningful and useful, and your brain applies them outside your awareness to construct your experiences. (33)
This theory has much in common with theorizing about the nature of perception and thought within cognitive psychology, where the constructive nature of perception and representation has been a core tenet. Paul Kolers' motion perception experiments in the 1960s and 1970s established that perception is an active and constructive process, not a simple rendering of information from the retina into visual diagrams in the mind (Aspects of Motion Perception). And Daniel Dennett's Consciousness Explained argues for a "multiple drafts" theory of conscious experience which once again emphasizes the active and constructive nature of consciousness.

One implication of Barrett's theory is that emotions are concept-dependent. We need to learn the terms for emotions in our ambient language community before we can experience them. The emotions we experience are conceptually loaded and structured.
People who exhibit low emotional granularity will have only a few emotion concepts. In English, they might have words in their vocabulary like "sadness," "fear," "guilt," "shame," "embarrassment," "irritation," "anger," and "contempt," but those words all correspond to the same concept whose goal is something like "feeling unpleasant." This person has a few tools -- a hammer and Swiss Army knife. (106)
In a later chapter Barrett takes her theory in a Searle-like direction by emphasizing the inherent and irreducible constructedness of social facts and social relations (chapter 7). Without appropriate concepts we cannot understand or represent the behaviors and interactions of people around us; and their interactions depend inherently on the conceptual systems or frames within which we place their actions. Language, conceptual frames, and collective intentionality are crucial constituents of social facts, according to this perspective. I find Searle's arguments on this subject less than convincing (link), and I'm tempted to think that Barrett is going out on a limb by embracing his views more extensively than needed for her own theory of the emotions.

I find Barrett's work interesting for a number of reasons. One is the illustration it provides of human plasticity and heterogeneity. "Any category of emotion such as "Happiness" or "Guilt" is filled with variety" (35). Another is the methodological sophistication Barrett demonstrates in her refutation of two thousand years of received wisdom about the emotions, from Aristotle and Plato to Paul Ekman and colleagues. This sophistication extends to her effort to avoid language in describing emotions and research strategies that embeds the ontology of the old view -- an ontology that reifies particular emotions in the head and body of the other human being (40). She correctly observes that language like "detecting emotion X in the subject" implies that the psychological condition exists as a fixed reality in the subject; whereas the whole point of her theory is that the experience of disgust or happiness is a transient and complex construction by the brain behind the scenes of our conscious experience. She is "anti-realist" in her treatment of emotion. "We don't recognize emotions or identify emotions: we construct our own emotional experiences, and our perceptions of others' emotions, on the spot, as needed, through a complex interplay of systems" (40). And finally, her theory of emotion as a neurophysiological construct has a great deal of credibility -- its internal logic, its fit with current understandings of the central nervous system, its convergence with cognitive psychology and perception theory, and the range of experimental evidence that Barrett brings to bear.

Sunday, September 30, 2018

Philosophy and the study of technology failure

image: Adolf von Menzel, The Iron Rolling Mill (Modern Cyclopes)

Readers may have noticed that my current research interests have to do with organizational dysfunction and largescale technology failures. I am interested in probing the ways in which organizational failures and dysfunctions have contributed to large accidents like Bhopal, Fukushima, and the Deepwater Horizon disaster. I've had to confront an important question in taking on this research interest: what can philosophy bring to the topic that would not be better handled by engineers, organizational specialists, or public policy experts?

One answer is the diversity of viewpoint that a philosopher can bring to the discussion. It is evident that technology failures invite analysis from all of these specialized experts, and more. But there is room for productive contribution from reflective observers who are not committed to any of these disciplines. Philosophers have a long history of taking on big topics outside the defined canon of "philosophical problems", and often those engagements have proven fruitful. In this particular instance, philosophy can look at organizations and technology in a way that is more likely to be interdisciplinary, and perhaps can help to see dimensions of the problem that are less apparent from a purely disciplinary perspective.

There is also a rationale based on the terrain of the philosophy of science. Philosophers of biology have usually attempted to learn as much about the science of biology as they can manage, but they lack the level of expertise of a research biologist, and it is rare for a philosopher to make an original contribution to the scientific biological literature. Nonetheless it is clear that philosophers have a great deal to add to scientific research in biology. They can contribute to better reasoning about the implications of various theories, they can probe the assumptions about confirmation and explanation that are in use, and they can contribute to important conceptual disagreements. Biology is in a better state because of the work of philosophers like David Hull and Elliot Sober.

