Conversations in Cardiology: In the ISCHEMIA Era, What Role for FFR? – TCTMD

Morton Kern, MD, of VA Long Beach Healthcare System and University of California, Irvine, often engages his colleagues via email in brief, informal dialogue on clinically relevant topics in interventional cardiology. With permission from the participants, TCTMD presents their conversations for the benefit of the cardiology community. Your feedback is welcomefeel free to comment at the bottom of the page.

David Cox, MD (Brookwood Baptist Health, Birmingham, AL), asks:

I need help with another question posed by many of the docs at my site. While I agree fully with Sunil Rao that 70% of what most of us do is ACS, and that was my practice in Pennsylvania and North Carolina, I find myself in a situation in Birmingham with my hospital on a hill surrounded by a number of PCI hospitals who get most of the ACS.

Consequently and surprisingly, about 80% of this practice is elective stable ischemic heart disease (SIHD) PCI with much less ACS.

The conundrum exists, of course, like the patient I saw yesterday in office whose chest pain has heated up the past few weeks. He has gone from angina 2x/week to now daily angina with minimal exertion and some pain at rest. I wanted to admit. He will come in electively this AM.

1. Count him as crescendo angina/Class III, and this doesnt become a ISCHEMIA patient.

2. The question at hand is, lets say he did have a recent nuclear scan with moderate ischemia and Class II angina, what is the role of FFR after ISCHEMIA?

3. Are all the data in FAME and FAME 2 now superseded by this trial? I know not all patients with SIHD needed FFR, but the goodmajority did.

4. If you do an FFR and its positive in a patient who met entrance criteria for ISCHEMIA (lets leave the truly asymptomatic patientsaside) and the FFR is done well and is positive . . . then what?

Kern replies:

Dave is struggling with the approach to SIHD in his area. Here is my response to Dave:

I'm not sure why you're struggling so much.

I don't think I missed the main point of the ISCHEMIA trial. Colleagues?

Jeffrey Moses, MD (NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY), replies:

Good summary, but I would add three concepts.

So the conversation with the patient can be built around these facts.

Bonnie Weiner, MD (Saint Vincent Hospital, Worcester, MA), replies:

I agree with all your comments, Mort. The critical issue here is that in the stable patient, it has not been about MI/death prevention but quality of life (QoL). We know that patient compliance and tolerance with complex medical therapy regimens outside of a clinical trial is less than optimal. The importance of patient preference and patient/doctor discussion remains the important message.

David Cohen, MD (University of Missouri-Kansas City), replies:

Here are my thoughts:

Technically, this is correct. But the truth is that the difference between Class II and Class III angina is pretty subtle, and I wouldn't hang my hat on it. The main reason why patients with accelerating angina were excluded from ISCHEMIA was not medical but more related to a desire to keep the rate of crossover to cath down among patients randomized to the conservative arm.

To me, the main role of FFR after ISCHEMIA is the same one it had before ISCHEMIAto identify which lesions in patients with significant angina do NOT need revascularization (ie, the key take-home messages from both DEFER and FAME). I agree with Mort that if the lesion causing the ischemiais clear from precath testing, theres no need to do FFR/iFR/etc to reconfirm. But if there is ambiguity, a key benefit of intracoronary physiology is sorting out which lesions are truly hemodynamically significant.

FAME is still as important as it was before ISCHEMIAuse physiology to identify which lesions to treat and which to leave alone in patients with multivessel disease requiring revascularization (ie, those with unsatisfactory symptom control). IMHO, the potential late spontaneous MI benefit in ISCHEMIA reinforces the same finding in FAME 2 (which previously seemed like a bit of an outlier). However, there is still no evidence that PCI saves any lives in the stable population, and the late MI benefit needs to be balanced against the early excess MI rate from PCI.

Then you can either treat with optimal medical therapy (OMT) alone or offer revascularization, depending on the patient's preferencebalancing the side effects from obligatory dual antiplatelet therapy (for some duration) versus those of antianginal therapy.

In my opinion, the main messages from ISCHEMIA are that not every patient with moderate-to-severe ischemia on functional testing needs to go to the cath lab. The cath lab should be reserved mainly for the following situations:

Kirk Noel Garratt, MD (Christiana Care, Newark, DE), replies:

Jeffs summary is a great distillation of the takeaways from ISCHEMIA. Weve been treating SIHD patients chiefly for symptom improvement for more than a decade, and this study confirms the appropriateness of our practice.

I thought the most provocative finding from ISCHEMIA was the reduction in spontaneous MIs. Lets remember that the big knock on COURAGE was the concern that the most at-risk patients were never enrolled. Presumably, those would be the folks at greatest risk of events like MI. Now that weve got a trial of SIHD that absolutely enrolled some high-risk people, we see an MI benefit from PCI and CABG. Sunil Rao, Tim Henry, and a couple others reminded me this was also observed in FAME 2 and COMPLETEsomewhat different populations but a signal of MI reduction benefit with revascularization nonetheless. Well have longer follow-up, but for now, Im comfortable telling patients that a lower risk of spontaneous MI is a potential benefit of early revascularization.

David R. Holmes Jr, MD (Mayo Clinic, Rochester, MN), replies:

I agree entirely with KNG. It is part of a strong data set.

Farouc Jaffer, MD, PhD (Massachusetts General Hospital, Boston), replies:

Great questions and insights. Would also offer that a spontaneous, unpredictable MI is a greater clinical stress to patients and physicians compared to a periprocedural MI occurring in-house.

