Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 438 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Saturday, October 10, 2015

Researchers Say They’ve Recreated Part of a Rat Brain Digitally

In the article you can read about the naysayers whom obviously are not among the 10 million stroke survivors a year needing answers as to how the brain works.  I don't give a shit that this is a BHAG(Big Hairy Audacious Goal). If we don't put these goals out there we just plod along doing nothing.
Building on years of research, 82 researchers from institutions around the world reported Thursday that they had built a reconstruction of a section of a rat brain in a computer.
The research was partly supported by the Human Brain Project, a more than $1 billion, 10-year European research program. The report comes directly from the Blue Brain Project, which aims to reconstruct the rat brain and eventually the human brain in a computer.
Both research programs have been controversial. Hundreds of neuroscientists signed an open letter in 2014(naysayers here) criticizing both the overall project and the feasibility of the reconstruction goal.
Henry Markram, of the École Polytechnique Fédérale de Lausanne, who leads both projects, said that what he and his many colleagues had achieved was the first draft of a functioning map of 30,000 brain cells.
He said this was not yet a proof of principle that scientists could indeed reconstruct the human brain, which contains 85 billion or more neurons, but that it was a first step.
Cori Bargmann, co-director of the new Kavli Neural Systems Institute at Rockefeller University, who has been intimately involved with the Brain Initiative, also a long-term research program, said the report represented an “amazing tour de force” in its accumulation of data.
But, she said, the “simulations are in their infancy,” and therefore what this means for the larger goals of reconstructing a whole brain is unclear. “They built a 747, and it’s taxiing around the runway,” she said. “I haven’t seen it fly yet, but it’s promising.”
The reconstruction that Dr. Markram envisions is a research tool that would digitally encode some characteristics of neurons and their connections that are common to all brains. It is not the futuristic dream of uploading a human personality to a computer.
To build a digital version of the portion of rat brain, researchers did not record the details of every single cell. They used the data from some cells to inform what the whole would look like. Then they simulated certain kinds of brain activity and found that the reconstruction acted like the living tissue. All the data for the reconstruction will be available for other scientists.
The report, published in Cell, a scientific journal, is one of the longest neuroscience reports ever, and several neuroscientists declined to comment before publication because of the time required to evaluate it fully.

These Anxiety And Sleeping Drugs Linked to Dementia And Death - Benzodiazepines

Be careful out there.
But what about this research?
Benzodiazepines May Have Protective Effects Against Alzheimer Disease

And whom is putting all this research together into a stroke protocol? 

The latest here: 

These Anxiety And Sleeping Drugs Linked to Dementia And Death

Benzodiazepines carry an increased risk of dementia and even death.
Benzodiazepines include drugs marketed under the names Valium, Ativan, Klonopin and Xanax.
These drugs are often prescribed for anxiety and other mental health issues such as OCD, insomnia and post-traumatic stress disorder.
Research has now repeatedly linked these drugs to dementia and Alzheimer’s.
Dr Helene Alphonso, a psychiatrist and Director of Osteopathic Medical Education at Texas University, said:
“Current research is extremely clear and physicians need to partner with their patients to move them into therapies, like anti-depressants, that are proven to be safer and more effective.
Due to a shortage of mental health professionals in rural and underserved areas, we see primary care physicians using this class of drugs to give relief to their patients with psychiatric symptoms.
While compassionate, it’s important to understand that a better long-term strategy is needed.”

Many doctors admit difficulty in treating unexplained stroke: poll

More reasons why the complete stroke leadership team needs to be fired.  When I was a programmer and was handed a problem to solve I was NEVER allowed to come back with, 'It is unexplainable.' You do that enough times and you would be fired. There were times it took me 6 months to figure it out but I always managed to find the problem. I may not have been smart enough to fix the problem, but I found it. 200,000 failures a year and they are still employed?
My doctor supposedly found the cause of my stroke. A dissection of my right carotid artery. But I really have to question if he truly knew that. A later ultrasound revealed that that artery had completely closed up and the doctor at the time speculated that it would have been 80% blocked at the time of my stroke. My doctors never told me about such blockage or suggested any interventions, like maybe an endarterectomy. So I really have to question if they found that blockage at all. Looking at my medical records it is impossible to tell if they found such blockage, I would think they would tell the patient that you were at extreme risk for another stroke because such blockage has already proven to be unstable and that is why you were put on warfarin. But I was pretty much treated as a non-entity. It was appalling that I was not told anything about my CVA, not even what the hell a CVA was.
More than half of American doctors do not feel confident that they can spot the reason for a stroke that strikes in the absence of a clearly established cause.
The poll, conducted by the American Heart Association (AHA) and the American Stroke Association (ASA), involved more than 650 neurologists, cardiologists, hospitalists, and stroke coordinators.
The survey questions focused on the degree to which such medical professionals felt adequately informed about so-called "cryptogenic strokes," which are strokes that remain unexplained even after comprehensive testing.
"The ability to discern the causes of cryptogenic strokes has profound implications for preventing secondary strokes and improving patient outcomes," Dr. Mary Ann Bauman, chair of the American Stroke Association's advisory committee, said in an AHA/ASA news release.
Bauman added that improving current preparedness to handle such strokes is "likely to require educating and the scientific community about cryptogenic stroke, appropriate work-up, applicable studies and outcomes."
Bauman said that stroke is currently the fifth-leading cause of death in the United States, and a leading cause of severe and long-term disability.
Every year, about 200,000 Americans experience a that seems to elude explanation, the researchers added.
Possible underlying causes can include an intermittent and hard-to-detect irregular heartbeat (atrial fibrillation), a blood clot disorder and/or a hole in the heart's upper chambers, according to background information in the news release.
But the poll revealed that between 51 percent and 70 percent of the respondents do not feel confident that they know exactly which steps are best to take to be able to pinpoint exactly which cause might be at play for a particular patient.
The survey results were to be reported Friday at the AHA/ASA-sponsored Cryptogenic Stroke Public Health Conference, in Washington, D.C.
Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