Philosophers have also made valuable contributions to science and technology studies, bringing a viewpoint that incorporates insights from the philosophy of science and a sensitivity to the social groundedness of technology. STS studies have proven to be a fruitful place for interaction between historians, sociologists, and philosophers. Here again, the concrete study of the causes and context of large technology failure may be assisted by a philosophical perspective.

There is also a normative dimension to these questions about technology failure for which philosophy is well prepared. Accidents hurt people, and sometimes the causes of accidents involve culpable behavior by individuals and corporations. Philosophers have a long history of contribution to these kinds of problems of fault, law, and just management of risks and harms.

Finally, it is realistic to say that philosophy has an ability to contribute to social theory. Philosophers can offer imagination and critical attention to the problem of creating new conceptual schemes for understanding the social world. This capacity seems relevant to the problem of describing, analyzing, and explaining largescale failures and disasters.

The situation of organizational studies and accidents is in some ways more hospitable for contributions by a philosopher than other "wicked problems" in the world around us. An accident is complicated and complex but not particularly obscure. The field is unlike quantum mechanics or climate dynamics, which are inherently difficult for non-specialists to understand. The challenge with accidents is to identify a multi-layered analysis of the causes of the accident that permits observers to have a balanced and operative understanding of the event. And this is a situation where the philosopher's perspective is most useful. We can offer higher-level descriptions of the relative importance of different kinds of causal factors. Perhaps the role here is analogous to messenger RNA, providing a cross-disciplinary kind of communications flow. Or it is analogous to the role of philosophers of history who have offered gentle critique of the cliometrics school for its over-dependence on a purely statistical approach to economic history.

So it seems reasonable enough for a philosopher to attempt to contribute to this set of topics, even if the disciplinary expertise a philosopher brings is more weighted towards conceptual and theoretical discussions than undertaking original empirical research in the domain.

What I expect to be the central finding of this research is the idea that a pervasive and often unrecognized cause of accidents is a systemic organizational defect of some sort, and that it is enormously important to have a better understanding of common forms of these deficiencies. This is a bit analogous to a paradigm shift in the study of accidents. And this view has important policy implications. We can make disasters less frequent by improving the organizations through which technology processes are designed and managed.

Thursday, September 27, 2018

James Scott on the earliest states

In 2011 James Scott gave a pair of Tanner Lectures at Harvard. He had chosen a topic for which he felt he had a fairly good understanding, having taught on early agrarian societies throughout much of his career. The topic was the origins of the earliest states in human history. But as he explains in the preface to the 2017 book Against the Grain: A Deep History of the Earliest States, preparation for the lectures led him into brand new debates, bodies of evidence, and theories which were pretty much off his personal map. The resulting book is his effort to bring his own understanding up to date, and it is a terrific and engaging book.

Scott gives a quick summary of the view of early states, nutrition, agriculture, and towns that he shared with most historians of early civilizations up through a few decades ago. Hunter-gatherer human groups were the primary mode of living for tens of thousands of years at the dawn of civilization. Humanity learned to domesticate plants and animals, creating a basis for sedentary agriculture in hamlets and villages. With the increase in productivity associated with settled agriculture, it was possible for nascent political authorities to collect taxes and create political institutions. Agriculture and politics created the conditions that conduced to the establishment of larger towns, and eventually cities. And humanity surged forward in terms of population size and quality of life.

But, as Scott summarizes, none of these sequences has held up to current scholarship.
We thought ... that the domestication of plants and animals led directly to sedentism and fixed-field agriculture. It turns out that sedentism long preceded evidence of plant and animal domestication and that both sedentism and domestication were in place at least four millennia before anything like agricultural villages appeared. (xi)
The early states were fragile and liable to collapse, but the ensuing "dark ages" may often have marked an actual improvement in human welfare. Finally, there is a strong case to be made that life outside the state -- life as a "barbarian" -- may often have been materially easier, freer, and healthier than life at least for nonelites inside civilization. (xii)
There is an element of "who are we?" in the topic -- that is, what features define modern humanity? Here is Scott's most general answer:
A sense, then, for how we came to be sedentary, cereal-growing, livestock-rearing subjects governed by the novel institution we now call the state requires an excursion into deep history. (3)
Who we are, in this telling of the story, is a species of hominids who are sedentary, town-living, agriculture-dependent subjects of the state. But this characterization is partial (as of course Scott knows); we are also meaning-makers, power-wielders, war-fighters, family-cultivators, and sometimes rebels. And each of these other qualities of humanity leads us in the direction of a different kinds of history, requiring a Clifford Geertz, a Michael Mann, a Tolstoy or a Marx to tell the story.