William Fearon, MD (Stanford University, CA), replies:

I agree completely with Jeffs comments. ISCHEMIA in fact reinforced much of what FAME 2 showed: in patients with stable CAD, compared with medical therapy, FFR-guided PCI reduced spontaneous MI at 5-year follow-up (same as revascularization in ISCHEMIA) at a cost of a small bump in peri-PCI MI (same in ISCHEMIA), decreased urgent revasc (revascularization significantly decreased unstable angina in ISCHEMIA), improved quality of life and angina relief (same as ISCHEMIA), without a change in overall mortality (same is ISCHEMIA). ISCHEMIA did not show a relationship between the degree of ischemia on stress imaging and outcomes, but I think this is simply a reflection of the lack of precision of the noninvasive tests (as mentioned by Jeff); numerous previous studies have shown a clear gradation between FFR values (degree of ischemia) and risk for events in medically treated patients. Of note, one-quarter of patients in ISCHEMIA had treadmill tests alone.

Since 35% of patients in ISCHEMIA were asymptomatic, it will be interesting to see how these patients fare as a subgroup. The forest plot suggested that more symptomatic patients received a greater benefit over asymptomatic. However, this substudy from FAME 2 suggests that symptomatic patients randomized to medical therapy were protected by their symptoms because they crossed over to PCI and avoided hard events. On the other hand, asymptomatic patients with low FFR randomized to medical therapy had increased death/MI compared with those who received PCI, presumably because they had no warning system.

George Vetrovec, MD (VCU Pauley Heart Center, Richmond, VA), replies:

At least one unanswered question for the ISCHEMIA trial is the impact of completeness of revascularization on the results. Dr. Judith Hochman noted that this was still awaiting analysis. There is significant data that shows the completeness of revascularization, ie, the effectiveness of alleviatingischemia is an important factor in PCI outcome. PCIs limitations in the most complex disease are often the reason that surgical revascularization is more effective. Until we know those results, I think we are somewhat limited in being certain of the outcome results. Even later follow-up will also provide importantlate resultson MI prevention and, I believe, for completeness of revascularization. However, the current completeness of revascularization data should be availablehopefully by the time of publication or for an upcoming scientific meeting like the ACC.

Keith Oldroyd, MBChB (Golden Jubilee National Hospital, Glasgow, Scotland), replies:

Great discussion. There is also a potentially important issue in relation to complete relief of ischemia or, if you prefer, functionally complete revascularization. For various reasons, we all know that significant numbers of patients are left with potential ischaemia even after revascularization, whether by PCI or CABG. FAME 3 will shed some further light on thisit should finally complete recruitment next month.

Gregg W. Stone, MD (Icahn School of Medicine at Mount Sinai, New York, NY), replies:

We plan on reporting the impact and implications of complete versus incomplete and anatomic and functional revascularization at the ACC in 2020.

Ajay Kirtane, MD (NewYork-Presbyterian/Columbia University Irving Medical Center), replies:

All great points. Dave, regarding your patient, one thing to remember about QoL is that the number need to treat to render a patient with weekly angina completely angina-free with the invasive approach versus the conservative one is three. Also, only 29% of patients in ISCHEMIA had angina that started or became more frequent in the last 3 months, with the median angina frequency being monthly.

Beyond your patient, some take homes from the trial for me:

Neal Kleiman, MD (Houston Methodist Hospital, TX), replies:

Another parallel question is adequacy of revascularization. Based on ULTIMATE and DEFINE-PCI, Id want to know how often stents were optimized and would also be concerned about not truly eliminating the ischemia.

David Kandzari, MD (Piedmont Heart Institute, Atlanta, GA), replies:

My two additional takeaway messages from ISCHEMIA:

Augusto Pichard, MD (MedStar Washington Hospital Center, Washington, DC), replies:

In addition, most of them had 50% lesions by CT, with some 70%. We know physiology has proven most of these do not need intervention! No wonder the PCI arm ended up similar (in some respects) to OMT.

Cohen replies:

I don't think we know what the lesion severity was by CT, Gus. We know the patients had to have at least one 50% lesion to qualify for the study and about half had "3Vdz" by this definition. But the CT results were blinded to the investigators, and I haven't seen any data on the actual lesion severity(yet).

John Hirshfeld Jr, MD (Penn Medicine, Philadelphia, PA), replies:

Im waiting for later follow-up.

Note that all the Kaplan-Meier curves cross at 1-2 years follow-up and continue to diverge. With the follow-up available at the time of this report, P values are in the 0.2-0.3 range (so not significant"). Only half of the cohort followed up at 3 years and one-third at 4 years.

It will be interesting to see what happens to this trend in the next several years.

Hopefully whatever effect there is will not be obscured by too much crossover from the conservative group to the revascularization group (already at 23%).

Cohen replies:

Let's hope that the extension gets funded by the NIHotherwise, there won't be longer follow-up.

Also, one thing that has not been appreciated is that fully half of the crossovers occurred AFTER a primary endpoint had already occurred (I don't know the details, but presumably in most cases, the patient presented with a NSTEMI and underwent PCI during the hospitalization). Given the sequence, those types of crossovers actually have no effect on the primary endpoint Kaplan-Meier curves (although they could lead to some erosion of the antianginal benefit). So from the standpoint of CV death/MI, the effective crossover rate is only around 10-11%, which isn't bad for a 4-year trial.

Larry S. Dean, MD (UW Medicine, Seattle, WA), replies:

Thanks to David for starting the conversation. Very interesting to read everyones take on the trial, and it will be helpful as our patients begin to ask the questions we know will come. I guess my main concern is all we have so far is whats been presented without the publication.

Kirtane replies:

But Dave: either of those things is failing the strategy. Whether the patient crosses over OR has an MI event (because death is low), both are not great.

Cohen replies:

Yes, but most people worry about crossover because it dilutes the treatment effect. In the case of an MI preceding a revasc, the event is counted correctly and theres no dilution.

Stone replies to Cohen:

Only 8% of patients of the 28% who underwent angiography by 4 years in the conservative arm crossed over for nonadherence to the protocol (ie, without a valid reason a protocol violation). The remainder had valid reasons such as development of refractory angina or an actual or suspected endpoint event. Hard to argue any of these crossovers affected the absolutely neutral mortality outcomes or the markedly positive QoL benefits (100% certainty of effect by Bayesian in patients with baseline angina).

