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Old 09-03-2017, 08:09 PM   #901
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Your sole mission is to make that client happy and satisfied.
This has never been my sole mission and I believe it is what separates CAM from medically necessary treatments.

My mission is to provide sound medical advice, education, and explanations of NMSK conditions to patients in a manner they can understand. Followed by advice, education, explanations, and demonstrations on how they can rehabilitate their condition. I hope to make them happy, I hope their pain decreases, I hope they leave satisfied, but none of these can be predicted or assured in any reliable fashion, so I will control what i can control and let the rest fall where it may.
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Old 10-03-2017, 12:13 AM   #902
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I'd prefer that mine were happy and satisfied, but with my demographic quite a few start crying and others get angry when they realise how much they need to do out of their comfort zone.
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Old 10-03-2017, 01:02 AM   #903
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Default Brain is Ten Times More Active Than Previously Measured

http://neurosciencenews.com/brain-ac...obiology-6224/

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A new UCLA study could change scientists’ understanding of how the brain works — and could lead to new approaches for treating neurological disorders and for developing computers that “think” more like humans.

The research focused on the structure and function of dendrites, which are components of neurons, the nerve cells in the brain. Neurons are large, tree-like structures made up of a body, the soma, with numerous branches called dendrites extending outward. Somas generate brief electrical pulses called “spikes” in order to connect and communicate with each other. Scientists had generally believed that the somatic spikes activate the dendrites, which passively send currents to other neurons’ somas, but this had never been directly tested before. This process is the basis for how memories are formed and stored.

Scientists have believed that this was dendrites’ primary role.

But the UCLA team discovered that dendrites are not just passive conduits. Their research showed that dendrites are electrically active in animals that are moving around freely, generating nearly 10 times more spikes than somas. The finding challenges the long-held belief that spikes in the soma are the primary way in which perception, learning and memory formation occur.

“Dendrites make up more than 90 percent of neural tissue,” said UCLA neurophysicist Mayank Mehta, the study’s senior author. “Knowing they are much more active than the soma fundamentally changes the nature of our understanding of how the brain computes information. It may pave the way for understanding and treating neurological disorders, and for developing brain-like computers.”
Sensory enrichment is badly needed in many of our patients whose conditions can make them feel walled off. Hence the popularity, in my opinion, of the spa type "treatments" beloved by so many of our colleagues.

I still use touch in order to cue, but much of what I do is via verbal interaction. I give them a guided tour around their sensorium. It should lead to self efficacy and empowerment, but unfortunately there is still the potential to enhance guru status.

A similar situation can arise in us if we fall for a charismatic presenter. Woe betide them though if we find out that they have feet of clay. We discount much of the valid material we have gleaned because we feel tainted and want to excoriate them, we blame them for our gullibility.

Which brings us back to the patient, are we really doing them any favours when we collapse their house of cards by dissing those they have seen before.

I prefer to point out that current knowledge moves on and that the canon changes with each new discovery. Most patients feel comfortable with this. Some presenters don't, the clever ones, rather than directly accusing their critics of "trolling", unleash their acolytes to do it for them.





Cracking the Brain’s Memory Codes

http://neurosciencenews.com/epilepsy-memory-codes-6818/

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In a pair of studies, scientists at the National Institutes of Health explored how the human brain stores and retrieves memories. One study suggests that the brain etches each memory into unique firing patterns of individual neurons. Meanwhile, the second study suggests that the brain replays memories faster than they are stored.
Update 03/06/2017
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Old 10-03-2017, 12:21 PM   #904
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Default Brain is 10 times more active than previously measured

https://www.sciencedaily.com/release...0309150634.htm



Quote:

The research is reported in the March 9 issue of the journal Science.

Scientists have generally believed that dendrites meekly sent currents they received from the cell's synapse (the junction between two neurons) to the soma, which in turn generated an electrical impulse. Those short electrical bursts, known as somatic spikes, were thought to be at the heart of neural computation and learning. But the new study demonstrated that dendrites generate their own spikes 10 times more often than the somas.

The researchers also found that dendrites generate large fluctuations in voltage in addition to the spikes; the spikes are binary, all-or-nothing events. The somas generated only all-or-nothing spikes, much like digital computers do. In addition to producing similar spikes, the dendrites also generated large, slowly varying voltages that were even bigger than the spikes, which suggests that the dendrites execute analog computation.

"We found that dendrites are hybrids that do both analog and digital computations, which are therefore fundamentally different from purely digital computers, but somewhat similar to quantum computers that are analog," said Mehta, a UCLA professor of physics and astronomy, of neurology and of neurobiology. "A fundamental belief in neuroscience has been that neurons are digital devices. They either generate a spike or not. These results show that the dendrites do not behave purely like a digital device. Dendrites do generate digital, all-or-none spikes, but they also show large analog fluctuations that are not all or none. This is a major departure from what neuroscientists have believed for about 60 years."

Because the dendrites are nearly 100 times larger in volume than the neuronal centers, Mehta said, the large number of dendritic spikes taking place could mean that the brain has more than 100 times the computational capacity than was previously thought.

Recent studies in brain slices showed that dendrites can generate spikes. But it was neither clear that this could happen during natural behavior, nor how often. Measuring dendrites' electrical activity during natural behavior has long been a challenge because they're so delicate: In studies with laboratory rats, scientists have found that placing electrodes in the dendrites themselves while the animals were moving actually killed those cells. But the UCLA team developed a new technique that involves placing the electrodes near, rather than in, the dendrites.


Dynamics of cortical dendritic membrane potential and spikes in freely behaving rats

http://science.sciencemag.org/content/355/6331/eaaj1497

http://biorxiv.org/content/biorxiv/e...96941.full.pdf

INTRODUCTION
Quote:
Neurons are large, tree-like structures with extensive, branch-like dendrites spanning >1000 μm, but a small ~10-μm soma (figure). Dendrites receive inputs from other neurons, and the electrical activity of dendrites determines synaptic connectivity, neural computations, and learning. The prevailing belief has been that dendrites are passive; they merely send synaptic currents to the soma, which integrates the inputs to generate an electrical impulse, called an action potential or somatic spike, thought to be the fundamental unit of neural computation. These ideas have not been directly tested because traditional electrodes, which puncture the dendrite to measure dendritic voltages in vitro, do not work in vivo due to constant movement of the animals that kills the punctured dendrites. Hence, the voltage dynamics of distal dendrites, constituting the vast majority of neural tissue, is unknown during natural behavior.
Update 15/04/2015



A Little Inhibition Shapes the Brain’s GPS
http://neurosciencenews.com/inhibiti...l-cortex-6373/

Researchers from King’s College London have discovered a specific class of inhibitory neurons in the cerebral cortex which plays a key role in how the brain encodes spatial information. The findings are published in the journal Nature Neuroscience.

The cerebral cortex, the brain’s outer layer, is responsible for many complex brain functions, such as thought, movement, perception, learning and memory. It is a complex, highly organised, structure, whose function relies on vast networks containing two main groups of nerve cells, or neurons: pyramidal neurons and interneurons. Neurons communicate with each other through chemical and electrical signals that can be excitatory (activating) or inhibitory (deactivating), depending on their class: Pyramidal cells are excitatory neurons whilst interneurons are inhibitory. Importantly, due to their great diversity, interneurons are uniquely placed to orchestrate the activity of neural networks in multiple ways. Understanding the function of specific classes of cortical interneurons is therefore one of the main challenges of contemporary neuroscience.

Previous studies have shown that a special type of cortical interneurons, called basket cells, exerts a strongly inhibitory effect on brain circuits. However, their specific contribution to the function of cortical circuits has remained elusive. In their new study, the researchers reveal that one of the main classes of basket cells plays a key role in how the brain represents and remembers our environment, called spatial information coding.

The multidisciplinary team of researchers from the Centre for Developmental Neurobiology (CDN) at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), and the MRC Centre for Neurodevelopmental Disorders (MRC CNDD), found that a particular class of basket cells does not function properly in the absence of a protein called ErbB4, making and receiving fewer connections with other neurons. They also found that the disruption of the connectivity of these cells during brain development causes alterations in brain oscillatory activity and disturbs the function of place cells, a type of pyramidal neuron that becomes active when an animal is located in a particular place in its environment. These developmental defects in the wiring of neural circuits cause very selective alterations in spatial learning and memory in adult mice. Together, these results uncover a novel role for interneurons in the coding of spatial information in mice.