A particularly interesting part of the novel story about these early origins of human civilization that Scott provides has to do with the use of fire in the material lives of pre-technology humans -- hunters, foragers, and gatherers -- in a deliberate effort to sculpt the natural environment around then to concentrate food resources. According to Scott's readings of recent archeology and pre-agriculture history, human communities used fire to create the specific habitats that would entice their prey to make themselves readily available for the season's meals. He uses a strikingly phrase to capture the goal here -- reducing the radius of a meal. Early foragers literally reshaped the natural environments in which they lived.
What we have here is a deliberate disturbance ecology in which hominids create, over time, a mosaic of biodiversity and a distribution of desirable resources more to their liking. (40)
Most strikingly, Scott suggests a link between massive Native American use of fire to reduce forests, the sudden decline in their population from disease following contact with Europeans and consequent decline in burning, and the onset of the Little Ice Age (1500-1850) as a result of reduced CO2 production (39). Wow!

Using fire for cooking further reduced this "radius of the meal" by permitting early humans to consume a wider range of potential foods. And Scott argues that this innovation had evolutionary consequences for our hominid ancestors: human populations developed a digestive gut only one-third the length of that of other non-fire-using hominids. "We are a fire-adapted species" (42).

Scott makes an intriguing connection between grain-based agriculture and early states. The traditional narrative has it that pre-farming society was too low in food productivity to allow for sedentary life and dense populations. According to Scott this assumption is no longer supported by the evidence. Sedentary life based on foraging, gathering, and hunting was established several thousand years earlier than the development of agriculture. Gathering, farming, settled residence, and state power are all somewhat independent. In fact, Scott argues that these foraging communities were too well situated in their material environment to be vulnerable to a predatory state. "There was no single dominant resource that could be monopolized or controlled from the center, let alone taxed" (57). These communities generally were supported by three or four "food webs" that gave them substantial independence from both climate fluctuation and domination by powerful outsiders (49). Cereal-based civilizations, by contrast, were vulnerable to both threats, and powerful authorities had the ability to confiscate grain at the point of harvest or in storage. Grain made taxation possible.

We often think of hunter-gatherers in terms of game hunters and the feast-or-famine material life described by Marshall Sahlins in Stone Age Economics. But Scott makes the point that there are substantial ecological niches in wetlands where nutrition comes to the gatherers rather than the hunter. And in the early millennia of the lower Nile -- what Scott refers to as the southern alluvium -- the wetland ecological zone was ample for a very satisfactory and regular level of wellbeing. And, of special interest to Scott, "the wetlands are ungovernable" (56). (Notice the parallel with Scott's treatment of Zomia in The Art of Not Being Governed: An Anarchist History of Upland Southeast Asia.)

So who are these early humans who navigated their material worlds so exquisitely well and yet left so little archeological record because they built their homes with sticks, mud, and papyrus?
It makes most sense to see them as agile and astute navigators of a diverse but also changeable and potentially dangerous environment.... We can see this long period as one of continuous experimentation and management of this environment. Rather than relying on only a small bandwidth of food resources, they seem to have been opportunistic generalists with a large portfolio of subsistence options spread across several food webs. (59)
Later chapters offer similarly iconoclastic accounts of the inherent instability of the early states (like a pyramid of tumblers on the stage), the advantages of barbarian civilization, the epidemiology of sedentary life, and other intriguing topics in the early history of humanity. And pervasively, there is the under current of themes that recur often in Scott's work -- the validity and dignity of the hidden players in history, the resourcefulness of ordinary hominids, and the importance of avoiding the received wisdom of humanity's history.

Scott is telling a new story here about where we came from, and it is a fascinating one.

Tuesday, September 25, 2018

System safety

An ongoing thread of posts here is concerned with organizational causes of large technology failures. The driving idea is that failures, accidents, and disasters usually have a dimension of organizational causation behind them. The corporation, research office, shop floor, supervisory system, intra-organizational information flow, and other social elements often play a key role in the occurrence of a gas plant fire, a nuclear power plant malfunction, or a military disaster. There is a tendency to look first and foremost for one or more individuals who made a mistake in order to explain the occurrence of an accident or technology failure; but researchers such as Perrow, Vaughan, Tierney, and Hopkins have demonstrated in detail the importance of broadening the lens to seek out the social and organizational background of an accident.

