tag:blogger.com,1999:blog-17625381308813476602024-03-13T04:03:39.065-07:00Tropical Synapses<b>TROPICAL SYNAPSES</b><br>
Reflections on topics including clinical neurology, recent publications in neuroscience,
philosophy of biology, "neuro-doubt" about modern media hype of new neuro-scientific procedures and methods, consciousness, scuba diving, horticulture, jazz, blues, slack key guitar music, the Hawai'i health scene, and whatever else dat's da kine...Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.comBlogger369125tag:blogger.com,1999:blog-1762538130881347660.post-44616004474301566032024-02-07T21:22:00.000-08:002024-02-07T21:22:17.244-08:00Risks for impaired post-stroke cognitive functionIn a printed posted to the medRxiv preprint archive this month, I found a chart review of patients with stroke to determine factors (other than the stroke itself) which could predict cognitive impairment following the stroke admission to hospital.
<br />
The paper used patients admitted to Massachusetts General Hospital as their cases for which to form a risk factor formula, and then validated the formula against cases in a sister Boston hospital, Brighamm and Women’s Hospital.
<br />
The results are quoted as a table below:
<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZ7oXtHk7vpc-6euNxOJ2XqOVOru3a6c26b0bslJ2RNq5I9-D2S-hIdNP9nR1boAnaD2fdcBx6-NDFg_DIKo6t5PuldybgUwMAfDTlpSQk2WqcmVM-g729lPQut2a_ZVRFzdO-R6411EoHEkKC6tO4751LzkObgyg_69PdLUEDyees9zWTrwUz605gsmY/s1007/table202402.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="818" data-original-width="1007" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZ7oXtHk7vpc-6euNxOJ2XqOVOru3a6c26b0bslJ2RNq5I9-D2S-hIdNP9nR1boAnaD2fdcBx6-NDFg_DIKo6t5PuldybgUwMAfDTlpSQk2WqcmVM-g729lPQut2a_ZVRFzdO-R6411EoHEkKC6tO4751LzkObgyg_69PdLUEDyees9zWTrwUz605gsmY/s400/table202402.png"/></a></div>
<br />
The results found were that older age was the biggest overall risk factor (weighted for example as 4 for > 65, 8 for > 85), followed by those weighted 2: insurance of Medicare (a proxy for age over 65), mobility problems, delirium, peripheral vascular disease, and depression. Other factors were rated only at a weight of 1: these included Medicaid(a proxy for low income), prior falls, Parkinson’s, kidney disease, weight loss, and nursing home placement from the acute hospital stay.
<br />
Indeed, it seems that the factors found more significant, such as age, gait status, depression, delirium, vascular disease, are actually all also known from other, prospective studies to be risk factors for dementia in the general population, even in those without any stroke.
<br />
==================================================================================================
<br />
ABSTRACT
<br />
Predicting post-stroke cognitive impairment using electronic health record data
<br />
Jeffrey M. Ashburner, PhD, MPH1,2; Yuchiao Chang, PhD1,2; Bianca Porneala, MS1; Sanjula D. Singh, MD, PhD3; Nirupama Yechoor, MD, MSc3; Jonathan M. Rosand, MD, MSc3; Daniel E. Singer, MD1,2; Christopher D. Anderson, MD, MMSc4; Steven J. Atlas, MD, MPH
<br />
medRxiv preprint: https://doi.org/10.1101/2024.02.02.24302240
<br />
Importance: Secondary prevention interventions to reduce post-stroke cognitive impairment (PSCI) can be aided by the early identification of high-risk individuals who would benefit from risk factor modification.
<br />
Objective: To develop and evaluate a predictive model to identify patients at increased risk of PSCI over 5 years using data easily accessible from electronic health records.
<br />
Design: Cohort study with patients enrolled between 2003-2016 with follow-up through 2022. Setting: Primary care practices affiliated with two academic medical centers.
<br />
Participants: Individuals 45 years or older, without prior stroke or prevalent cognitive impairment, with primary care visits and an incident ischemic stroke between 2003-2016 (development/internal validation cohort) or 2010-2022 (external validation cohort).
<br />
Exposures: Predictors of PSCI were ascertained from the electronic health record.
<br />
Main Outcome: The outcome was incident dementia/cognitive impairment within 5 years and beginning 3 months following stroke, ascertained using ICD-9/10 codes. For model variable selection, we considered potential predictors of PSCI and constructed 400 bootstrap samples with two-thirds of the model derivation sample. We ran 10-fold cross-validated Cox proportional hazards models using a least absolute shrinkage and selection operator (LASSO) penalty. Variables selected in >25% of samples were included. Results: The analysis included 332 incident diagnoses of PSCI in the development cohort (n=3,741), and 161 and 128 incident diagnoses in the internal (n=1,925) and external (n=2,237) validation cohorts. The c-statistic for predicting PSCI was 0.731 (95% CI: 0.694-0.768) in the internal validation cohort, and 0.724 (95% CI: 0.681-0.766) in the external validation cohort. A risk score based on the beta coefficients of predictors from the development cohort stratified patients into low (0-7 points), intermediate (8-11 points), and high (12-35 points) risk groups. The hazard ratios for incident PSCI were significantly different by risk categories in internal (High, HR: 6.2, 95% CI 4.1-9.3; Intermediate, HR 2.7, 95% CI: 1.8-4.1) and external (High, HR: 6.1, 95% CI: 3.9-9.6; Intermediate, HR 2.8, 95% CI: 1.9-4.3) validation cohorts.
<br />
Conclusions and Relevance: Five-year risk of PSCI can be accurately predicted using routinely collected data. Model output can be used to risk stratify and identify individuals at increased risk for PSCI for preventive efforts.
<br />
Key Words: post-stroke cognitive impairment, risk stratification, risk prediction
<br />
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-20507549278831413182023-06-20T10:26:00.002-07:002023-06-22T10:01:38.030-07:00On medical AI in 2023<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaLPHUkJ7xBj8lruz_Q_3hWv0JjmaNqWe13omIFLfHVZYFc-F5GIJiOwgGe0E8kp-i0n8qFaVEqcfgBLHuZSyaWe7jpK2qpgCSNDMYQNT2lhniaGPG8Qpv_nObAlkEQfu8WUVEx8zwwTsXu38U9X2-_80d0O_35Uf0--AHh8FCx1mB6OxDj6uMlmtaTOo/s223/craiyon_065323_medical_AI.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" height="320" data-original-height="223" data-original-width="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaLPHUkJ7xBj8lruz_Q_3hWv0JjmaNqWe13omIFLfHVZYFc-F5GIJiOwgGe0E8kp-i0n8qFaVEqcfgBLHuZSyaWe7jpK2qpgCSNDMYQNT2lhniaGPG8Qpv_nObAlkEQfu8WUVEx8zwwTsXu38U9X2-_80d0O_35Uf0--AHh8FCx1mB6OxDj6uMlmtaTOo/s320/craiyon_065323_medical_AI.png"/></a></div>
“To study persons is to study beings who only exist in, or are partly constituted by a certain language”.
-- Charles Taylor, Sources of the Self
<br /><br />
Large language model-based AI (LLM’s) are the epitome of what can be constituted by language alone. They can easily take isolated linguistic philosophy to its absurd extreme.
<br /><br />
Unfortunately, this means there is a disconnect between a statement that is correct in the context of its LLM and the statements we want, which appropriately address a scientific or clinical context in the world outside of the LLM. This results in AI dialog replies that currently make medical advisory AI impossible to trust.
<br /><br />
Current LLM base AI’s are masters of what Harry G. Frankfurt called “bullshit.” Until AI can distinguish and eliminate fictional or obsolete diagnoses and treatments within its model, separating them from those which help the patient, it cannot be trusted with any unsupervised role in patient care.
