Linearization lowers anxiety

Posted in Neuroscience, social behavior with tags , , on May 25, 2011 by nvm.m

One of the interesting features of the approach called getting things done is establishing a priority that makes it easier to follow a sequential list of tasks. By relieving the individual from the need for reformulating priorities on every step of her daily activities, it allows for faster results with a lower level of stress.
Sorting out a set in a multidimensional space through unidimensional relationships is an intensive process, especially when that is required within very narrow time constraints (as it usually happens in ‘real life’). This type of processing is highly associated with what some people call (vaguely) “executive functions“. The ability to reformulate our (perceptive) world in such a way can be significantly compromised in persons who suffer conditions that affect their “executive abilities“. The anxiety and frustration derived from this type of demand obviously adds up to these people’s suffering, and impair them even further. This positive feedback probably contributes to the time distortion they tend to experience.
Within an anthropological framework, it is interesting that, once some vulnerable individuals fall into this “cognitive vortex”, modern societies do very little to pull them out of it. We have endless sources of entertainment (to alienate us from the real problems), but very few tools to rebuild our work methods and restructure our life. Once facing the major existential dilemma of engineering our life, the most straightforward solution is to forfeit our “executive functions” altogether, and let others structure our life “for our own good”. As contemporary society becomes more demanding and dehumanized, we are witnessing the emergence of cults, societies, gangs or clubs of all flavors (most of them totalitarian in nature). They all offer a cheap way to structure our life from outside, according to some narrow-minded vision of the world, hence lowering people’s baseline anxiety. The result is a proclivity for establishing vertical hierarchies within society and for increasing struggles (often violent) between various fanatic ideologies. Until we acquire (individually) critical thinking, we can anticipate the flourishing of revamped breeds of fascism and a delightful cornucopia of “jihads” (of all flavors).

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Multiplexing probably requires dreaming

Posted in Neuroscience with tags , , on January 29, 2011 by nvm.m

Multiplexing (utilization of the same microcircuitry for different computational tasks) has been proposed as one of the properties of the nervous system.

It does make sense from an evolutionary standpoint, since it increases the efficiency and speed of the system (which can certainly use some help whenever it attempts to solve real world problems using deterministic approaches, and inevitably chokes with immense numbers).

Considering this, along with the fact that the production of language acts like the vehicle for sequentially increasing levels of abstraction, the existence of homomorphism is a highly likely (although not necessary) consequence. In a clinical setting, likely beyond a reasonable limit (let’s say 0.9999) is good enough for me.

So, mapping different layers of homomorphism (as some sort of metacognition) is probably another important cognitive activity in itself. That is the realm of ‘free association’, dreams and all sorts of art. Maybe that is what the frontal lobe does frantically during those precious REM sleep minutes. Maybe survival depends on it. Establishing a strong connection between the physical world and this metacognitive world should be the most important goal for humankind as a species. Considering that living systems are operationally closed (and have no way to distinguish between the inside and the outside), studying organization in general is equivalent to studying ourselves. Let’s do that.

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New Year

Posted in Miscelaneous on January 26, 2011 by nvm.m

As usual, over the last few weeks we have been receiving postcards and electronic greetings from friends all over the continent and across the pond, usually summarizing their year for us. Thanks to all of you.
On our end, there is little to say (which in my book is a good sign). Lots of clinical work, one or two hires for the company and a few innovations to our practice that we have lined up for this year.
Leaving academia to pursue “real world” goals has been quite exciting, but not in the sense it would be for a yuppie or for a regular “blue collar” clinician. It has been rather like becoming a character of some type of a postapocalyptic dystopia.

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Honorific affixes

Posted in Neuroscience with tags , on April 30, 2010 by nvm.m

Peoples names usually indicate, directly or indirectly, the person’s hierarchy in the pack.
In some languages the personal hierarchic statement consists of a prefix accompanying the name (Count Tepes, Dr. Mengele). In other languages, such as Japanese, it is usually a suffix (Homer Simpson San).
I wonder if the fact that the affix denoting the person’s rank goes before or after the name has some association with the way a particular culture handles social hierarchies. The order in which the brain perceives and decodes the verbal or written expression may impose certain time limits to the behavioral response, especially when particular words, such as those indicating your level on the food chain, contain a high emotional load.