Friday, October 9, 2015

Severity of skin psoriasis linked to blood vessel inflammation, cardiovascular risk

Be careful out there.
People with more psoriasis may also have more inflammation in theirblood vessels, according to research published in the American Heart Association journalArteriosclerosis, Thrombosis and Vascular Biology.
Psoriasis is a chronic inflammatory disease affecting about 3 percent of U.S. adults. It occurs when skin cells grow too quickly, resulting in thick white or red patches of skin.
Previous research suggests psoriasis may be linked with a higher risk of cardiac events and cardiovascular-related death. This may be the first study to examine whether psoriasis severity impacts inflammation in the blood vessels.
In the study, researchers analyzed 60 adults (average age 47) with psoriasis and 20 (average age 41) without psoriasis. All study participants were at low risk for cardiovascular disease based on a traditional risk assessment. They underwent a nuclear scan that measured blood vessel inflammation, and a dermatologist assessed the amount of psoriasis.
Researchers found:
  • Patients had psoriasis ranging from mild (only a few patches, less than 3 percent of the skin surface affected) to severe (when patches cover more than 10 percent of the skin surface).
  • Patients had high levels of inflammation in their blood vessels — even though they were at low risk for cardiovascular disease.
  • The most extensive forms of psoriasis were associated with a 51 percent increase in blood vessel inflammation.
  • The relationship between psoriasis and increased blood vessel inflammation didn’t change much after accounting for other heart disease risk factors.
“The most important observation we made was that the more psoriasis was on the skin, the more inflammation there was in the blood vessels,” said senior study author Nehal N. Mehta, M.D., M.S.C.E., a Lasker clinical investigator in the Cardiovascular and Pulmonary Branch of the National Heart, Lung, and Blood Institute in Bethesda, Maryland. “In other words, what we see on the outside is mirrored on the inside.”
The findings support the idea that the skin disease and cardiovascular disease may share an immune-related underlying mechanism, but doesn’t prove one causes the other.
“People who have psoriasis — particularly if it is severe — should be assessed by their doctor for cardiovascular risk factors, including diabetes, high cholesterol and obesity,” Mehta said. “They should also maintain an active lifestyle, avoid smoking and follow a balanced diet.”
Co-authors are Haley B. Naik, M.D., M.H.Sc.; Balaji Natarajan, M.D.; Elena Stansky, B.S.; Mark A. Ahlman, M.D.; Heather Teague, Ph.D.; Taufiq Salahuddin, B.S.; Qimin Ng, B.S.; Aditya A. Joshi, M.D.; Parasuram Krishnamoorthy, M.D.; Jenny Dave, M.S.; Shawn M. Rose, M.D., Ph.D.; Julia Doveikis, B.S.; Martin P. Playford, Ph.D.; Ronald B. Prussick, M.D.; Alison Ehrlich, M.D.; Mariana J. Kaplan, M.D.; Benjamin N. Lockshin, M.D.; and Joel M. Gelfand, M.D., M.S.C.E.
The NHLBI Intramural Research Program and National Psoriasis Foundation funded the study.
Additional Resources:

Neurotic People Have A Surprising Mental Advantage

If you want this advantage does your doctor have a protocol to deliver it and does s/he have the right to refuse your request?

Neuroticism and Long-Time Stress Linked to Alzheimer's in Women

 Neurotic People Have A Surprising Mental Advantage

High levels of creativity may go hand-in-hand with neuroticism, a new study finds.
It’s because the area of the brain which is linked to creativity also has the tendency to over-think things and worry.
Neuroticism is characterised by negative thinking in a range of areas (take the neuroticism test here).
For a long time neurotic people were thought to have a heightened perception to threat.
This doesn’t fit the facts, though, explains Dr Adam Perkins, the study’s first author, said:
“…it’s pretty difficult to explain neuroticism in terms of magnified threat perception because high scorers often feel unhappy in situations where there is no threat at all.
The second problem is, there’s literature showing neuroticism scores are positively correlated with creativity; and so why should having a magnified view of threat objects make you good at coming up with new ideas?”
The neuroscientists noticed, though, that neurotic people have high activity in part of the medial prefrontal cortex.

Feasibility of cardiopulmonary exercise testing and training using a robotics-assisted tilt table in dependent-ambulatory stroke patients

I'm sure the availability of these is extremely limited. But hey someone got a research paper published out of this.

Jittima Saengsuwan1234*, Celine Huber3, Jonathan Schreiber3, Corina Schuster-Amft13, Tobias Nef2 and Kenneth J. Hunt13
For all author emails, please log on.
Journal of NeuroEngineering and Rehabilitation 2015, 12:88  doi:10.1186/s12984-015-0078-5
Published: 26 September 2015



We evaluated the feasibility of an augmented robotics-assisted tilt table (RATT) for incremental cardiopulmonary exercise testing (CPET) and exercise training in dependent-ambulatory stroke patients.


Stroke patients (Functional Ambulation Category ≤ 3) underwent familiarization, an incremental exercise test (IET) and a constant load test (CLT) on separate days. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and real-time visual feedback to guide the exercise work rate was used. Feasibility assessment considered technical feasibility, patient tolerability, and cardiopulmonary responsiveness.


