Auden, whose lyrics were considered too dark and satirical for a mainstream production. Against the odds, however — much like Quixote himself — Man of La Mancha became the hit of the season, eventually garnering five Tony Awards in , including Best Musical. More personally, however, Jack Jones had a similar man-out-of-time quality as Don Quixote, who yearned for the days of chivalry and knights errant. Statements like, "You're a blankety-blank" close discussions rather than open them.
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Instead, say, "You know, that's interesting. That's not the way I see it. Tell me more about why you think that. Tell the person that you see the issue from a different angle, and ask them what they think of your view. A key rule for civil discourse, especially in this political climate, is to recognize the difference between emotion and argument.
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The depth of conviction with which something is said is not a substitute for argument quality or truth. Keep reading Show less. Think Again Podcasts Etgar Keret writer — a tunnel dug under the prison floor. Should all speech be free? How much intolerance should society tolerate? For society to stay open and free, you don't need to eliminate prejudice.
You need the opposite: All kinds of prejudice pitted against each other.
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Intellectual diversity helps society as a whole learn the truth. And as long as society has rules that force ideas to be openly tested, the intolerant will not gain the upper hand. It may not be right. It may not get you accepted or respected. But absolutely it's legal and it should be legal," says Jonathan Rauch. Think Again Podcasts "Prior to nervous systems: no mind, no consciousness, no intention in the full sense of the term.
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After nervous systems, gradually we ascend to this possibility of having to this possibility of having minds, having consciousness, and having reasoning that allows us to arrive at some of these very interesting decisions. All that it takes is a little bit of bad luck in the management of those supports, and you're cooked…you can actually be cooked—with global warming! If you want to write about yourself you have to write about other people who are unwitting and don't want to be written about…".
Connect with us bigthinkagain Friends of Think Again. Elif Shafak - the story no one hears. Thus, it is understandable that they might ascribe a variety of symptoms to their medication. Third, it is generally thought that some patients feel better when they are slightly hyperthyroid 6. It is often difficult to reduce the dose of T 4 in patients who have been overreplaced for a prolonged period of time, because they develop low energy and other symptoms. Finally, because symptoms such as fatigue, constipation, and difficulty losing weight are common in the general population, it would be expected that they would occur in some hypothyroid patients even after appropriate thyroid hormone replacement.
T 4 alone, using a different study design, a randomized double-blinded trial with two patient groups in Hamilton, Ontario. Both studies used a variety of standardized instruments to measure psychological status, including quality of life, thyroid symptoms, and cognitive function. In contrast to the findings from Kaunas, the results of a series of primary and subgroup analyses indicate that T 3 substitution is no better, and in some comparisons, worse, than T 4 alone.
What are the strengths and weaknesses of the three studies and what factors could explain the different results? Because the Kaunas investigation can be looked upon as a pilot study, it may be understandable that power calculations were not performed at the outset. We must assume, however, that the study size was predetermined and not extended during the study until positive observations were made.
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Because many measurements were made, another concern is that no mention is made of correcting the statistical tests for multiple endpoints. However, many of the endpoints were statistically significant in the positive direction, making it unlikely that the findings arose by chance. Several cogent concerns have been raised about the Kaunas study. The patients were heterogeneous. One of the participants in the study was overtly hypothyroid, and three had marked depression 9. About half were taking T 4 for hypothyroidism arising from thyroid cancer treatment, and about half of these had fully suppressed TSH levels.
In a post hoc analysis 9 , 11 patients with autoimmune thyroiditis had less mental improvement than 15 thyroid cancer patients. Because the amount of T 3 was fixed at T 3 was given once a day, resulting in a large diurnal variation. T 3 levels were measured near the peak of the administered dose. There was no washout period between the two doses, and the duration of treatment was short 5 wk.
First, it is larger than the one from Kaunas, vs.
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It is notable that the number of subjects was determined by power calculations for the principal outcome analyses. Without this preplanning, negative findings, such as those observed in this case, would not be as convincing. However, the reported power calculations were made at the outset of the study, based on certain assumptions about the variance of the measurements. Ideally, when a study is completed, these assumptions should be checked with the actual observations, and power should be calculated again.
The patients in this study were more homogeneous, but not completely so, and the treatments were given for 10 wk, compared with 5 wk in the Kaunas study. The study avoided the problem of including patients being treated for thyroid cancer with supraphysiological T 4 doses, but it included about equal numbers of patients assessed to be satisfied and not satisfied with their T 4 therapy. This distinction was made by one observer, not by the patients, by criteria that are not presented.
Also, the inclusion of such a high fraction of patients who were classified as not satisfied suggests that the recruitment methods encouraged such patients to participate. The authors also included measurements of thyroid hormone action in peripheral tissues.
Of most concern to the integrity of the findings is that the average TSH level was higher after T 3 substitution. The authors, realizing that these factors could affect the findings, either before satisfaction classification or after TSH levels the study, performed subgroup analyses that confirm and strengthen their conclusion. However, when subgroup analyses are performed, it is almost certain that the power will be reduced. Decreased statistical power may not occur if the variance of the observations decreases, but it is best to calculate and report this in quantitative terms. The Ontario study had a relatively homogeneous population of T 4 -treated subjects with noniatrogenic primary hypothyroidism, but specifically selected patients with depressive symptoms not severe enough to meet criteria for major depression.
The study duration was 15 wk.