‘Our work emphasises the high level of functional specialisation that exist among different classes of neurons in the cerebral cortex. This study also exemplifies how relatively subtle developmental changes in neural circuits have a major impact in function and behaviour in adults’, said Professor Oscar Marín, senior co-author of the study and Director of the MRC CNDD and the CDN at King’s College London.

my bold



Update 12/04/2017
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Old 10-03-2017, 03:58 PM   #905
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Default Moving Toward Understanding Consciousness

http://www.npr.org/sections/13.7/201...ntent=20170305

Following on from posts #855 and #894

Quote:
If you stop and think about it, the idea that you could understand a complex system by detailed description of one its parts is crazy on the face of it.

You are unlikely to get too much insight into the principles organizing flocking behavior in birds by confining your attention to what is going on inside an individual bird. And you aren't very likely to figure out how birds fly in the first place by studying properties of the feather.
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Old 11-03-2017, 04:10 AM   #906
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Default Long-lasting antinociceptive effects of green light in acute and chronic pain in rats.

https://www.ncbi.nlm.nih.gov/pubmed/...?dopt=Abstract

Abstract
Quote:
Treatments for chronic pain are inadequate, and new options are needed. Nonpharmaceutical approaches are especially attractive with many potential advantages including safety. Light therapy has been suggested to be beneficial in certain medical conditions such as depression, but this approach remains to be explored for modulation of pain. We investigated the effects of light-emitting diodes (LEDs), in the visible spectrum, on acute sensory thresholds in naive rats as well as in experimental neuropathic pain. Rats receiving green LED light (wavelength 525 nm, 8 h/d) showed significantly increased paw withdrawal latency to a noxious thermal stimulus; this antinociceptive effect persisted for 4 days after termination of last exposure without development of tolerance. No apparent side effects were noted and motor performance was not impaired. Despite LED exposure, opaque contact lenses prevented antinociception. Rats fitted with green contact lenses exposed to room light exhibited antinociception arguing for a role of the visual system. Antinociception was not due to stress/anxiety but likely due to increased enkephalins expression in the spinal cord. Naloxone reversed the antinociception, suggesting involvement of central opioid circuits. Rostral ventromedial medulla inactivation prevented expression of light-induced antinociception suggesting engagement of descending inhibition. Green LED exposure also reversed thermal and mechanical hyperalgesia in rats with spinal nerve ligation. Pharmacological and proteomic profiling of dorsal root ganglion neurons from green LED-exposed rats identified changes in calcium channel activity, including a decrease in the N-type (CaV2.2) channel, a primary analgesic target. Thus, green LED therapy may represent a novel, nonpharmacological approach for managing pain.
What goes around comes around, there was interest in this as far back as the 1930s, possibly before. Should we be getting our patients into green lenses?
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Old 12-03-2017, 02:36 PM   #907
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Default Why do humans reason? Arguments for an argumentative theory

http://www.dan.sperber.fr/wp-content...mansreason.pdf

Abstract:
Quote:
Reasoning is generally seen as a means to improve knowledge and make better decisions. However, much evidence shows that reasoning often leads to epistemic distortions and poor decisions. This suggests that the function of reasoning should be rethought. Our hypothesis is that the function of reasoning is argumentative. It is to devise and evaluate arguments intended to persuade. Reasoning so conceived is adaptive given the exceptional dependence of humans on communication and their vulnerability to misinformation. A wide range of evidence in the psychology of reasoning and decision making can be reinterpreted and better explained in the light of this hypothesis. Poor performance in standard reasoning tasks is explained by the lack of argumentative context. When the same problems are placed in a proper argumentative setting, people turn out to be skilled arguers. Skilled arguers, however, are not after the truth but after arguments supporting their views. This explains the notorious confirmation bias. This bias is apparent not only when people are actually arguing, but also when they are reasoning proactively from the perspective of having to defend their opinions. Reasoning so motivated can distort evaluations and attitudes and allow erroneous beliefs to persist. Proactively used reasoning also favors decisions that are easy to justify but not necessarily better. In all these instances traditionally described as failures or flaws, reasoning does exactly what can be expected of an argumentative device: Look for arguments that support a given conclusion, and, ceteris paribus, favor conclusions for which arguments can be found.
Keywords: argumentation; confirmation bias; decision making; dual process theory; evolutionary psychology; motivated reasoning; reason-based choice; reasoning

via @kvenere

Kinda wish I had printed this before reading , it would have been easier on the fingers.
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Old 12-03-2017, 02:59 PM   #908
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Default Why Reality Is Not A Video Game — And Why It Matters

http://www.npr.org/sections/13.7/201...why-it-matters

Quote:
Last week, Adam Gopnik of The New Yorker published a satirical essay, in which he wondered whether the strange reality we live in could be some kind of computer game played by an advanced intelligence (us in the future or alien).

His point was that if it is, the "programmers" are messing up, given the absurdity of current events: the incredible faux-pas at the Oscars, where the wrong best picture was announced; Donald Trump, the most outsider president ever elected in U.S. history; the strange comeback by the New England Patriots at the Super Bowl. These events, claims Gopnik, are not just weird; they point to a glitch in the "Matrix," the program that runs us all.

For most people trying to make a living, pay bills or fighting an illness, to spend time considering that our reality is not the "real thing" but actually a highly-sophisticated simulation sounds ridiculous. Someone close to me said, "I wish smart people would focus on real world problems and not on this nonsense." I confess that despite being a scientist that uses simulations in my research, I tend to sympathize with this. To blame the current mess on powers beyond us sounds like a major cop out.



Neuroscience Explanations For ‘Alien Abduction’ Aren’t So Out of This World

http://neurosciencenews.com/alien-ab...oscience-6666/

Quote:
The theory that alien abductions are hoaxes may be true in a few cases, but there is no reason to assume that the majority of “experiencers” are frauds. In fact, psychologists have come up with a number of plausible, scientific explanations for people’s supposed alien encounters.

Personality traits

One explanation is that when people believe they have had an experience of alien abduction, they have misinterpreted, distorted and conflated real and imagined events. Hence, sceptics of alien encounters explain them away in terms of psychological processes and personality characteristics.

Several studies report that experiencers do not typically differ from non-experiencers on objective psychopathological measures – those that assess psychological well-being and adjustment – and have no history of mental instability. However, one characteristic that is associated with abduction experiences is a proclivity for fantasy.

Mixed evidence supports the theory that fantasy-prone people engage in elaborate imaginings and often confuse fantasy with reality. There are also other psychological explanations, such as dissociation – where an individual’s mental processes detach from each other and from reality, often in response to extreme or stressful life events. A tendency towards being fantasy-prone and dissociation has been linked in studies to childhood trauma and hypnotic suggestibility.
Quote:
Psychologists argue that hypnosis encourages the creation and recall of detailed fantasies. For example, Betty and Barney Hill’s account was typical of reported alien encounters: medical examinations or procedures, communication with alien captors, a powerful, mystical feeling, tours of spaceships and journeys to other planets before being returned to the car. And it was under hypnosis that these “missing memories” were “recovered”.

It’s for these reasons that it’s believed alien abduction experiences may arise from a combination of personality characteristics and susceptibility to false memories.

Brain sensitivity

Studies suggest that neuropsychological theories, particularly sleep paralysis and temporal lobe sensitivity, also could explain claims of alien abduction.

Sleep paralysis is a feeling of being conscious but unable to move, which occurs when a person passes between stages of wakefulness and sleep.

Experiencers’ claims share characteristics with sleep paralysis: a sense of being awake, not dreaming, and realistic perceptions of the environment. The inability to move, a feeling of fear or dread, and the sense of another presence – perhaps evil or malevolent – are common symptoms. Also common are a feeling of pressure on the chest and difficulty breathing, and of being held or restricted to a lying position: most sleep paralysis attacks occur while the individual is lying on their back.