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Neurobiology and drug dinners

Posted in Clinical topics with tags , , , on November 8, 2009 by nvm.m

I have to confess that I’m currently attending drug dinners. The reason? My wife (also a physician) happens to like the food.
Even more shameful than attending them is writing about them. Why posting about one now? Sometimes you can hear about interesting problems even in prosaic events.
In this particular case the speaker brought up the old but still important issue of neuroprotection in stroke. Apparently, Lamotrigine may reduce the extension of the infarct when given shortly after the beginning of the process. I was aware of the use of Phenytoin experimentally for the same purpose in the old times (decades ago), with ambiguous results. It was found later on that there were different stages after the initial ischemic process, with a different type of intervention being useful for each stage. Phenytoin showed some limited efficacy on one of the early stages; however, at the end, the area of infarct was about the same as in controls. After a rather cursory search posterior to the drug dinner, it appeared to me that the neuroprotective power of Lamotrigine on an ischemic setting was equally controversial. In general, antiepileptic drugs have been good candidates for neuroprotective agents. It could be speculated that, since the effect of some of them (in this case Lamotrigine) is on voltage gated channels, they may help by curbing the excitotoxicity vicious cycle (NMDA receptors, calcium influx, further excitation, all of this enhanced by open potassium channels in the astroglia, which conforms a ionic syncitium when the pH is low).
It is always a pleasant surprise when, in a typically non-scientific event such a as a drug dinner, the speaker brings up, even en passant, a scientific topic.

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Why getting up early is so important

Posted in Neuroscience with tags , on February 10, 2009 by nvm.m

Our sleep-wake cycles are governed by internal clocks in our brains, obviously connected to other clocks in the rest of our bodies. It’s like an internal orchestra.
The period (time needed to complete a full revolution) of our sleep-wake cycle clock is close to 24 hours but not quite that. It’s actually slightly longer. That is why we need a daily “entrainment” from natural light to reset our clocks to the external (geophysical) time.
It is well known that as people grow older, they tend to wake up earlier. One explanation is that their internal clock controlling their sleep-wake cycles changes with age; its period becomes shorter, which means the frequency of the oscillations increases; that is enough to change the phase relation between the internal clock and the external (“real”) time. It’s a fact documented in golden hamsters (a preferred mamal chronobiology model for decades) and presumably other species too.
In humans, early awakening is a problem for many reasons. Remember the elderly gentleman who wakes up before dawn to count the silverware in his home to make sure nobody has stolen one his his spoons? Yes, early awakening may be a sign of more than one illness.
In human societies, traditionally the ones in power have been individuals of advanced age; this is not so often these days; additionally, alpha males are known to be more aggressive than the average in primates; aggressive behavior in mammals is associated with more regular sleep-wake cycles.

Among primates, and humans are no exception, to hold their power, the dominant individuals need to systematically oppress their orderlings. Since early awakening is a common feature in old age, a good use of this feature by the dominant males is to force others to wake up early too. That way what is basically a health problem becomes a virtue and also a mechanism of domination. They can force all their subordinates to be at work before dawn. That helps them look responsible, hard working and productive. It’s also a way to infuse a sense of defeat on the ones in the lower ranks.
So, here is the answer why so many institutions have a mandatory early schedule. Our leaders set an example of virtue and work ethics by showing up at work earlier than everyone and obviously forcing everybody else to do the same. Only recently some voices have been raised to question the early schedules in schools, for example. However, popular culture (which is usually shaped by the dominant groups) still maintains the traditional association between early rising and hard work, virtue and honesty.

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A new president

Posted in Miscelaneous with tags , on November 5, 2008 by nvm.m

Obama

Life goes on, sometimes at mind boggling speeds.
However, I cannot overlook the importance of this historical day.
Many believe that this change is going to have positive repercussions all over the world.
On a deeper sense, for some reason Barak Obama reminds me a little bit of all-time human rights hero Nelson Mandela.

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I like the Locum Tenens system

Posted in Clinical topics with tags , on July 4, 2008 by nvm.m

After finishing another successful assignment as a Locum doctor, I have to say that I find the system very appealing. Most of the time, the physician can choose the duration of the assignment, the clinical setting and the location, among the many offered by the companies that manage this system.

The physician turnover in hospitals all over the nation is very high; I recently read that it was 20% per year; different sources may probably disagree on the exact figure, but they will surely agree that it is above what you would usually expect. That strongly denotes a problem in the industry. Although financial incentives for physicians are good motivators to accept job offers, there is need for more to keep the new employee. What forces clinicians to leave the institutions? I speculate that it is quality of life.

