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"In the midst of winter I finally learned that there was in me an invincible summer." - Alert Camus

Sunday, August 28, 2016

Multiple Sclerosis: Types, Symptoms, Causes, ...

Saturday, August 27, 2016

Wednesday, July 20, 2016

Patience is the companion of wisdom.

Patience is the companion of wisdom. 
-- Saint Augustine (354 AD - 430 AD)

There art two cardinal sins from which all others spring: Impatience and Laziness. 
-- Franz Kafka (1883 - 1924)
If I have ever made any valuable discoveries, it has been owing more to patient attention, than to any other talent. 
- Isaac Newton (1642 - 1727)

Patience serves as a protection against wrongs as clothes do against cold. For if you put on more clothes as the cold increases, it will have no power to hurt you. So in like manner you must grow in patience when you meet with great wrongs, and they will then be powerless to vex your mind. 
-- Leonardo da Vinci (1452 - 1519)

Have patience with all things, but chiefly have patience with yourself. Do not lose courage in considering your own imperfections but instantly set about remedying them - every day begin the task anew. 
-- Saint Francis de Sales (1567 - 1622)
Patience is the best remedy for every trouble. 
- Titus Maccius Plautus (254 BC - 184 BC), Rudens

Have courage for the great sorrows of life and patience for the small ones; and when you have laboriously accomplished your daily task, go to sleep in peace. God is awake. 
- Victor Hugo (1802 - 1885)
A high hope for a low heaven: God grant us patience! 
- William Shakespeare (1564 - 1616), Love's Labour's Lost, Act I, sc. 1
A very little thief of occasion will rob you of a great deal of patience
-William Shakespeare (1564 - 1616), Coriolanus, Act II, sc. 1
Had it pleas'd heaven to try me with affliction... I should have found in some place of my soul a drop of patience. 
- William Shakespeare (1564 - 1616), Othello, Act IV, sc. 2
How poor are they that have not patience! What wound did ever heal but by degrees? 
- William Shakespeare (1564 - 1616), Othello, Act II, sc. 3
How poor are they who have not patience! What wound did ever heal but by degrees. 
- William Shakespeare (1564 - 1616)
I do oppose my patience to his fury, and am arm'd to suffer with a quietness of spirit, the very tyranny and rage of his. 
- William Shakespeare (1564 - 1616), The Merchant of Venice, Act IV, sc. 1
Patience is sottish, and impatience does become a dog that's mad
- William Shakespeare (1564 - 1616), Antony and Cleopatra, Act IV, sc. 15
Though patience be a tired mare, yet she will plod.
- William Shakespeare (1564 - 1616), Henry V, Act II, sc. 1
Upon the heat and flame of thy distemper sprinkle cool patience. 
- William Shakespeare (1564 - 1616), Hamlet, Act III, sc. 4

Patience, my lord. Why, 'tis the soul of peace.
Of all the virtues 'tis near'st kin to heaven.
It makes men look like gods; the best of men
That e'er wore earth about him was a sufferer,
A soft, meek, patient, humble, tranquil spirit,
The first true gentleman that ever breath'd.

- Thomas Dekker and Thomas Middleton
The Honest Whore Part One, act V scene II
Patience is the ballast of the soul, that will keep it from rolling and tumbling in the greatest storms: and he, that will venture out without this to make him sail even and steady will certainly make shipwreck, and drown himself; first, in the cares and sorrows of this world; and, then, in perdition.
- Ezekiel Hopkins,  Death disarmed of it Sting Of Patience under Afflictions.
Patience is the guardian of faith, the preserver of peace, the cherisher of love, the teacher of humility; Patience governs the flesh, strengthens the spirit, sweetens the temper, stifles anger, extinguishes envy, subdues pride; she bridles the tongue, refrains the hand, tramples upon temptations, endures persecutions, consummates martyrdom; Patience produces unity in the church, loyalty in the State, harmony in families and societies; she comforts the poor and moderates the rich; she makes us humble in prosperity, cheerful in adversity, unmoved by calumny and reproach; she teaches us to forgive those who have injured us, and to be the first in asking forgiveness of those whom we have injured; she delights the faithful, and invites the unbelieving; she adorns the woman, and approves the man; is loved in a child, praised in a young man, admired in an old man; she is beautiful in either sex and every age.
- Bishop Horne, Discourses on Several Subjects and Occasions Patience Portrayed

Perfer et obdura; dolor hic tibi proderit olim.
Have patience and endure; this unhappiness will one day be beneficial.
- Ovid, Amorum (16 BC), III. 11. 7.