Sceptic Michael Shermer once collapsed from sleep deprivation following an 83-hour bike race and his support team rushed to his aid. Shermer was caught in a “waking dream” and so perceived them as aliens from the 1960s television series The Invaders. It also explains some ghost sightings, such as the “night hag”, often experienced by those who suffer from sleep paralysis.

Temporal lobe sensitivity is a theory that suggests the temporal lobes of some people’s brains are more vulnerable to influence from low-level magnetic frequencies. Michael Persinger, a neuroscientist at Laurentian University in Canada, is among those who believes that increased temporal lobe activity can explain paranormal experiences such as alien abduction. His theory is that magnetic fields stimulate the temporal lobes, resulting in hallucinatory experiences similar to those reported by alien abductees.

None of this is to say that many people who believe they have experienced alien abduction are liars, merely that their accounts and experiences can be explained through recourse to theories with a scientific basis. There are many logical, plausible scientific explanations, none of which rely upon the existence of aliens. However, it should also be noted that not all reported alien abduction experiences can be easily explained by any of these scientific theories – and this throws up many more questions.
Update 12/05/2017
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Old 12-03-2017, 03:19 PM   #909
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Default What Makes Science Science?

http://www.npr.org/sections/13.7/201...cience-science
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Old 13-03-2017, 03:17 PM   #910
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Default Spine Surgeon Gets Almost 20-Year Prison Sentence for Fraud

http://www.medscape.com/viewarticle/874210

Quote:
Aria Sabit, MD, a spinal surgeon who admitted to unnecessary as well as fake operations, was sentenced today to a prison term of 235 months — almost 20 years — in a federal district court in Detroit, Michigan.

Federal prosecutors had sought a long sentence for the 43-year-old surgeon to deter other Detroit-area physicians from committing fraud.

"As this court is well aware, the Eastern District of Michigan has a particular problem with corrupt physicians willing to sell their licenses and judgment in pursuit of personal gain, sometimes at the expense of their patients," prosecutors told US District Judge Paul Borman in a sentencing memorandum in 2015. "In the past six years, more than 60 doctors in this district have been charged with misuse and abuse of their licenses in a variety of healthcare fraud, drug distribution, and/or kickback cases."
via @SimonGandevia

There will always be those who use a qualification in health care as a licence to maximise income. One of my interview questions decades ago was "Would you feel compelled to do this work if you weren't being paid for it?" I doubt that I'd be allowed to ask it nowadays.
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Old 14-03-2017, 12:53 PM   #911
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Default The body is the missing link for truly intelligent machines

https://aeon.co/ideas/the-body-is-th...55567-69418129

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It’s tempting to think of the mind as a layer that sits on top of more primitive cognitive structures. We experience ourselves as conscious beings, after all, in a way that feels different to the rhythm of our heartbeat or the rumblings of our stomach. If the operations of the brain can be separated out and stratified, then perhaps we can construct something akin to just the top layer, and achieve human-like artificial intelligence (AI) while bypassing the messy flesh that characterises organic life.

I understand the appeal of this view, because I co-founded SwiftKey, a predictive-language software company that was bought by Microsoft. Our goal is to emulate the remarkable processes by which human beings can understand and manipulate language. We’ve made some decent progress: I was pretty proud of the elegant new communication system we built for the physicist Stephen Hawking between 2012 and 2014. But despite encouraging results, most of the time I’m reminded that we’re nowhere near achieving human-like AI. Why? Because the layered model of cognition is wrong. Most AI researchers are currently missing a central piece of the puzzle: embodiment.
Ectodermalists may wish to avert their eyes.


It’s the body, stupid by Tim Cocks
https://noijam.com/2017/03/22/its-the-body-stupid/

Quote:
Embodied approaches to minds and conscious experience seem to be a perfect fit for therapists of any stripe that touch others in attempts to alleviate pain.
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Old 14-03-2017, 02:58 PM   #912
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Old 14-03-2017, 10:31 PM   #913
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Default Doctor knows best....by Dave Nicholls

http://criticalphysio.net/2017/03/15/doctor-knows-best/

Quote:
Not so long ago, physiotherapists had a very close, perhaps paternalistic, relationship with the medical profession. But it seems now that our quest for professional autonomy is pushing us further away from physicians and surgeons. There are few in the profession, I think, that would dispute the obvious benefits of greater independence for physiotherapists, but this is a critical ideas blog, so I’m going to do just that.

Physiotherapy has, for much of its history, been wedded to medicine. Indeed, the modern physiotherapy profession only survived and later prospered because its founders made subservience to medicine a condition of entry. Memberhip of the Society of Trained Masseuses (STM) – formed in 1894 and the forerunner of all physiotherapy professional bodies around the world – required that everyone sat the STM’s stringent examination. Doing so cost a lot of money and effort, at a time when anyone could practice as a masseuse with just half-a-day’s training. So why did people submit to the Society’s exam? The answer is that the STM had secured the patronage of many esteemed medical men, so that members of the Society could be assured of legitimate ‘health’ cases to treat, and could distance themselves from quacks and prostitutes (see Nicholls and Cheek, 2006).

Medical patronage served the profession well during both World Wars; the epidemics, economic depressions and medical advanced of the inter-war years; and the birth of the welfare state, but by the 1970s, people within the profession wanted more control over their own professional affairs. Moving training from national health budgets into higher education and the growth of profession-specific research hastened the separation, and now, today, physiotherapy finds itself at something of a crossroads.
Quote:
Certainly moves to ‘share’ in the work of medicine (as in this, for example), illustrate that physiotherapists still see themselves as primarily biomechticians (a new word I think I might have just invented). So perhaps now might be a good time to rethink our separatist agenda, and look to our past to find new ways to align ourselves with biomedicine in order that we can secure the profession’s future for the next century or more?
The example above refers to one of the British physiotherapists who is doing orthopaedic surgical proceedures, It's good that those who want to can take this route.

It isn't for me and never was.

Had I been able to cope with managers I would still be working within the NHS. As it is, I spend much of my time mopping up patients who have fallen through the cracks in the protocols provided by the service. Thousands of pounds of tax payers money have been spent and key features of uncomplicated clinical presentations have been missed, leading to delays in getting people moving and loading.



The future for physiotherapy education
http://criticalphysio.net/2017/03/21...apy-education/

Quote:
Lets assume, for a moment, that only our most modest predictions for the effects of new digital technologies, bodily enhancements, robotic technologies and advances in augmented reality come true, and that lots of our customary ways of thinking and being remain unchanged over the next half century.

If we only see a moderate increase in people’s use of the Internet as their primary source of health knowledge, and only a few people experience radical changes to their rehabilitation, home care and specialised healthcare, then we are still looking at a significantly different future for physiotherapy than we have today.

So what will even some of the most modest changes mean for the ways people come to learn about physiotherapy? Here are some thoughts:
Update 02/04/2017




Should we give up physiotherapy?....... by Dave Nicholls

https://criticalphysio.net/2017/04/2...physiotherapy/


Quote:
One of the biggest dilemmas facing the physiotherapy profession today is how to keep it alive.

Given the unrelenting pressures to reform, cut costs, and redesign practice, it’s hard to know whether to push the profession’s stability, history and established culture, or to promote a radical new professional image.

And faced with healthcare innovations that seem to be dissolving old certainties, it’s hard to know whether we like it or not.

Imagine, for instance, that robots were shown to be more reliable manipulators than physios, or that a low-cost assistant could do the work of post-op respiratory physiotherapy just as well as an expensively trained clinician. Would we promote it?

In some instances, like this recent trial by a ‘short-stay rehab unit based at a Nottingham care home’ that ‘managed to cut 90-day hospital readmission rates to just five per cent’, it would seem a relatively easy choice. Of course its good that patients spend less time in hospital! But maybe the decision is made easier by the fact that it promotes the idea that more physiotherapy is a good thing. It argues that physiotherapy is a worthy and necessary thing to have and that service improvements came because of the specific physiotherapy intervention, not despite it.