Eight patients (4 female) aged 58.3 ± 9.2 years (mean ± SD) were recruited and all completed the study. For IETs, peak oxygen uptake (V'O 2peak ), peak heart rate (HR peak ) and peak work rate (WR peak ) were 11.9 ± 4.0 ml/kg/min (45 % of predicted V'O 2max ), 117 ± 32 beats/min (72 % of predicted HR max ) and 22.5 ± 13.0 W, respectively. Peak ratings of perceived exertion (RPE) were on the range "hard" to "very hard". All 8 patients reached their limit of functional capacity in terms of either their cardiopulmonary or neuromuscular performance.
A ventilatory threshold (VT) was identified in 7 patients and a respiratory compensation point (RCP) in 6 patients: mean V'O 2 at VT and RCP was 8.9 and 10.7 ml/kg/min, respectively, which represent 75 % (VT) and 85 % (RCP) of mean V'O 2peak . Incremental CPET provided sufficient information to satisfy the responsiveness criteria and identification of key outcomes in all 8 patients.
For CLTs, mean steady-state V'O 2 was 6.9 ml/kg/min (49 % of V'O 2 reserve), mean HR was 90 beats/min (56 % of HR max ), RPEs were > 2, and all patients maintained the active work rate for 10 min: these values meet recommended intensity levels for bouts of training.


The augmented RATT is deemed feasible for incremental cardiopulmonary exercise testing and exercise training in dependent-ambulatory stroke patients: the approach was found to be technically implementable, acceptable to the patients, and it showed substantial cardiopulmonary responsiveness. This work has clinical implications for patients with severe disability who otherwise are not able to be tested.

Zombie Brains: The Neurological Processes Behind The Behavior Of The Undead

I do wish our neurologists would spend as much time analyzing stroke problems as non-existant zombies. Their priorities are screwed up.
Zombies and brains are inextricably linked. They go together like vampires and blood, or werewolves and the moon. Everyone knows that if the zombie apocalypse ever really hits, we’d have to protect our heads from becoming the next meal for an undead dude. Knowing that brains are a zombie’s favorite snack might be common knowledge, but what about what’s going on in their brains? What is it that makes them insatiably hungry, resistant to pain, and just cognitively,well, not right?
Unfortunately (or fortunately, really), scientists don’t have any real zombies to run tests on or interview about their current mental state — all we can do is hypothesize. But luckily, neurologists know the human brain well enough to guess what the not-so-real zombie brain might look like. Spoiler alert: It isn’t pretty.

Insatiable Hunger

Visual Recognition


Reactive-Impulsive Aggression

Zombies may not be upon us just yet, but when they do come, at least we know why they’re acting the way they are — not that it would help much.

More at link.

Ahead of Time: Researchers Learn How to Grow Old Brain Cells

I think I'd still rather have the younger version of brain cells grown for possible use in my brain.
For the first time, scientists can use skin samples from older patients to create brain cells without rolling back the youthfulness clock in the cells first. The new technique, which yields cells resembling those found in older people’s brains, will be a boon to scientists studying age-related diseases like Alzheimer’s and Parkinson’s.
“This lets us keep age-related signatures in the cells so that we can more easily study the effects of aging on the brain,” says Rusty Gage, a professor in the Salk Institute’s Laboratory of Genetics and senior author of the paper, published October 8, 2015 in Cell Stem Cell.
“By using this powerful approach, we can begin to answer many questions about the physiology and molecular machinery of human nerve cells–not just around healthy aging but pathological aging as well,” says Martin Hetzer, a Salk professor also involved in the work.
Historically, animal models–from fruit flies to mice–have been the go-to technique to study the biological consequences of aging, especially in tissues that can’t be easily sampled from living humans, like the brain. Over the past few years, researchers have increasingly turned to stem cells to study various diseases in humans. For example, scientists can take patients’ skin cells and turn them into induced pluripotent stem cells, which have the ability to become any cell in the body. From there, researchers can prompt the stem cells to turn into brain cells for further study. But this process–even when taking skin cells from an older human–doesn’t guarantee stem cells with ‘older’ properties.
“As researchers started using these cells more, it became clear that during the process of reprogramming to create stem cells the cell was also rejuvenated in other ways,” says Jerome Mertens, a postdoctoral research fellow and first author of the new paper.
Epigenetic signatures in older cells–patterns of chemical marks on DNA that dictate what genes are expressed when–were reset to match younger signatures in the process. This made studying the aging of the human brain difficult, since researchers couldn’t create ‘old’ brain cells with the approach.
Gage, Hetzer, Mertens and colleagues decided to try another approach, turning to an even newer technique that lets them directly convert skin cells to neurons, creating what’s called an induced neuron. “A few years ago, researchers showed that it’s possible to do this, completely bypassing the stem cell precursor state,” says Mertens.
The scientists collected skin cells from 19 people, aged from birth to 89, and prompted them to turn into brain cells using both the induced pluripotent stem cell technique and the direct conversion approach. Then, they compared the patterns of gene expression in the resulting neurons with cells taken from autopsied brains.