Durate, et vosmet rebus servate secundis.
Persevere and preserve yourselves for better circumstances.
Virgil, Æneid (29-19 BC), I. 207.

Superanda omnis fortuna ferendo est.
Every misfortune is to be subdued by patience.Virgil, Æneid (29-19 BC), V. 710.

Patience and diligence, like faith, remove mountains.
- William Penn, Some Fruits of Solitude In Reflections And Maxims (1682) no. 234.

Font plus que force ni que rage.
By time and toil we sever
What strength and rage could never.
Jean de La Fontaine, Fables, II. 11.

Rule by patience, Laughing Water!
Henry Wadsworth Longfellow, The Song of Hiawatha (1855), Part X. Hiawatha's Wooing.

Still achieving, still pursuing,
Learn to labor and to wait.
Henry Wadsworth Longfellow, A Psalm of Life, Stanza 9.

All things come round to him who will but wait.
Henry Wadsworth Longfellow, Tales of a Wayside Inn, The Student's Tale, Part I.

Endurance is the crowning quality,
And patience all the passion of great hearts.
James Russell Lowell, Columbus, line 241.

Sua quisque exempla debet æquo animo pati.
Every one ought to bear patiently the results of his own conduct.
Phaedrus, Fables, I. 26. 12.

La patience est amère, mais son fruit est doux.
Patience is bitter, but its fruit is sweet.
Jean-Jacques Rousseau.

Nihil tam acerbum est in quo non æquus animus solatium inveniat.
There is nothing so disagreeable, that a patient mind can not find some solace for it.
Seneca, De Animi Tranquilitate, X.

Furor fit læsa sæpius patientia.
Patience, when too often outraged, is converted into madness.
-- Syrus, Maxims. 289.

La patience est l'art d'espérer.
Patience is the art of hoping.
-- Luc de Clapiers, Marquis de Vauvenargues, Réflexions, CCLI.

It is not necessary for all men to be great in action. The greatest and sublimest power is often simple patience.
- Horace Bushnell, p. 443.

Teach me to feel that Thou art always nigh;
Teach me the struggles of the soul to bear;
To check the rising doubt, the rebel sigh;
Teach me the patience of unanswered prayer.
- George Croly, p. 444.

Patience! why, it is the soul of peace; of all the virtues it is nearest kin to heaven; it makes men look like gods. The best of men that ever wore earth about Him was a Sufferer,— a soft, meek, patient, humble, tranquil spirit; the first true gentleman that ever breathed.
- Thomas Decker, p. 443.

Patience is enduring love; experience is perfecting love; and hope is exulting love.
- Alexander Dickson, p. 442.

It is easy finding reasons why other folks should be patient.
- George Eliot, p. 443.

Patience is the ballast of the soul that will keep it from rolling and tumbling in the greatest storms.
- Bishop Hopkins, p. 442.

Dispose thyself to patience rather than to comfort, and to the bearing of the cross rather than to gladness.
- Thomas à Kempis, p. 442.

The holier one is, the more forbearing and loving he is; the more tender and patient and anxious to help others in every way. Think how forbearing and loving Christ is when we do wrong; and there we are to be like Him.
- Arthur Henry Kenney, p. 444.

Therefore, let us be patient, patient; and let God our Father teach His own lesson, His own way. Let us try to learn it well and quickly; but do not let us fancy that He will ring the school-bell, and send us to play before our lesson is learnt.
- Charles Kingsley, p. 443.

