To sleep or to snooze? You probably know the answer, but you don’t prefer it.
Most of us probably use the snooze function on our alarm clocks at some point in our lives. Just a few more minutes under the covers, a time to gather our thoughts, right?
While such snoozing might seem harmless, it may not be. For starters, it is important to understand why we are using the snooze button in the first place. For some it’s a habit that started early on. But for many, it can signal a significant problem with sleep. Poor sleep has been shown to be associated with a number of health disorders including high blood pressure, memory problems and even weight control.
I’m a facial pain specialist and have extensively studied sleep and how it impacts painful conditions. With testing, we discover that many of our chronic pain patients also suffer with various sleep disorders.
What does normal sleep look like?
If one is tired when the alarm goes off, is it helpful to use the snooze button? While there are no scientific studies that address this topic specifically, the answer is probably not. Our natural body clock regulates functions through what’s known as circadian rhythms – physical, mental and behavioral changes that follow a daily cycle.
Most adults require approximately seven and a half to eight hours of good sleep per night. This enables us to spend adequate time in the stages of sleep known as nonrapid eye movement sleep (NREM) and rapid eye movement sleep (REM).
We tend to cycle from the three stages of NREM into REM sleep four to six times per night. The first portion of the night is mostly NREM deep sleep and the last portion consists of mostly REM sleep.
Good sleep is important
Maintaining this well-defined structure is important for good, restful sleep. If this process is disturbed, we tend to awaken still feeling tired in the morning.
A number of factors can affect the sleep cycles. For example, if a person is not breathing well during sleep (snoring or sleep apnea), this will disturb the normal sequences and cause the individual to awaken feeling unrestored. Sleep quality can be diminished by the use of electronic devices, tobacco or alcohol in the evening. Even eating too close to bedtime can be problematic.
The use of snooze buttons often starts during the teenage years, when our circadian rhythms are altered somewhat, causing us to want to stay up later and get up later in the morning. Delaying getting out of bed for nine minutes by hitting the snooze is simply not going to give us any more restorative sleep. In fact, it may serve to confuse the brain into starting the process of secreting more neurochemicals that cause sleep to occur, according to some hypotheses.
Bottom line: It’s probably best to set your alarm for a specific time and get up then. If you are consistently tired in the morning, consult with a sleep specialist to find out why.
But beyond these immediate responses, this terrible incident presents an opportunity for longer term reform. It’s time for social media platforms to be more open about how livestreaming works, how it is moderated, and what should happen if or when the rules break down.
With the alleged perpetrator apparently flying under the radar prior to this incident in Christchurch, our collective focus is now turned to the online radicalisation of young men.
As part of that, online platforms face increased scrutiny and Facebook and Youtube have drawn criticism.
After dissemination of the original livestream occurred on Facebook, YouTube became a venue for the re-upload and propagation of the recorded footage.
Both platforms have made public statements about their efforts at moderation.
In the first 24 hours we removed 1.5 million videos of the attack globally, of which over 1.2 million were blocked at upload […]
Focusing chiefly on live-streaming is somewhat reductive. Although the shooter initially streamed his own footage, the greater challenge of controlling the video largely relates to two issues:
the length of time it was available on Facebook’s platform before it was removed
the moderation of “mirror” video publication by people who had chosen to download, edit, and re-upload the video for their own purposes.
These issues illustrate the weaknesses of existing content moderation policies and practices.
Not an easy task
Content moderation is a complex and unenviable responsibility. Platforms like Facebook and YouTube are expected to balance the virtues of free expression and newsworthiness with socio-cultural norms and personal desires, as well as the local regulatory regimes of the countries they operate in.
People might reasonably expect platforms like Facebook and YouTube to have thorough controls over what is uploaded on their sites. However, the companies’ huge user bases mean they often must balance the application of automated, algorithmic systems for content moderation (like Microsoft’s PhotoDNA, and YouTube’s ContentID) with teams of human moderators.