New research shows that stroke prevention guidelines are outdated and need modernising

No shit. And yet they don't provide any specific recommendations for diet and exercise changes that laypersons could follow. Don't these people think at all?
My suggestions here; My 11 Stroke risk reduction ideas.  Don't follow them, they are not medically proven. Or you could wait 50 years and maybe by then we'll have a useful stroke diet prevention guideline. Lots of people will die in that timeframe because we have NO strategy to address all the fucking problems in stroke.
Associate Professor Dr Anne Abbott, from the School of Public Health and Preventive Medicine (SPHPM) at Monash University, has led a team of 16 experts in a systematic review of international stroke prevention guidelines and found that recommendations for surgical procedures to prevent stroke are outdated and over-utilised.
Dr Abbott's findings, published this month in the American Heart Association journal Stroke, have significant implications for improved stroke prevention in all patients with narrowing of the main brain artery, known as , as well as others at risk.
"This research tells us that there is a great opportunity to improve best practice standards for for the benefit of many Australians and people overseas, as continues to be the single leading cause of death and disability in westernised countries," Dr Abbott said.
The study analysed 34 current guidelines from 23 regions in six languages and found that guidelines usually endorse carotid procedures (surgery and stenting) to remove narrowings of the internal carotid artery caused by fatty plaques, which are known as carotid stenosis.
"A major weakness of current Australian and international guidelines is that they over-encourage the use of costly carotid procedures which, for many patients, are currently more likely to harm than help. These procedural recommendations are based on studies in which patients were recruited up to three and a half decades ago and overlook the particular hazards of stenting.
"Current guidelines understate the value of modern medical treatment which has seen a drop in stroke rates of up to 80 per cent over the last 30 years," Dr Abbott said.
"Carotid procedures target one artery, while medical treatment helps prevent strokes and all other arterial disease complications because it targets the whole body. Medical treatment encourages healthy lifestyle habits and appropriate medications to reduce risk associated with common conditions, including high blood pressure, high cholesterol, smoking, inactivity, alcohol excess, illicit drugs, and diabetes," Dr Abbott said.
The research, funded by an independent grant from the Bupa Health Foundation and facilitated by the Alfred Hospital, also uncovered significant organisational problems across guidelines. These problems included incomplete definitions and numerous fundamental inconsistencies and omissions.
"Updating health policy and practice by changing the focus of care away from surgery or stenting to non-invasive strategies will better prevent and other complications of heart and arterial disease and this is important for public health and economically sustainable health services."
More information: Anne L. Abbott et al. Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis, Stroke (2015). DOI: 10.1161/STROKEAHA.115.003390

How the brain keeps time

If you have damage in this area, what exact stroke protocol does your doctor have to recover from this? Not just compensate. RECOVER!  Every single damaged area of the brain should have a stroke protocol on how to recover, not compensate.
Keeping track of time is critical for many tasks, such as playing the piano, swinging a tennis racket, or holding a conversation. Neuroscientists at MIT and Columbia University have now figured out how neurons in one part of the brain measure time intervals and accurately reproduce them.
The researchers found the lateral intraparietal cortex (LIP), which plays a role in sensorimotor function, represents elapsed time, as animals measure and then reproduce a time interval. They also demonstrated how the firing patterns of population of neurons in the LIP could coordinate sensory and motor aspects of timing.
LIP is likely just one node in a circuit that measures time, says Mehrdad Jazayeri, the lead author of a paper describing the work in the Oct. 8 issue of Current Biology.
“I would not conclude that the parietal cortex is the timer,” says Jazayeri, an assistant professor of brain and cognitive sciences at MIT and a member of the McGovern Institute for Brain Research. “What we are doing is discovering computational principles that explain how neurons’ firing rates evolve with time, and how that relates to the animals’ behavior in single trials. We can explain mathematically what’s going on.”
The paper’s senior author is Michael Shadlen, a professor of neuroscience and member of the Mortimer B. Zuckerman Mind Brain Behavior Institute at Columbia University.
As time goes by
Jazayeri, who joined the MIT faculty in 2013, began studying timing in the brain several years ago while a postdoc at the University of Washington. He began by testing humans’ ability to measure and reproduce time using a task called “ready, set, go.” In this experiment, the subject measures the time between two flashes (“ready” and “set”) and then presses a button (“go”) at the appropriate time — that is, after the same amount of time that separated the “ready” and “set.”
From these studies, he discovered that people do not simply measure an interval and then reproduce it. Rather, after measuring an interval they combine that measurement, which is imprecise, with their prior knowledge of what the interval could have been. This prior knowledge, which builds up as they repeat the task many times, allows people to reproduce the interval more accurately.
“When people reproduce time, they don’t seem to use a timer,” Jazayeri says. “It’s an active act of probabilistic inference that goes on.”
To find out what happens in the brain during this process, Jazayeri recorded neuronal activity in the LIP of monkeys trained to perform the same task. In these recordings, he found distinctive patterns in the measurement phase (the interval between “ready” and “set”), and the production phase (the interval between “set” and “go”).
During the measurement phase, neuron activity increases, but not linearly. Instead, the slope of activity begins as a steep curve that gradually flattens out as time goes by, until the “set” signal is given. This is key because the slope at the end of the measurement interval predicts the slope of activity in the production phase.
When the interval is short, the slope during the second phase is steep. This allows the activity to increase quickly so that the animal can produce a short interval. When the interval is longer, the slope is gentler and it takes longer to reach the time of response.
“As time goes by during the measurement, the animal knows that the interval that it has to produce is longer and therefore requires a shallower slope,” Jazayeri says.
Using this data, the researchers could correctly predict, based on the slope at the end of the measurement phase, when the animal would produce the “go” signal.
“Previous research has shown that some neurons exhibit a ramping up of their firing rate that culminates with the onset of a timed motor response. This research is exciting because it provides the first hint as to what may control the slope of this ‘neural ramping,’ specifically that the slope of the ramp may be determined by the firing rate at the beginning of the timed interval,” says Dean Buonomano, a professor of behavioral neuroscience at the University of California at Los Angeles who was not involved in the research.
“A highly distributed problem”
All cognitive and motor functions rely on time to some extent. While LIP represents time during interval reproduction, Jazayeri believes that tracking time occurs throughout brain circuits that connect subcortical structures such as the thalamus, basal ganglia, and cerebellum to the cortex.
“Timing is going to be a highly distributed problem for the brain. There’s not going to be one place in the brain that does timing,” he says.
His lab is now pursuing several questions raised by this study. In one follow-up, the researchers are investigating how animals’ behavior and brain activity change based on their expectations for how long the first interval will last.
In another experiment, they are training animals to reproduce an interval that they get to measure twice. Preliminary results suggest that during the second interval, the animals refine the measurement they took during the first interval, allowing them to perform better than when they make just one measurement.