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-39178582799148654912022-12-04T10:18:00.001-08:002022-12-04T14:41:33.160-08:00Mountain and City<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmsxd3zMe78tmlb25Gc7ORB6fy6ZeGZdzyShF_udnW_eq-dCn6AQAIOELESYGUqwSR4Y86O9ZhtB8m1uHTHq46OzKpdKAWS94A0ysOxurnTrWGSwXFiLMsVFX0jMFF00TZfdWUnfUsVvp4i_e19rFq8bCXHiooklLsJv8Qbqjk1MxktuQZnxgI88G1/s1600/mauna-loa-november-2022-hilo-bay-view.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" data-original-height="491" data-original-width="683" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmsxd3zMe78tmlb25Gc7ORB6fy6ZeGZdzyShF_udnW_eq-dCn6AQAIOELESYGUqwSR4Y86O9ZhtB8m1uHTHq46OzKpdKAWS94A0ysOxurnTrWGSwXFiLMsVFX0jMFF00TZfdWUnfUsVvp4i_e19rFq8bCXHiooklLsJv8Qbqjk1MxktuQZnxgI88G1/s1600/mauna-loa-november-2022-hilo-bay-view.png"/></a></div>Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-89054378617639146492022-12-03T22:10:00.001-08:002022-12-03T22:10:18.575-08:00Mauna Loa November-December 2022 Eruption Livestream<iframe width="560" height="315" src="https://www.youtube.com/embed/SnjGqn1K9ZQ" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-1132043131145210242022-10-19T21:08:00.001-07:002022-10-19T21:08:53.501-07:00Life expectancy dropped much more with the Spanish flu in 1918 than COVID-19 so far.<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyzkOIKRRaH5cAH_oo6U1hX3ojB_6-ZhUzPIb6CwbKWHydUVKzgqxbBwaeuUvtS5vBQ90xXM6hJp3FWYlJ9aX6Z5XadlcSW9pCKmhORuFhRB-nHQJnyJeQPHaPOgWvUaERQXrhmL3OFptM13qpqHiTxuo_-1Kx1-r5ezcjI92etr6nGgrS-77zzMZw/s3400/life-expectancy.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="2400" data-original-width="3400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyzkOIKRRaH5cAH_oo6U1hX3ojB_6-ZhUzPIb6CwbKWHydUVKzgqxbBwaeuUvtS5vBQ90xXM6hJp3FWYlJ9aX6Z5XadlcSW9pCKmhORuFhRB-nHQJnyJeQPHaPOgWvUaERQXrhmL3OFptM13qpqHiTxuo_-1Kx1-r5ezcjI92etr6nGgrS-77zzMZw/s400/life-expectancy.png"/></a></div><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2aaE97TD0I-9_O7n7622u-FUsXqKxzWZ_f5CWlK1COBJMt5iWj6oAOroxx3c-rocUtdj6YltOJxTgbk_QTbdI9fiBbIcBh842P4u5qBdHxSTuEIo_9_opzMBrDcPJ9fYCaufTHaVkPOzXvkKEKcZGdZlBgsi4MlZdkRTNZ6CQ3M51AqXqgYaTzWAg/s590/covid-19-life-expectancy-CDC-2022.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="408" data-original-width="590" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2aaE97TD0I-9_O7n7622u-FUsXqKxzWZ_f5CWlK1COBJMt5iWj6oAOroxx3c-rocUtdj6YltOJxTgbk_QTbdI9fiBbIcBh842P4u5qBdHxSTuEIo_9_opzMBrDcPJ9fYCaufTHaVkPOzXvkKEKcZGdZlBgsi4MlZdkRTNZ6CQ3M51AqXqgYaTzWAg/s400/covid-19-life-expectancy-CDC-2022.png"/></a></div><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizTGAMgS-YDEEbSvaJPRM1B4ErKR-x69pqXgyOo45hLIhIzgt1IEKKN63d0lX_a9LkfWixcW7_DB6Q5lmJbB-UAYANR-kC-y4sFzilu60uCHIxUDSgOeXa-5pc4RHiZa81PI0IoFlzsI1z62HWNmgVGl-6NdD5lzTZMxXb2EL3rBKAMYUzw9CEGsja/s1230/from-www.scientificamerican.comarticlethe-u-s-just-lost-26-years-worth-of-progress-on-life-expectancy.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="926" data-original-width="1230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizTGAMgS-YDEEbSvaJPRM1B4ErKR-x69pqXgyOo45hLIhIzgt1IEKKN63d0lX_a9LkfWixcW7_DB6Q5lmJbB-UAYANR-kC-y4sFzilu60uCHIxUDSgOeXa-5pc4RHiZa81PI0IoFlzsI1z62HWNmgVGl-6NdD5lzTZMxXb2EL3rBKAMYUzw9CEGsja/s400/from-www.scientificamerican.comarticlethe-u-s-just-lost-26-years-worth-of-progress-on-life-expectancy.png"/></a></div>Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-65952486817212602702022-09-25T16:34:00.019-07:002022-09-28T23:36:12.522-07:00Dammed lies and statistics<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheBNCmuQipXNaOjZYo0g5j1bspyj6wJ85JkiUJh-fZ4JsQ80UL9Sud36RiU9cPlzZ_lxxW1t9aaoGgvH_W2no3CAXbSKraevw7TzmUeAi5LIvcQBEjdtTsqurP7DUcT6_dgDI8MAPkJnG3wGd6v7LJEtiuZBgROeCKVNeyoSslu7o3MDWxMKKOOtEJ/s640/640px-Itajai_Aerial-from-wikipedia.jpg" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="231" data-original-width="640" alt="Picture of Itajai, Brazil" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheBNCmuQipXNaOjZYo0g5j1bspyj6wJ85JkiUJh-fZ4JsQ80UL9Sud36RiU9cPlzZ_lxxW1t9aaoGgvH_W2no3CAXbSKraevw7TzmUeAi5LIvcQBEjdtTsqurP7DUcT6_dgDI8MAPkJnG3wGd6v7LJEtiuZBgROeCKVNeyoSslu7o3MDWxMKKOOtEJ/s400/640px-Itajai_Aerial-from-wikipedia.jpg"/></a></div>
<p>
Mark Twain wrote: “There are three kinds of lies: lies, damned lies, and statistics.”
</p><p>
Statistics continue to mislead the unwary in the current milieu of rapid online publication of articles and preprints. A case in point is the study published last month in the fast-tracking online medical journal <em>Cureus</em>. This study, entitled <em>Regular Use of Ivermectin as Prophylaxis for COVID-19 Led Up to a 92% Reduction in COVID-19 Mortality Rate in a Dose-Response Manner: Results of a Prospective Observational Study of a Strictly Controlled Population of 88,012 Subjects</em>, purported to show that prolonged, regular use of ivermectin lessened the incidence and mortality of COVID-19 as measured by total dose taken in the period before infection occurred.
</p><p>
Note that though the study title states it was prospective, planning a study in advance is not sufficient for a study to be prospective. Because subjects were only placed into their treatment groups after the study outcomes were known, this was a retrospective study.
</p><p>
The problem lies in the study's design: total dosage of ivermectin over the entire period before COVID infection was the regression variable, versus mortality in those infected. However, because <em>intention-to-treat analysis was thus bypassed</em>, the study was <em>actually</em> measuring the mortality in the group which took ivermectin for many months and either never got COVID-19 or got COVID-19 only after that period, versus the mortality in those who <em>either</em> never took ivermectin <em>or</em> who took ivermectin for only a short time. This means that during the early months of this study, almost all of the patients who developed COVID-19 were placed in the non-ivermectin or the "irregular user" group <em>even if they would have been placed in the ivermectin group had they NOT come down with COVID (and thus have more time to take doses of ivermectin, as many ultimately did).</em> In other words, the fact that some who got COVID-19 before taking ivermectin might well have taken ivermectin later in any given study period had they not gotten COVID-19 first was ignored.
</p><p>
Was this study "strictly controlled"? Yes, in a manner that biases it beyond repair, unless they had ALSO given intent-to-treat data! Only the authors know why their design was designed the way it was.
</p><p>
----------------------------------------------------------------------------------
</p><p>
REFERENCE: Kerr L, Baldi F, Lobo R, et al. (August 31, 2022) Regular Use of Ivermectin as Prophylaxis for COVID-19 Led Up to a 92% Reduction in COVID-19 Mortality Rate in a Dose-Response Manner: Results of a Prospective Observational Study of a Strictly Controlled Population of 88,012 Subjects. Cureus 14(8): e28624.
</p><p>
DOI: 10.7759/cureus.28624
</p><p>
---------------------------------------------------------------------------------
</p><p>
Here is a computer simulation (written in Julia) which demonstates the study bias mentioned above. In the program, the treatment is set to have no actual effect on the infection rate. The highly significant results are purely from the bias of excluding those who become infected from later entering a treatment arm.