Stone replies to Hirshfeld:

It is difficult to describe the overall treatment effect when the curves are crossing. The HR is not completely accurate given the nonproportional hazards, and Cox models are invalid. There were actually statistically fewer events in the invasive arm at 4 yearsthe CV death/MI risk difference was -2.2% (95% CI -4.4%, -0.1%). However, given the upfront risk of periprocedural MI, the total event-free time in both groups was not different.

The Bottom Line (According to Kern):

The ISCHEMIA trial reinforces some of our beliefs in the need for better anti-ischemic medical therapy prior to revascularization in SIHD patients and that absent objective ischemic findings FFR still applies to decision-making. What may be in question is what will be the best noninvasive ischemic testing: FFRCT, PET, or something else? The longer-term follow-up of ISCHEMIA will be warmly welcomed to this debate.

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Conversations in Cardiology: In the ISCHEMIA Era, What Role for FFR? - TCTMD

How do plants tell the time? – The John Innes Centre

Dr Antony Dodd joined the John Innes Centre from the University of Bristol towards the end of 2019.

With his research covering circadian rhythm and signalling in plants, we asked him how do plants tell the time and, if they have a circadian rhythm, whether plants suffer from jet lag?

Yes, plants can suffer from jet lag. If you were to fly a plant from China to London, that plants circadian rhythm would be temporarily incorrect for the time zone. The evidence we have suggests that plants are much better than mammals at readjusting their internal body clocks to their local time zone, so they get back in-sync much more quickly than we do.

Circadian rhythms are what our bodies and many other living organisms use to measure the passage of time in order to co-ordinate their daily responses to the environment around them.

My lab studies the circadian rhythms of plants, because they affect a number of important factors in plant performance; things like growth rates, seasonal flowering and the accumulation of various chemicals like starch are all controlled by the plants internal circadian clock. Understanding how these clocks work and the signalling pathways connecting a plants circadian rhythm and the rest of the organism are therefore important on both a fundamental level but can also be applied to improving crops.

The genes that encode the circadian clock in plants have a lot of commonality between plant species, and most of the key underpinning work to understand the circadian clocks in plants has been done on the model species Arabidopsis. We are now beginning to learn more about circadian rhythms in crop species and is becoming apparent that, while there are lots of similarities, there are some important differences as well.

Recently, we had a significant breakthrough when we were able to show that a plants circadian rhythm can affect the responses of plants to some herbicides that are very commonly used in agriculture. The paper; Plant circadian rhythms regulate the effectiveness of a glyphosate-based herbicide was published in Nature last year and we are now building on that work.

Other things we are interested in at the moment include the signalling pathways between a plants circadian clock and those areas of that plants physiology that are controlled by that clock, such as photosynthesis and the plants responses to environmental stress. We would like to understand the communication that happens between those aspects of the lives of plants.

We are also interested in how circadian rhythms function in natural environments. Currently, most of the work in this area has been done in the lab under tightly controlled conditions, so we are currently collaborating with the Professor Hiroshi Kudoh lab in Kyoto to conduct field studies of circadian rhythms in naturally fluctuating conditions.

Throughout my life I have been really fortunate to meet a number of really inspiring people, that have led me to pursue different paths.

When I was an Undergraduate at Newcastle University, one of my lecturers was Professor Howard Griffiths, who was a fantastic lecturer and was at the time working on a specific type of photosynthesis known as CAM which is found in cacti and other succulents and allows them to open their stomata at night. This in-turn allows them to conserve lots of water and survive in the arid conditions, they are famous for thriving in. A key feature of CAM photosynthesis is the strict timing that governs when different processes can occur and different types of enzymes can be active, all of which relies on circadian rhythms. I was hooked.

During my PhD I worked in his lab and became increasingly interested in how circadian rhythms control metabolism and signalling. I then became a Postdoc in the Professor Alex Webb lab in Cambridge that looked at circadian rhythms of signalling. This led me to the question I work on now; how can plants tell the time?

It is something we see all around us. For example, it was documented by Charles Darwin who recorded that plants shifted the positions of their leaves during the day, which he described in a book that he wrote called The Power of Movement in Plants.

Outside the lab, I love hiking particularly mountain hiking. Norfolk doesnt quite offer that, so I am really keen to head down to South America and hike there in the future. Back at home, I have recently started growing vegetables, particularly pumpkins. I am fascinated by the amazing variety of form and the diversity of the fruit you can get.

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How do plants tell the time? - The John Innes Centre

The Face of Science – Clemson World magazine

That next day, Drake preferred sleeping over eating. But then, thats common with newborns. Tarah and Eric would wake him for feeding, careful to make sure he got plenty of nourishment.

By Saturday, these experienced parents became uneasy. Drake was just too lethargic. It was harder to wake him for feedings. The OSullivans called Drakes doctor and were assured there was nothing to be concerned about; Drake had been healthy when he left the hospital two days ago. And, the doctors office assured them, they would be checking him again on Monday at a scheduled office visit.

But the OSullivans disquiet grew by the hour. By Sunday evening, Drake would not open his eyes or respond to them. He was growing limp and struggling to breathe. The OSullivans rushed Drake to the hospital where the staff flew into emergency mode. Too sick for care at the local hospital, Drake was stabilized for transport to the pediatric intensive care unit (PICU) at Greenville Memorial Hospital. Just 72 hours after birth, Drake lapsed into a coma. And no one knew why.

That unforgettable night was the beginning of a long journey of test after test and a diagnosis by elimination.

Drake continued to decline as each negative test pushed aside another horrible possibility. You would think that eliminating terrible diseases would be a good thing, says Eric. But that just meant we were looking at something very rare.

Finally, blood tests revealed an ever-elevating level of glycine in Drakes blood, a symptom of an extremely rare, genetic metabolic disease called nonketotic hyperglycinemia or NKH.