Be patient, my friends; time rolls rapidly away; our longing has its end. The hour will strike, who knows how soon?— when the maternal lap of everlasting Love shall be opened to us, and the full peace of God breathe around us from the palmy summits of Eden.
- Friedrich Wilhelm Krummacher, p. 613.

When I am about my work, sometimes called unexpectedly and suddenly from one thing to another, I whisper in my heart, " Lord, help me to be patient, help me to remember, and help me to be faithful. Lord, enable me to do all for Christ's sake, and to go forward, leaning on the bosom of His infinite grace."
-- Mary Lyon, p. 444.

We are waiting, Master, waiting,
Wayworn, pressed with toils and strife;
Waiting, hoping, watching, praying,
Till we reach the gates of life.
-- Ray Palmer, p. 613.

Not without design does God write the music of our lives. Be it ours to learn the time, and not be discouraged at the rests. If we say sadly to ourselves, "There is no music in a rest," let us not forget " there is the making of music in it." The making of music is often a slow and painful process in this life. How patiently God works to teach us! How long He waits for us to learn the lesson!
- John Ruskin, p. 443.

Show yourself a Christian by suffering without murmuring. In patience possess your soul — they lose nothing who gain Christ.
- Samuel Rutherford, p. 444.

The disciples of a patient Saviour should be patient themselves.
- Charles Spurgeon, p. 442.

How poor are they that have not patience!
What wound did ever heal but by degrees?
-- William Shakespeare, Othello (c. 1603), Act II, scene 3, line 376.

Had it pleas'd heaven
To try me with affliction * * *
I should have found in some place of my soul
A drop of patience.
-- William Shakespeare, Othello (c. 1603), Act IV, scene 2, line 47.

Like Patience gazing on kings' graves, and smiling
Extremity out of act.
- William Shakespeare, Pericles, Prince of Tyre (c. 1607-08), Act V, scene 1, line 139.

She sat like patience on a monument
Smiling at grief.
- William Shakespeare, Twelfth Night (c. 1601-02), Act II, scene 4, line 117.

He that will have a cake out of the wheat must tarry the grinding.
- William Shakespeare, Troilus and Cressida Act I, scene i.

Patience is the art of hoping.
- Marquis De Vauvenargues, Reflections and Maxims (1746) no. 251.

Durate, et vosmet rebus servate secundis.
Persevere and preserve yourselves for better circumstances.
-- Virgil, Æneid (29-19 BC), I. 207.

Superanda omnis fortuna ferendo est.
Every misfortune is to be subdued by patience.
-- Virgil, Æneid (29-19 BC), V. 710.

With strength and patience all his grievous loads are borne,
And from the world's rose-bed he only asks a thorn.
- William R. Alger, Oriental Poetry, Mussud's Praise of the Camel.

I worked with patience which means almost power.
-- Elizabeth Barrett Browning, Aurora Leigh (1856), Book III, line 205.

And I must bear
What is ordained with patience, being aware
Necessity doth front the universe
With an invincible gesture.
-- Elizabeth Barrett Browning, Prometheus Bound.

But there are times when patience proves at fault.
- Robert Browning, Paracelsus, scene 3.

There is however a limit, at which forbearance ceases to be a virtue.
- Edmund Burke, Observations on a Late Publication on the Present State of the Nation.

Thus with hir fader for a certeyn space
Dwelleth this flour of wyfly pacience,
That neither by hir wordes ne hir face
Biforn the folk, ne eek in her absence,
Ne shewed she that hir was doon offence.
- Geoffrey Chaucer, The Clerkes Tale, V, line 13,254.

Patience is sorrow's salve.
- Charles Churchill, Prophecy of Famine, line 363.

Patience is a necessary ingredient of genius.
- Benjamin Disraeli, Contarini Fleming, Part IV, Chapter V.

But the waiting time, my brothers,
Is the hardest time of all.
- Sarah Doudney, Psalms of Life, The Hardest Time of All.