It seems important to distinguish between system flaws and organizational dysfunction in considering all of the kinds of accidents mentioned here. We might specify system safety along these lines. Any complex process has the potential for malfunction. Good system design means creating a flow of events and processes that make accidents inherently less likely. Part of the task of the designer and engineer is to identify chief sources of harm inherent in the process -- release of energy, contamination of food or drugs, unplanned fission in a nuclear plant -- and design fail-safe processes so that these events are as unlikely as possible. Further, given the complexity of contemporary technology systems it is critical to attempt to anticipate unintended interactions among subsystems -- each of which is functioning correctly but that lead to disaster in unusual but possible interaction scenarios.

In a nuclear processing plant, for example, there is the hazard of radioactive materials being brought into proximity with each other in a way that creates unintended critical mass. Jim Mahaffey's Atomic Accidents: A History of Nuclear Meltdowns and Disasters: From the Ozark Mountains to Fukushima offers numerous examples of such unintended events, from the careless handling of plutonium scrap in a machining process to the transfer of a fissionable liquid from a vessel of one shape to another. We might try to handle these risks as an organizational problem: more and better training for operatives about the importance of handling nuclear materials according to established protocols, and effective supervision and oversight to ensure that the protocols are observed on a regular basis. But it is also possible to design the material processes within a nuclear plant in a way that makes unintended criticality virtually impossible -- for example, by storing radioactive solutions in containers that simply cannot be brought into close proximity with each other.

Nancy Leveson is a national expert on defining and applying principles of system safety. Her book Engineering a Safer World: Systems Thinking Applied to Safety is a thorough treatment of her thinking about this subject. She offers a handful of compelling reasons for believing that safety is a system-level characteristic that requires a systems approach: the fast pace of technological change, reduced ability to learn from experience, the changing nature of accidents, new types of hazards, increasing complexity and coupling, decreasing tolerance for single accidents, difficulty in selecting priorities and making tradeoffs , more complex relationships between humans and automation, and changing regulatory and public view of safety (kl 130 ff.). Particularly important in this list is the comment about complexity and coupling: "The operation of some systems is so complex that it defies the understanding of all but a few experts, and sometimes even they have incomplete information about the system's potential behavior" (kl 137).

Given the fact that safety and accidents are products of whole systems, she is critical of the accident methodology generally applied to serious industrial, aerospace, and chemical accidents. This methodology involves tracing the series of events that led to the outcome, and identifying one or more events as the critical cause of the accident. However, she writes:
In general, event-based models are poor at representing systemic accident factors such as structural deficiencies in the organization, management decision making, and flaws in the safety culture of the or industry. An accident model should encourage a broad view of accident mechanisms that expands the investigation beyond the proximate evens.A narrow focus on technological components and pure engineering activities or a similar narrow focus on operator errors may lead to ignoring some of the most important factors in terms of preventing future accidents. (kl 452)
Here is a definition of system safety offered later in ESW in her discussion of the emergence of the concept within the defense and aerospace fields in the 1960s:
System Safety ... is a subdiscipline of system engineering. It was created at the same time and for the same reasons. The defense community tried using the standard safety engineering techniques on their complex new systems, but the limitations became clear when interface and component interaction problems went unnoticed until it was too late, resulting in many losses and near misses. When these early aerospace accidents were investigated, the causes of a large percentage of them were traced to deficiencies in design, operations, and management. Clearly, big changes were needed. System engineering along with its subdiscipline, System Safety, were developed to tackle these problems. (kl 1007)
Here Leveson mixes system design and organizational dysfunctions as system-level causes of accidents. But much of her work in this book and her earlier Safeware: System Safety and Computers gives extensive attention to the design faults and component interactions that lead to accidents -- what we might call system safety in the narrow or technical sense.
A systems engineering approach to safety starts with the basic assumption that some properties of systems, in this case safety, can only be treated adequately in the context of the social and technical system as a whole. A basic assumption of systems engineering is that optimization of individual components or subsystems will not in general lead to a system optimum; in fact, improvement of a particular subsystem may actually worsen the overall system performance because of complex, nonlinear interactions among the components. (kl 1007)
Overall, then, it seems clear that Leveson believes that both organizational features and technical system characteristics are part of the systems that created the possibility for accidents like Bhopal, Fukushima, and Three Mile Island. Her own accident model designed to help identify causes of accidents, STAMP (Systems-Theoretic Accident Model and Processes) emphasizes both kinds of system properties.
Using this new causality model ... changes the emphasis in system safety from preventing failures to enforcing behavioral safety constraints. Component failure accidents are still included, but or conception of causality is extended to include component interaction accidents. Safety is reformulated as a control problem rather than a reliability problem. (kl 1062)
In this framework, understanding why an accident occurred requires determining why the control was ineffective. Preventing future accidents requires shifting from a focus on preventing failures to the broader goal of designing and implementing controls that will enforce the necessary constraints. (kl 1084)
Leveson's brief analysis of the Bhopal disaster in 1984 (kl 384 ff.) emphasizes the organizational dysfunctions that led to the accident -- and that were completely ignored by the Indian state's accident investigation of the accident: out-of-service gauges, alarm deficiencies, inadequate response to prior safety audits, shortage of oxygen masks, failure to inform the police or surrounding community of the accident, and an environment of cost cutting that impaired maintenance and staffing. "When all the factors, including indirect and systemic ones, are considered, it becomes clear that the maintenance worker was, in fact, only a minor and somewhat irrelevant player in the loss. Instead, degradation in the safety margin occurred over time and without any particular single decision to do so but simply as a series of decisions that moved the plant slowly toward a situation where any slight error would lead to a major accident" (kl 447).