And while some algorithmic systems can be effective at scale, they can also be subverted by competent users who understand aspects of their methodology. If you’ve ever found a video on YouTube where the colours are distorted, the audio playback is slightly out of sync, or the image is heavily zoomed and cropped, you’ve likely seen someone’s attempt to get around ContentID algorithms.
For online platforms, the response to terror attacks is further complicated by the difficult balance they must strike between their desire to protect users from gratuitous or appalling footage with their commitment to inform people seeking news through their platform.
Facebook and YouTube’s challenges in addressing the issue of livestreamed hate crimes tells us something important. We need a more open, transparent approach to moderation. Platforms must talk openly about how this work is done, and be prepared to incorporate feedback from our governments and society more broadly.
A good place to start is the Santa Clara principles, generated initially from a content moderation conference held in February 2018 and updated in May 2018. These offer a solid foundation for reform, stating:
companies should publish the numbers of posts removed and accounts permanently or temporarily suspended due to violations of their content guidelines
companies should provide notice to each user whose content is taken down or account is suspended about the reason for the removal or suspension
companies should provide a meaningful opportunity for timely appeal of any content removal or account suspension.
A more socially responsible approach to platforms’ roles as moderators of public discourse necessitates a move away from the black-box secrecy platforms are accustomed to — and a move towards more thorough public discussions about content moderation.
In the end, greater transparency may facilitate a less reactive policy landscape, where both public policy and opinion have a greater understanding around the complexities of managing new and innovative communications technologies.
This is part of a major series called Advancing Australia, in which leading academics examine the key issues facing Australia in the lead-up to the 2019 federal election and beyond. Read the other pieces in the series here.
Over the last 35 years, Medicare has given Australians access to high-quality health care at a reasonable cost. But, despite our justifiable pride in Medicare, it’s time to reconsider the way we pay for health care.
Australia’s Medicare system is a A$20 billion-a-year program. It subsidises most of our out-of-hospital doctor consultations, blood tests, X-rays and scans, physio appointments, eye tests and many other health services. It’s based on a long list of items and each time an item is provided, Medicare pays a benefit.
But paying doctors and other health providers a set fee for each service they deliver is not delivering optimal value for the health dollar. There are two reasons for this.
First, it encourages a higher volume of services, but not necessarily better-value services.
Second, it constrains doctors into delivering the care based on the items in the schedule, which often don’t meet the needs of complex patients.
One promising alternative is “bundled payments”. Rather than paying doctors a “fee for service”, they would be paid a prospective lump sum to care for the patient’s medical problem, over a specified period.
The lump sum would be a pooled payment for all services provided to treat the condition. The provider’s role would be to coordinate the patient’s care across different parts of the health system and work with a range of health professionals to deliver high-quality care.
This would give doctors greater flexibility to manage the care patients need. At the same time, doctors would be held accountable via measurements of the quality of their care.
Importantly, this would give patients greater access to a broader range of services and make it easier to navigate our complicated health system.
Why health costs are rising
Between 1984 and 2018, Australian government spending on services outside of hospitals has increased from A$426 to A$818 per person, after adjusting for inflation.
This increase is almost entirely due to service volume. Back in 1984, the average Australian made 7.25 out-of-hospital Medicare claims a year. By 2018, this had escalated to 15.34; a doubling in the average number of claims.
The biggest growth has been in the number of pathology claims for blood and tissue tests (1.4 in 1984 to 5.2 in 2018), followed by GP consultations (4.2 compared to 6.3) and diagnostic imaging, including X-rays and other types of scans (0.3 versus 1.0).
This is not just the result of population ageing. At every age, we are making more Medicare claims. In 1985, people aged between 75 and 84 made 16.1 Medicare claims per year. In 2018, this number had grown to 44.6 claims per person per year.
Medicare prices have been very steady. For GP consultations, for example, the benefit paid per service has increased by 72% over the 35-year period, and mostly as a direct result of policy initiatives such as the Strengthening Medicare reforms introduced in 2004-05.