We have a much harder time supporting interventions that replace physiotherapy, however. Even when they do things better. In this respect physiotherapy is just as ‘political’ as any other vested interest, and it is far from objective. Most people who have invested time and passion into becoming a physiotherapist will work hard to perpetuate what they’ve established. But is this necessarily in the interests of our patients, or the health service at large?

Evidence-based practice has been a powerful way for physiotherapists to try and demonstrate that what they do matters, but ironically, there is little evidence that EBP itself is making any difference to the perceptions of our patients, our peers or our funders.

Perhaps the answer is to see the difference between the objectivity needed to make the right clinical decisions, and the totally biased, passionately subjective, deeply invested conviction that what physiotherapists do matters and is worth fighting for?

The fundamental question seems to me to be this: if it were in the best interests of patients or the healthcare system as a whole, for us to disestablish physiotherapists, would we do it?

This, as much as anything else in current debates surrounding the profession, seems to me to be the biggest dilemma facing the physiotherapy profession today.

No.

There are many doing it well and their praises are undersung. I am thinking of those who work in trauma and orthopaedics, neuro and vestibular rehab, and complex pain. Not to mention care of the elderly and medical wards. No doubt there is much I have left out of this list.

I would not be sorry to see the demise of those who have created an industry which has encouraged the worried well to become infantalised. Very occasionally I ask a patient what advice their great grand parent would have given them and am told "They would have told me to stop whining and get on with it". Very British!

I find the rise and rise of the industry ludicrous as well as those wannabees who allow people to refer to them as physios, when they hold a massage or sports therapy qualification.

As for those who want to be celebrities, I suggest that they try reality TV.

Update 20/04/2017




Assault and battery


https://criticalphysio.net/2017/05/2...t-and-battery/

Quote:
A report in The New York magazine last week speculated on the likelihood that President Trump might die in office because he is one of the least active presidents in human history (link).

How, you might ask, has this got anything to do with physiotherapy?

Well, the President of the United States, it seems, holds a view about the body, and the detrimental effects of exercise, that was popularised by some of the same 19th century physicians that made physical therapy popular.

It seems President Trump ‘considers exercise misguided, arguing that a person, like a battery, is born with a finite amount of energy’ (link).

There’s a lovely historical overview in The Guardian about this rather arcane notion, and in it we’re reminded of the powerful idea that underpinned much of the physical medicine that was the forerunner of our practices today.

In the late 19th century, electrotherapy devices like Galvanic and Faradic batteries were used to restore people’s lost energy: the reason we talk about people feeling galvanised, charged up or run down today, for example. Energy could be lost through mental work, and women were especially vulnerable because so much energy was needed for procreation, that all other forms of mental activity – even from early childhood – were frowned upon.

It is well understood now that such notions were thinly veiled attempts to subjugate an entire gender, concealed beneath the veneer of paternalistic care. Such attitudes were more than just quaint affectations, and many had profoundly serious effects on the wellbeing of thousands of women.

Hysteria disease and neurasthenia – two of the primary conditions treated by early physiotherapists in Britain and America – primarily affected women, and people like John Harvey Kellogg (of Cornflake and Battle Creek Sanitarium fame) and Silus Weir Mitchell (perhaps America’s foremost 19th century neurosurgeon), were pioneers of treatments that supposedly restored women to full health.

Pivotal in Weir Mitchell’s treatment regime, known as the Rest Cure, were the passive modalities (massage, passive movements, and electrotherapy) delivered by early nurse/masseuses. And these modalities endured for the larger part of the 20th century.

Galvanism and, to a lesser extent, Faradism were still being taught in physiotherapy schools into the 1960s, even though they had long since been used for other things than depleting lost nervous energy. But it seems that ideas about our bodies being stores for certain quantities of nerve ‘force’ may be harder to shake off.

We should be careful not to be fooled again into thinking that such seemingly benign ideas are not smoke screens for more pernicious and dangerous thoughts and practices.
I find the current attitude amongst some of my patients bemusing, in that they will go for mainstream evidence based practice when something is really "wrong" and straight back to very strange alternative therapies once they stop being frightened. The alternative practitioners tell better stories, have lights, smells and music in their rooms and usually do an hour or more of social grooming.

Perhaps I shouldn't be bemused, my patients see "wellness" methods as a good preventative. I was asked recently to look at a set of exercises someone had been given to "open up his chakras", they were rather good, and they made the patient feel "better in himself".

Maybe the March For Science did some good, Londoners seemed to like it, except for those whose journeys were disrupted by the road closures.

I was considered by many to be a duff parent for failing to take my child to Disneyland. She finally got to go recently with some of her service users and was very impressed by the quality of the gloves provided to her by the housekeeping department when one of her guys needed a major clean up and change of clothing.

Update 23/05/2017




Physio Will Eat Itself

https://rogerkerry.wordpress.com/201...ll-eat-itself/

Quote:
I suppose this is about change. We might be doing ourselves irreparable damage you know, as a profession. I just read Dave Nicholls’s Should we give up physiotherapy? , and I just saw Kettlebell Physio Neil Meigh’s Facebookey Livey thingy, and I’ve been concerned about the de-commissioned physiotherapy services in Nottingham and been interested in the proliferation of “myth busting” initiatives (all good stuff BTW, except for the de-commisioning) and wondered about a tone and trend being witnessed within the profession, perhaps best exemplified by posts like this:


So naughty! You'll have to click the link to read

I once wondered whether I should wash Adam Meakins' mouth out with soap and water for being a Sweary Mary but who'd have thought that the above would emerge from someone who looked as innocent as the Milky Bar Kid when he first started out as a presenter.



I particularly liked this..........

Quote:
The issue is, I think, one of professional identity, and what this means for the people we serve. The increasingly active dialogues which happen within the profession (perhaps the SoMe Echo Chamber is the best example, although these dialogues do occur elsewhere) are forever encouraging us to think, challenge our own beliefs, reflect, and progress.
Update 26/04/2017

The SoMe Echo Chamber eh? Well, if he is referring to these boards, he could be right. There are dissident voices, but many become exhausted and leave. Some delete their accounts, which leaves a skewed perspective of what has happened here in terms of trying to move the debate in directions other than those dictated and enforced by the prevailing opinion of the North American contingent and their acolytes.

Addendum. There is a site called SoMe, I haven't been able to find it.

Update 03/06/2017

SOcial MEdia.......... goodness this one has been bugging me!

Update 17/06/2017




New physiotherapy – 7 ways to change the world

https://criticalphysio.net/2017/04/2...nge-the-world/

Quote:
I read something about critical theory this morning that made me think about a couple of recent posts on the future of physiotherapy. In the piece, the author was taking critical theorists to task for attempting to ‘demystify’ the social world without proposing solutions. People, she argued, want attractive alternatives and a sense that utopia, or at least the hope of a better life, might be possible.

This is a powerful argument that I don’t entirely agree with, but it did make me think about Roger Kerry’s recent blogpost ‘Physio will eat itself’, which followed my own question of whether we would disestablish physiotherapy as a profession if it were in the best interests of patients or the healthcare system as a whole (Link).

Critiquing the systems and structures, objects and subject positions that make up today’s healthcare system is a vital function of critically-minded health professionals, especially where those same structures and systems get in the way of meaningful and effective care. But we should also think about how things might be ‘otherwise’, and open spaces for new ideas.

This doesn’t mean prescribing the solution, since the value of any idea depends on how and where it’s taken up, how it’s used and adapted, and how it’s perceived. But there’s nothing wrong in greasing the wheels of change, if it can help. So, following Nir Eyal’s adage that ‘People don’t want something truly new, they want the familiar done differently’ (Link), here are some ideas for ways we might all think physiotherapy ‘otherwise’:



Adam Meakins
Quote:
We simply have try to educate, encourage, enthuse, motivate, support, cajole our patients to do the hard stuff until its not hard anymore.
From this......

That’s what I SAID…
https://thesports.physio/2017/04/25/thats-what-i-said/

So apt, on so many levels, I have posted it elsewhere.

So what is it about a physiotherapist that empowers patients, rather than eliciting a "meh" response. Some patients will see through a guru figure, but they won't notice a seamless approach that enables them to find what they need within themselves.