Saturday, September 15, 2018

Patient safety

An issue which is of concern to anyone who receives treatment in a hospital is the topic of patient safety. How likely is it that there will be a serious mistake in treatment -- wrong-site surgery, incorrect medication or radiation dose, exposure to a hospital-acquired infection? The current evidence is alarming. (Martin Makary et al estimate that over 250,000 deaths per year result from medical mistakes -- making medical error now the third leading cause of mortality in the United States (link).) And when these events occur, where should we look for assigning responsibility -- at the individual providers, at the systems that have been implemented for patient care, at the regulatory agencies responsible for overseeing patient safety?

Medical accidents commonly demonstrate a complex interaction of factors, from the individual provider to the technologies in use to failures of regulation and oversight. We can look at a hospital as a place where caring professionals do their best to improve the health of their patients while scrupulously avoiding errors. Or we can look at it as an intricate system involving the recording and dissemination of information about patients; the administration of procedures to patients (surgery, medication, radiation therapy). In this sense a hospital is similar to a factory with multiple intersecting locations of activity. Finally, we can look at it as an organization -- a system of division of labor, cooperation, and supervision by large numbers of staff whose joint efforts lead to health and accidents alike. Obviously each of these perspectives is partially correct. Doctors, nurses, and technicians are carefully and extensively trained to diagnose and treat their patients. The technology of the hospital -- the digital patient record system, the devices that administer drugs, the surgical robots -- can be designed better or worse from a safety point of view. And the social organization of the hospital can be effective and safe, or it can be dysfunctional and unsafe. So all three aspects are relevant both to safe operations and the possibility of chronic lack of safety.

So how should we analyze the phenomenon of patient safety? What factors can be identified that distinguish high safety hospitals from low safety? What lessons can be learned from the study of accidents and mistakes that cumulatively lead to a hospitals patient safety record?

The view that primarily emphasizes expertise and training of individual practitioners is very common in the healthcare industry, and yet this approach is not particularly useful as a basis for improving the safety of healthcare systems. Skill and expertise are necessary conditions for effective medical treatment; but the other two zones of accident space are probably more important for reducing accidents -- the design of treatment systems and the organizational features that coordinate the activities of the various individuals within the system.

Dr. James Bagian is a strong advocate for the perspective of treating healthcare institutions as systems. Bagian considers both technical systems characteristics of processes and the organizational forms through which these processes are carried out and monitored. And he is very skilled at teasing out some of the ways in which features of both system and organization lead to avoidable accidents and failures. I recall his description of a safety walkthrough he had done in a major hospital. He said that during the tour he noticed a number of nurses' stations which were covered with yellow sticky notes. He observed that this is both a symptom and a cause of an accident-prone organization. It means that individual caregivers were obligated to remind themselves of tasks and exceptions that needed to be observed. Far better was to have a set of systems and protocols that made sticky notes unnecessary. Here is the abstract from a short summary article by Bagian on the current state of patient safety:
Abstract The traditional approach to patient safety in health care has ranged from reticence to outward denial of serious flaws. This undermines the otherwise remarkable advances in technology and information that have characterized the specialty of medical practice. In addition, lessons learned in industries outside health care, such as in aviation, provide opportunities for improvements that successfully reduce mishaps and errors while maintaining a standard of excellence. This is precisely the call in medicine prompted by the 1999 Institute of Medicine report “To Err Is Human: Building a Safer Health System.” However, to effect these changes, key components of a successful safety system must include: (1) communication, (2) a shift from a posture of reliance on human infallibility (hence “shame and blame”) to checklists that recognize the contribution of the system and account for human limitations, and (3) a cultivation of non-punitive open and/or de-identified/anonymous reporting of safety concerns, including close calls, in addition to adverse events.
(Here is the Institute of Medicine study to which Bagian refers; link.)