</p>
<p style="{font-family: monospace; font-size: 8px}">
<pre>
using HypothesisTests
@enum TreatmentClass Untreated Irregular Excluded Regular
mutable struct Subject
cum_dose::Float64
treatment_class::TreatmentClass
had_covid::Bool
last_dose_day::Int
end
function update!(subjects::Vector{Subject}, day, pcovid = 0.001, pstart = 0.0075, pdosing = 0.25, dosage = 35)
for subj in subjects
if subj.had_covid
continue
elseif rand() < pcovid
subj.had_covid = true
elseif (subj.cum_dose > 0 && rand() <= pdosing && (day > subj.last_dose_day + 14 || day == subj.last_dose_day + 1)) ||
(subj.cum_dose == 0 && rand() < pstart)
subj.cum_dose += dosage
subj.last_dose_day = day
subj.treatment_class =
subj.cum_dose == 0 ? Untreated : subj.cum_dose >= 180 ? Regular : subj.cum_dose <= 60 ? Irregular : Excluded
end
end
end
function run_study(N = 10_000, duration = 150)
population = [Subject(0.0, Untreated, false, 0) for _ in 1:N]
unt, unt_covid, irr, irr_covid, reg, reg_covid, excluded = 0, 0, 0, 0, 0, 0, 0
println("Population size $N, daily infection risk 0.1%")
for day in 1:duration
update!(population, day)
if day % 30 == 0
println("\nDay $day:")
unt = count(s -> s.treatment_class == Untreated, population)
unt_covid = count(s -> (s.treatment_class == Untreated) && s.had_covid, population)
println("Untreated: N = $unt, with infection = $unt_covid")
irr = count(s -> s.treatment_class == Irregular, population)
irr_covid = count(s -> (s.treatment_class == Irregular) && s.had_covid, population)
println("Irregular Use: N = $irr, with infection = $irr_covid")
reg = count(s -> s.treatment_class == Regular, population)
reg_covid = count(s -> (s.treatment_class == Regular) && s.had_covid, population)
println("Regular Use: N = $reg, with infection = $reg_covid")
exc = count(s -> (s.treatment_class == Excluded) && s.had_covid, population)
println("Excluded: N = $exc")
end
if day == 75
println("\nAt midpoint, Infection case percentages are:")
println(" Untreated : ", Float16(100 * unt_covid / unt))
println(" Irregulars: ", Float16(100 * irr_covid / irr))
println(" Regulars : ", Float16(100 * reg_covid / reg))
end
end
println("\nAt study end, Infection case percentages are:")
println(" Untreated : ", Float16(100 * unt_covid / unt), " of group size of $unt")
println(" Irregulars: ", Float16(100 * irr_covid / irr), " of group size of $irr")
println(" Regulars : ", Float16(100 * reg_covid / reg), " of group size of $reg")
untreated = [s.had_covid for s in population if s.treatment_class == Untreated]
irregular = [s.had_covid for s in population if s.treatment_class == Irregular]
regular = [s.had_covid for s in population if s.treatment_class == Regular]
excluded = [s.had_covid for s in population if s.treatment_class == Excluded]
println("\n\n Final statistics:\n")
@show KruskalWallisTest(untreated, irregular, regular, excluded)
end
run_study()
</pre>
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-67062450702213761602022-09-07T01:38:00.000-07:002022-09-07T01:38:09.048-07:00Treating late-presenting strokes from large vessel occlusion<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYuhPSit6xoYis89BC8IJQ96vFKblgMgYXlot-ymFIaNPf_zV0OxEzNhpC2UbLVGgRD0ci54xruVRZJC0EpFOWwJmwPHtGoC8dgAh5Tu-fFUMwamo7Kwk0ZmXTEBOPP31hPyo4-qItj2kqS38pXUmZTb_gAUHwGjDERAXVyotW_wwSKTfTLJWpwa65/s369/mca-stenosis.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="319" data-original-width="369" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYuhPSit6xoYis89BC8IJQ96vFKblgMgYXlot-ymFIaNPf_zV0OxEzNhpC2UbLVGgRD0ci54xruVRZJC0EpFOWwJmwPHtGoC8dgAh5Tu-fFUMwamo7Kwk0ZmXTEBOPP31hPyo4-qItj2kqS38pXUmZTb_gAUHwGjDERAXVyotW_wwSKTfTLJWpwa65/s400/mca-stenosis.png"/></a></div>
<p>
Only a small minority of large vessel strokes which might be eligible for TPA
thrombolysis of clot extraction removal of blockage are so treated. WOne
reason is that such strokes often have a stuttering course which causes them
to present to the ER only well after they have begun, or to present with
changes on CT from previously begun tissue infaction even when deficits are
small.
</p>
<p>
Unfortunately, many such persons with stroke worsen in the hospital. The study
below offers hope for late treatment of at least some of these patients to
reduce their stroke burden.
</p>
<p>
=============================================================
</p><p>
ABSTRACT
</p><p>
Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite
Delays of up to a Day
</p><p>R. Gilberto González, Gisele Sampaio Silva, Julian He, Saloomeh Sadaghiani, Ona Wu, Aneesh B. Singhal
</p><p>
Scientific Reports, August 2022
</p><p>
doi: 10.1038/s41598-020-60933-3 0000005
</p><p>
Abstract
</p><p>
Selected patients with large vessel occlusions (LVO) can
benefit from thrombectomy up to 24 hours after onset. Identifying patients who
might benefit from late intervention after transfer from community hospitals
to thrombectomy-capable centers would be valuable. We searched for
presentation biomarkers to identify such patients. Frequent MR imaging over 2
days of 38 untreated LVO patients revealed logarithmic growth of the ischemic
infarct core. In 24 patients with terminal internal carotid artery or the
proximal middle cerebral artery occlusions we found that an infarct core
growth rate (IGR) <4.1 ml/hr and initial infarct core volumes (ICV) <19.9 ml
had accuracies >89% for identifying patients who would still have a core of
<50ml 24 hours after stroke onset, a core size that should predict favorable
outcomes with thrombectomy. Published reports indicate that up to half of all
LVO stroke patients have an IGR<4.1 ml/hr. Other potentially useful biomarkers
include the NIHSS and the perfusion measurements MTT and Tmax. We conclude
that many LVO patients have a stroke physiology that is favorable for late
intervention, and that there are biomarkers that can accurately identify them
at early time points as suitable for transfer for intervention.
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-37228770056599861532021-10-12T00:09:00.000-07:002021-10-12T00:09:09.363-07:00Aerobic exercise speeds recovery in adolescents with concussion.<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-aE07sMW3YJo/YWU0bY978-I/AAAAAAACHRg/oMoz65OO8UsGw525IHyjFWLFZge_BjiiQCLcBGAsYHQ/s700/concussion%2Bfrom%2Bhcamp.info%2B%2528Hawaii%2529.jpg" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="400" data-original-width="700" src="https://1.bp.blogspot.com/-aE07sMW3YJo/YWU0bY978-I/AAAAAAACHRg/oMoz65OO8UsGw525IHyjFWLFZge_BjiiQCLcBGAsYHQ/s400/concussion%2Bfrom%2Bhcamp.info%2B%2528Hawaii%2529.jpg"/></a></div>
<h2><a href=""> Here. </a></h2>
<br />
<p>
ABSTRACT
</p><p>
--------------------------------------------------------
</p><p>
Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial
</p><p>
Authors: Prof John J Leddy, MD, Prof Christina L Master, MD, Rebekah Mannix, MD, Douglas J Wiebe, PhD, Matthew F Grady, MD, William P Meehan, MD, et al.
</p><p>
Published:September 30, 2021
</p><p>
DOI:https://doi.org/10.1016/S2352-4642(21)00267-4
</p><p>
Summary
</p><p>
Background
</p><p>
Sport-related concussion is a public health problem, particularly in adolescents. Quality of life is reduced in adolescents with persistent post-concussive symptoms (symptoms >28 days). We replicated a previous randomised controlled trial to validate the safety, efficacy, and generalisability of, and objective adherence to, prescribed early targeted heart rate subsymptom threshold aerobic exercise compared with placebo-like stretching exercise for adolescent recovery from sport-related concussion and for reducing the risk of persistent post-concussive symptoms.