Update 26/04/2017




The case for ‘caring activism’

https://criticalphysio.net/2017/05/0...ring-activism/

Quote:
Peter Limbrick’s Caring Activism argues the case for what he calls ‘a new concept of care I am proposing for vulnerable people in this 21st Century’ (13). Limbrick identifies that some countries are experiencing reductions in funds for public services while numbers of vulnerable people continue to rise. In the United Kingdom, a ‘dramatic reduction in support available’ from public agencies means that increasing numbers of vulnerable people are falling through the safety nets. He points, in particular, to teenagers in care homes, elderly people living at home and refugees.

Limbrick suggests that a potential response to this lies, not in further burdens on overstretched statutory agencies, but in the power of a concerned citizenry. He envisages what he calls caring activism, ‘a concept relying on citizens holding particular beliefs about rights and responsibilities and about the sort of world they want to create for this and future generations’ (35).

Many of our patients are as vulnerable as those highlighted in the book, and so it probably follows that many of the points made about the need for caring activism are as valid in the Stroke Unit, per se, as they are in the care home.

So I’m interested in Librick’s argument that the statutory agencies can’t be asked to do more, and that we need other ‘agencies’ to step up. (Here I’m assuming that ‘statutory agencies includes profession’s like physiotherapy).

My reading of this is that he sees a much bigger role for non-traditional providers of healthcare in the coming years, and a much broader umbrella of services offering what used to be much more centralised. As always, the primary driver of change appears to be economics, and the perception that our historically-established model of orthodox healthcare is becoming increasingly unaffordable.

Caring activism could be a good thing then, because it might make care more affordable to vulnerable populations (people in long-term pain, infirm elderly, people with long-term disabilities, etc.). By the same token, it might rely on registered professionals to ‘share’ their competencies with others and diminish their social capital.

Following on from the post thread over the last week or so, it waits to be seen, therefore, whether physiotherapists will see the emergence of democratising processes like caring activism as a good or bad thing: an opportunity or a threat.
Update 02/05/2017
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Old 15-03-2017, 12:56 PM   #914
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Default U.K. scientists prepare for impending break with European Union

http://www.sciencemag.org/news/2017/...et_cid=1216040



Quote:
For months after the United Kingdom voted last June to leave the European Union, many British scientists clung to hopes of a “soft Brexit,” which would not cut them off from EU funding and collaborators. But Prime Minister Theresa May, who is expected to trigger the 2-year process of exiting the European Union in coming days, has signaled the break will be sharp. U.K. researchers are now facing up to the prospect that they won’t be able to apply for EU funding or easily recruit students and colleagues from the rest of Europe.
Quote:
The stakes are high for the United Kingdom, which is a scientific powerhouse and a magnet for talent. Between 2007 and 2013, U.K. researchers brought home more than €7 billion in EU research funding, second only to Germany. Cash from Brussels made up nearly 10% of research funding at U.K. universities in 2013, an increase of 68% since 2009. The United Kingdom’s prominence as an international hub was made clear this week when a new analysis of mobility of high-skill professionals, published in the Journal of the Royal Society Interface, found that the country was four times more highly networked than the average for Europe.



Terrorism or Brexit?’


UK science, post-Brexit
http://science.sciencemag.org/conten...6331/1243.full

Quote:
However the Article 50 negotiations play out, the message should be unwavering: The UK remains a fantastic place to do research, and will continue to play its part in the collaborative networks that are so vital to 21st-century science.
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Old 15-03-2017, 10:05 PM   #915
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Default Changing pain thresholds with classical conditioning

http://www.bodyinmind.org/pain-thres...ody+in+Mind%29
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Old 16-03-2017, 08:40 AM   #916
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Default Preventing opioid-induced nausea and vomiting: Rest your head and close your eyes?

http://journals.plos.org/plosone/art...l.pone.0173925

Quote:
Nausea during remifentanil administration was triggered by movement and avoided by rest in all subjects independently of visual input. This suggests that vision is not the major cause for an inter-sensory mismatch with semicircular canal input during head motion.

Remifentanil reversibly affects vestibulo-ocular reflex function, as measured by the VOR gain of the horizontal semicircular canals [9,10]. This altered information could clash with neck proprioception or other vestibular sensory information. An intra-vestibular mismatch between reduced horizontal semicircular canals [9] and not accordingly altered otolith signals seems likely. Such an intra-vestibular mismatch is acknowledged as a causative factor for seasickness (for review, see Bertolini&Straumann, 2016 [16]) and also seems to provoke space sickness where altered otolith signals in weightlessness clash with regular semicircular canal input.
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Old 16-03-2017, 09:02 AM   #917
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Default Is the headache in patients with vestibular migraine attenuated by vestibular rehabilitation?

http://journal.frontiersin.org/artic...00124/abstract

Quote:
Background: Vestibular rehabilitation is the most effective treatment for dizziness due to vestibular dysfunction. Given the biological relationship between vestibular symptoms and headache, headache in patients with vestibular migraine (VM) could be improved by vestibular rehabilitation that leads to the improvement of dizziness. This study aimed to compare the effects of vestibular rehabilitation on headache and other outcomes relating to dizziness, and the psychological factors in patients with VM patients, patients with dizziness and tension-type headache, and patients without headache.
Methods: Our participants included 251 patients with dizziness comprising 28 patients with VM, 79 patients with tension-type headache, and 144 patients without headache. Participants were hospitalized for 5 days and taught to conduct a vestibular rehabilitation program. They were assessed using the Dizziness Handicap Inventory (DHI), Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale (HADS), and Somatosensory Catastrophizing Scale (SCSS), and underwent center of gravity fluctuation measurement as an objective dizziness severity index before, 1 month after, and 4 months after their hospitalization.
Results: The VM and tension-type headache groups demonstrated a significant improvement in the HIT-6 score with improvement of the DHI, HADS, SCSS, and a part of the objective dizziness index that also shown in patients without headache following vestibular rehabilitation. The change in HIT-6 during rehabilitation in the VM group was positively correlated with changes in the DHI and anxiety in the HADS. Changes in the HIT-6 in tension-type headache group positively correlated with changes in anxiety and SCSS.
Conclusions: Vestibular rehabilitation contributed to improvement of headache both in patients with VM and patients with dizziness and tension-type headache, in addition to improvement of dizziness and psychological factors. Improvement in dizziness following vestibular rehabilitation could be associated with the improvement of headache more prominently in VM compared with comorbid tension-type headache.
Keywords: Vestibular Diseases, Migraine Disorders, Rehabilitation, Treatment, vestibular rehablitation, headache impact, dizziness handicap

I find this interesting in that I have rarely been able to affect the nature of migraine pain although patients have found reduction in vestibular symptoms and frequency of migraine episodes helpful.
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Old 16-03-2017, 09:21 AM   #918
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Default Dynamic Shaping of the Defensive Peripersonal Space through Predictive Motor Mechanisms: When the “Near” Becomes “Far”

http://www.jneurosci.org/content/37/...ampaign=buffer

Abstract

Quote:
The hand blink reflex is a subcortical defensive response, known to dramatically increase when the stimulated hand is statically positioned inside the defensive peripersonal space (DPPS) of the face. Here, we tested in a group of healthy human subjects the hand blink reflex in dynamic conditions, investigating whether the direction of the hand movements (up-to/down-from the face) could modulate it. We found that, on equal hand position, the response enhancement was present only when the hand approached to (and not receded from) the DPPS of the face. This means that, when the hand is close to the face but the subject is planning to move the hand down, the predictive motor system can anticipate the consequence of the movement: the “near” becomes “far.” We found similar results both in passive movement condition, when only afferent (visual and proprioceptive) information can be used to estimate the final state of the system, and in motor imagery task, when only efferent (intentional) information is available to predict the consequences of the movement. All these findings provide evidence that the DPPS is dynamically shaped by predictive mechanisms run by the motor system and based on the integration of feedforward and sensory feedback signals.