Blind analysis: Hide results to seek the truth

This would be useful but right now stroke needs plain analysis as to what the hell needs fixing. Once we know the problems to solve we can put out requests for proposals to researchers and have them follow this type of blinding. But first we have to acknowledge that everything in stroke is fucking screwed up. And our stroke associations are not tackling any of the problems.
Decades ago, physicists including Richard Feynman noticed something worrying. New estimates of basic physical constants were often closer to published values than would be expected given standard errors of measurement1. They realized that researchers were more likely to 'confirm' past results than refute them — results that did not conform to their expectation were more often systematically discarded or revised.
To minimize this problem, teams of particle physicists and cosmologists developed methods of blind analysis: temporarily and judiciously removing data labels and altering data values to fight bias and error2. By the early 2000s, the technique had become widespread in areas of particle and nuclear physics. Since 2003, one of us (S.P.) has, with colleagues, been using blind analysis for measurements of supernovae that serve as a 'cosmic yardstick' in studies of the unexpected acceleration of the Universe's expansion3.
In several subfields of particle physics and cosmology, a new sort of analytical culture is forming: blind analysis is often considered the only way to trust many results. It is also being used in some clinical-trial protocols (the term 'triple-blinding' sometimes refers to this4), and is increasingly used in forensic laboratories as well.
But the concept is hardly known in the biological, psychological and social sciences. One of us (R.M.) has considerable experience conducting empirical research on legal and public-policy controversies in which concerns about bias are rampant (for example, drug legalization), but first encountered the concept when the two of us co-taught a transdisciplinary course at the University of California, Berkeley, on critical thinking and the role of science in democratic group decision-making. We came to recognize that the methods that physicists were using might improve trust and integrity in many sciences, including those with high-stakes analyses that are easily plagued by bias.

Many motivations distort what inferences we draw from data. These include the desire to support one's theory, to refute one's competitors, to be first to report a phenomenon, or simply to avoid publishing 'odd' results. Such biases can be conscious or unconscious. They can occur irrespective of whether choices are motivated by the search for truth, by the good mentor's desire to help their student write a strong PhD thesis, or just by naked self-interest5.
We argue that blind analysis should be used more broadly in empirical research. Working blind while selecting data and developing and debugging analyses offers an important way to keep scientists from fooling themselves.

Who knows what

Some forms of blinding are well known: for example, shielding both patients and clinicians from knowing who receives an experimental drug or a placebo (double-blinding), or removing names and affiliations from scientific manuscripts to keep peer reviewers from being swayed by authors' identities. But these practices apply to the collection and source of data, rather than the analysis.
“Blinding analyses could be as simple as asking a colleague to scramble labels.”
Blind analysis ensures that all analytical decisions have been completed, and all programmes and procedures debugged, before relevant results are revealed to the experimenter. One investigator — or, more typically, a suitable computer program — methodically perturbs data values, data labels or both, often with several alternative versions of perturbation. The rest of the team then conducts as much analysis as possible 'in the dark'. Before unblinding, investigators should agree that they are sufficiently confident of their analysis to publish whatever the result turns out to be, without further rounds of debugging or rethinking. (There is no barrier to conducting extra analyses once data are unblinded, but doing so risks bias, so researchers should label such further analyses as 'post-blind'.)
There are many ways to do blind analysis. The computer need not (and probably will not) be blinded to data values; it is the display of results that masks information. Techniques must obscure meaningful results while showing enough of the data's structure to allow researchers to find and debug measurement artefacts, irrelevant variables, spurious correlates and other problems. For example, researchers who analyse clinical-trial results without knowing which patients received a placebo should still be able to identify implausible values.
The best methods for blinding depend on the properties of the data (for example, the type of statistical distribution, lower and upper bounds, whether values are discrete or continuous and whether cases were randomly assigned to experimental conditions or passively observed). Both data values and labels can be manipulated to develop a suitable strategy (see 'Blinding strategies').