</p><p>
Methods
</p><p>
This randomised controlled trial was done at three community and hospital-affiliated sports medicine concussion centres in the USA. Male and female adolescent athletes (aged 13–18 years) presenting within 10 days of sport-related concussion were randomly assigned to individualised subsymptom threshold aerobic or stretching exercise at least 20 min daily, for up to 4 weeks after injury. Exercise adherence and intensity were measured by heart rate monitors. The primary outcome was clinical recovery (ie, return to baseline symptoms, normal exercise tolerance, and a normal physical examination) within the 4-week intervention period, and development of persistent post-concussive symptoms beyond 28 days after injury. This study is registered with ClinicalTrials.gov, NCT02959216.
</p><p>
Findings
</p><p>
Between Aug 1, 2018, and March 31, 2020, 118 adolescents were recruited (61 were randomly assigned to the aerobic exercise group and 57 to the stretching exercise group) and included in the intention-to-treat analysis. On survival analysis, controlling for sex, site, and mean daily exercise time, patients assigned to aerobic exercise were more likely to recover within 4 weeks after injury compared with those assigned to stretching exercise, with a 48% reduced risk of persistent post-concussive symptoms (hazard ratio for stretching vs aerobic exercise of 0·52 [95% CI 0·28–0·97], p=0·039). No adverse events were reported.
</p><p>
Interpretation
</p><p>
This multicentre study found that early treatment with subsymptom threshold aerobic exercise safely speeds recovery from sport-related concussion and reduces the risk for persistent post-concussive symptoms, an important result given the impact of delayed recovery on adolescent quality of life. Adherence was good and there were no adverse events from this non-pharmacological treatment. These results suggest that physicians should not only permit, but consider prescribing, early subsymptom threshold physical activity to adolescents as treatment for sport-related concussion and to reduce the risk of persistent post-concussive symptoms.
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-3772256243059729702021-07-02T14:24:00.006-07:002021-07-07T00:13:47.964-07:00COVID-19 on the Big Island after vaccine availability At Hilo Medical Center, there have been 0 Covid related hospitalizations for vaccinated individuals in recent weeks! This means that 100% of our hospitalized COVID-19 patients are unvaccinated, suggesting that here we see that vaccinations against COVID-19 are effective in preventing severe illness, hospitalizations and utilization of our limited resources and staff time.
<br />
There have been a few ED visits for flulike and related vaccine reactions, none serious.
<br />
As of 2 July 2021, we have 4 unvaccinated, COVID-positive patients in our hospital, 3 in our 11-bed ICU with 1 patient on a ventilator and 1 in our Obstetric Unit. 98% of hospitalized COVID-positive patients in our state are unvaccinated, and these still can get very very sick. Clearly the risk benefit favors vaccines at any adult age!
<br />
After all, currently we have about a 50 50 ratio of fully vaccinated to not people on island, and it's clear who the losers in that gamble are...Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-88023684837266161662021-06-05T16:09:00.003-07:002021-06-05T16:18:04.188-07:00World distribution of mammalian coronaviruses: One reason the pandemic started in Wuhan<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-mQ8zG5d1Ol4/YLwDqdz4F1I/AAAAAAACHM4/hLet2Nvjid4tQZn0IK7Hn4eG1FDb_7djACLcBGAsYHQ/s2048/vex012f4.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" height="600" data-original-height="2048" data-original-width="1580" src="https://1.bp.blogspot.com/-mQ8zG5d1Ol4/YLwDqdz4F1I/AAAAAAACHM4/hLet2Nvjid4tQZn0IK7Hn4eG1FDb_7djACLcBGAsYHQ/s600/vex012f4.png"/></a></div>
<p>
It's currently fashionable in many US circles to speculate that Covid-19 started in a Wuhan lab. But <a href="" > according to this 2017 paper, more coronaviruses are to be found in the regions around Wuhan than much of the rest of the world.</a> The next SARS will also likely start in Asia, or perhaps Africa. That could have happened with or without help of a lab, and without a lab seems more likely at the moment.
</p><p>
-----------------------------------------------------------------------------
</p><p>
ABSTRACT
</p><p>
</p><p>
Global patterns in coronavirus diversity
</p><p>
Simon J. Anthony, Christine K. Johnson, Denise J. Greig, Sarah Kramer, Xiaoyu Che, Heather Wells, Allison L. Hicks, Damien O. Joly, Nathan D. Wolfe, Peter Daszak
</p><p>
Virus Evolution, Volume 3, Issue 1, January 2017, vex012, https://doi.org/10.1093/ve/vex012
</p><p>
Published: 12 June 2017
</p><p>
Since the emergence of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrom Coronavirus (MERS-CoV) it has become increasingly clear that bats are important reservoirs of CoVs. Despite this, only 6% of all CoV sequences in GenBank are from bats. The remaining 94% largely consist of known pathogens of public health or agricultural significance, indicating that current research effort is heavily biased towards describing known diseases rather than the ‘pre-emergent’ diversity in bats. Our study addresses this critical gap, and focuses on resource poor countries where the risk of zoonotic emergence is believed to be highest. We surveyed the diversity of CoVs in multiple host taxa from twenty countries to explore the factors driving viral diversity at a global scale. We identified sequences representing 100 discrete phylogenetic clusters, ninety-one of which were found in bats, and used ecological and epidemiologic analyses to show that patterns of CoV diversity correlate with those of bat diversity. This cements bats as the major evolutionary reservoirs and ecological drivers of CoV diversity. Co-phylogenetic reconciliation analysis was also used to show that host switching has contributed to CoV evolution, and a preliminary analysis suggests that regional variation exists in the dynamics of this process. Overall our study represents a model for exploring global viral diversity and advances our fundamental understanding of CoV biodiversity and the potential risk factors associated with zoonotic emergence.
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-18082073741152288332021-05-16T13:17:00.000-07:002021-05-16T13:17:01.228-07:00Remaining risks<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-3ldHsh1NN0s/YKF9I6c5pUI/AAAAAAACHMg/me1-IP7qZjU1Nip6Ijsn_H86GKi5c68CwCLcBGAsYHQ/s0/608846420da8f40018033bf1.jpg" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" data-original-height="517" data-original-width="1000" src="https://1.bp.blogspot.com/-3ldHsh1NN0s/YKF9I6c5pUI/AAAAAAACHMg/me1-IP7qZjU1Nip6Ijsn_H86GKi5c68CwCLcBGAsYHQ/s0/608846420da8f40018033bf1.jpg"/></a></div>
<h3>"The big risk unmasked, unvaccinated people are posing is to themselves."
<br />
<a href="https://www.bloomberg.com/opinion/articles/2021-05-15/the-cdc-s-new-mask-rules-just-follow-the-science"> Article here (Bloomberg).</a>
</h3>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-34051734252824826642021-02-27T01:28:00.006-08:002021-02-27T01:28:52.419-08:00The map is not the territory<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/--BpFtzGQuoI/YDoQlujgs8I/AAAAAAACHIc/5xSnuF3psAMoaHeDEE0Tr0T3VjNKEivrACLcBGAsYHQ/s1137/AImap.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="400" data-original-height="777" data-original-width="1137" src="https://1.bp.blogspot.com/--BpFtzGQuoI/YDoQlujgs8I/AAAAAAACHIc/5xSnuF3psAMoaHeDEE0Tr0T3VjNKEivrACLcBGAsYHQ/s400/AImap.png"/></a></div>
If consciousness is the territory, current AI is at best a partial map of that territory.
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-50217048229222238592021-02-24T22:29:00.000-08:002021-02-24T22:29:32.709-08:00Rare and Common Presentations and Conditions<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-eWQgdZsGbbM/YDdDY8G2duI/AAAAAAACHII/f_C3hh2Sd24poNCoM2N7iWoYtddB2muEQCLcBGAsYHQ/s2409/rare-from-news24com-infographic2.jpg" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" height="600" data-original-height="2409" data-original-width="1024" src="https://1.bp.blogspot.com/-eWQgdZsGbbM/YDdDY8G2duI/AAAAAAACHII/f_C3hh2Sd24poNCoM2N7iWoYtddB2muEQCLcBGAsYHQ/s600/rare-from-news24com-infographic2.jpg"/></a></div>
<b>Common presentations of rare conditions are more common than rare presentations of common conditions.<i></i></b>
<p>
What does the above even mean?
</p><p>
There are a very large number — thousands — of individually rare conditions. So even though any <i>single</i> given rare condition is only rarely seen, having <i>any rare condition whatsoever </i>is relatively common. On the other hand, there are a limited number of truly common conditions: the common cold, reactive depression, and back pain, for example.