The worst speak something good; if all want sense,
God takes a text, and preacheth patience.
- George Herbert, The Church Porch, Stanza 72.

Durum! sed levius fit patientia
Quicquid corrigere est nefas.
It is hard! But what can not be removed, becomes lighter through patience.
- Horace, Carmina, I. 24. 19.

For patience, sov'reign o'er transmuted ill.
- Samuel Johnson, The Vanity of Human Wishes, line 352.


Monday, June 27, 2016

The Impoverishment of Attention

“While the link between attention and excellence remains hidden most of the time, it ripples through almost everything we seek to accomplish.”
Focus matters enormously for success in life and yet we seem to give it little attention.
Daniel Goleman‘s book, Focus: The Hidden Driver of Excellence, explores the power of attention. “Attention works much like a muscle,” he writes, “use it poorly and it can wither; work it well and it grows.”
To get the results we want in life, Goleman argues we need three kinds of focus: inner, other, and outer.
Inner focus attunes us to our intuitions, guiding values, and better decisions. Other focus smooths our connections to the people in our lives. And outer focus lets us navigate in the larger world. A (person) tuned out of his internal world will be rudderless; one blind to the world of others will be clueless; those indifferent to the larger systems within which they operate will be blindsided.
How we deploy attention shapes what we see. Or as Yoda says, “Your focus is your reality.”
Goleman argues that, despite the advantages of everything being only a click away, our attention span is suffering.
An eighth-grade teacher tells me that for many years she has had successive classes of students read the same book, Edith Hamilton’s Mythology. Her students have loved it— until five years or so ago. “I started to see kids not so excited— even high-achieving groups could not get engaged with it,” she told me. “They say the reading is too hard; the sentences are too complicated; it takes a long time to read a page.”
She wonders if perhaps her students’ ability to read has been somehow compromised by the short, choppy messages they get in texts. One student confessed he’d spent two thousand hours in the last year playing video games. She adds, “It’s hard to teach comma rules when you are competing with World of War Craft.”
Here is a telling story. I was in a coffee shop just the other day and I noticed that when two people were having a conversation they couldn’t go more than a few minutes without picking up their phone. Our inability to resist checking email, Facebook, and Twitter rather than focus on the here and now leads to a real life out-of-office. Sociologist Erving Goffman, calls this “away,” which tells other people “I’m not interested” in you right now.
We continually fight distractions. From televisions on during supper, text messages, emails, phone calls … you get the picture. This is one reason I’ve changed my media consumption habits.
It feels like we’re going through life in a state of “continuous partial attention.” We’re there but not really there. Unaware of where we place our attention. Unconscious about how we live.
I once worked with the CEO of a private organization. We often discussed board meetings, agendas, and other areas of time allocation. I sensed a disconnect between where he wanted to spend his time and what he actually spent time on.
To verify, I went back over the last year of board meetings and categorized each scheduled agenda item. I found a substantial mismatch; he was spending a great deal of time on issues he thought were not important. In fact, the ‘scheduled time’ was almost the complete inverse of what he wanted to focus on.
Goleman also points to some of the implications of our modern world.
The onslaught of incoming data leads to sloppy shortcuts, like triaging email by heading, skipping much of voice mails, skimming messages and memos. It’s not just that we’ve developed habits of attention that make us less effective, but that the weight of messages leaves us too little time simply to reflect on what they really mean.
In 1977, foreseeing what was going to happen, the Nobel-winning economist Herbert Simon wrote:
What information consumes is rather obvious: it consumes the attention of its recipients. Hence a wealth of information creates a poverty of attention, and a need to allocate that attention efficiently among the overabundance of information sources that might consume it.
William James, a pioneer of modern psychology, defined attention as “the sudden taking possession by the mind, in clear and vivid form, of one of what seems several simultaneously possible objects or trains of thought.”
We naturally focus when we’re lost. Imagine for a second the last time you were driving in your car without your GPS and you got lost. Think back to the first thing you did in response. I bet you turned off the radio so you could increase your focus.
Goleman, paraphrasing research, argues there are two main varieties of distractions: sensory and emotional.