For example, physicians are usually considered “exempt employees”, meaning that they have a variable daily schedule and are not required to punch time cards. This is supposed to be a privilege. The concept looks progressive because of its apparent flexibility and may probably apply very nicely to workers like programmers, writers or artists; you may come to work and leave at different times without being micromanaged, as long as you complete your projects in time and fulfill your duties. The physician, however, despite being an exempt employee, is required to be in the hospital at a specific time, usually 7:30 or 8:00 in the morning; what is really variable is the finish time, which is usually well beyond that of other employees; personally, I seldom left the hospital before 6 PM and met colleagues who would never leave before 9 PM. That obviously means that the “exempt employee” status is a sleight of hand to avoid having to pay the physician overtime.

Working hours are just one aspect of many that make current hospital jobs unattractive in the long run. But I think it is the administrators’ job to do their homework and figure it out by themselves. I don’t think it is as much a matter of insight as it is a matter of decision; I believe they know that it would be a lot cheaper to improve the permanent doctors’ conditions (and hire more of them) instead of getting a continuous flow of Locum physicians; I also believe that they somehow sense what has to be done to improve efficiency, decrease their department overhead and increase the workers’ satisfaction; it is not rocket science. What actually stops them from carrying out the necessary changes is probably fear to angry the establishment, since such changes would entail treading into the terrifying land of the unconventional. In the meantime, I believe that the Locum companies are going to keep flourishing during the following years, providing care for the areas with no permanent physicians.

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Why Open Source

Posted in Science/Tech with tags , on April 30, 2008 by nvm.m

Linux

Years ago, when I got acquainted with Linux, I was annoyed. I wondered why anybody would be willing to learn how to type all those cryptic commands and perform mysterious operations just to work on a computer. Gradually, I learned to appreciate its unexpected virtues. These days, it’s the environment where I feel most comfortable. Some will say, however, that BSD (another flavor of free Unix) is even better.

What are the advantages of an open source operating system? I would list them in two main categories.

Personal benefits

linux lock

For the Linux user, those days shopping for anti virus, firewalls and similar security software are over. Trojans, bots and similar are things of the past. In a complex and hectic world, that is one less problem to worry about. You will not have to suffer all those false alarms from your “security suite” interrupting your work.

Speed notoriously increases, especially in intensive tasks, like image processing or number crunching. The computer boots faster and many programs, including Microsoft Office, typically run better.

Stability becomes the rule. In a well configured system, computer crashes are a sporadic phenomenon.

For scientists, there are plenty of excellent programs available for download. Most of the tasks that would require thousands of dollars in proprietary software to implement, can be currently performed with efficient and reliable open software.

Environmental benefits

Using Open Source products supports a number of small companies all over the world, even in very poor communities. It promotes development of resources that will be used by a greater number of people and that will help reduce poverty. Many of our brothers and sisters in the world who are less fortunate will have access to current technology thanks to massive participation in the Open Source movement.

Open Source directly helps green computing. This will reduce global warming and pollution in general.

Finally, as a form of social therapy, the Open Source movement promotes unselfish collaboration without political or ideological boundaries. In a world troubled by greed and hatred, this effect in itself constitutes a priceless tool.

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The eternal immutability of Electrocardiography

Posted in Science/Tech with tags , , on April 21, 2008 by nvm.m

VectorCardiogram

I usually believe to be a salutary exercise to reminisce our most salient personal mistakes.

When I was doing my neurosurgery residency in 1990, most of my colleagues looked pretty uncomfortable with electrophysiological diagnostic techniques, probably because, as opposed to imaging, these require a wider conceptual shift from the more concrete surgical experience. One of them asked me if I knew enough about ECG to help him out. Instead of doing just that, I gave him a lecture about how ECG was soon going to give way to vectorcardiography, a more mature, flexible and user-friendly technique. I tried to dissuade him from paying any more attention to ECG. Shame on me.

Although I had been interested in ECG as a medical student in the early 80s, I soon decided to give up any further study of it. “Why did they not use vectors in the first place?”, I asked myself. I decided that the most likely reason was the initial lack of hardware to make the calculations and images feasible. Since this fact was changing rapidly, I thought it would be a matter of just a couple of years until having multicolor rotating 3D vector graphs as the main initial diagnostic tool for heart disease. Vectors would make anatomical and functional interpretation of the electrical signals straightforward and amenable to further, more detailed analysis.

However, time went on. Many years after these events, I found myself studying ECG (again) in order to get my medical license in the US. While doing that, I laughed at my past naiveté. Of course, ECG is living and well; no clinician would ever think of switching it for anything different, and vectorcardiography is still at this moment considered “an experimental technique”, with no appeal to anybody but lab nerds. And my old neurosurgery colleague may still be angry at me.

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