In fact, since 2005, the benefit per service has declined by 6% in real terms. This is a result, in part, of the Medicare freeze imposed by government between 2012 and 2018.
So price control is only one part of constraining expenditure growth. The other is the volume of services.
The medical care market has undergone considerable corporatisation. Corporate entities now own around 10% to 15% of all GP practices in Australia.
Corporate entities can own and run primary care practices as well as pathology laboratories, diagnostic imaging services and even pharmacies. This creates more incentive to refer patients to their own businesses for blood tests and imaging to increase the volume of claims, and therefore increase profits.
Greater spending doesn’t mean better care
The second critique of Medicare is that current funding arrangements create disincentives for delivering optimum care over a longer period, particularly for complex patients who require multiple services from multiple providers. They might have cancer, for instance, or multiple chronic diseases such as heart disease and diabetes or dementia.
Currently, Medicare makes a payment for every claim made within what we call an “episode of care” – a set of services to treat a condition, or a procedure. Each provider in that episode has an incentive to increase their own volume of care, but there are virtually no incentives to coordinate or deliver an optimum pathway of care for the patient.
Further, there are too few opportunities and rewards in this system to give doctors flexibility to offer different types of care for patients. This includes care provided by nurses, physiotherapists or dietitians; email or telephone consultations; patient education; and coordination services.
Instead, pay doctors a lump sum
The main feature of a good payment system is that it creates the right incentives for providers and patients to use health care resources effectively, efficiently and equitably.
Bundling payment involves working out the best care pathways for each condition. Cancer, for example, is a complex disease that requires ongoing care from primary, specialist and hospital services.
Under a bundled payment, the patient’s GP clinic would be paid a lump sum to ensure the patient receives all the services they need. This includes consultations, health checks, blood tests, physiotherapy, dietetics, patient education, and so on. The GP would have more control over how each of those services is delivered.
If viable, the GP could bring some of these services into their practice, or they could subcontract them to other organisations.
The practice would be held accountable for providing high-quality care through various performance measures. These could range from patient satisfaction measures to objective measures such as timeliness of care or fewer avoidable complications. Payments could, in part, be made conditional on meeting performance targets.
Ultimately, because we are giving the provider more say over how care is delivered, the model of care can be more easily adapted to the needs of the patient.
Health reform must be based on evidence
In the small number of countries where bundled payments have been piloted, they are associated with improved quality, financial savings and increased patient satisfaction.
Although these studies show promise, the evidence base is still in its infancy.
Successful reform in this area will require careful design of the bundles, the payment levels and patient selection process, as well as how best to monitor quality care. In particular it requires robust evidence to determine:
what constitutes an optimal bundle of care for a particular condition
the cost of delivering those services
how the payment should be adjusted for the specific characteristics of a patient
the role performance targets may play in motivating health providers to deliver high-quality care.
There is an emerging view that there should be much greater use of evaluations of public policies, including randomised controlled trials (RCTs), to test the effectiveness of new policies before they are rolled out. This applies particularly to policies or programs for which there is limited or no evidence about their likely impact.
RCTs have been around for years in medicine and other sciences, and are increasingly being used by small and large companies to test products and services. Conceptually they are simple, although implementing one can be complex. A RCT involves selecting a sample from a population of interest and randomly dividing them into two groups (using the equivalent of a coin toss). One group is given an intervention (that is, a program or policy) and the other is not. If the RCT has been done properly, the differences in the outcomes of the two groups tells us the impact of the intervention being trialled.
There are other ways to try to measure causation, and some are necessary when an RCT isn’t possible. However, Shadow Assistant Treasurer Andrew Leigh argues in his new book Randomistas that:
Researchers have spent years thinking about how best to come up with credible comparison groups, but the benchmark to which they keep returning is the randomised controlled trial. There’s simply no better way to determine the counterfactual than to randomly allocate participants into two groups: one that gets the treatment, and another that does not.