</p><p>
<a href="https://www.genome.gov/FAQ/Rare-Diseases"> According to the geneticists, “A rare disease is generally considered to be a disease that affects fewer than 200,000 people in the United States at any given time. There are more than 6,800 rare diseases. Altogether, rare diseases affect an estimated 25 million to 30 million Americans.” </a>
</p><p>
If we consider a rare presentation of a common disease to be defined similarly, this would mean that this would likewise be about a 1 in 1500 presentation of a common condition. If 1/3 of the US population has at least one common condition at any given time, this means that about 100,000,000 persons in the US have a common condition; if 1/1500 had a rare presentation, this would in turn mean that there are only about 70,000 persons with rare presentations of common conditions per year. This is much less than the over 25,000,000 with a rare condition.
</p><p>
So it turns out that, based on prevalence data, the number of people with a rare but otherwise typical condition significantly outnumbers the number of people with only a rare presentation of one of the common conditions.
</p><p>
The anxious patient doing an unfortunate Internet search for their diagnosis may err because they choose a rare presentation of a rare condition over the common presentation of a common condition from which they suffer, and not because they find a rare condition that truly fits them best.
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-53137724564257206092021-02-08T00:15:00.001-08:002021-02-08T00:15:47.087-08:00The machine runs on: "The Machine Stops" by yearend in 2021, we hope?<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-eu2G92V-AE8/YCDxZ5qB0YI/AAAAAAACHHc/YKNjppqLtmoWjdMn-cjPDGbAfz3d-Jc0gCLcBGAsYHQ/s400/s-l400.jpg" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="320" data-original-height="400" data-original-width="400" src="https://1.bp.blogspot.com/-eu2G92V-AE8/YCDxZ5qB0YI/AAAAAAACHHc/YKNjppqLtmoWjdMn-cjPDGbAfz3d-Jc0gCLcBGAsYHQ/s320/s-l400.jpg"/></a></div>
<p>
If you've never read E. M. Forster's classic <em>The Machine Stops</em>, written when the telephone was cutting edge tech, 2021 is the year you should.
</p><p>
See <a href="https://en.wikisource.org/wiki/The_Machine_Stops"> this link: <h4>The Machine Stops</h4></a><br />
Let us not forget that social distancing is not social. Quarantine and related distancing is a necessary evil, and necessary evils are still, well, evil.
</p><p>
<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-V_F67f-7XkI/YCDv1wQSpSI/AAAAAAACHHE/YC81UmX72t4YTkFQ74J89Q5SyINeCYjJACLcBGAsYHQ/s1200/from_medium_com_quiztime.png" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="600" data-original-height="757" data-original-width="1200" src="https://1.bp.blogspot.com/-V_F67f-7XkI/YCDv1wQSpSI/AAAAAAACHHE/YC81UmX72t4YTkFQ74J89Q5SyINeCYjJACLcBGAsYHQ/s600/from_medium_com_quiztime.png"/></a></div>
</p></p>
The dysfunctions promoted by our isolation under fear of the coronavirus should not be permitted to outlast the need for isolation. There are far better solutions incoming, such as immunization.
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-52045521086573143482020-12-25T18:20:00.004-08:002020-12-25T18:20:44.335-08:00Sanbokan Marinade<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-sec_9_zPflg/X-abwtEGe_I/AAAAAAACHFA/gdU7t2RM60kbOSbXKn9ont8P7jpLzOK7gCLcBGAsYHQ/s2048/IMG_0452.JPG" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="600" data-original-height="1536" data-original-width="2048" src="https://1.bp.blogspot.com/-sec_9_zPflg/X-abwtEGe_I/AAAAAAACHFA/gdU7t2RM60kbOSbXKn9ont8P7jpLzOK7gCLcBGAsYHQ/s600/IMG_0452.JPG"/></a></div>
<p>
The Sanbokan lemon is an heirloom variety of mandarin/pomelo cross which makes a great marinade for meat in the style of the Japanese ponzu sauces. Note that, here in Hawaii at least, the Sanbokan fruit is at is juiciest just as it begins to turn from green to yellow, and gets only slightly sweeter, but much less juicy as it ripens to bright yellow.
</p><p>
<em>Ingredients:</em>
</p><p>
1 cup tamari (soy) sauce
</p><p>
1/2 cup Sanbokan lemon juice
</p><p>
2 teaspoons fresh ground pepper
</p><p>
4 cloves finely chopped garlic
</p><br /><p>
Marinade steaks or pork chops for at least 2 hours, turning about every 15 minutes. Grill meat on both sides (gas grill preferred).
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-79310933475851220022020-12-22T19:19:00.002-08:002020-12-22T19:20:28.541-08:00The BOMC<div class="separator" style="clear: both;"><a href="https://1.bp.blogspot.com/-wW1cSFb7c1s/X-K1gbxUhwI/AAAAAAACHEs/qHsMX0a9W54iQLPGxWVitIC0-eLdliPQgCLcBGAsYHQ/s2048/bomc.jpg" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" height="400" data-original-height="2048" data-original-width="1583" src="https://1.bp.blogspot.com/-wW1cSFb7c1s/X-K1gbxUhwI/AAAAAAACHEs/qHsMX0a9W54iQLPGxWVitIC0-eLdliPQgCLcBGAsYHQ/s400/bomc.jpg"/></a></div>
<p>
The BOMC Test is above. Originally developed by British psychiatrist Blessed as the Blessed Information-Memory-Concentration Test in the 1960's, and later shortened and validated with autopst neuropathological correlation as the Blessed Orientation-Memory-Concentration Test in the the 1980's, the BOMC test is seeing a lot more use in clinical neurology here these days.
</p><p>
Why? Of the commonly used standardized cognitive tests for dementia, including the Mini-Mental State Examination (MMSE) and Trump favorite Montreal Cognitive Assessment (MoCA), only the BOMC can be done without passing the patient a prepared piece of paper upon which to draw, copy, or write. The BOMC can be done purely over the video telemedicine conference line, no physical contact required!
</p><p>
The coronavirus epidemic has had many unforseen effects on 21st century medical practice, and the increase in our use of an older but fully validated tool because of an unforseen virtue for telemedicine is a quirky such effect.
</p><br /><p>
---------------------------------------------
</p><p>
Am J Psychiatry. 1983 Jun;140(6):734-9. doi: 10.1176/ajp.140.6.734.
</p><p>
Validation of a short Orientation-Memory-Concentration Test of cognitive impairment
</p><p>
Authors: R Katzman, T Brown, P Fuld, A Peck, R Schechter, H Schimmel
</p><p>
PMID: 6846631 DOI: 10.1176/ajp.140.6.734
</p><p>
Abstract
</p><p>
A 6-item Orientation-Memory-Concentration Test has been validated as a measure of cognitive impairment. This test predicted the scores on a validated 26-item mental status questionnaire of two patient groups in a skilled nursing home, patients in a health-related facility, and in a senior citizens' center. There was a positive correlation between scores on the 6-item test and plaque counts obtained from the cerebral cortex of 38 subjects at autopsy. This test, which is easily administered by a nonphysician, has been shown to discriminate among mild, moderate, and severe cognitive deficits.
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-89314038704987661772020-07-24T15:07:00.000-07:002020-07-24T15:08:22.527-07:00Friday music: Swift on the pandemic<p>From the 2020 album.<br /></p>
<p>
<iframe width="560" height="315" src="https://www.youtube.com/embed/DUnDkI7l9LQ" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe></p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-78321635242124690932020-04-16T05:19:00.002-07:002020-04-16T05:27:19.892-07:00Ono RecipeWe've had a big of mac nut collection from the front yard this season, as well as a few mangoes. The local fisherman still sells the days's catch from giant ice chests on the back of his truck a couple time a week. So, with a hat tip for the original recipe by <a href="http://gannonsrestaurant.com/about-bev/"> Bev Gannon of Maui</a>, here is a tasty recipe for cooking at home.