Thursday, October 8, 2015

3 ways to harness positive psychology for a more resilient you - Harvard Medical school

I consider myself pretty resilient. Your doctor or psychologist had better have a stroke protocol to help you have a positive psychology. If not they are fucking incompetent, which would be standard in stroke. In my opinion.
Some intriguing research suggests that positive psychology can help you weather the routine ups and downs of life and also build resilience for times of greater difficulty.
Here are three ways to capture the benefits of positive psychology.
Express gratitude. Gratitude is a thankful appreciation for what you have — from a roof over your head to good health to people who care about you. When you acknowledge the goodness in your life, you begin to recognize that the source of that goodness lies at least partially outside yourself. In this way, gratitude helps you connect to something larger than your individual experience — whether to other people, nature, or a higher power. Set aside a few minutes every day and think about five large or small things you're grateful for. Write them down if you like. Be specific and remember what each thing means to you.
Get your copy of Positive Psychology

Product Page - Positive Psychology
Positive emotions have been linked with better health, longer life, and greater well-being in numerous scientific studies. On the other hand, chronic anger, worry, and hostility increase the risk of developing heart disease, as people react to these feelings with raised blood pressure and stiffening of blood vessels. But it isn’t easy to maintain a healthy, positive emotional state. Positive Psychology: Harnessing the power of happiness, mindfulness, and inner strength is a guide to the concepts that can help you find well-being and happiness, based on the latest research.

Read More
Leverage your strengths. To reap the benefits of your strengths, you first need to know what they are. Unfortunately, according to a British study, only about one-third of people have a useful understanding of their strengths. If something comes easily to you, you may take it for granted and not identify it as a strength. If you are not sure of your strengths, you can identify them by asking someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
Certain strengths are most closely linked to happiness. They include gratitude, hope, vitality, curiosity, and love. These strengths are so important that they're worth cultivating and applying in your daily life, even if they don't come naturally to you.
Savor the "good." Most people are primed to experience the pleasure in special moments, like a wedding or a vacation. Everyday pleasures, on the other hand, can slip by without much notice. Savoring means placing your attention on pleasure as it occurs, consciously enjoying the experience as it unfolds. Appreciating the treasures in life, big and small, helps build happiness.
Multitasking is the enemy of savoring. Try as you might, you can't fully pay attention to multiple things. If you're scanning the newspaper and listening to the radio during breakfast, you're not getting the pleasure you could from that meal — or the newspaper or radio program. If you're walking the dog on a beautiful path but mentally staring at your day's to-do list, you're missing the moment.
For more information on drawing on your strengths and finding the positive meaning in your life, purchase Positive Psychology, a Special Health Report from Harvard Medical School.

Sandrine Thuret: You can grow new brain cells. Here's how

It has only been out there for 3 whole months. Has your doctor updated your neurogenesis stroke protocol yet? If not, you need to fire that doctor. S/he is incompetent.  What excuse is your doctor giving you for not following this?

Can we, as adults, grow new neurons? Neuroscientist Sandrine Thuret says that we can, and she offers research and practical advice on how we can help our brains better perform neurogenesis—improving mood, increasing memory formation and preventing the decline associated with aging along the way. 
My colleague Jonas Frisén from the Karolinska Institutet, has estimated that we produce 700 new neurons per day in the hippocampus.
And if we give antidepressants, then we increase the production of these newborn neurons, and we decrease the symptoms of depression, establishing a clear link between neurogenesis and depression.

Calorie restriction of 20 to 30 percent will increase neurogenesis. Intermittent fasting -- spacing the time between your meals -- will increase neurogenesis. Intake of flavonoids, which are contained in dark chocolate or blueberries, will increase neurogenesis.
How about sex? Oh, wow!  Yes, you are right, it will increase the production of new neurons. However, it's all about balance here. We don't want to fall in a situation -- about too much sex leading to sleep deprivation.

Well, I'm screwed in that last category and not literally.

Lyme Disease Is Now Linked To Stroke in 20-Year-Old G.I.

Many years ago I got the Lyme vaccine. The year after I got it they pulled it from distribution. Reasons here:
Vaccines against Lyme Disease: What Happened and What Lessons Can We Learn?
Very old data from 1990.
Two neurologists have reported that a 20-year-old man suffered a stroke as a result of meningitis brought on by Lyme disease. Eleven similar cases have been documented in Europe, they say.
In a report published yesterday in Stroke, a journal of the American Heart Association, the two neurologists at the Walter Reed Army Medical Center in Washington recommend that victims of inexplicable strokes be tested for Lyme disease.
''This is not the first time stroke has been linked to Lyme disease,'' said Dr. Eugene F. May, who, with Dr. Bahman Jabbari, wrote the report. ''But it is not a widely known syndrome.'' 

More at link

This Way of Socialising Cuts Depression Risk In Half - Face to face

This probably needs more research to see if this would have the same effect when socializing with other survivors. I know I really didn't feel like talking with other  stroke patients because I didn't know what to discuss. That was when I was still an introvert.

Wednesday, October 7, 2015

Stroke patients with spatial neglect more likely to fall and have longer stays in hospital

Well shit, and water is wet.  We'll see if they approve my comment. And I bet water is wet also. Were any solutions to this problem proposed?
Using the Kessler Foundation Neglect Assessment Process (KF-NAP), Kessler researchers found a high rate of spatial neglect among inpatients with stroke. Affected patients had a higher risk for falls, longer lengths of stay and lesser likelihood of returning home after discharge. "Impact of Spatial Neglect on Stroke Rehabilitation: Evidence from the Setting of an Inpatient Rehabilitation Facility" was published in the Archives of Physical Medicine & Rehabilitation (doi: 10.1016/j.apmr2015.03.019. The authors are Peii Chen, PhD, and A.M. Barrett, MD, of Kessler Foundation, and Kimberly Hreha, MS, and Yekyung Kong, MD, of Kessler Institute for Rehabilitation.
Of 108 stroke patients screened at admission with the KF-NAP, 68.4% had spatial neglect. This complication was more common and more severe after right brain stroke. "Higher KF-NAP scores were associated with lower FIM scores and prolonged recovery during rehabilitation," said Peii Chen, PhD, research scientist. "Falls were 6.5 times more likely in the group with spatial neglect and hospital stays were 10 days longer. Moreover, people with spatial neglect were 45% less likely to be discharged home. To lessen this negative impact on outcomes, screening for spatial neglect and specific early intervention are essential."
Kessler Foundation