The words nonketotic hyperglycinemia meant nothing to Tarah and Eric. But the next words were clear: Drake had a less than 10 percent chance of survival.

The diagnosis was like a starters pistol for the OSullivans. From that moment, everything would be a race against time to save Drake.

After 28 days of tests, monitors, tubes and wires, Drake was released to go home. There, as Tarah explains, Our house became a sort of lab. There were blood tests, feedings, medications and monitoring day and night, 24/7. Glycine became the OSullivans obsession as they tried desperately through medication and diet to moderate Drakes levels. They began to search for information, research, treatment, medical advice anything to save his life.

The OSullivans contacted anyone who might know about NKH, have a related research project or could tell them more. They learned that NKH affects fewer than 500 people worldwide and has no cure. There was no research underway, and no funding for research. And because there is no medically recognized cure for NKH, all treatments are considered experimental and not covered by medical insurance. Period.

So Tarah became a lay scientist. She read everything, called and emailed medical researchers and established the Drake Rayden Foundation to raise awareness for NKH, fight for better treatment and support research. She entered a world of genetics and vectors, glycine and metabolic pathways. Tarah had quit college just shy of completing her business degree. Now she desperately needed the scientific expertise that would help her understand the disease and find the cure.

Tarah decided to return to college.

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The Face of Science - Clemson World magazine

A Note On Genetics Generation Advancement Corp.s (GTSM:4160) ROE and Debt To Equity – Simply Wall St

While some investors are already well versed in financial metrics (hat tip), this article is for those who would like to learn about Return On Equity (ROE) and why it is important. Well use ROE to examine Genetics Generation Advancement Corp. (GTSM:4160), by way of a worked example.

Our data shows Genetics Generation Advancement has a return on equity of 5.7% for the last year. One way to conceptualize this, is that for each NT$1 of shareholders equity it has, the company made NT$0.06 in profit.

Check out our latest analysis for Genetics Generation Advancement

The formula for return on equity is:

Return on Equity = Net Profit (from continuing operations) Shareholders Equity

Or for Genetics Generation Advancement:

5.7% = NT$20m NT$352m (Based on the trailing twelve months to September 2019.)

Its easy to understand the net profit part of that equation, but shareholders equity requires further explanation. It is all earnings retained by the company, plus any capital paid in by shareholders. You can calculate shareholders equity by subtracting the companys total liabilities from its total assets.

ROE looks at the amount a company earns relative to the money it has kept within the business. The return is the profit over the last twelve months. That means that the higher the ROE, the more profitable the company is. So, all else being equal, a high ROE is better than a low one. Clearly, then, one can use ROE to compare different companies.

One simple way to determine if a company has a good return on equity is to compare it to the average for its industry. Importantly, this is far from a perfect measure, because companies differ significantly within the same industry classification. The image below shows that Genetics Generation Advancement has an ROE that is roughly in line with the Biotechs industry average (5.7%).

That isnt amazing, but it is respectable. ROE doesnt tell us if the share price is low, but it can inform us to the nature of the business. For those looking for a bargain, other factors may be more important. If you like to buy stocks alongside management, then you might just love this free list of companies. (Hint: insiders have been buying them).

Companies usually need to invest money to grow their profits. The cash for investment can come from prior year profits (retained earnings), issuing new shares, or borrowing. In the first two cases, the ROE will capture this use of capital to grow. In the latter case, the use of debt will improve the returns, but will not change the equity. Thus the use of debt can improve ROE, albeit along with extra risk in the case of stormy weather, metaphorically speaking.

Shareholders will be pleased to learn that Genetics Generation Advancement has not one iota of net debt! So although its ROE isnt that impressive, we shouldnt judge it harshly on that metric, because it didnt use debt. After all, with cash on the balance sheet, a company has a lot more optionality in good times and bad.

Return on equity is one way we can compare the business quality of different companies. In my book the highest quality companies have high return on equity, despite low debt. If two companies have around the same level of debt to equity, and one has a higher ROE, Id generally prefer the one with higher ROE.

But ROE is just one piece of a bigger puzzle, since high quality businesses often trade on high multiples of earnings. Profit growth rates, versus the expectations reflected in the price of the stock, are a particularly important to consider. Check the past profit growth by Genetics Generation Advancement by looking at this visualization of past earnings, revenue and cash flow.

Of course Genetics Generation Advancement may not be the best stock to buy. So you may wish to see this free collection of other companies that have high ROE and low debt.

If you spot an error that warrants correction, please contact the editor at editorial-team@simplywallst.com. This article by Simply Wall St is general in nature. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. Simply Wall St has no position in the stocks mentioned.

We aim to bring you long-term focused research analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Thank you for reading.

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A Note On Genetics Generation Advancement Corp.s (GTSM:4160) ROE and Debt To Equity - Simply Wall St

Five Different Types of Psychology and What They Mean – The Good Men Project

Psychology is the field that teaches us about how human beings act and the reasons for those actions. Its the study of human behavior, and it helps us understand ourselves on a deeper level. But did you know that there are different types of psychology? When we think of psychology, we might think about learning about different kinds of mental health disorders. But there are so many different types of psychology out there. In this article, were going to examine five different types of psychology that you may not know about, and you can learn more.

Clinical psychology deals with science and handling psychological issues. Its also called psychotherapy or counseling. Clinical psychologists diagnose and treat mental health disorders. They also perform research and find ways to help us learn more in-depth about human behavior. A clinical psychologist does not prescribe medication to clients, but they utilize various psychological techniques. They might practice a kind of behavior therapy or psychoanalysis. Typically clinical psychologists hold a Ph.D., and they may see clients in a private practice setting. If theyre not working in prior practice, they will be conducting psychological research or testing, and you may find them working at universities teaching psychology to students.

