Evidence of disagreement between patient-perceived change and conventional longitudinal evaluation of change in health-related quality of life among older adults

Objective: To identify agreement levels between conventional longitudinal evaluation of change (post–pre) and patient-perceived change (post–then test) in health-related quality of life. Design: A prospective cohort investigation with two assessment points (baseline and six-month follow-up) was implemented. Setting: Community rehabilitation setting. Subjects: Frail older adults accessing community-based rehabilitation services. Intervention: Nil as part of this investigation. Main measures: Conventional longitudinal change in health-related quality of life was considered the difference between standard EQ-5D assessments completed at baseline and follow-up. To evaluate patient-perceived change a ‘then test’ was also completed at the follow-up assessment. This required participants to report (from their current perspective) how they believe their health-related quality of life was at baseline (using the EQ-5D). Patient-perceived change was considered the difference between ‘then test’ and standard follow-up EQ-5D assessments. Results: The mean (SD) age of participants was 78.8 (7.3). Of the 70 participants 62 (89%) of data sets were complete and included in analysis. Agreement between conventional (post–pre) and patient-perceived (post–then test) change was low to moderate (EQ-5D utility intraclass correlation coefficient (ICC)¼0.41, EQ-5D visual analogue scale (VAS) ICC¼0.21). Neither approach inferred greater change than the other (utility P¼0.925, VAS P¼0.506). Mean (95% confidence interval (CI)) conventional change in EQ-5D utility and VAS were 0.140 (0.045,0.236) and 8.8 (3.3,14.3) respectively, while patient-perceived change was 0.147 (0.055,0.238) and 6.4 (1.7,11.1) respectively. Conclusions: Substantial disagreement exists between conventional longitudinal evaluation of change in health-related quality of life and patient-perceived change in health-related quality of life (as measured using a then test) within individuals.

Ends, means, beginnings: environmental technocracy, ecological deliberation or embodied disagreement

Technocratic attitudes suggest that decisions about environmental policy should be led by scientific experts. Such decisions, it is expected, will be more rational than any arrived at by a democratic mediation between the narrow, short-term interests and uninformed preferences of the general public. Within green political theory, deliberative democracy has emerged as the dominant repost to technocracy, offering an account of how democratic polities can deal with complex scientific and technological decisions through the emergence of communicative rationality. This article argues that neither appeals to expert knowledge, nor communicative rationality, are likely to deliver the optimal green outcomes that proponents suggest, but rather will cover up the inevitable disagreements over environmental policy making. Instead the article suggests that more ecologically-sensitive and democratic decision making about complex scientific and technological issues can emerge if we acknowledge the differently embodied perspectives of decision-makers – from scientists to citizens. This prioritises democratic means over green ends, yet incorporates the environment at the beginning of the decision-making process. The article aims to sketch out the theoretical and practical implications of such an embodied turn for responding to the anti-democratic tendencies of environmental technocracy.

Respiratory Sinus Arrhythmia and Emotional Responding to Dyadic Discussions of a Disagreement as Predictors of Helping Related Subjective Well-Being in Older Mothers and Their Adult Daughters

The current study considered affect-related variables as predictors of the quality of helping relationships between older mothers and their adult daughters. Specifically, self-reported and observed emotional responses to the dyadic discussion of a disagreement between mothers and daughters, as well as baseline measures of respiratory sinus arrhythmia were considered as predictors of mothers' and daughters' satisfaction with their helping relationships. Relationship satisfaction was measured by considering mothers' and daughters' subjective well-being specifically in regards to the help they gave and received. Overall, these variables predicted more variance in mothers' satisfaction with their helping relationships than daughters', and RSA (respiratory sinus arrhythmia) was a stronger predictor than the self-reported or observed emotional reactions to the dyadic discussion of a disagreement. Implications of these findings and limitations to the current study are discussed.

Chronicles of a disagreement foretold. CEPS Commentary, 28 November 2012

In the wake of the collapsed talks on a new EU budget for 2014-20, a new CEPS Commentary by Jorge Núñez Ferrer allows that there is a good chance that agreement will be reached before the summer but that the instrument will remain largely disconnected from the fundamental needs of the EU, foremost of which is the imperative to address imbalances in the eurozone.

Analysing UK real estate market forecast disagreement

Given the significance of forecasting in real estate investment decisions, this paper investigates forecast uncertainty and disagreement in real estate market forecasts. Using the Investment Property Forum (IPF) quarterly survey amongst UK independent real estate forecasters, these real estate forecasts are compared with actual real estate performance to assess a number of real estate forecasting issues in the UK over 1999-2004, including real estate forecast error, bias and consensus. The results suggest that real estate forecasts are biased, less volatile compared to market returns and inefficient in that forecast errors tend to persist. The strongest finding is that real estate forecasters display the characteristics associated with a consensus indicating herding.