The sensory distractors are easy: as you read these words you’re tuning out (our sponsor and all of the text on the right). Or notice for a moment the feeling of your tongue against your upper palate—just one of an endless wave of incoming stimuli your brain weeds out from the continuous wash of background sounds, shapes and colors, tastes, smells, sensations, and on and on.
More daunting is the second variety of lures: emotionally loaded signals. While you might find it easy to concentrate on answering your email in the hubbub of your local coffee shop, if you should overhear someone mention your name (potent emotional bait, that) it’s almost impossible to tune out the voice that carries it— your attention reflexively alerts to hear what’s being said about you. Forget that email. The dividing line between fruitless rumination and productive reflection lies in whether or not we come up with some tentative solution or insight and then can let those distressing thoughts go—or if, on the other hand, we just keep obsessing over the same loop of worry.
The more our focus gets disrupted, the worse we do.
To focus we must tune out emotional distractions. But not at all costs. The power to disengage focus is also important.
That means those who focus best are relatively immune to emotional turbulence, more able to stay unflappable in a crisis and to keep on an even keel despite life’s emotional waves.
Failure to drop one focus and move on to others can, for example, leave the mind lost in repeating loops of chronic anxiety. At clinical extremes it means being lost in helplessness, hopelessness, and self-pity in depression; or panic and catastrophizing in anxiety disorders; or countless repetitions of ritualistic thoughts or acts (touch the door fifty times before leaving) in obsessive-compulsive disorder. The power to disengage our attention from one thing and move it to another is essential for well-being.
We’ve all seen what a strong selective focus looks like. It’s the couple in the coffee shop mentioned above, eyes locked, who fail to realize they are not alone.
It should come as no surprise that we learn best with focused attention.
As we focus on what we are learning, the brain maps that information on what we already know, making new neural connections. If you and a small toddler share attention toward something as you name it, the toddler learns that name; if her focus wanders as you say it, she won’t.
When our mind wanders off, our brain activates a host of brain circuits that chatter about things that have nothing to do with what we’re trying to learn. Lacking focus, we store no crisp memory of what we’re learning.
Goleman goes on to discuss how we connect what we read to our mental models, which is the heart of learning.
As we read a book, a blog, or any narrative, our mind constructs a mental model that lets us make sense of what we are reading and connects it to the universe of such models we already hold that bear on the same topic.
If we can’t focus we’ll have more holes in our understanding. (To find holes in your understanding, try the Feynman Technique, which was actually an invention of George Eliot’s but I’ll save that for another day.)
When we read a book, our brain constructs a network of pathways that embodies that set of ideas and experiences. Contrast that deep comprehension with the interruptions and distractions that typify the ever-seductive Internet.
The continuous onslaught of texts, meetings, videos, music, email, Twitter, Facebook, and more is the enemy of understanding. The key, argues Nicolas Carr, author of The Shallows: What the Internet Is Doing to Our Brains, is “deep reading.” And the internet is making this nearly impossible.
There is, however, perhaps no skill better than deep and focused thought. The more information that’s out there,” says Tyler Cowen, author of Average Is Over: Powering America Beyond the Age of the Great Stagnation, “the greater the returns to just being willing to sit down and apply yourself. Information isn’t what’s scarce; it’s the willingness to do something with it.”
Deep thought must be learned. In order to do that, however, we must tune out most of the distractions and focus.
Goleman reminds us that some of this too was foreseen.
Way back in the 1950s the philosopher Martin Heidegger warned against a looming “tide of technological revolution” that might “so captivate, bewitch, dazzle, and beguile man that calculative thinking may someday come to be … the only way of thinking.” That would come at the loss of “meditative thinking,” a mode of reflection he saw as the essence of our humanity.
I hear Heidegger’s warning in terms of the erosion of an ability at the core of reflection, the capacity to sustain attention to an ongoing narrative. Deep thinking demands sustaining a focused mind. The more distracted we are, the more shallow our reflections; likewise, the shorter our reflections, the more trivial they are likely to be. Heidegger, were he alive today, would be horrified if asked to tweet.
The rest of Focus: The Hidden Driver of Excellence goes on to narrow in on “the elusive and under-appreciated mental faculty in the mind’s operations” known as attention and its role in living “a fulfilling life.”