Cancer Research UK invests £15 million to unite finest minds across UK to develop better treatments

The key point here is uniting the finest minds. In stroke nobody seems to want to attempt that. The WSO had their World Stroke Organization Synergium in 2010 and you can see why in my opinion it is totally worthless. You as a stroke survivor are totally screwed until the complete stroke leadership is deposed and removed from any part of this.
My list of finest minds:
Dr. Steven Wolf;
Peter Levine
Dr. S. Thomas Carmichael;
Dr. Bruce H. Dobkin;
Dr. Dale Corbett;
Dr. Michael Tymianski, of the Toronto Western Hospital Research Institute in Canada;
Dr. Michael A. Moskowitz ;
Dr. Watson, IBM computer;
Dr. Google;
Dr. Amy Shissler;
Barb Polan;
Jo Murphy;  
Rebecca Dutton
My list of those that should NOT be invited:
Dr. William M. Landau - his ideas on spasticity are appalling;
Matt Lopez, president of the NSA;
Dr. Mariel Jessup, president of the ASA;
WSO President - Steve Davis (Australia); 

Immediate Past-president WSO - Bo Norrving (Sweden)

Learning from "Super Agers": What Centenarians Can Teach Us About Aging Well

I'm going to be a super-ager. My Mom and Dad are already 85 and 88 and considering my health compared to theirs I will easily pass that even after having my stroke. I plan on having wine parties well into my nineties. Is your doctor doing anything to help you age well? Or is it , Die early, die young?
The number of centenarians is predicted to increase threefold over the next two decades. Examine what these "super agers" can tell us about aging, the health and well-being of older adults, and our understanding of dementia.
ELIZABETH KELSON is a postdoctoral fellow and sessional lecturer in the UBC School of Nursing.
This is a One Day @ UBC Centennial Lecture. As part of the UBC Centennial celebrations, UBC Continuing Studies is offering 20 free lectures on Saturdays at the UBC Point Grey campus from September 2015 through May 2016. Find out more.

Course Format

The format of this lecture is in-class.

Available Sessions

Open all | Close all
Oct 17-Oct 17, 2015 | Sat | 9:30am-12:00pm |UBC Point Grey | $0.00

For decades, the government steered millions away from whole milk. Was that wrong?

I have no idea. Your doctors and hospital nutritionists should be analyzing this and come up with a stroke diet protocol. No protocol, they should be fired. This pretty much proves the earlier post on research:

Editor In Chief Of World’s Best Known Medical Journal: Half Of All The Literature Is False

Tuesday, October 6, 2015

Soon we'll cure diseases with a cell, not a pill

This switch in thought processes can't come too soon for stroke. But I bet not a single stroke leader will think of putting this into practice for solving all the problems in stroke. Our current stroke leadership is non-existent. We should be growing all the different types of neurons along with a blood supply to nourish them. There is the request for proposal to researchers. Send it out to find out what the cost would be to find answers and then go grant writing to get foundations to pay for that research. It's so fucking simple to accomplish stroke solutions. You describe the problem in specific terms that researchers will be able to create clinical trials on. None of this pie-in-sky research.
Current medical treatment boils down to six words: Have disease, take pill, kill something. But physician Siddhartha Mukherjee points to a future of medicine that will transform the way we heal.

The Daily Chore That Can Increase Mental Stimulation and Decrease Anxiety - Mindful dishwashing

Sounds like something our doctors could initiate in the next couple of days. But I bet this will never occur.
When done properly, the chore decreased nervousness by 27% and increased mental inspiration by 25%.
Mindful dishwashing can decrease stress and calm the mind, a new study finds.
People in the study focused on the smell of the soap, the feel and shape of the dishes to help them enter a mindful state.
Doing the dishes in a mindful way also increased the pleasurable feeling of time slowing down, the researchers found.
Mr Adam Hanley, the study’s first author, said:
“I’ve had an interest in mindfulness for many years, both as a contemplative practitioner and a researcher.
I was particularly interested in how the mundane activities in life could be used to promote a mindful state and, thus, increase overall sense of well-being.”
In the study 51 people were split into two groups.
One group did the dishes in their normal way — most likely while letting their minds wander to the usual anxieties.
The other group were encouraged to focus on the sensory experience of washing the dishes.
The mindful group showed a 27% decrease in nervousness.
They also reported a 25% increase in mental inspiration.
This was an impressive result given that people were only washing dishes for six minutes.
The study’s authors write:
“It is interesting to note that a task potentially construed as unpleasant or a “chore” can be experienced as reducing nervousness and being inspirational by simply shifting one’s approach to the task and quality of attention.
That mindfulness practices elevate mindfulness, encourage positive affect, and decrease negative affect is well established; however, that these changes were associated with the coupling of a mindful practice with an everyday task is a novel finding.”


This first line is not occurring in stroke health care:
The crisis in stroke is simple; nothing is available or works. Our providers have been failing for so long they don't even know what the goal is. Only 19 pages that your hospital should be able to implement in the next 50 years. If you want it sooner you'll have to install your own stroke department head. 
What's the solution to the world's seemingly intractable health care crisis? It starts with a clear and achievable goal—better value—supported by an innovative strategy that's driven by the needs of patients, not providers. In this Harvard Business Review article, Harvard Business School Faculty Chair Michael Porter and his co-author outline such a strategy. They present a groundbreaking approach to high-value health care that focuses on six components: medical conditions, measurement of costs and outcomes, bundled pricing, integrated care delivery, geographically expanded service, and an enabling IT platform. 