Intuitions, disagreement and referential pluralism

Mallon, Machery, Nichols and Stich (Philosophy and Phenomenological Research 79: 332–356, 2009) argue that the use of intuitions in the philosophy of reference is problematic as recent studies show intuitions about reference vary both within and between cultures. I use some ideas from the recent literature on disagreement and truth relativism to shed light on the debate concerning the appropriate reaction to these studies. Mallon et al. argue that variation is problematic because if one tries to use intuitions which vary to find the correct theory of reference one will end up endorsing an absurd position: referential pluralism. I argue that there is hope for intuition-based philosophy of reference. One can avoid endorsing referential pluralism (as Mallon et al. understand it). Furthermore, referential pluralism may not be so absurd after all.

Opinion dynamics of learning agents: does seeking consensus lead to disagreement?

We study opinion dynamics in a population of interacting adaptive agents voting on a set of issues represented by vectors. We consider agents who can classify issues into one of two categories and can arrive at their opinions using an adaptive algorithm. Adaptation comes from learning and the information for the learning process comes from interacting with other neighboring agents and trying to change the internal state in order to concur with their opinions. The change in the internal state is driven by the information contained in the issue and in the opinion of the other agent. We present results in a simple yet rich context where each agent uses a Boolean perceptron to state their opinion. If the update occurs with information asynchronously exchanged among pairs of agents, then the typical case, if the number of issues is kept small, is the evolution into a society torn by the emergence of factions with extreme opposite beliefs. This occurs even when seeking consensus with agents with opposite opinions. If the number of issues is large, the dynamics becomes trapped, the society does not evolve into factions and a distribution of moderate opinions is observed. The synchronous case is technically simpler and is studied by formulating the problem in terms of differential equations that describe the evolution of order parameters that measure the consensus between pairs of agents. We show that for a large number of issues and unidirectional information flow, global consensus is a fixed point; however, the approach to this consensus is glassy for large societies.

How sensitive are bargaining outcomes to changes in disagreement payoffs?

We use a human-subjects experiment to investigate how bargaining outcomes are affected by changes in bargainers’ disagreement payoffs. Subjects bargain against changing opponents, with randomly drawn asymmetric disagreement outcomes that vary over plays of the game, and with complete information about disagreement payoffs and the cake size. We find that subjects only respond about half as much as theoretically predicted to changes in their own disagreement payoff and to changes in their opponent’s disagreement payoff. This effect is observed in a standard Nash demand game and a related unstructured bargaining game, in both early and late rounds, and is robust to moderate changes in stake sizes. We show theoretically that standard models of expected utility maximisation are unable to account for this under-responsiveness, even when generalised to allow for risk aversion. We also show that quantal-response equilibrium has, at best, mixed success in characterising our results. However, a simple model of other-regarding preferences can explain our main results.

Limited attention and investor disagreement: a nowcasting approach

When disagreement in economic models occurs due to different interpretations of public signals, the level of ``marketwide disagreement'' not necessarily decreases upon the arrival of a public signal. We propose an empirical assessment of this phenomenon. By using a measure of attention based on Google Trends, we show that an increase in the attention allocated by the market to a company is associated to a significant increase in disagreement about it.

Investor disagreement: the modern approach

Disagreement between economists is a well know fact. However, it took a long time for this concept to be incorporated in economic models. In this survey, we review the consequences and insights provided by recent models. Since disagreement between market agents can be generated through different hypotheses, the main differences between them are highlighted. Finally, this work concludes with a short review of nowcasting using google trends, emphasizing advances connecting both literatures.

Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 266/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions.Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. © 2012 Nature America, Inc.

Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death. Study Design: Prospective cohort of 484 infants with 23(0/7) to 26(6/7) weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of >= 1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life. Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions. Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. Journal of Perinatology (2012) 32, 913-919; doi:10.1038/jp.2012.28; published online 29 March 2012

Updating on the Credences of Others: Disagreement, Agreement, and Synergy

We introduce a family of rules for adjusting one’s credences in response to learning the credences of others. These rules have a number of desirable features. 1. They yield the posterior credences that would result from updating by standard Bayesian conditionalization on one’s peers’ reported credences if one’s likelihood function takes a particular simple form. 2. In the simplest form, they are symmetric among the agents in the group. 3. They map neatly onto the familiar Condorcet voting results. 4. They preserve shared agreement about independence in a wide range of cases. 5. They commute with conditionalization and with multiple peer updates. Importantly, these rules have a surprising property that we call synergy — peer testimony of credences can provide mutually supporting evidence raising an individual’s credence higher than any peer’s initial prior report. At first, this may seem to be a strike against them. We argue, however, that synergy is actually a desirable feature and the failure of other updating rules to yield synergy is a strike against them.