While there is strong support within the policy and research community on the important role of trials and evaluations, we know far less about what the general public thinks about how policies should be implemented and to what extent they should be trialled before widespread introduction.
In a survey undertaken as part of the ANUPoll series, we ran an online survey experiment that measured the level of support for trials in general and RCTs in particular. We also looked at the factors that influence that support, and whether there is a causal relationship between expert opinion, party identification and support for an RCT.
That is, we ran an RCT on RCTs.
As part of the survey, we asked respondents to “consider a hypothetical proposal to reform” in one of five policy areas (school education; early childhood education; health; policing; support for those seeking employment). We then asked “which of the following approaches do you think the government should take?”:
Introduce the policy for everyone in Australia at the same time
Introduce the policy to everyone, but do it in stages
Trial on a small segment of the population who need it most, or
Trial on a small segment of the population chosen randomly,
We found that more people want new government policies rolled out without testing – except for jobless support.
Some key findings emerge:
There is a roughly even split between those who think a new policy should be introduced to everyone at once and those who think it should be trialled on a small segment of the population.
Respondents support trials for employment policies the most strongly but are most likely to support an RCT for a policy related to school education. They are least likely to support it for health service delivery and employment support.
Those who live in disadvantaged areas and those with low levels of education are the least supportive of RCTs.
What influence do experts’ views have?
The type of policy that is being proposed clearly matters for whether the general public thinks it should be trialled as part of an RCT. However, the views of those outside the political system also matter. We tested this potential effect by randomly varying the wording of the question across respondents.
One “treatment” that we applied to the question was to vary what respondents were told on whether experts generally support the policy, are generally opposed to the policy, or are divided on the policy (with one-third of respondents given each of the options).
The greatest support for a trial in general or an RCT in particular occurs when experts are generally opposed to the policy. Conversely, the least support for a trial or an RCT comes when experts are generally in support of the policy, implying respondents believe sufficient evidence must already exist. Support is somewhere in between when there is variation in support.
This has implications, we think, for researchers engaged in policy debates. One potential effect of arguing publicly for a different point of view to policymakers or other researchers is to increase the level of support for trials among the general population. We should make a case for uncertainty when it does exist, as that would appear to increase support for future gathering of evidence.
Indeed, this advocacy for uncertainty has underpinned the push for greater trials and evaluations in policy (and the social sciences).
It is clear that RCTs are likely to be increasingly used by policymakers to test the effect of policy interventions. However, to be truly effective and to avoid a backlash, RCTs need to be supported not only by researchers and policymakers but also by the general public. At first glance, this buy-in is a long way off.
The articles linked to above are by Compass Direct News and relate to persecution of Christians around the world. Please keep in mind that the definition of ‘Christian’ used by Compass Direct News is inclusive of some that would not be included in a definition of Christian that I would use or would be used by other Reformed Christians. The articles do however present an indication of persecution being faced by Christians around the world.
The article below is about one megachurch pastor in the United States and his questioning of marketing values in the church today. I think there are some hopeful signs in his comments, but there is no convincing evidence of a better way about to be trod.
Muslim militants shoot young man dead after learning he had begun to follow Christ.
NAIROBI, Kenya, April 20 (CDN) — Two Muslim extremists in Somalia on Monday (April 18) murdered a member of a secret Christian community in Lower Shabele region as part of a campaign to rid the country of Christianity, sources said.
An area source told Compass two al Shabaab militants shot 21-year-old Hassan Adawe Adan in Shalambod town after entering his house at 7:30 p.m.
“Two al Shabaab members dragged him out of his house, and after 10 minutes they fired several shots on him,” said an area source who requested anonymity. “He then died immediately.”
The militants then shouted “Allahu Akbar [God is greater]” before fleeing, he said.