Columbia River M21-12 Carson Design Combo Edge 3" Blade Aluminum

  Columbia River M21-12 Carson Design Combo Edge 3 inch Blade Aluminum

Columbia River M21-12 Carson Design Combo Edge 3" Blade Aluminum

Customer Reviews 4.500 Read 2 reviewsWrite a Review
Part Number: CRM2112
Manufacturer: Columbia River (CRKT)

These new swedged and recurved blade are ground to a spear point shape, using premium AUS 8 stainless steel in non-reflective frost finish to offer superior edge retention. The grind incorporates a false top edge and deep belly, yet retains a full width central spine for most of its width for maximum strength.
Teflon bearings at the blade pivot assure velvety smooth one hand opening and closing, using Kit Carson's trademark dual checkered thumb studs which also act as a blade stop.
The M21 feature the very popular "Carson Flipper" blade extension, which aids opening and acts as an additional blade guard.
Kit Carson's open build uses contoured handles of 6061 T6 aluminum, hard anodized charcoal gray. They are CNC machined with a perimeter radius for a comfortable grip with or without work gloves, skeletonized to reduce weight. There is a single stainless steel locking liner with friction grooves for positive locking.
Columbia River has also incorporated the patented Lake And Walker Knife Safety (LAWKS®) into the M21 models, which converts them into virtual fixed blades when engaged.
Every model features a removable Teflon plated stainless steel pocket clip.
Carson M21
M2112: Combined Razor-Sharp & Triple-Point Serrated Cutting Edge
Blade: Overall length: 3.12" (7.9 cm)
Cutting edge: 3.00" (7.6 cm)
Thickness: 0.12" (0.30 cm)
Steel: AUS 8, 57-58 HRC
Handle: Closed length: 4.25" (10.8 cm)
Weight: 3.3 oz. (94 g)

Friday, June 24, 2016

Practical Neurology

Current issue

June 2016
Volume 16
Issue 3
The essential point of Practical Neurology is that it is practical in the sense of being useful for everyone who sees neurological patients and who wants to keep up to date, and safe, in managing them. In other words this is a journal for jobbing neurologists who plough through the tension headaches and funny turns week in and week out.

Practical Neurology is included as part of a subscription to JNNP and provided in print to all members of the Association of British Neurologists



Thursday, June 23, 2016

Pamela Anderson


Vitamin D and remyelination in multiple sclerosis.

Vitamin D and remyelination in multiple sclerosis.

Matías-Guíu J, et al. Neurologia. 2016.


INTRODUCTION: Several studies have found an association between multiple sclerosis and vitamin D (VD) deficiency, which suggests that VD may play a role in the immune response. However, few studies have addressed its role in remyelination.

DEVELOPMENT: The VD receptor and the enzymes transforming VD into metabolites which activate the VD receptor are expressed in central nervous system (CNS) cells, which suggests a potential effect of VD on the CNS. 

Both in vitro and animal model studies have shown that VD may play a role in myelination by acting on factors that influence the microenvironment which promotes both proliferation and differentiation of neural stem cells into oligodendrocyte progenitor cells and oligodendrocytes. 

It remains unknown whether the mechanisms of internalisation of VD in the CNS are synergistic with or antagonistic to the mechanisms that facilitate the entry of VD metabolites into immune cells.

CONCLUSIONS: VD seems to play a role in the CNS and our hypothesis is that VD is involved in remyelination. 

Understanding the basic mechanisms of VD in myelination is necessary to manage multiple sclerosis patients with VD deficiency.

Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.


27321170 [PubMed - as supplied by publisher]

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