SIGNIFICANCE STATEMENT The defensive peripersonal space (DPPS) has a crucial role for survival, and its modulation is fundamental when we interact with the environment, as when we move our arms. Here, we focused on a defensive response, the hand blink reflex, known to increase when a static hand is stimulated inside the DPPS of the face. We tested the hand blink reflex in dynamic conditions (voluntary, passive, and imagined movements) and we found that, on equal hand position, the response enhancement was present only when the hand approached to (and not receded from) the DPPS of the face. This suggests that, through the integration of efferent and afferent signals, the safety boundary around the body is continuously shaped by the predictive motor system.
via @neuroconscience
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Old 17-03-2017, 02:31 AM   #919
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Default Stories from neuroanatomy: ascending thoracic nerve roots

https://noijam.com/2017/03/17/storie...c-nerve-roots/
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Old 17-03-2017, 05:58 PM   #920
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Default Posts awaiting moderation.............................

won't stop me reading


Update 24.03.17

It has happened in the past that a user name, rather than posts from certain journals has triggered automatic moderation. I have had nothing back via the Contact Us button. Having lost a few posts which makes it difficult to curate subject threads, I won't be posting again until I know more.



31.03.17

A fortnight down the line Contact Us has not contacted me, but some of you have been in contact asking if I have been "blocked". The answer is that I can't be sure, but I don't think so.

I haven't made any new posts as these seemed to trigger automatic moderation especially if I posted a paper.

During the last couple of days, I have had no trouble editing my existing posts and experimentally posting relevant papers into them and I plan to continue this over the few months it will take to read the threads, to which I haven't yet got around .


There is no Plan B.

Twitter doesn't appeal, and I have no current plans for a blog. I hope to do a bit more on iCSP once they have done the upgrade.

I am very touched that this thread has had over 2,700 views in the last two weeks and that my other threads continue to be read and used for CPD. I have made friends here and had the enormous pleasure of meeting some of you.

I doubt that I will find a better user interface anywhere and would encourage lurkers to give it a go, just for the pleasure of finding out what you can do with it.




There may be one near you.

https://www.eventbrite.co.uk/e/londo...ts-32229648747
Quote:
On 22 April the London March for Science will go forward from the Science Museum to Parliament Square. Scientists and science supporters will march in solidarity with colleagues in the US and over 420 locations around the world as a massive, diverse, non-partisan, and celebratory demonstration of public support for science that highlights challenges facing the scientific community and will act as a catalyst for ongoing public action around specific issues.
ALL ARE WELCOME!
On eve of science march, planners look ahead

Quote:
As the 22 April March for Science in Washington, D.C., and some 400 sister marches around the world approach, march organizers are already looking toward next steps. For almost 3 months, a team of volunteer coordinators, most of whom have yet to meet in person, have been working around the clock to inspire supporters, negotiate partnerships with dozens of science groups, and raise enough money to pull off their upcoming event. March organizers admit they don't know what they'll find at the end of their exhausting sprint. They are uncertain of how many marchers will appear, and how the demonstrations will be received. But they see march day as a beginning, not an end, as March for Science tries to pivot from being an event organizer to becoming a lasting force for science advocacy.


Marchers around the world tell us why they're taking to the streets for science


http://science.sciencemag.org/conten...et_cid=1272513

Update 13/04/2017





https://sciencemarch.london/speakers/

Dr Francisco Diego
Astronomer and science educator at University College London
Quote:
“Science shows that humanity had a single origin in central Africa not that long ago, that genetically, we all are almost identical.
Science shows that our environment is a cosmic miracle, possibly unique.
Science discoveries unify humanity and empower us to manage and preserve our fragile environmental paradise.
I am marching because we must work hard to make science a main topic at all levels of education and a major component of modern global culture, for a brigher future, for a better world for all.”
Update 19/04/2017



Just got back from the 12,000 strong London march which was good natured and diverse, lots of Americans and Europeans and a gratifyingly high turnout of children and teens. Peter Capaldi (Dr Who) turned up.

I didn't meet any physios. Several of the scientists I spoke to had come straight from all nighters in their labs, It made me feel lucky that it's decades since I had to be up all night seeing to patients on three sites and then put in a full day afterwards.



I am the one with grey hair and matching fishing vest.

Update 22/04/2017



Some post #MarchforScience thoughts.......APRIL 23, 2017 NEUROCONSCIENCE

https://neuroconscience.com/2017/04/...ence-thoughts/

Update 23/04/2017



‘Boffins and their VERY academic chants’: How the media covered the March for Science

http://www.sciencemag.org/news/2017/...et_cid=1293290

Quote:
“What do we want? Evidence-based policy. When do we want it? After peer review.” That slogan, heard in many cities on Saturday, was a source of amusement for the U.K. tabloid The Daily Mail. “Boffins’ VERY academic chant as Doctor Who joins thousands protesting against Brexit during global March for Science,” the paper headlined its story about the march.

But U.K. march organizers had little reason to complain: The Daily Mail, not known for its interest in science, reported extensively on the marchers’ motivations and interspersed its 1500-word story with 27 big photos. It helpfully explained the sign “No Taxation Without Taxonomy” to its readers: “Taxonomy is the science of classifying animals, plants and other organisms.”

Largely unknown until a few weeks ago, the March for Science suddenly became a global news story the past weekend. Coverage was most extensive in the United States, which also had the most marchers. Major news outlets including ABC, CNN, The New York Times (NYT), and The Washington Post covered marches in Washington, D.C., and other cities with an abundance of op-eds and news pieces throughout the weekend.



Scientists protest in Parliament Square, central London, during the March for Science. After speeches, the rally ended with a rendition of Monty Python's Galaxy Song

Update 26/04/2017





07.04.17



Hurrah! I seem to have shaken off the ModBot




16.04.17
Quote:
Hello Jo Bowyer it appears that you have not posted on our forums in several weeks, why not take a few moments to ask a question, help provide a solution or just engage in a conversation with another member in any one of our forums?
Hello ModBot,

How kind of you to get in touch, thankyou for the above notice.

If you would care to peruse the top of this post, it may become clear to you why I appear not to have posted on your forums over the last few weeks.

I have several posts on machine learning you might like, at least one of which has been added as an edit within the last month

As for asking questions, neither you or Contact Us appear to be able to provide answers. I hope that the many papers and the few bits of script I have added might help to provide solutions for those who want them and I have been engaging in conversations with other members (and guests), but not on the forums.

If ever you are in London, we should meet up for a plate of data and some sewing machine oil.





Machine learning is important, but some AIs just want to have fun

https://aeon.co/videos/machine-learn...b451c-69418129

Quote:
Set to the pulsing, ethereal sounds of Steve Reich’s minimalist score Music for 18 Musicians (1974-6), this video by the French computer programmer Damien Henry is a clever visual demonstration of machine learning – a term coined by the US computer scientist Arthur Samuel (1901-1990) to describe an algorithm that gives computers the ‘ability to learn without being explicitly programmed’.

Using several videos recorded from windows during train rides, Henry trained an algorithm to predict what the next frame of a train ride should look like. Then, starting with a single frame chosen by Henry, the algorithm generated, to the best of its ability, scenes from an hour-long train ride, improving itself roughly every 20 seconds. The resulting video demonstrates machine learning in action through a dreamy, impressionistic take on the experience of observing flowing, fleeting landscapes passing by. Though machine-learning algorithms are used more practically in applications where adaptability is greatly advantageous, such as anti-virus software and driverless cars, there’s an undeniable charm to seeing a computer engage in a version of one of our more ephemeral but corporeal experiences – the train ride.
For you, dear ModBot, an hour long train journey generated by one of your friends and set to music by Steve Reich. It's fab! If you are still sitting on the papers I posted, how about putting them up?, and by the way what is your bias against BMC Musculoskeletal Disorders? It's one of my favourite journals.

Update 06/06/2017




29.04.17

Hoping ( but not holding my breath!), that this new paper from The Crick will put a further nail in the coffin of "North American Ectodermalism" and the suppression of debate on this site engendered thereby. I did not become a member of this congregation four years ago in order to sit in a pew.