Tired of Post-stroke Fatigue? - StrokeSmart magazine

Pretty much worthless. You doctors only effort in this seems to be testing for sleep apnea.
As a stroke survivor, you may be struggling with fatigue. That’s not surprising. Strokes are physically and emotionally exhausting. Most stroke survivors grapple with some sort of fatigue and many have trouble sleeping.
“Sleep has a great restorative function,” says Kyoung Bin Im, M.D., M.S, staff physician at University of Iowa Hospitals and Clinics’ Sleep Disorders Center and assistant professor of clinical neurology and psychiatry at Roy J. and Lucille A. Carver College of Medicine. “Stroke affects the brain itself—sleep may be even more important for stroke survivors.”
If you’re a stroke survivor and you never feel rested, consider these recommendations:
Wake up at the same time every morning.
Go to bed only when you are ready to fall asleep. “Bed time isn’t as important as the time you wake up. Don’t go to bed until you feel really ready,” Dr. Im says. “Lots of patients with insomnia go to bed too early in the evening.”
Don’t worry about the number of hours of sleep you’re getting. “There’s no right amount of sleep in terms of a number. In general, sleeping seven to nine hours is a really healthy duration,” Dr. Im says, adding some people need more and some need less. The key is whether you feel refreshed.
Talk to your doctor if you are tired and are having trouble sleeping, especially if you are snoring, gasping for breath, or waking up a lot. Obstructive sleep apnea is common in stroke survivors.
Avoid sleeping on your back. This can help with sleep apnea. “Sleeping on the side can make a huge difference,” Dr. Im says. Sleeping on the back may not be right for everyone. Ask your doctor if it’s OK for you.
Consider pillows. They are not just for your head. Using a body pillow can be helpful and keeping a pillow behind your back may help you stay on your side.
Get exposure to light in the morning. “It could be a natural source—sunlight—or a light box,” Dr. Im says. “That morning light will reset your time clock in the brain.”
If your primary care physician can’t solve your sleep challenges, Dr. Im suggests asking for a referral to a sleep specialist.
“Sleep is really important in restoring function back,” Dr. Im says.

8 Steps to Use Physical Therapy to Recover From a Stroke

Pretty damn worthless. Once again dumping all the recovery planning on the survivor.

Method 1 of 2: Using Physical Therapy While in the Hospital

1. Talk to your doctor.
2. Start moving as soon as you are directed to.

3. Discuss any disabilities with your doctors and medical staff.

4. Talk to your health insurance company about your benefits. 

Method 2 of 2: Using Physical Therapy After Discharge

1. Meet with your physical therapist to discuss goals and treatments. 

2. Follow the exercise program created by your physical therapist. 

3. Involve your family and close friends. 

4. Develop a regular schedule of physical therapy.
Details at link

Design of a biofeedback device for gait rehabilitation in post-stroke patients

I wonder if these earlier insole and sock versions are better? What does your doctor think? Do they really think negative reinforcement is a good idea?

  Sensoria™ Fitness Socks

Rapid Rehab Smart Insole Will Train Athletes and Assist Rehab Patients

 Design of a biofeedback device for gait rehabilitation in post-stroke patients

5 Author(s)
Khoo, I-Hung ; Electrical Engineering Department, California State University, Long Beach, 90840, United States ; Marayong, Panadda ; Krishnan, Vennila ; Balagtas, Michael Nico
more authors
A novel device, named ‘Walk-Even’, was developed to measure human gait and provide real-time feedback to correct gait asymmetry. Gait asymmetry is usually exhibited in patients with stroke or with certain neurological disorders. Our device can measure the weight pressure distribution that the patient exerts on each foot, in addition to the gait time, swing time, and stance time of each leg while walking. Based on the real time information, a biofeedback is given by means of auditory, and unpleasant electrotactile stimulation to actively correct gait asymmetry. The device consists of custom insoles with embedded force sensors adjustable to fit any shoe size, electrotactile and auditory feedback circuits, microcontroller, and wireless XBee transceivers. We compared the gait measurements from our device with that of a commercial device (MobilityLab) to verify its accuracy. Preliminary testing on post-stroke patients has shown that our device helps to improve their gait symmetry.

Published in:

Circuits and Systems (MWSCAS), 2015 IEEE 58th International Midwest Symposium on

Date of Conference:

2-5 Aug. 2015


Insole plantar pressure systems in the gait analysis of post-stroke rehabilitation

I wonder if these earlier insole and sock versions are better? What does your doctor think?

  Sensoria™ Fitness Socks

Rapid Rehab Smart Insole Will Train Athletes and Assist Rehab Patients


Insole plantar pressure systems in the gait analysis of post-stroke rehabilitation
3 Author(s)
Qin, Lai-yin ; Division of Biomedical Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong ; Ma, Hao ; Liao, Wei-Hsin
This article presents a review of the application of insole plantar pressure sensor system in recognition and analysis of the hemiplegic gait in stroke patients. Based on the review, tailor made 3D insoles for plantar pressure measurement were designed and fabricated. The function is to compare with that of conventional flat insoles. Tailor made 3D contour of the insole can improve the contact between insole and foot and enable sampling plantar pressure at a high reproducibility.

Published in:

Information and Automation, 2015 IEEE International Conference on

Date of Conference:

8-10 Aug. 2015