<br />
<br />
<br />
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><b>Mac Nut Rice Flour Crusted Ono</b></span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">Use a cast iron skillet for
frying and to hold baking fish.</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">Preheat oven to 425 degrees.</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><u>Ingredients</u></span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><u>Fish</u></span><span style="font-size: x-small;">:
2 lbs thick ono fillets</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><u>Sauce</u></span><span style="font-size: x-small;">:</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1/2 cup chopped fresh mango</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1/2 cup white wine or
grapes</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1/3 cup sugar</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1 tablespoon minced ginger</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1/4 cup lime juice</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">Bring to a boil, add 1/4 cup
sour cream and 1/4 cup butter, mix in blender.</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><u>Breading</u></span><span style="font-size: x-small;">:</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">Salt / pepper / garlic
seasoning</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1/2 cup macadamia nuts, whole
or pieces</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1 cup rice flour</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1/2 cup fresh basil (or other
green herb seasoning</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">Set seasoning aside for now. Grind nuts, flour, and herbs in blender until fully
mixed.</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><u>COOKING 1</u></span><span style="font-size: x-small;">: Coat fish with seasoning. Place ono skin side down in lightly oiled frying pan and lightly
fry skin side.</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><u>Undercoat</u></span><span style="font-size: x-small;">:</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">1/2 cup good-quality
mayonnaise</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">2 teaspoons Sriracha</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">Mix mayo and sriracha and
spread on the skinless side of ono fillets. </span>
</div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">Add rice flour mixture so that
the spicy mayo sticks the flour mixture to the ono fillets. </span>
</div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><u>COOKING 2</u></span><span style="font-size: x-small;">:
Flip ono flour side down in pan and brown flour side. </span>
</div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;"><u>COOKING 3</u></span><span style="font-size: x-small;">:
Transfer to hot (425 degrees) oven and bake for 8 </span>
</div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">minutes, then shut off oven,
vent, and allow fish to sit warmly in oven til time </span>
</div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">to serve (will finish cooking
during this time).</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<span style="font-size: x-small;">Serve flour side up with the
sauce to ladle as a gravy.</span></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<div align="left" class="western" style="line-height: 100%; margin-bottom: 0in;">
<br /></div>
<br />Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-74685253934432637482020-04-06T03:37:00.001-07:002020-04-07T02:19:29.218-07:00Covid-19 Modeling for the Big Island<p>Extrapolations, anyone? Here are some of mine (see bottom for sources):
</p><p>
<a href="https://1.bp.blogspot.com/-pL3Fi_T5n-4/XoxFb_4DqVI/AAAAAAACGqg/4aVnthT3EI4D9KIdZZA4AasZIf7fWWX5wCLcBGAsYHQ/s1600/covid-projections.png" imageanchor="1" ><img border="0" src="https://1.bp.blogspot.com/-pL3Fi_T5n-4/XoxFb_4DqVI/AAAAAAACGqg/4aVnthT3EI4D9KIdZZA4AasZIf7fWWX5wCLcBGAsYHQ/s640/covid-projections.png" width="640" height="427" data-original-width="600" data-original-height="400" /></a>
<a href="https://3.bp.blogspot.com/-VIMhVoQDQUQ/XosGXKmoZLI/AAAAAAACGqU/pavhvGPbSfEf_jYbgut1W7HliGHqkS5_gCLcBGAsYHQ/s1600/newplot.png" imageanchor="1" ><img border="0" src="https://3.bp.blogspot.com/-VIMhVoQDQUQ/XosGXKmoZLI/AAAAAAACGqU/pavhvGPbSfEf_jYbgut1W7HliGHqkS5_gCLcBGAsYHQ/s640/newplot.png" width="640" height="427" data-original-width="600" data-original-height="400" /></a>
</p><p>
<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231236"> HERE, from Plos One, is a good discussion of why extrapolations such as the above are often very wrong, just published last week:</a>
</p><p>
-----------------------------------------------------------------------------------------------
</p><p>
ABSTRACT
</p><p>
Forecasting the novel coronavirus COVID-19
</p><p>
Fotios Petropoulos ,Spyros Makridakis
</p><p>
Published: March 31, 2020https://doi.org/10.1371/journal.pone.0231236
</p><p>
Abstract
</p><p>
What will be the global impact of the novel coronavirus (COVID-19)? Answering this question requires accurate forecasting the spread of confirmed cases as well as analysis of the number of deaths and recoveries. Forecasting, however, requires ample historical data. At the same time, no prediction is certain as the future rarely repeats itself in the same way as the past. Moreover, forecasts are influenced by the reliability of the data, vested interests, and what variables are being predicted. Also, psychological factors play a significant role in how people perceive and react to the danger from the disease and the fear that it may affect them personally. This paper introduces an objective approach to predicting the continuation of the COVID-19 using a simple, but powerful method to do so. Assuming that the data used is reliable and that the future will continue to follow the past pattern of the disease, our forecasts suggest a continuing increase in the confirmed COVID-19 cases with sizable associated uncertainty. The risks are far from symmetric as underestimating its spread like a pandemic and not doing enough to contain it is much more severe than overspending and being over careful when it will not be needed. This paper describes the timeline of a live forecasting exercise with massive potential implications for planning and decision making and provides objective forecasts for the confirmed cases of COVID-19.
</p><p>
</p><p>
-----------------------------------------------------------------------------------------------
</p><p>
FOOTNOTE
<br /> <br /> <br /> The origin of the R0 of 0.1 in the curve above is based on the following analysis:
</p><p><pre>
# Simplistic Julia extrapolation model to fit world data totals
using LsqFit
const K = 7_800_000_000 # approximate world population
const n0 = 27 # starting at day 0 with 27 Chinese cases
""" The model for logistic regression with a given r0 """
@. model(t, r) = (n0 * exp(r * t)) / (( 1 + n0 * (exp(r * t) - 1) / K))
# Source: https://ourworldindata.org/coronavirus#all-charts-preview
# Daily world totals, including China and all countries
ydata = [
27, 27, 27, 44, 44, 59, 59, 59, 59, 59, 59, 59, 59, 60, 60,
61, 61, 66, 83, 219, 239, 392, 534, 631, 897, 1350, 2023,
2820, 4587, 6067, 7823, 9826, 11946, 14554, 17372, 20615,
24522, 28273, 31491, 34933, 37552, 40540, 43105, 45177,
60328, 64543, 67103, 69265, 71332, 73327, 75191, 75723,
76719, 77804, 78812, 79339, 80132, 80995, 82101, 83365,
85203, 87024, 89068, 90664, 93077, 95316, 98172, 102133,
105824, 109695, 114232, 118610, 125497, 133852, 143227,
151367, 167418, 180096, 194836, 213150, 242364, 271106,
305117, 338133, 377918, 416845, 468049, 527767, 591704,
656866, 715353, 777796, 851308, 928436, 1000249, 1082054,
1174652,
]
# The initial data is for 97 days starting with day 0 = 31 December 2019
tdata = collect(LinRange(0.0, 96, 97))
# starting approximation for r of 1/2
rparam = [0.5]
fit = curve_fit(model, tdata, ydata, rparam)
# Our answer for r given the world data and simplistic model
r = fit.param
println("The logistic r for the world data is: ", r)
println("The confidence interval at 5% significance is: ",
confidence_interval(fit, 0.05))
println("Since R0 is about exp(G * r), and G is about 12, R0 ≈ ", exp(12r[1]))
# Output:
# The logistic r for the world data is: [0.11230217572265622]
# The confidence interval at 5% significance is: [(0.11199074156706985, 0.11261360987824258)]
# Since R0 is about exp(G * r), and G is about 12, R0 ≈ 3.8482792820761063
</pre>
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-8667275441149928032020-03-21T21:49:00.001-07:002020-03-22T22:12:25.543-07:00Medical Isolationism in HawaiiHawaii puts all future entrants to the state on mandatory 14-day quarantine this season. This seems reasonable, as virtually all cases so far have been in visitors or, especially, residents who returned from trips away from the islands.