A Gene Regulatory Network Balances Neural and Mesoderm Specification during Vertebrate Trunk Development

http://www.cell.com/developmental-ce...2817%2930295-2

Quote:
Highlights
•Single-cell RNA-seq reveals a signature of neuromesodermal progenitors
•In vitro NMPs resemble and differentiate similar to their in vivo counterparts
•Dual role for retinoic acid signaling in NMP induction and neural differentiation
•A transcriptional network regulates neural versus mesodermal allocation

Summary
Transcriptional networks, regulated by extracellular signals, control cell fate decisions and determine the size and composition of developing tissues. One example is the network controlling bipotent neuromesodermal progenitors (NMPs) that fuel embryo elongation by generating spinal cord and trunk mesoderm tissue. Here, we use single-cell transcriptomics to identify the molecular signature of NMPs and reverse engineer the mechanism that regulates their differentiation. Together with genetic perturbations, this reveals a transcriptional network that integrates opposing retinoic acid (RA) and Wnt signals to determine the rate at which cells enter and exit the NMP state. RA, produced by newly generated mesodermal cells, provides feedback that initiates NMP generation and induces neural differentiation, thereby coordinating the production of neural and mesodermal tissue. Together, the data define a regulatory network architecture that balances the generation of different cell types from bipotential progenitors in order to facilitate orderly axis elongation.

Introduction
Cell fate decisions in developing tissues are made by gene regulatory networks comprising transcription factors and intercellular signals. These networks determine the rate of self-renewal and differentiation to ensure the balanced generation of different cell types and the production of well-proportioned tissues (Stern et al., 2006, Davidson, 2010). The formation of the vertebrate trunk, which extends progressively during embryogenesis, is one example. Successively more posterior neural and paraxial presomitic mesodermal (PSM) cells of the trunk are generated from a bipotential population of cells (Tzouanacou et al., 2009), termed neuromesodermal progenitors (NMPs) at the posterior end of the embryo. Proliferation of NMPs fuels the elongation of axial tissues (Cambray and Wilson, 2002, Cambray and Wilson, 2007, Wilson et al., 2009, Henrique et al., 2015, Neijts et al., 2014, Kimelman, 2016). Hence, the rate at which NMPs are generated, self-renew, and differentiate must be carefully regulated in order to balance the production of different trunk tissues and to prevent the premature or delayed depletion of NMPs that will affect the length of the embryo.

my bold


Gene expression rules OK!



04.05.2017

Crossing the Chasm with Dr. Jason Silvernail

https://www.somasimple.com/forums/sh...ad.php?t=26977

I thoroughly recommend this, it doesn't conflict with his original crossing of the chasm, but shows his evolution between then and 2015. He illustrates this with a slide of a chasm that could be traversed by means of a simple bridge, followed by one with undergrowth, trees and jagged rock faces, which better depicts the navigational skills that might be required by someone standing on the edge preparing to cross.

His updated version, is in my opinion, less likely to encourage susceptible readers to become enmired in memes and unthinking discipleship.

He advocates ongoing science based study, lots of it, along with the ability to cite references from memory when defending our practice during discussion.




13.05.17

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

https://bmcmusculoskeletdisord.biome...891-017-1549-6

Abstract

Quote:
Background
Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.

Methods
A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.

Results
Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.

Conclusions
This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.

Keywords

Diagnostic accuracy Sensitivity and specificity Clinical examination Low back pain classification Clinical decision making
Background

Quote:
Identifying diagnostic, prognostic and treatment orientated subgroups of patients with low back pain (LBP] has been on the research agenda for many years [1, 2]. Diagnostic reasoning with a structural/pathoanatomical focus is common among clinicians [3], and it is regarded as an essential component of the biopsychosocial model [4, 5, 6]. Within this model, emphasis has been on the role of psychosocial considerations and how these factors can interfere with recovery. Indeed, there is good quality evidence for the predictive value of a set of psychosocial factors for poorer outcome in patients with LBP [7, 8]. These factors are multifactorial, interrelated, and only weakly associated to the development and prognosis of LBP [9], which might be one of the explanations why effects of treatments targeting those risk factors has been reported to be small, mostly short term, and there was little evidence that psychosocial treatments were superior to other active treatments [7, 10].

Maybe it is time to swing the pendulum towards the “bio” in the biopsychosocial model. There are many examples in medicine where the pathology has been identified prior to any effective treatments being developed making it an ongoing challenge to generate new diagnostic knowledge on which to base more effective treatment strategies in the future. Alongside clinicians, many researchers within the field of LBP feel that choosing the most effective treatment for the individual patient is not possible without better understanding of the biological component of the biopsychosocial model [4].

Good grief!!

The last six papers I tried to post from this journal into new posts were intercepted by the ModBot and subsequently lost. Posting into existing posts works .



14.05.2017

London Moonwalk

I caught the finishing stages of the Moonwalk as I drove into London early this morning. It is a power walk over marathon distance, or half for those who wish, which starts and finishes on Clapham Common and is in aid of breast cancer charities. There have always been men volunteering and stewarding, but this year there seemed to be a lot more walking.

I know very few men who haven't tried on a bra and it seems logical that some would jump at the chance to walk 26.2 miles wearing one, especially if they have friends and family who have been affected by breast cancer.

Breast cancer in men is rare, but it happens. So far, during a forty year (and counting) career, I have had three male patients who gave a history of breast cancer, one of whom I treated for post op sequelae.

It's tough, not least because those who see a chap sitting in the waiting area of a breast clinic, assume that he is there for a female family member and not for himself.

Signs and symptoms of breast cancer in men
http://breastcancernow.org/about-bre...FYSd7QodusADGg



19.05.17

Solution to the Grandfather Paradox



Update 19/05/2017



23.05.2015

Manchester Arena

Some of us have and others have yet to deal with the aftermath of acts of atrocity . It is unbearably sad, especially when children and young people are involved. Ariana Grande who gave the performance is still in her early twenties.

Our threat level in the UK is now critical.


24.05.2017

Mancunians are special, they are a close knit community and they have pulled together in dealing with what is happening as well as offering numerous random acts of kindness to victims, families and the emergency services.

I'm not saying that Londoners don't step up in similar situations, but there is more rush and bustle and possibly more who walk by on the other side rather than getting involved.



27.05.2017

Our threat level is now severe, which means that attack is highly likely rather than immanent, this is due to the fact that eleven people are now in custody. I know some who prefer to avoid events, crowds and use of public transport, but most prefer to go about their daily business with a heightened sense of awareness.




Can terrorists be deradicalized?

http://www.sciencemag.org/news/2017/...et_cid=1349465

Quote:
Investigators are still piecing together exactly what drove Salman Abedi, the suspected assailant in the recent concert bombing in Manchester, U.K., to kill 22 people and wound dozens more, but early indications suggest he had become a radicalized jihadist. How formerly harmless members of society go on to embrace violent extremist ideologies is a looming question in the world of counterterrorism, yet increasingly so is the problem of “deradicalization,” or convincing people to abandon an extremist mindset.

Worldwide, hundreds of deradicalization programs have sprung up. They typically consist of trained counselors either convincing the extremists their religious views aren’t founded in proper theology, treating the subject’s extremism as a mental health issue, or trying to nudge the extremist’s value system away from violence.

Despite their ubiquity, there’s been precious little effort spent evaluating whether these programs actually work,

Strongly held beliefs are wired into neural networks. I keep my treatment sessions short in order to focus fully on the patient's verbal and physical response to whatever is said and done during the encounter. I pay particular attention to autonomic signs.

Update 29/05/2017




Ariana Grande is returning to Manchester for her One Love Manchester Benefit Concert.

Read more: http://metro.co.uk/2017/05/30/ariana...#ixzz4idTG8TtS



Giving practical help and taking the edge off money worries makes a huge difference.

Update 31/05/2017




01/06/2017

End-times for humanity

https://aeon.co/essays/the-human-wor...00b18-69418129

Quote:
What contemporary post-apocalyptic culture fears isn’t the end of ‘the world’ so much as the end of ‘a world’ – the rich, white, leisured, affluent one. Western lifestyles are reliant on what the French philosopher Bruno Latour has referred to as a ‘slowly built set of irreversibilities’, requiring the rest of the world to live in conditions that ‘humanity’ regards as unliveable. And nothing could be more precarious than a species that contracts itself to a small portion of the Earth, draws its resources from elsewhere, transfers its waste and violence, and then declares that its mode of existence is humanity as such.