Biopsychology examines the brain and how it influences the way that we think and feel its a combination of neuroscience and clinical psychology. We know so little about the brain, and we are learning more every day. Biopsychologists focus on the mind-body connection. They want to understand how our brains influence our emotions and cognitive processes. They can be found researching to understand how our brains are impacting our daily functioning and our emotional life. Biopsychologists may become neuroscientists, evolutionary psychologists, or comparative psychologists.

Experimental psychologists are like detectives. They work to understand the underlying causes of human behavior. They often work in laboratories and conduct research. They study humans and animals and understand their subjects by creating various trials. They focused a lot on evolution and understanding the significance behind certain types of human behavior. As the term would suggest, they perform a lot of experiments. Experimental psychologists Are a bit like philosophers. They study theoretical topics and work to understand our perceptions, memories, and cognitive processes. Some experimental psychologist hyper-focused on one question and spend years researching that hypothesis. This is one of the fields that focuses heavily on research.

Educational psychology explores human behavior in an educational environment. These clinicians analyze learning disabilities and actions that can be problematic in the teen years. Educational psychologists focus primarily on a younger age group, such as children and adolescents. You can find them conducting assessments in various settings. Some educational psychologists work in preschools, some of them work in community centers, as private consultants, or in college environments. Many educational psychologists work with children on a one on one basis. They can also involve the parents as well as the teachers in their treatment plans.

Social psychologists focus on people that live in a community. They are similar to a sociologist. They explore how people within a community are interdependent on one another. They focus on political issues and environmental factors. Social psychologists rely on the scientific method. They focus on gaining empirical evidence for their hypotheses. This type of mental health professional studies how human behavior is caused or affected by the community around them. They take into account social and cultural norms.

Psychology is a fascinating field. It is the study of human behavior, and it has many sub-specialty is. Whether you are an educational psychologist or a clinical psychologist, youre still studying the way that humans think and act. Another way to gain insight into your behavior is to go to therapy or counseling. Whether you see a counselor in your local area or try online therapy, you can better understand your motivations by going to therapy.

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Five Different Types of Psychology and What They Mean - The Good Men Project

Emotional Intelligence Is The Skill We Need For The Future – The Good Men Project

When artificial intelligence becomes a major part of society, emotional intelligence is going to be much more important for humans.

As technology advances exponentially, our human minds only progress linearly, which means the gap between people and technology will only increase. How will humans keep up?

One thing we can do is increase our emotional intelligence. As artificial intelligence is already automating most of our monotonous and repetitive tasks (e.g. data entry/analysis, audio transcription, email marketing, bartending, vacuum cleaners, autonomous vehicles, etc), humans will need to become more competitive by creating solutions to the more complex problems that require creativity or insight on human behavior.

Humans are social, emotional beings and we will always have to interact with each other in some capacity, even when technology might be doing most of it for us. Humans will always need each other, so we will need the skills to be able to develop ourselves and our relationships productively.

Unfortunately, were already seeing how technology has been disconnecting us from each other, creating siloed camps of thought, perspectives, and beliefs. We see people who prefer to scroll through their phones at dinner rather than become curious about their company. We see people not able to handle their emotions to discuss sensitive topics. We see how convenience have fueled the introverted side of us, where our cravings can be satisfied with delivery services and instant access to a less fulfilling version of social connection.

This makes the understanding of our individuality that much more important because our emotions heavily influence how we think, behave, and communicate with one another. If you allow your emotions to fluster you, youre more likely to react poorly to that co-worker, your parents, even yourself, harming your relationships and self-regard. And if your instinct is to then retreat or suppress, life will start feeling shallow and unfulfilling.

This is not meant to sound anti-technology. In modern society, its unrealistic to completely avoid technology. Doing so actually puts you at a competitive disadvantage, where those around you would be able to learn, create, and connect more efficiently than if they didnt have these tools. But moving forward, it would benefit us to also look at the effectiveness of technology, as well as its impact on mental and emotional well-being. We need to start thinking about how to use tech with intention rather than allowing it to consume us, both socially and professionally.

Technology is a tool that has been augmenting human performance and progress for centuries. A farmer would not be able to plant her crops efficiently enough to produce enough revenue to support her family if she didnt even have a shovel. To be even more effective, she could upgrade to a tractor, optimizing the farm and giving her time to spend with her family.

When given the opportunity, everyone would choose to save time. Instinctively, we know that time is our most precious resource. Its the only currency that we cant get back. And it makes sense that we want to automate as much as we could, especially the menial tasks that are unfulfilling or cause burn out.

This is the key perspective shift. Automation exists to help us perform certain tasks more efficiently, freeing up time for us to engage in other, more meaningful parts of not just our jobs but our personal lives, the more human parts. Talking to people, being creative/experimental, producing something, exercising, being of service to others, volunteering, spending time with loved ones, staying active in hobbies.

The crucial ingredient to those human parts of life is emotional intelligence (which Ive defined here for you). When we get out of the mindset of scarcity and basic survival mode, well have the physical and mental space to explore deeper. We can then go from stagnation to thriving, taking full advantage of what the human experience has to offer. And the first step is being honest with how youre feeling.

Emotional intelligence is more than being smart with our emotions, or being touchy-feely. Its about understanding who we are at a deeper level and what powers us so that we can show up as our unique and best self to the people around us.

Many people will prioritize acquiring the hard skills needed to perform the job, or the perfect body and looks to impress people on the outside. But not everyone goes through the more intangible, deep, personal work of understanding who they are, how they want to align their interests, skills, and values, and how that all fits into that business or relationship.

That emotional intelligence is what makes you stand apart from the technological future. Its what makes you more human than the future human and robot drones. Every human is unique. Only you have the skills, the training, the practice, the experience, the history, the upbringing, the relationships, the resources, the interest, the gumption to do what you do. It will be different than your siblings, your parents, your co-worker, your boss, that random social media personality you scrolled past.