Adan, single and living with his Muslim family, was said to have converted to Christianity several months ago. Area Christians said they suspected someone had informed the Islamic militants of his conversion. One source said that a relative who belonged to al Shabaab had told Adan’s mother that he suspected her son was a Christian.
“This incident is making other converts live in extreme fear, as the militants always keep an open eye to anyone professing the Christian faith,” the source said.
Two months ago there was heavy fighting between the rebel al Shabaab militants and forces of the Transitional Federal Government (TFG), in which the TFG managed to recover some areas controlled by the rebels. Al Shabaab insurgents control much of southern and central Somalia.
With estimates of al Shabaab’s size ranging from 3,000 to 7,000, the insurgents seek to impose a strict version of sharia (Islamic law), but the transitional government in Mogadishu fighting to retain control of the country treats Christians little better than the al Shabaab extremists do. While proclaiming himself a moderate, President Sheikh Sharif Sheik Ahmed has embraced a version of sharia that mandates the death penalty for those who leave Islam.
Al Shabaab was among several splinter groups that emerged after Ethiopian forces removed the Islamic Courts Union, a group of sharia courts, from power in Somalia in 2006. Said to have ties with al Qaeda, al Shabaab has been designated a terrorist organization by several western governments.
On Jan. 7, a mother of four was killed for her Christian faith on the outskirts of Mogadishu by al Shabaab militia, according to a relative. The relative, who requested anonymity, said Asha Mberwa, 36, was killed in Warbhigly village when the Islamic extremists cut her throat in front of villagers who came out of their homes as witnesses.
She is survived by her children – ages 12, 8, 6 and 4 – and her husband, who was not home at the time she was apprehended. Her husband and children have fled to an undisclosed location.
MOGADISHU, Somalia, October 6 (CDN) — An underground Christian family from central Somalia is agonizing over the kidnapping of their daughter nearly eight months ago by Islamic militants bent on punishing those who leave Islam.
Ghelle Hassan Aded told Compass that he has not seen his 15-year-old daughter, Anab Ghelle Hassan, since Islamic extremists from the al Shabaab (“the Youth”) insurgency kidnapped her on Feb. 15. Certain that the militants would come after the rest of the family, they immediately fled, said Aded, who spoke with Compass from an undisclosed location in Somalia’s autonomous region of Puntland.
The family formed part of a growing movement of underground Christians in Dhusa Mareb, capital of Galgaduud Region in central Somalia, said other sources in Somalia who confirmed the kidnapping. Aded and his family had become Christians in 2001 while living in Kampala, Uganda. In 2008, the family returned to Somalia and settled in Dhusa Mareb, where their tribesmen live.
The al Shabaab insurgents fighting the Transitional Federal Government soon began monitoring the family’s activities. Aded said they took note that the family did not attend mosque, and on several occasions the insurgents or other Muslims questioned him. In Somalia, Christians hold small meetings in secret and are advised not to keep Bibles or other Christian literature at their homes; they often have to keep them buried in a hole.
On Feb. 15, Aded and his wife sent young Hassan to the market to buy food, he said; relatives told them later that day that they saw al Shabaab insurgents kidnap her at 10 a.m. as she was going about her business at the local market. Knowing that the insurgents would soon come after the rest of his family, Aded said, he fled immediately with his wife, 11-year-old daughter and 10-year-old son to Puntland.
At their location in Puntland, the family appeared devastated by the kidnapping, with Aded’s wife often weeping over the loss, but they said they maintain hope of seeing Anab again.
“We are increasingly afraid of being discovered by the militants on our trail and wish to go back to Kampala as soon as possible,” Aded said. “After months of monitoring, the militants were convinced that we were practicing Christianity, contrary to their banning of all other religions in Somalia.”
Al Shabaab insurgents control much of southern and central Somalia and have embarked on a campaign to rid the country of its hidden Christian population. With estimates of al Shabaab’s size ranging from 3,000 to 7,000, the insurgents seek to impose a strict version of sharia (Islamic law).