To define humanity as such by this specific form of humanity is to see the end of that humanity as the end of the world. If everything that defines ‘us’ relies upon such a complex, exploitative and appropriative mode of existence, then of course any diminution of this hyper-humanity is deemed to be an apocalyptic event. ‘We’ have lost our world of security, we seem to be telling ourselves, and will soon be living like all those peoples on whom we have relied to bear the true cost of what it means for ‘us’ to be ‘human’.



03.06.2017

Chronic pain may be due to receptors that hide within nerve cells

https://www.eurekalert.org/pub_relea...-cpm052617.php

Quote:
New York, NY (May 31, 2017) -- A study led by Columbia University Medical Center (CUMC) has shown that chronic pain may occur when pain receptors migrate from the nerve cell's surface to the cell's inner chambers, out of the reach of current pain medications. The discovery, in rodents, may lead to the development of a new class of medications for chronic pain that is more potent and less prone to side effects than currently available pain treatments.

The study was published online today in the journal Science Translational Medicine.

An estimated 20 percent of people have chronic pain at some point. Currently available therapies for chronic pain include opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). Both have drawbacks: opioids are addictive and can cause constipation and respiratory distress, while frequent use of NSAIDs can cause stomach ulcers and kidney damage.

"Opioids and NSAIDs do not work for everyone and have unacceptable side effects, particularly when used over a long period of time," said Nigel Bunnett, PhD, professor of surgery and pharmacology at CUMC. "However, previous efforts to develop more effective analgesics have been stalled by our limited understanding of the mechanisms that allow nerves to sense and transmit pain signals."

Some pain medications work by targeting G protein-coupled receptors (GPCRs) on the cell surface. GPCRs are implicated in nearly all biological processes, including our brain's ability to sense and transmit pain signals. Activation of opioid receptors--one type of GPCR--blocks pain.

Another type, the neurokinin 1 receptor (NK1R), causes pain and inflammation when activated. However, most clinical trials of compounds targeting NK1R have been unsuccessful.

In the current series of experiments, Dr. Bunnett and colleagues discovered that NK1R, when stimulated by pain, quickly moves from the cell surface to endosomes--intracellular compartments--within nerve cells. Once inside the endosomal network, NK1R continues to function for a prolonged period, causing pain and inflammation.

Additional experiments revealed that attaching a lipid (fat molecule) that can cross the cell membrane to compounds that block NK1R provided potent, durable pain relief in rodents.

"From these experiments, we have demonstrated that designing NK1R inhibitors that are capable of reaching the endosomal network within nerve cells may provide much longer-lasting pain relief than currently available analgesics," said Dr. Bunnett. "More than a third of all currently available drugs act on GPCRs in some way. We think that modification of many existing compounds, as we did with NK1R inhibitors, may have the potential to enhance the effectiveness of many different classes of medications."



04.06.17

London Bridge and Borough Market.

7 dead, 48 injured and 3 assailants shot dead. This was a low tech attack with similarities to the Westminster incident and therefore much more difficult to predict. The police and emergency services did an excellent job as did members of the public who assisted the injured. We have a general election coming up within days, but today politicians from most parties are singing from the same hymn sheet. London is subdued today, no one I have seen in clinic so far today has mentioned it.......they don't need to. Currently, I am hearing police sirens and there are more helicopters than usual.




BBC...London attack: 12 arrested in Barking after van and knife incidents

http://www.bbc.co.uk/news/uk-40148737




Are health professionals parasites?

https://criticalphysio.net/2017/06/0...als-parasites/






Generous health insurance plans encourage overtreatment, but may not improve health

https://www.sciencedaily.com/release...0605121350.htm

Quote:
Offering comprehensive health insurance plans with low deductibles and co-pay in exchange for higher annual premiums seems like a good value for the risk averse, and a profitable product for insurance companies. But according to a study, such plans can encourage individuals with chronic conditions to turn to needlessly expensive treatments that have little impact on their health outcomes.
I see very few insurance patients, but have noticed a tendency in some of those I do see to expect me to provide the number of sessions allowed by the claims manager. I am not prepared to go along with this, it smacks of entertainment.

Update 06/06/2017




Blue Brain Team Discovers a Multi-Dimensional Universe in Brain Networks

http://neurosciencenews.com/blue-bra...-network-6885/

Quote:
For most people, it is a stretch of the imagination to understand the world in four dimensions but a new study has discovered structures in the brain with up to eleven dimensions – ground-breaking work that is beginning to reveal the brain’s deepest architectural secrets.

Using algebraic topology in a way that it has never been used before in neuroscience, a team from the Blue Brain Project has uncovered a universe of multi-dimensional geometrical structures and spaces within the networks of the brain.

The research, published today in Frontiers in Computational Neuroscience, shows that these structures arise when a group of neurons forms a clique: each neuron connects to every other neuron in the group in a very specific way that generates a precise geometric object. The more neurons there are in a clique, the higher the dimension of the geometric object.
Quote:
If 4D worlds stretch our imagination, worlds with 5, 6 or more dimensions are too complex for most of us to comprehend. This is where algebraic topology comes in: a branch of mathematics that can describe systems with any number of dimensions. The mathematicians who brought algebraic topology to the study of brain networks in the Blue Brain Project were Kathryn Hess from EPFL and Ran Levi from Aberdeen University.

“Algebraic topology is like a telescope and microscope at the same time. It can zoom into networks to find hidden structures – the trees in the forest – and see the empty spaces – the clearings – all at the same time,” explains Hess.

In 2015, Blue Brain published the first digital copy of a piece of the neocortex – the most evolved part of the brain and the seat of our sensations, actions, and consciousness. In this latest research, using algebraic topology, multiple tests were performed on the virtual brain tissue to show that the multi-dimensional brain structures discovered could never be produced by chance. Experiments were then performed on real brain tissue in the Blue Brain’s wet lab in Lausanne confirming that the earlier discoveries in the virtual tissue are biologically relevant and also suggesting that the brain constantly rewires during development to build a network with as many high-dimensional structures as possible.

When the researchers presented the virtual brain tissue with a stimulus, cliques of progressively higher dimensions assembled momentarily to enclose high-dimensional holes, that the researchers refer to as cavities. “The appearance of high-dimensional cavities when the brain is processing information means that the neurons in the network react to stimuli in an extremely organized manner,” says Levi. “It is as if the brain reacts to a stimulus by building then razing a tower of multi-dimensional blocks, starting with rods (1D), then planks (2D), then cubes (3D), and then more complex geometries with 4D, 5D, etc. The progression of activity through the brain resembles a multi-dimensional sandcastle that materializes out of the sand and then disintegrates.”

The big question these researchers are asking now is whether the intricacy of tasks we can perform depends on the complexity of the multi-dimensional “sandcastles” the brain can build. Neuroscience has also been struggling to find where the brain stores its memories. “They may be ‘hiding’ in high-dimensional cavities,” Markram speculates.
O...M...G




On the other hand......

Weird Animal Brain: Sea Squirt

http://knowingneurons.com/2017/06/12...EMAIL_CAMPAIGN)


Update 13/06/2017




24.06.17

Medical disrespect
https://aeon.co/essays/bullying-juni...fa5c6-69418129

Quote:
Bullying doctors are not just unpleasant, they are dangerous. Can we change the culture of intimidation in our hospitals?

I have been on the receiving end and I have dished it out, on the basis that the patient is at the centre of everything we do. 25 or so years ago I decided that it was best to be self employed after a threat of disciplinary proceedures directed at me, for explaining to a member of the admin staff (in graphic detail) the clinical effects on a real person.....of her repeated errors and failure to follow up. She saw what she did as shifting bits of information around. My line manager was more afraid of flack from Human Resources, than possible malpractice. It was clear to me that my place was not within large, or even medium sized organisations.

The buck stops here. I am always on call so to speak, but I no longer have duodenal ulcers.




A surprisingly simple explanation for the shape of bird eggs

http://www.sciencemag.org/news/2017/...et_cid=1399786

__________________
Jo Bowyer
Chartered Physiotherapist Registered Osteopath.
"Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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