Nancy Leveson is an aeronautical and software engineer who has spent most of her career devoted to designing safe systems. Her book Engineering a Safer World: Systems Thinking Applied to Safety is a recent presentation of her theories of systems safety. She applies these approaches to problems of patient safety with several co-authors in "A Systems Approach to Analyzing and Preventing Hospital Adverse Events" (link). Here is the abstract and summary of findings for that article:
Objective: This study aimed to demonstrate the use of a systems theory-based accident analysis technique in health care applications as a more powerful alternative to the chain-of-event accident models currently underpinning root cause analysis methods.
Method: A new accident analysis technique, CAST [Causal Analysis based on Systems Theory], is described and illustrated on a set of adverse cardiovascular surgery events at a large medical center. The lessons that can be learned from the analysis are compared with those that can be derived from the typical root cause analysis techniques used today.
Results: The analysis of the 30 cardiovascular surgery adverse events using CAST revealed the reasons behind unsafe individual behavior, which were related to the design of the system involved and not negligence or incompetence on the part of individuals. With the use of the system-theoretic analysis results, recommendations can be generated to change the context in which decisions are made and thus improve decision making and reduce the risk of an accident.
Conclusions: The use of a systems-theoretic accident analysis technique can assist in identifying causal factors at all levels of the system without simply assigning blame to either the frontline clinicians or technicians involved. Identification of these causal factors in accidents will help health care systems learn from mistakes and design system-level changes to prevent them in the future.
Key Words: patient safety, systems theory, cardiac surgical procedures, adverse event causal analysis (J Patient Saf 2016;00: 00–00)
Crucial in this article is this research group's effort to identify causes "at all levels of the system without simply assigning blame to either the frontline clinicians or technicians involved". The key result is this: "The analysis of the 30 cardiovascular surgery adverse events using CAST revealed the reasons behind unsafe individual behavior, which were related to the design of the system involved and not negligence or incompetence on the part of individuals."

Bagian, Leveson, and others make a crucial point: in order to substantially increase the performance of hospitals and the healthcare system more generally when it comes to patient safety, it will be necessary to extend the focus of safety analysis from individual incidents and agents to the systems and organizations through which these accidents were possible. In other words, attention to systems and organizations is crucial if we are to significantly reduce the frequency of medical and hospital mistakes.

(The Makary et al estimate of 250,000 deaths caused by medical error has been questioned on methodological grounds. See Aaron Carroll's thoughtful rebuttal (NYT 8/15/16; link).)

Friday, August 31, 2018

Turing's journey

A recent post comments on the value of biography as a source of insight into history and thought. Currently I am reading Andrew Hodges' Alan Turing: The Enigma (1983), which I am finding fascinating both for its portrayal of the evolution of a brilliant and unconventional mathematician as well as the honest efforts Hodges makes to describe Turing's sexual evolution and the tragedy in which it eventuated. Hodges makes a serious effort to give the reader some understanding of Turing's important contributions, including his enormously important "computable numbers" paper. (Here is a nice discussion of computability in the Stanford Encyclopedia of Philosophylink.) The book also offers a reasonably technical account of the Enigma code-breaking process.

Hilbert's mathematical imagination plays an important role in Turing's development. Hilbert's speculation that all mathematical statements would turn out to be derivable or disprovable turned out to be wrong, and Turing's computable numbers paper (along with Godel and Church) demonstrated the incompleteness of mathematics. But it was Hilbert's formulation of the idea that permitted the precise and conclusive refutations that came later. (Here is Richard Zack's account in the Stanford Encyclopedia of Philosophy of Hilbert's program; link.)