<br /><h3><a href="https://www.youtube.com/watch?v=LUG2xWq7w58&feature=emb_logo&start=134"> Here.</a></h3>
<p>
<br />
<a href="https://1.bp.blogspot.com/-yXMylcIdUvM/XnhEnnff4JI/AAAAAAACGoo/75bzRr2fi9IJMAIb87i-MymTQwHHQLAWQCLcBGAsYHQ/s1600/covid-19-airport-quarantine-poster-768x493.png" imageanchor="1" ><img border="0" src="https://1.bp.blogspot.com/-yXMylcIdUvM/XnhEnnff4JI/AAAAAAACGoo/75bzRr2fi9IJMAIb87i-MymTQwHHQLAWQCLcBGAsYHQ/s640/covid-19-airport-quarantine-poster-768x493.png" width="640" height="411" data-original-width="768" data-original-height="493" /></a>
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-27286067144832389802020-03-17T17:47:00.000-07:002020-03-17T18:01:35.021-07:00Plague Ship<a href="https://4.bp.blogspot.com/-BC_WFPO77sA/XnFvHm2zaHI/AAAAAAACGoU/9pHVVGUI5g0IFO_o1w7vzQ2bVP8LtijuwCLcBGAsYHQ/s1600/corona-diamond-princess-from%2Bwsj.jpg" imageanchor="1" ><img border="0" src="https://4.bp.blogspot.com/-BC_WFPO77sA/XnFvHm2zaHI/AAAAAAACGoU/9pHVVGUI5g0IFO_o1w7vzQ2bVP8LtijuwCLcBGAsYHQ/s640/corona-diamond-princess-from%2Bwsj.jpg" width="640" height="426" data-original-width="275" data-original-height="183" /></a>
<br /><p>
The Big Island has had its first confirmed SARS-CoV-2 case confirmed today: rumor has it that it was one of two visitors who jumped ship from the ill fated Diamond Princess cruise ship when it docked in Hilo about two weeks ago.
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-88760842832837352832020-03-14T01:39:00.001-07:002020-03-14T01:50:19.769-07:00LAVA: 24 seconds for hand washingWho would have thought that the chorus to <em>Lava</em> would make a good handwashing timing song? For your hand washing entertainment, here.
<iframe width="560" height="315" src="https://www.youtube.com/embed/e-vCNmJXnHM" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-45781707166700553862020-03-13T17:54:00.001-07:002020-03-13T19:02:32.844-07:00COVID TRIAGE IN ITALY, MARCH 2020<a href="https://3.bp.blogspot.com/-HAInQGyqMvk/XmwrE5AaZaI/AAAAAAACGoE/zfZr2tGRUFQppq6qFxaX3OwdpLAv3h1uwCLcBGAsYHQ/s1600/italy1000_1584060927_from_new_straits_times.webp" imageanchor="1" ><img border="0" src="https://3.bp.blogspot.com/-HAInQGyqMvk/XmwrE5AaZaI/AAAAAAACGoE/zfZr2tGRUFQppq6qFxaX3OwdpLAv3h1uwCLcBGAsYHQ/s640/italy1000_1584060927_from_new_straits_times.webp" width="640" height="425" data-original-width="900" data-original-height="598" /></a>
<p>
<em>The below is a translation of the official Italian document. Here is the original: </em><a href=”http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid19%20-%20Raccomandazioni%20di%20etica%20clinica.pdf ”> Italian PDF</a>
</p><p>
With current projections of the coronavirus epidemic (COVID-19) currently underway in some Italian regions, there are estimates of an increase in cases of acute respiratory failure in the next few weeks in many centers (with need for ICU admission) of such magnitude as to cause an enormous imbalance between the real clinical needs of the population and the actual availability of intensive resources.
</p><p>
It is a scenario where criteria for access to intensive care (and discharge) may be needed not only strictly according to clinical appropriateness and proportionality of care, but also inspired by shared criterions of distributive justice and appropriate allocation of resources under conditions of limited healthcare.
</p><p>
A scenario of this kind can be substantially assimilated to the field of "disaster medicine", for which ethical reflection has over time developed many concrete indications for doctors and doctors
nurses engaged in difficult choices. As an extension of the principle of proportionality of care, allocation in a context of a serious shortage of health resources must aim at guaranteeing intensive treatments to patients with greater chances of therapeutic success: it is therefore a matter of privileging the "greatest life expectancy ".
</p><p>
The need for intensive care must therefore be integrated with other elements of "clinical suitability" to intensive care, thus including: the type and severity of the disease, the presence of comorbidities, the impairment of other organs and systems and their reversibility. This means not necessarily having to follow a criterion for access to intensive care like "first come, first served". It is understandable that the carers, by culture and training, are not accustomed to reasoning with criteria of maxi-emergency triage, as the current situation has exceptional characteristics. The availability of resources does not usually enter the decision-making process and the choices of the individual case, until resources become so scarce as to not allow to treat all patients who they could hypothetically benefit from a specific clinical treatment. It is implicit that the application of rationing criteria is justifiable only after all the subjects involved (in particular the "Crisis Units" and the governing bodies of hospital facilities) have made all possible efforts to increase the availability of resources available (in particular, Intensive Care beds) and after any possibility of transfer of the patients to centers with greater availability of resources.
</p><p>
It is important that a change in access policies should be shared as much as possible among the operators involved. Patients and their families interested in applying the criteria must be informed of the extraordinary nature of the measures in place, due to a question of duty of transparency and maintenance of trust in the public health service.
</p><p>
The purpose of the recommendations is also to:
</p><p>
(A) to relieve clinicians from a part of responsibility in choices, which can be emotionally
burdensome, carried out in individual cases;
</p><p>
(B) to make the allocation criteria for healthcare resources explicit in a condition of their own
extraordinary scarcity.
</p><p>
From the information available now, a substantial part of subjects diagnosed with infection from Covid-19 requires ventilatory support due to interstitial pneumonia characterized by severe hypoxemia. Interstitial disease is potentially reversible, but the acute phase can last many days. Unlike more familiar ARDS cadres, with the same hypoxemia, Covid-19 pneumonia appears to have slightly better lung compliance and respond better to recruitment, medium PEEP, pronation cycles, inhaled nitric oxide. As for the most well-known paintings of habitual ARDS, these patients require protective ventilation, with low driving pressure.
</p><p>
All this implies that the intensity of care can be high, as well as the use of human resources. From the data reported for the first two weeks in Italy, about one tenth of infected patients require intensive care treatment with assisted ventilation, invasive or non-invasive.
</p><p>
<h3>RECOMMENDATIONS</h3>
</p><p>
1. Extraordinary admission and discharge criteria are flexible and can be adapted locally
the availability of resources, the real possibility of transferring patients, the number of accesses in progress or
expected. The criteria apply to all intensive patients, not only to patients infected with Covid-19 infection.
</p><p>
2. Allocation is a complex and very delicate choice, also due to the fact that an excessive increase
Extraordinary intensive beds would not ensure adequate care for individual patients and would distract
resources, attention and energy to the remaining patients admitted to Intensive Care. It is to be considered
also the foreseeable increase in mortality due to clinical conditions not linked to the ongoing epidemic,
due to the reduction of surgical and outpatient elective activity and the scarcity of intensive resources.
</p><p>
3. It may be necessary to place an age limit on entry into ICU. It is not a question of making choices merely of value, but to reserve resources that could be very scarce first, for those who are primarily more likely to survive and second, for those who can have more years of life saved, with a view to maximizing of benefits for most people.
</p><p>
In a scenario of total saturation of intensive resources, to decide to keep a criterion of "First come, first served" would still amount to choosing not to treat any subsequent patients that would be excluded from Intensive Care.
</p><p>
4. The presence of comorbidities and functional status must be carefully evaluated, in addition to age registry. It is conceivable that a relatively short course in healthy people will potentially become longer and therefore more resource consuming on the health service in the case of elderly, frail or disabled patients or in those with severe comorbidity.
</p><p>
The specific and general clinical criteria which can be particularly useful for this purpose can be seen in the 2013 multi-company SIAARTI document on major end-stage organ failure (https://bit.ly/2Ifkphd). It is also appropriate to refer also to the SIAARTI document relating to the admission criteria in intensive care (Minerva Anestesiol 2003; 69 (3): 101–118)
</p><p>
5. Care should be taken as to the possible presence of a living will previously expressed by the patients through any DAT (advance treatment provisions) and, in particular, any end-of-life preferences that may have already been expressed (by patients and their caregivers) by people who are have already gone through care planning in the case of prior chronic disease.
</p><p>
6. For patients for whom access to an intensive course is deemed "inappropriate", the decision to set a ceiling of care should be motivated, communicated and documented. The ceiling of care placed before mechanical ventilation must not preclude intensity of inferior care.
</p><p>
7. Any judgment of inappropriateness in accessing intensive care based solely on criteria of distributive justice (extreme imbalance between demand and availability) should find justification in the extraordinary nature of the situation.
</p><p>
8. In the decision-making process, if situations of particular difficulty and uncertainty arise, it can be useful to have a "second opinion" (possibly even by phone) from interlocutors of particular experience (for example, through the Regional Coordination Center).