But you cant find that uniqueness, you have to create it. And you create it by getting a better understanding of how you feel and how thats affecting your habits and behavior.

Besides time, its safe to say that most humans value relationships over anything else. In the end, we can acquire all the knowledge, money, and toys in the world, but it doesnt mean much when we cant share it with anyone.

Theres something satisfying about natural human connection. We can interact with people all day on social media, for example, but for many of us, it isnt as fulfilling as a deep conversation with a good friend in-person.

As technology becomes even more ubiquitous than it already is, there wont be as many opportunities to have these meaningful interactions. Which means the muscle for authentic social and emotional connection will atrophy.

To train that muscle, we have to practice sitting with what we feel. It might be easy and convenient to distract ourselves from any negative emotion that comes up, like boredom, anger, sadness, stress, but we have to learn to stretch those emotions so that we can better understand their stories and validity. Having better emotional self-awareness will help us have better relationships with ourselves, which will then create better relationships with others. When we have a healthy grip on our emotions, as well as the empathy to understand those of others, it will become that much easier to foster the relationships that we want in our lives

The technology has the potential to do so much for us. Its now our responsibility to make the most of it.

Previously published here and reprinted with the authors permission.

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Emotional Intelligence Is The Skill We Need For The Future - The Good Men Project

Editorial: New Year’s wishes for the 2020s – Los Angeles Times

The 2020s begin today, arriving at a time of increasingly bitter political rancor a disturbing state of affairs that we hope will give way soon to the better angels of our nature. But thats hardly our only aspiration after the tumultuous 2010s, which began with the country still reeling from the Great Recession and ended with three years of spectacularly divisive leadership from President Trump. In no particular order, heres our wish list for how things might be improved during the decade ahead, if we resolve to change them:

A radical transformation in the way we produce and consume power, along with an end to our reliance on fossil fuels. This is more than just a wish; the world has known for years that human behavior is imperiling the habitability of the Earth.

A return to respect and comity, not just in politics, but in how we handle all our disagreements. We hope as well that all Americans recognize that there are such things as facts, and they should be indisputable.

A realization by the various generations of Americans that were not rival interest groups with little in common. OK, boomer? OK, millennial?

For the sake of the planet and for Los Angeles embattled commuters, a public transit renaissance in which Angelenos can leave their cars behind and enjoy fast, convenient and comfortable rides on new rail lines (especially the infamously clogged 405 corridor) and on buses that travel in their own traffic-free lanes.

A complete, global shift away from disposable plastic to packaging thats fully recyclable or compostable.

2028 Olympic Games that leave Los Angeles in the best financial and physical condition of its life.

A recognition that our support of diversity should include not just diversity of race, gender, social class and sexual orientation, but diversity of viewpoint as well.

Access to affordable healthcare in the United States as a human right. Once we embrace that idea as a society, the solutions will flow from there.

A coordinated effort by policymakers, educators, business owners and labor leaders to prepare Americans for widespread automation and artificial intelligence in the workplace, so that the technological advances of the 2020s help rather than replace employees, and ultimately make work safer and more productive.

Public schools, colleges and universities in California that are funded at a level that allows them to produce students ready for the next generation of work. The era of nickel-and-diming public education in this state needs to end.

A Chinese government that respects human rights, the dignity of the individual and the commitments it made (but routinely ignores) to abide by World Trade Organization rules. That country must stop abusing the Uighur population in western China and trampling on the freedoms of the people of Hong Kong.

A California housing building boom, with lots of new homes in all shapes and sizes and prices so Californians of all income levels can find and afford to put a reliable roof over their heads. Political leaders at all levels of state government need to rally behind real solutions, rather than clinging to housing and zoning policies that have failed.

Corporate C-suites and boards of directors that reflect the gender and ethnic diversity of the U.S. itself.

Homeless and low-income Angelenos, keys in hand, walking into the 10,000 units of housing that Los Angeles voters helped finance through Proposition HHH. While were at it, how about cutting the number of people falling into homeless each day in Los Angeles from 150 to zero?

An end to federal and state policies that enable or, in some cases, promote the concentration of wealth. Once the land of the upwardly mobile, the United States has become a land of near-stagnant median incomes and intergenerational poverty, despite a steadily growing economy.

An end to the death penalty, which no civilized society should inflict on itself.

An electric grid in California that no longer causes wildfires or relies on massive preventive blackouts to deliver power safely.

A long-term fix for the looming shortfall in funding for Social Security benefits. Longer lifespans and an aging population are combining to threaten Social Security benefits for future generations, and the longer policymakers wait to fix the problem, the harder it will be to solve.

An end to the terrorizing of the Rohingya Muslims by the government of Myanmar, whose security forces have burned villages, committed mass murder and raped civilians, according to human rights groups.

An end to the forever wars in the Middle East, Afghanistan and the Korean peninsula.

U.S. elections free of both voter suppression and voter apathy.

A solution to the unsustainable growth in college debt. The heavy burden of this debt is distorting peoples career choices and slowing the economy.

Comprehensive immigration reforms that secure the countrys borders while providing a path to legal residency for people who have been living in the shadows for a decade or more.

Sensible and workable approaches to gun control, including banning combat-style firearms for civilian use. With Congress approving $25 million in funding for gun safety research, and the National Rifle Assn. reeling from external investigations and internal turmoil, were hoping the tide has finally turned.

An end to the stalemate between Israelis and Palestinians that has left the once-promising two-state solution moribund and the century-old conflict as far from resolution as ever.

A reversal of the habitat destruction and other forces that have threatened the existence of orangutans, vaquita porpoises, western lowland gorillas and other endangered species.

A new determination to lift more people out of poverty in this land of plenty. That means finding and funding programs that work, rather than cutting holes in the safety net and expecting those who fall out to land on their feet.

Ratification, at long last, of the Equal Rights Amendment to the U.S. Constitution.

A Russian government that abandons Vladimir Putins military expansionism and intrusive meddling in foreign elections, choosing instead to be a responsible player on the world stage.