And then there were the machines. I had always thought of the Turing machine as a pure thought experiment designed to give specific meaning to the idea of computability. It has been eye-opening to learn of the innovative and path-breaking work that Turing did at Bletchley Park, Bell Labs, and other places in developing real computational machines. Turing's development of real computing machines and his invention of the activity of "programming" ("construction of tables") make his contributions to the development of digital computing machines much more advanced and technical than I had previously understood. His work late in the war on the difficult problem of encrypting speech for secure telephone conversation was also very interesting and innovative. Further, his understanding of the priority of creating a technology that would support "random access memory" was especially prescient. Here is Hodges' summary of Turing's view in 1947:
Considering the storage problem, he listed every form of discrete store that he and Don Bayley had thought of, including film, plugboards, wheels, relays, paper tape, punched cards, magnetic tape, and ‘cerebral cortex’, each with an estimate, in some cases obviously fanciful, of access time, and of the number of digits that could be stored per pound sterling. At one extreme, the storage could all be on electronic valves, giving access within a microsecond, but this would be prohibitively expensive. As he put it in his 1947 elaboration, ‘To store the content of an ordinary novel by such means would cost many millions of pounds.’ It was necessary to make a trade-off between cost and speed of access. He agreed with von Neumann, who in the EDVAC report had referred to the future possibility of developing a special ‘Iconoscope’ or television screen, for storing digits in the form of a pattern of spots. This he described as ‘much the most hopeful scheme, for economy combined with speed.’ (403)
These contributions are no doubt well known by experts on the history of computing. But for me it was eye-opening to learn how directly Turing was involved in the design and implementation of various automatic computing engines, including the British ACE machine itself at the National Physical Laboratory (link). Here is Turing's description of the evolution of his thinking on this topic, extracted from a lecture in 1947:
Some years ago I was researching on what might now be described as an investigation of the theoretical possibilities and limitations of digital computing machines. I considered a type of machine which had a central mechanism and an infinite memory which was contained on an infinite tape. This type of machine appeared to be sufficiently general. One of my conclusions was that the idea of a ‘rule of thumb’ process and a ‘machine process’ were synonymous. The expression ‘machine process’ of course means one which could be carried out by the type of machine I was considering…. Machines such as the ACE may be regarded as practical versions of this same type of machine. There is at least a very close analogy. (399)
At the same time his clear logical understanding of the implications of a universal computing machine was genuinely visionary. He was evangelical in his advocacy of the goal of creating a machine with a minimalist and simple architecture where all the complexity and specificity of the use of the machine derives from its instructions (programming), not its specialized hardware.

Also interesting is the fact that Turing had a literary impulse (not often exercised), and wrote at least one semi-autobiographical short story about a sexual encounter. Only a few pages survive. Here is a paragraph quoted by Hodges:
Alec had been working rather hard until two or three weeks before. It was about interplanetary travel. Alec had always been rather keen on such crackpot problems, but although he rather liked to let himself go rather wildly to newspapermen or on the Third Programme when he got the chance, when he wrote for technically trained readers, his work was quite sound, or had been when he was younger. This last paper was real good stuff, better than he'd done since his mid twenties when he had introduced the idea which is now becoming known as 'Pryce's buoy'. Alec always felt a glow of pride when this phrase was used. The rather obvious double-entendre rather pleased him too. He always liked to parade his homosexuality, and in suitable company Alec could pretend that the word was spelt without the 'u'. It was quite some time now since he had 'had' anyone, in fact not since he had met that soldier in Paris last summer. Now that his paper was finished he might justifiably consider that he had earned another gay man, and he knew where he might find one who might be suitable. (564)
The passage is striking for several reasons; but most obviously, it brings together the two leading themes of his life, his scientific imagination and his sexuality.

This biography of Turing reinforces for me the value of the genre more generally. The reader gets a better understanding of the important developments in mathematics and computing that Turing achieved, it presents a vivid view of the high stakes in the secret conflict that Turing was a crucial part of in the use of cryptographic advances to defeat the Nazi submarine threat, and it gives personal insights into the very unique individual who developed into such a world-changing logician, engineer, and scientist.

