Fastest processor as of 2010? 

I think it may be this one
The IBM z196 processor can execute 50 billion instructions per second, which
makes the current generation of desktop processors look like a pauper. The
CPU also has 1.4 billion transistors. The CPU also has a 64KB L1 instruction
cache, 128KB L1 data cache and a 1.5 L2 cache (Tom's Hardware)

Amy

-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Djulbegovic,
Benjamin
Sent: 24 March 2011 07:50 PM
To: [log in to unmask]
Subject: Re: Clinical Decision Making and Diagnostic Error

perhaps we identify with the conscious but not with the non-conscious
because we consider technological and other advances as an integral part of
our logical, conscious system...but I don't believe that with all inventions
at our disposal we are close to processing 10,000,000 bits of information
per second (and without overheating!)
BTW, what is the fastest modern computer in terms of processing power?
ben

________________________________________
From: Jim Walker [[log in to unmask]]
Sent: Thursday, March 24, 2011 4:13 PM
To: Djulbegovic, Benjamin; [log in to unmask]
Subject: Re: Clinical Decision Making and Diagnostic Error

The non-conscious system is massively parallel and processes something on
the order of 10,000,000 bits of information per second, the conscious
between 16 and 32 bits.
So the conscious is something like the tip of a fully integrated iceberg,
dependent on the pre-processing of disparate inputs by the non-conscious
system for the highly (and necessarily) filtered information which it
manipulates.
So while the conscious can direct the attention of some aspects of the
non-conscious system to some extent, there is no theoretical or empiric
reason to think that the conscious system can "train" the non-conscious--or
that we would benefit if it could. (Interesting how we identify with the
conscious but not with the non-conscious.)

Jim

James M. Walker, MD, FACP
Chief Health Information Officer
Geisinger Health System


>>> "Djulbegovic, Benjamin" <[log in to unmask]> 3/24/2011 3:31 PM >>>

Hi Amy,
I am at the moment reading some papers by Read Montague (from Baylor)...
He has written some interesting stuff...
Best
ben

From: Dr. Amy Price [mailto:[log in to unmask]]
Sent: Thursday, March 24, 2011 3:13 PM
To: Djulbegovic, Benjamin; [log in to unmask]
Subject: RE: Clinical Decision Making and Diagnostic Error

Dear Ben ,Neal and all,

I am interested in the fMRI data identifying discrete brain areas for
systems 1 and 2. I am particularly intrigued by how/when they link and if
the unconscious bias might be trained .  Do you have authors names, links or
papers you could share. I am looking at this area in regards to addiction
and collaborating with others who are identifying genomics. Presently
exploring QEEG to see if this uncovers anything of interest...

Best regards,
Amy

From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Djulbegovic,
Benjamin
Sent: 24 March 2011 02:55 PM
To: [log in to unmask]
Subject: Re: Clinical Decision Making and Diagnostic Error


Neal,
Thanks for these insights - it is a really interesting thought about the
fMRI data identifying discrete brain areas as location of system 1 and
system 2 (at the moment, I am too reading on this fascinating stuff, and
after you pointed this out, I wonder what would Hammond say about the
empirical data that seems to be falsyfying his thesis?)
Regarding which reasoning system gets its more right than wrong, I think we
are saying the same thing, except (that in my reading of Hammond he seems to
be saying) that when we get it wrong, the consequences of relying on
intuition vs. logic are of the magnitude order less significant? (We are, of
course, talking about decisions related to human affairs and social
policies, not to the stuff in the realm of the quantum physics!)
Best
ben

From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Maskrey Neal
Sent: Thursday, March 24, 2011 2:04 PM
To: [log in to unmask]
Subject: Re: Clinical Decision Making and Diagnostic Error

Ben

Good to hear from you. Spring's arrived in England and it's lovely, but it
sure ain't Florida!

My reading is slightly different. From that, neither system 1 nor system 2
are superior, but system 1 is our "default". If we are talking about errors
of commission, then then Pat Coskerry shows these occur predominately in
system 1 due to the common cognitive and affective biases. My own personal
dramatic memories are fortunately few in number, but when I got it wrong the
usual contributing factors were availability bias and  affective - notably
work overload and sleep deprivation. And I'm sure Hammond isn't right about
us never being spectacularly wrong in system 1. In system 2 the common
problem is omission - if a common medical emergency presents it isn't
optimal to have to spend lots of time working out the diagnosis and
treatment plan. Broadly speaking, as Pat Croskerry says, we're safer in
system 2 - but we're a lot slower.

The MRI emission data identifies particular and quite different areas of the
brain being used live with system 1 and system 2 decision making and that's
harder to explain as a continuum - happy to debate. We've obviously
"cartooned" some of this necessarily in these brief, awareness-raising group
discussions and one of the facets we've not mentioned is the frequent live
toggling in decision making between system 1 and system 2.

The key trick is to train people to step back and re-examine the
issue...both from logical (system 2) and affective side (system 1)...a tough
to do when decisions have to be made in a short time-frame...

Absolutely. The next step is to prove teaching these approaches changes
behaviour, and then that change in behaviour improves the processes used in
decision making if that's possible. Showing improved outcomes or less errors
or both would be ideal, but if we're honest the definitive literature
showing "teaching EBM" or for that matter teaching anatomy or teaching
genetics improves outcomes isn't massive either. The quick "could this be
anything else" or "are there any other / better treatment options" or "did I
check for contraindications / interactions" calibration at the end of the
consultation is simply plain old fashioned good medical practice, so if this
is well presented its (a) an interesting subject to teach and learn, and (b)
some of the content has excellent face validity for students. Likewise the
more leisurely reflection - but then maybe the St Pete police would want
drivers to be concentrating on the road!

I keep hearing about on going research which might move all of this forward,
and there's certainly lots of interest. Fabulous.

Best

Neal

Neal  Maskrey
National Prescribing Centre
Liverpool UK

________________________________
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Djulbegovic,
Benjamin
Sent: 24 March 2011 11:02
To: [log in to unmask]
Subject: Re: Clinical Decision Making and Diagnostic Error


Neal, a challenge is, of course, to know when to use our intuitive (system
1) vs. logical (system 2) inferential process...Kenneth Hammond, who has
promoted idea of a continuum between system 1 and system 2 (instead two
sharply demarcated systems), has made a point that if we rely on the system
1, we will often be more wrong than right, but never spectacularly wrong. On
other hand, reasoning based on system 2 (this would include EBM) would be
more often right, but when it is wrong it can be phenomenally wrong (as our
models of the world can be hugely mistaken)... A practical/educational
corrolary from this is "rely on EBM, but if it does not agree with your
intuition, don't go there go/re-examine your decision..."  The key trick is
to train people to step back and re-examine the issue...both from logical
(system 2) and affective side (system 1)...a tough to do when decisions have
to be made in a short time-frame...My own approach has been to ask
students/residents/fellows is a) to review mentally all patient'stories
("cases") at the end of the day and focus on any possible oversights/errors
that may occurred that day (e.g. while driving back home), b) ask yourself "
if I were the patient, would I like to be taken care by thy guy/girl like
me?"

I have been doing this for years- wish I can report that I found the
"solution"...unfortunately, I still find myself much deficient as I try to
answer these questions...but resoluted to do better next day...

ben djulbegovic




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