An end to the politically expedient attacks on American public servants. There is no deep state, nor any vast conspiracy of government employees determined to make their elected leaders fail.

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Editorial: New Year's wishes for the 2020s - Los Angeles Times

Opinion/Column: Looking ahead, looking back: Life 100 years ago – The Daily Progress

Its can be useful and instructive to observe the turning of a decade by looking back on what life was like in America a mere 100 years ago.

On Jan. 2, 1920, the Dow Jones Industrial Average was 108.76. Today it is over 28,000 points.

In 1920, the U.S. had become an economic power, which is remarkable considering the bloody war to end all wars that ended just two years earlier. Republican presidents shifted their attention from foreign entanglements to economic growth (sound familiar?).

The beginning of the Roaring 20s featured new rights for women, including the right to vote, daring flapper outfits and cigarette smoking. It also included Prohibition, which lead to the rise of Al Capone and the Mafia. People should have been convinced that attempts to regulate human behavior by government fiat only works if the public is willing to obey the law, which in the case of liquor it clearly was not.

The one thing that hasnt changed in the last 100 years and, for that matter, since the first humans walked the Earth is human nature. One can change styles of clothing and hair, change modes of transportation, even change politicians, but human nature never changes. Greed, lust and the quest for power are embedded in each of us in every generation.

The impact of the Industrial Revolution found more people living in big cities than on farms for the first time beginning in 1920. That year also launched what we today call the consumer society. Americas total wealth more than doubled between 1920 and 1929.

As the website history.com notes: People from coast to coast bought the same goods (thanks to nationwide advertising and the spread of chain stores), listened to the same music, did the same dances and even used the same slang. Many Americans were uncomfortable with this urban, sometimes racy mass culture, and for many people in the U.S., the 1920s brought more conflict than celebration.

Isnt it the same today? Have we learned nothing? The tension between people with opposing political and social views and religious beliefs has increased these last 100 years because of contemporary social media and the 24/7 news cycle in which revolution sells better than resolution.

Cars, washing machines, new forms of birth control and other creations gave especially women new freedoms. Radio united the nation; and phonograph records, which sold 100 million in 1927 alone, created a common culture, even if some older people didnt like the modern music.

As with Frank Sinatra and Elvis Presley in the 1940s and 50s, some older folks in the 1920s rejected the dance hall lifestyle and what they saw as the vulgarity and depravity of jazz music and the moral erosion they claimed it caused. But for the younger generation, it was a new world in which the future looked bright.

What will America be like in 2120? In 1920 no one could have foreseen a Great Depression, or a second World War, much less the prosperity and cultural changes that would come, or the threat of nuclear annihilation.

The saying that the more things change, the more they remain the same has never seemed more accurate and providential.

Happy new decade!

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Opinion/Column: Looking ahead, looking back: Life 100 years ago - The Daily Progress

Anne Dagg, pioneering giraffe biologist and feminist critic of "evolutionary psychology" receives the Order of Canada – Boing Boing

Anne Innis Dagg was the first female biologist to study giraffes; while all the men who preceded her had observed firsthand that male giraffes are super queer (their primary form of play is a game dubbed "penis fencing," which is exactly what it sounds like), only Dagg was willing to write it down and publish it.

Dagg's work on giraffes -- several of the seminal books on the animals -- was initially mocked or ignored, partly because of her pioneering approach of living among the animals (as opposed to observing them at a distance) offended the establishment; partly because of her gender.

Though Dagg earned a PhD and taught for decades, she was denied tenure. She continued to produce challenging, brave, brilliant work at the intersection of biology and gender politics, ranging over both scholarly and popular works. In particular, she specialized in pointing out the lack of rigor in her male colleagues' work when discussing sex and gender among animals, and how that spilled over into the way the field was organized, and gender bias within research institutions and in research publishing.

Her 2004 book, Love of Shopping is Not a Gene, is an absolute must-read book on the subject, addressing the total absence of rigor and falsifiability in hypotheses from male biologists to explain human gender and power roles with reference to animal behavior and/or the imaginary lives of early hominids -- howlers like "Rape is genetic" or "Black people are genetically destined to have lower IQ scores than white people."

These comforting fairy tales (I always think of them as being reducible to, "But honey, it's not my fault I'm fucking my undergrads, it's because of the chimps!") are especially in vogue today, as white nationalists, plutocrats (and their bootlickers), and other advocates for gross inequality and population-scale subjugation seek to justify their ideology by claiming that it is biologically determined, and any attempt to change it is literally unnatural. Exhibit A for this is Jordan Peterson, whose obsession with a single species of lobsters is the founding myth of a transphobic, misogynist cult.

Dagg anticipated this debate decades in advance and repeatedly demolished its arguments for anyone who would listen, wielding science to slice through the self-serving bullshit of mediocre thinkers who want so desperately for their privilege to be the result of a biological process and not their own sociopathy.

Despite organized campaigns to marginalize Dagg and her work, she never gave up and was hugely influential on all kinds of scholars and thinkers. She was my own undergrad advisor at the University of Waterloo's Independent Studies program, and was an excellent mentor to me there. More broadly, she inspired generations of largely female giraffe biologists (I just met a giraffe keeper at Walt Disney World's Animal Kingdom who was a fan!), serving as a mentor and inspiration.

Dagg just received the Order of Canada, the second-highest honor awarded to Canadians (after the Order of Merit). The honor comes on the heels of The Woman Who Loves Giraffes, a documentary on Dagg's life and work.

wonderful news, seriously. Dagg is such a clear, uncompromising advocate for a rigorous approach to biology both as a means of understanding other animals and as a means for understand humans -- and is such a strong tonic against those who would abuse this tool for making sense of human behavior and social organization -- and she has accepted her marginalization as the price for her commitment to the truth.