Wednesday, August 29, 2018

The insights of biography

I have always found biographies a particularly interesting source of learning and stimulation. A recent example is a biography and celebration of Muthuvel Kalaignar Karunanidhi published in a recent issue of the Indian semi-weekly Frontline. Karunanidhi was an enormously important social and political leader in India for over sixty years in the Dravidian movement in southern India and Tamil Nadu, and his passing earlier this month was the occasion for a special issue of Frontline. Karunanidhi was president of the Dravidian political party Dravida Munnetra Kazhagam (DMK) for more than fifty years. And he is an individual I had never heard of before opening up Frontline. In his early life he was a script writer and film maker who was able to use his artistic gifts to create characters who inspired political activism among young Tamil men and women. And in the bulk of his career he was an activist, orator, and official who had great influence on politics and social movements in southern India. The recollection and biography by A.S. Panneerselvan is excellent. (This article derives from Panneerselvan's forthcoming biography of Karunanidhi.) Here is how Panneerselvan frames his narrative:
In a State where language, empowerment, self-respect, art, literary forms and films coalesce to lend political vibrancy, Karunanidhi's life becomes a sort of natural metaphor of modern Tamil Nadu. His multifaceted personality helps to understand the organic evolution of the Dravidian Movement. To understand how he came to the position to wield the pen and his tongue for his politics, rather than bombs and rifles for revolution, one has to look at his early life. (7)
I assume that Karunanidhi and the Dravidian political movement would be common currency for Indian intellectuals and political activists. For an American with only a superficial understanding of Indian politics and history, his life story opens a whole new aspect of India's post-independence experience. I think of the primary dynamic of Indian politics since Independence as being a struggle between the non-sectarian political ideas of Congress, the Hindu nationalism of BJP, and the secular and leftist position of India's Communist movement. But the Dravidian movement diverges in specific ways from each of these currents. In brief, the central thread of the Dravidian is the rejection of the cultural hegemony of Hindi language, status, and culture, and an expression of pride and affirmation in the cultures and traditions of Tamil India. Panneerselvan describes an internal difference of emphasis on the topic of language and culture within the early stage of the Dravidian movement:
The duality of the Self-Respect Movement emerged very clearly during this phase. While Periyar and Annadurai were in total agreement in the diagnosis of the social milieu, their prognoses were quite opposite: For Periyar, language was an instrument for communication; for Annadurai, language was an organic socio-cultural oeuvre that lends a distinct identity and a sense of pride and belonging to the people. (13).
The Dravidian Movement was broadly speaking a movement for social justice, and it was fundamentally supportive of the rights and status of dalits. The tribute by K. Veeramani expresses the social justice commitments of DMK and Karunanidhi very well:
The goal of dispensation of social justice is possible only through reservation in education and public employment, giving adequate representation to the Scheduled Castes, the Scheduled Tribes and Other Backward Classes. Dispensation of social justice continues to be the core principle of the Dravidian movement, founded by South Indian Liberal Federation (SILF), popularly known as the Justice Party. (36) ... The core of Periyar's philosophy is to bring about equality through equal opportunities in a society rife with birth-based discrimination. Periyar strengthened the reservation mode as a compensation for birth-based inequalities. In that way, reservation has to be implemented as a mode of compensatory discrimination. (38)
Also important in the political agenda of the Dravidian Movement was a sustained effort to improve the conditions of tenants and agricultural workers through narrowing of the rights of landlords. J. Jeyaranjan observes:
The power relation between the landlord and the tenant is completely reversed, with the tenant enjoying certain powers to negotiate compensation for giving up the right to cultivate. Mobilisations by the undivided Communist Party of India (CPI) and the Dravidian movement, the Dravidar Kazhagam in particular, have been critical to the creation of a culture of collective action and resistance to landlord power. Further, the coming to power of the Dravida Munnetra Kazhagam (DMK) in 1967 created conditions for consolidating the power of lower-caste tenants who benefited both from a set of State initiatives launched by the DMK and the culture of collective action against Brahmin landlords. (52)
What can be learned from a detailed biography of a figure like Karunanidhi? For myself the opportunity such a piece of scholarship permits is to significantly broaden my own understanding of the nuances of philosophy, policy, values, and institutions through which the political developments of a relatively unfamiliar region of the world have developed. Such a biography allows the reader to gain a vivid experience of the issues and passions that motivated people, both intellectuals and laborers, in the 1920s, the 1960s, and the 1990s. And it gives a bit of insight into the complicated question of how talented individuals develop into impactful, committed, and dedicated leaders and thinkers.

(Here is a collection of snippets from Karunandhi's films; link.)

Sunday, August 19, 2018

Safety culture or safety behavior?

Saturday, July 28, 2018

Rob Sellers on recent social psychology

Wednesday, July 25, 2018

Cyber threats


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