</p><p>
9. The criteria for access to Intensive Care should be discussed and defined for each patient in the most possible way possible early, ideally creating in time a list of patients who will be deemed worthy of Intensive Care at the moment in which the clinical deterioration occurred, provided that the availability at that moment allow it.
</p><p>
Any “do not intubate” instruction should be present in the medical record, ready for be used as a guide if clinical deterioration occurs precipitously and in the presence of caregivers who have not participated in the planning and who do not know the patient.
</p><p>
10. Palliative sedation in hypoxic patients with disease progression is considered necessary as an expression of good clinical practice, and must follow existing recommendations. If there is a need for provision for a not short agonic period, a transfer to a nonintensive environment must be provided.
</p><p>
11. All accesses to intensive care must however be considered and communicated as an "ICU trial" and therefore undergo daily reassessment of appropriateness, goals of care and proportionality of care. If it is considered that a patient, perhaps hospitalized with borderline criteria, does not respond to prolonged initial treatment or is severely complicated by a decision by "Therapeutic desistance" and remodulation of intensive to palliative care - in a scenario of exceptionally high influx of patients - should not be postponed.
</p><p>
12. The decision to limit intensive care should be discussed and shared as collegially as possible of the treating team and - as far as possible - in dialogue with the patient (and family members), but must be able to be timely. It is foreseeable that the need to make choices of this type repeatedly will pay off in each stronger ICU the decision-making process is better adaptable to the availability of
resources.
</p><p>
13. ECMO support, as it is resource consuming compared to an ordinary ICU hospitalization, in conditions of extraordinary influx, should be reserved for extremely selected cases and with relatively rapid weaning forecast. It should ideally be reserved for hub centers at high volume, for which the patient in ECMO absorbs proportionately fewer resources than there are would absorb in a center with less expertise.
</p><p>
14. It is important to "network" through the aggregation and exchange of information between centers and individual professionals. When the working conditions allow it, at the end of the emergency, it will be important to dedicate time and resources to debriefing and monitoring any burnout professional and moral distress of operators.
</p><p>
15. Considerateness should be exercised for family members of those hospitalized in ICU with Covid-19, especially in cases in which the patient dies at the end of a total visit restriction period.
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-65931257211925340222020-01-26T00:58:00.003-08:002020-01-26T01:03:10.771-08:00On the Cooling of Humanity.<a href="https://4.bp.blogspot.com/-_VBASlLRnic/Xi1Uctk6tzI/AAAAAAACGnA/vzVVtWAiBpgUQyDsXPog584tk8xEgWixACLcBGAsYHQ/s1600/thermometer.png" imageanchor="1" ><img border="0" src="https://4.bp.blogspot.com/-_VBASlLRnic/Xi1Uctk6tzI/AAAAAAACGnA/vzVVtWAiBpgUQyDsXPog584tk8xEgWixACLcBGAsYHQ/s640/thermometer.png" width="320" height="301" data-original-width="1212" data-original-height="1141" /></a>
<p>
According to <a href="https://elifesciences.org/articles/49555"> this article, human body temperatures may be undergoing global cooling while our planet warms up!</a> Studies seem to indicate a downward trend in average body temperature of 0.03 C per decade -- about a degree F over the past 150 years. While small, this trend can be clinically significant, since it may mean that the range at which we decide a person has a fever may need to be changed downward.
</p><p>
What could be causing this trend? The authors of the study wonder if the incidence of inflammatory conditions has decreased. Since it is also clear that body weights and BMI have had a significant upward trend over the past century, I have another suggestion, based on <a href="https://europepmc.org/article/med/2759072">the study from 1989 below: the effect is due to the increase in overweight and obese contingents of the overall population.</a> At least some things about that are kind of cool.
</p><p>
ABSTRACT
</p><p>
-------------------------------------------------------------------------------------------------------------
</p><p>
Eur J Appl Physiol Occup Physiol. 1989;58(5):471-5.
</p><p>
Human body temperature is inversely correlated with body mass.
</p><p>
Adam K.
</p><p>
Abstract
</p><p>
Forty-two women and 18 men of mean age 54 years had their sub-lingual oral temperature measured hourly from 0700 h to 2300 h. Mean oral temperature (averaged over the 17 readings) was inversely correlated with body mass in the group as a whole (r = -0.44, df = 58, p = 0.0003). The women had significantly higher mean oral temperatures than the men, but the inverse relationship between mean oral temperature and body mass was still significant when the data from the women were analyzed separately (r = -0.37, df = 40, p = 0.013). The results suggest that in humans, mean body temperature is inversely related to body mass, irrespective of gender.
</p><p>
PMID: 2759072 DOI: 10.1007/bf02330699
</p>
Williamhttp://www.blogger.com/profile/12533263841520213358noreply@blogger.com0tag:blogger.com,1999:blog-1762538130881347660.post-47207185374776422592019-12-23T18:44:00.000-08:002019-12-23T18:54:54.323-08:00The nucleus papilio: a REM specific eye movement nucleus.<a href="https://3.bp.blogspot.com/--YaVrVW4qXQ/XgF6i2octYI/AAAAAAACGmY/ticog5NPXOkKVvBYKA7IpOBCn1tIWkpLwCLcBGAsYHQ/s1600/from_mcgill_ca_thebrain_site.jpg" imageanchor="1" ><img border="0" src="https://3.bp.blogspot.com/--YaVrVW4qXQ/XgF6i2octYI/AAAAAAACGmY/ticog5NPXOkKVvBYKA7IpOBCn1tIWkpLwCLcBGAsYHQ/s640/from_mcgill_ca_thebrain_site.jpg" width="640" height="253" data-original-width="500" data-original-height="198" /></a>
<p>
In mammals, the process of sleeping goes through stages of deepening sleep followed by shallower sleep. The
cycle repeats during sleep in humans about every 90 to 120 minutes, or about 4 or 5 cycles per night on average
during an eight-hour sleep period. At the shallowest phase of each cycle, mammals have a period of light sleep
accompanied by relaxation and stillness of the body, except for the eyes. The eyes in this sleep phase have rapid,
brief, nonrhythmic movements we call REM, for Rapid Eye Movements. <a href="https://www.webmd.com/sleep-disorders/sleep-101"></a>
The shallow sleep phase with REM is called REM sleep. Most dreaming in sleep in humans occurs during REM sleep.
</p><p>
During REM sleep, the body's muscles are kept relaxed due to action of the nucleus ceruleus in the pons of the
brainstem, which inhibits the spinal cord's motor neurons. Otherwise we might act out (with body motions)
our actions in our dreams.
</p><p>
The reason for REM remaining as eye movements while all other body motion is deactivated in sleep is not clear. One theory
I had thought likely (until the publication below) is that REM is just due to incomplete motor inhibition. In that
scenario, REM is just because the body does not specifically need to deactivate such eye movements, since eye movement
with eyes closed does not jeopardize safety as other body movements in sleep might.
</p><p>
But that theory about REM sleep seems much <em>less</em> likely in view of the new information about the REM-specificity of the
action of the cells of a small cluster of cells that make up the small nucleus papilio in the brainstem.
If the rapid eye movements in sleep were just due to dream actions, there would seem little reason to expect there to be a separate set of motor
neurons to maintain the movements of REM. The ordinary extraocular nuclei would be enough.
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Published: 19 November 2019
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Neurons in the Nucleus papilio contribute to the control of eye movements during REM sleep
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C. Gutierrez Herrera, F. Girard, A. Bilella, T. C. Gent, D. M. Roccaro-Waldmeyer, A. Adamantidis & M. R. Celio
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Nature Communications volume 10, Article number: 5225 (2019)
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Abstract
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Rapid eye movements (REM) are characteristic of the eponymous phase of sleep, yet the
underlying motor commands remain an enigma. Here, we identified a cluster of
Calbindin-D28K-expressing neurons in the Nucleus papilio (NPCalb), located in the
dorsal paragigantocellular nucleus, which are active during REM sleep and project
to the three contralateral eye-muscle nuclei. The firing of opto-tagged NPCalb
neurons is augmented prior to the onset of eye movements during REM sleep.
Optogenetic activation of NPCalb neurons triggers eye movements selectively
during REM sleep, while their genetic ablation or optogenetic silencing suppresses
them. None of these perturbations led to a change in the duration of REM sleep
episodes. Our study provides the first evidence for a brainstem premotor command
contributing to the control of eye movements selectively during REM sleep in the
mammalian brain.
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