Anne Dagg, Queen of Giraffes, appointed to Order of Canada among recipients with global influence [Stephanie Levitz/The National Post]

Wanda Diaz Merced is an astronomer at the International Astronomical Union (IAU) Office for Astronomy Outreach in Mitaka, Japan. Diaz Merced is blind and uses a technique to transform data from astronomical surveys into sounds for analysis. Over at Nature, Elizabeth Gibney interviewed Merced about how converting astronomical data into sound could bring discoveries that []

In the Galapagos Islands, a shoreside crane toppled over while loading a shipping container onto a barge, capsizing the boat and causing a terrible oil spill of hundreds of gallons of diesel fuel. It was Charles Darwins 1835 studies of the Galapagos Islandss biodiversity that sparked his theory of evolution by natural selection. From ABC []

Photographer Eric Brummel created this magnificent time-lapse video of the Milky Way in which the sky is stabilized so you can experience the Earths rotation. He captured the footage at Fonts Point, Anza-Borrego Desert State Park, California. From Universe Today: Eric created this time-lapse by using a star-tracker with his camera. A star-tracker rotates the []

Brush up on those interview skills all you like, but all the charm in the world wont help you past the primary obstacle for modern job seekers: Applicant tracking systems. These bots comb online applications before a human ever sees them, searching for keywords that would indicate particular titles or skills. Thats where Rezi Rsum []

Details are the bane of any manager. Its tough to innovate when youve got invoices to approve, gripes to address and countless fires to put out on any number of projects. Here is where technology can actually help you, because businesses run better when they integrate all their procedures, inflow and outflow under one system. []

You may have heard of air fryers, but theyre a lot more versatile than the name implies. Healthier (and quicker!) french fries are just the tip of the iceberg with these innovative cookers, and here are six of our favorites. As if they needed any additional highlighting, you can save an extra 20% off the []

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Anne Dagg, pioneering giraffe biologist and feminist critic of "evolutionary psychology" receives the Order of Canada - Boing Boing

After 20 Years of Trading, You Learn That You Actually Know Nothing – Newsmax

You ever notice rhat some memories tend to be stronger than others?

What sort of things do you remember?

You remember events in your life that had a lot of feelings associated with them.

You remember the death of your pet like it was yesterday. All the nights spent sitting on the couch watching "Wheel Of Fortune" i ts just a blur.

Researchers have studied this in rats. They found that rats remembered things better if they experienced a rush of adrenaline.

In those moments with strong memories, it feels like time slows down. Time doesnt actually slow down time is linear. But human beings experience time as flexible. Time also speeds up when things are boring.

Im fond of saying that all of finance, or at least the interesting part, is about human behavior. I find the daily fluctuations of stocks and credit spreads less interesting the older I get. And I think finance is more depraved the older I get. But the human behavior part fascinates me.

Millers Planet

The fact that time stretches and compresses isnt news to anyone whos traded options.

In the world of options, time and volatility work in opposite directions. As time passes, options decay. As volatility increases, options increase in value. All stuff you learned in class.

But if you think about it, volatility increasing is another way of saying that theres a lot of s--- going on. Things are crazy. Options increase in valuewhich is really like saying that time is slowing down.

Which is exactly how we experience it. Of all my days trading on Wall Street, what are the times that I remember most? The financial crisis, naturally. There was a lot of adrenaline associated with that.

We all have strong memories of it. And while we experienced it, it seemed like time was slowing down which was reflected in options prices. They were the highest in recorded history.

Finance is simply human behavior.

If I think back over the last 10 years, what do I remember?

All the crazy times. Nobody remembers the stuff in between. Old-timers like me remember all the way back to 1997 and 1998, with the Asian Financial Crisis and LTCM and the Russian debt default. Its the accidents that help us mark our time in the markets.

Perspective

We all perceive things differently. As I just demonstrated, we all perceive time differently.

We also might perceive color differently we just dont know. There is no way to know that the red I see is the red you see.

We all have different perspectives, especially when it comes to financial markets. I might find a stock attractive that you find unattractive. Happens all the time.

A lot of financial analysis is searching for some objective truth in the markets. This is what the value people try to do. They try to identify the correct value of a security and then buy it if its underpriced.

But there really is no objective truth in finance just a set of ever-changing perspectives.

Some examples:

Target is up over 90%, year to date:

Is Targets business 90% better? Is it earning 90% more revenue? Of course not more people find the stock attractive and fewer find it unattractive.

Pharmaceutical giant Bristol-Myers is up 48% in the last couple of months:

Again, is their business 50% better? No.

People have created several models to explain stock market behavior. Keyness beauty pageant is at the top of the list. I will always catch a beauty pageant if its on TV. The goal isnt picking the most attractive contestant. Its picking the contestant that the judges will find most attractive. Its a great exercise.

But I dont think thats the right model.

I came up with my own model and gave it to the world on the Bloomberg Opinion page. You can read about it here. But I feel like its incomplete, too.

Sentiment also plays a role big turning points are always at sentiment extremes.

Im not sure what the answer is or if there even is an answer. I think about it all the time. People smarter than me spend even more time thinking about it.

Maybe there is no Grand Unified Theory maybe there are regimes in the financial markets, and sometimes some things work and sometimes other things work.

Maybe the rules change all the time and there is nothing we can do about it.

I am not even sure buy-and-hold and dollar-cost averaging will work going forward.

And thats what you learn when you have 20 years of experience that you actually know nothing.

That said, one thing I do know is that the adrenaline rush reckless traders get throwing money at hot stocks is not something to aspire to. Its much better to even out your odds with a diversified, balanced portfolio and a long-term view.

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Jared Dillian writes The 10th Man, a free weekly newsletter for contrarian investors. Every Thursday, he delivers a torpedo of incisive commentary that crushes consensus thinking and exposes the true workings of Mr. Market. Subscribe now!

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After 20 Years of Trading, You Learn That You Actually Know Nothing - Newsmax