Al Shabaab was among several splinter groups that emerged after Ethiopian forces removed the Islamic Courts Union, a group of sharia courts, from power in Somalia in 2006. Said to have ties with al Qaeda, al Shabaab has been designated a terrorist organization by several western governments.
The transitional government in Mogadishu fighting to retain control of the country treats Christians little better than the al Shabaab insurgents do. While proclaiming himself a moderate, President Sheikh Sharif Sheik Ahmed has embraced a version of sharia that mandates the death penalty for those who leave Islam.
Without giving too much away, I would have to say that there have been many moments in my life when it was better to be safe than sorry. Really, when wouldn’t it be?
Though there are many times, one situation that continually presents itself is when you could choose to believe something or many things based on little evidence. Many people would simply react and at times I also do this, but I always try to be certain of the facts before I react. After all, it is better to be safe than sorry.
Al Shabaab insurgents allegedly seek to train young ones as Islamist soldiers.
NAIROBI, Kenya, September 7 (CDN) — Another member of an underground Christian movement in Somalia has been murdered by Muslim insurgents in a continuing campaign to eliminate converts from Islam.
Area sources said al Shabaab militants entered the house of Osman Abdullah Fataho in Afgoi, 30 kilometers (19 miles) from Mogadishu in Shibis district, at 10:30 the night of July 21 and shot him dead in front of his wife and children.
Fataho was a long-time Christian deeply involved in the activities of the small, secret Christian community, sources said. Area Christians said they suspected someone had informed the insurgents of Fataho’s faith.
The assailants abducted his wife and children, later releasing her on the condition that she surrender the little ones to be trained as soldiers, sources said.
“We know they have taken the children to brain-wash them, to change their way of life from Christian to Muslim and to teach them the Quran,” said one source. “Al Shabaab was aware that her husband was a Christian, but they were not sure of her faith.”
Abducted were 5-year-old Ali Daud Fataho, 7-year-old Fatuma Safia Fataho, 10-year-old Sharif Ahmed Fataho and Nur Said Fataho, 15.
A Christian leader who attended Fataho’s funeral on July 22 said that one of the slain man’s relatives noted that the insurgents had targeted him because he had left Islam. The al Shabaab militants are said to have links with al Qaeda.
The incident has spread fear among the faithful in the lawless country, much of which lies in the grip of ruthless insurgents intent on rooting out any person professing Christianity. Leaders of the Christian underground movement have been forced to flee their homes to avoid being killed by the insurgents, said one leader who together with seven others has temporarily moved to an undisclosed area.
The leader added that he was unable to go to his office for fear of falling into the hands of the hard-line Islamic insurgents.
Al Shabaab, which controls large parts of central Somalia, recently banned radio stations from playing music and outlawed bell ringing that signals the end of school classes “because they sound like church bells.”
In 2009 Islamic militants in Somalia sought out and killed at least 15 Christians, including women and children. This year, on Jan. 1 al Shabaab insurgents murdered 41-year-old Mohammed Ahmed Ali after the Christian had left his home in Hodan, on the outskirts of Mogadishu.
On March 15, al Shabaab rebels shot Madobe Abdi to death on March 15 at 9:30 a.m. in Mahaday village, 50 kilometers (31 miles) north of Jowhar. Abdi’s death was distinctive in that he was not a convert from Islam. An orphan, Abdi was raised as a Christian.
On May 4, the militants shot Yusuf Ali Nur to death in Xarardheere, about 60 kilometers (37 miles) from Jowhar. The 57-year-old Nur had been on a list of people al Shabaab suspected of being Christian, sources who spoke on condition of anonymity told Compass.
The transitional government in Mogadishu fighting to retain control of the country treats Christians little better than the al Shabaab insurgents do. While proclaiming himself a moderate, President Sheikh Sharif Sheik Ahmed has embraced a version of sharia (Islamic law) that mandates the death penalty for those who leave Islam.