Home

Science

Foundational concepts: Tissue types: Transitional epithelium, and how it makes it possible for the bladder to do its job

Submitted by RST on Sat, 12/15/2012 - 08:23
Posted in

 

When you hear hoofbeats, think horses, not zebras.

--Theodore Woodward, Wikipedia: "Zebra (medicine)" accessed 15 December 2012

 

 

We had a huge health scare with our beloved cat Marvin this last week. He began urinating blood, and we rushed him to the veterinarian immediately.

Ultrasound revealed a large mass in his bladder, making it 50% larger than it should have been.

There is a saying in clinical biomedicine about when you hear hoofbeats (a metaphor for seeing clinical signs), you should think it means that you hear horses running (a very common species, because common conditions are most likely to be seen in the clinic), rather than zebras (an exotic species, rarely seen, just as rare conditions are--by definition--rarely encountered in clinical treatment).

The "horse" in this case was a bladder cancer tumor, and the "zebra" was a blood clot.

Ultrasound, as we'll discuss when we talk about biomedical imaging, has a very low resolution compared to other imaging modalities, and while we were waiting to send the image out to a radiologist for a specialist to read, we began to make a treatment plan based on the amount of information that we had in the moment.

The horse--a bladder tumor--had a bad prognosis (predicted outcome), and our family spent a miserable evening planning how we would say goodbye to Marvin when the cancer got too advanced, and he had no more quality of life left.

Selfishly, we didn't want to let him go too soon--and yet, we feared that desire might lead us to keep him around too long for his comfort and happiness.

It was an awful night that we spent with that possibility.

And yet, our doctor--who also loves Marvin, and was very disturbed at the prospect of his impending death--went back and did a second ultrasound later on.

And when she did, she actually found a zebra, rather than the horse we thought we were dealing with.

In the second ultrasound, taken hours after we had discussed the first one, the mass had moved.

Tumors don't move--but blood clots do.

And as Marvin was urinating blood, the mass was getting smaller.

By the time we picked him up from the vet's a few days later and took him home--ecstatic that he wasn't going to die soon of a tumor--his bladder was back to normal size, and his urine was only a little pink, rather than bright red, and expected to return to normal urine over the next few days.

How could Marvin's bladder go up to one and a half times normal size, and then go back to normal size in only a few days for an uneventful recovery?

 

 

Let's go back to the very first topic on the very first day of the very first anatomy class: the four tissue types.

What are the four tissue types in human beings (and cats), and how and why are they different from one another?

They are:

  1. epithelial tissue;
  2. connective tissue;
  3. muscle tissue; and
  4. nervous tissue.

 

They are different from each other in structure, and also in function.

Based on their structure, each of them has a particular job to do, and they can't do each other's job because their structures are so different that they don't fit.

This, by the way, is the reason that anyone who says that skin, connective tissue, and muscle carry emotional memory is mistaken.

We used to believe that, and in, say, the 18th century, that would have been the state of the art of anatomical knowledge.

But in the 1800s, we began investigating neurons and other kinds of nervous tissue, and now we know that emotional memory is the job of the nervous system. Other kinds of tissue simply aren't equipped to do that job, and it's a mistake to confuse the job of nervous tissue with the jobs of other kinds of tissue.

One of the primary jobs of epithelial tissue is protection of other layers of different kinds of tissue. Just as the skin (made up of epithelial tissue) protects what's inside your body, the epithelial linings of organs, such as the bladder, also protect those organs from exposure to whatever passes through those organs.

So while there is a pervasive and mistaken myth, one that refuses to die among practicing MTs and still being taught to students in massage schools, about how massage "releases" toxins from tissues, and "flushes" them out of the body, there is actually a real-life physiologically-faithful example in the function of epithelial tissue of how the body really does process toxic substances and protect itself from them.

Anatomical reasoning brainstorming

Cigarette smoking is a leading cause of bladder cancer, as well as other cancers of the urinary tract, increasing the risk by up to three times as much as for nonsmokers.

Can you propose a mechanism or a pathway for how smoking (using the respiratory system) can lead to cancers in the urinary system?

Is it plausible or likely that massage can change this mechanism in one way or another?

 

 

 

 

Sometimes evidence shows that the old ways actually are the best

Submitted by RST on Wed, 10/03/2012 - 09:17
Posted in

While cherry-picking--the act of suppressing evidence that doesn't support our own particular biases--is something to be avoided, berry-picking, on the other hand--carrying out our searches for information in a way that is not strictly linear and that incorporates cognitive questions, by allowing those searches to evolve and change in response to what we initially come across--is not only to be encouraged, but can be absolutely delightful in the unexpected directions it leads us.

This morning, berry-picking took me in a most unexpected direction. On the way to looking up something else, I came across this:

Risks of consuming fermented foods

Alaska has witnessed a steady increase of cases of botulism since 1985. It has more cases of botulism than any other state in the United States of America. This is caused by the traditional Eskimo practice of allowing animal products such as whole fish, fish heads, walrus, sea lion, and whale flippers, beaver tails, seal oil, birds, etc., to ferment for an extended period of time before being consumed. The risk is exacerbated when a plastic container is used for this purpose instead of the old-fashioned, traditional method, a grass-lined hole, as the botulinum bacteria thrive in the anaerobic conditions created by the air-tight enclosure in plastic.--Wikipedia, "Fermentation: Risks of consuming fermented foods accessed 3 October 2012

 

Slightly off-topic, but interesting (I think!), in a berry-picking way, since we care about calling people by the names they want to be called: Did you notice that the paragraph used the word "Eskimo", and did that perhaps seem a little strange to you, because you've heard that you shouldn't use the term "Eskimo" when you mean the Inuit people, since the word is derogatory or pejorative or insulting?

You're not wrong, if you remember hearing that--the word "Eskimo" probably does, historically, have connotations that are belitting and insulting, and Native American and First Nations people have spoken out explicitly and firmly against the use of the word.

At the same time, there is no good inclusive replacement term that includes the Yup'ik peoples of Alaska--if you just say "Inuit" instead of "Eskimo", that's fine if you mean only Inuit people and no one else.

But if you mean Inuit people together with Yup'ik people, then there really isn't a well-known acceptable term that means both. So often, you will see Alaskan Native American (more so) and Canadian and Greenlandic First Nations and Inuit people (less so, or maybe even not at all, per Lee Kalpin's comment following this post) compromising, and using the term in order to be inclusive, despite the connotations that go along with the word.

 

What's happening in Alaska?

Alaska has witnessed a steady increase of cases of botulism since 1985. It has more cases of botulism than any other state in the United States of America.--Wikipedia, "Fermentation: Risks of consuming fermented foods accessed 3 October 2012

 

Botulism is a condition that paralyzes people and animals who eat food contaminated with botulin toxin, or who have an open wound through which the bacteria that produce the toxin (Clostridium botulinum) can enter the body. C. botulinum is an obligate anaerobic bacterium, meaning that it is obliged to grow in an environment without air--oxygen is deadly to it.

VERY IMPORTANT WARNING

This is why you absolutely never, under any conditions at all, give honey to babies under 1 year old--they don't yet have the immunity to fight off the bacteria that produce the toxin.

After 1 year of age and older, people can fight off the actual C. botulinum bacteria themselves, so the bacteria can't gain a foothold in their systems to begin pumping out the toxin.

But if the neurotoxic poison produced by that bacteria has already contaminated the food somehow--as opposed to the bacteria themselves--then that toxin can produce botulism in anyone.

 

Facial paralysis which spreads through the body is a typical symptom of botulism; very bad cases can actually cause death by paralyzing the muscles needed to breathe.

The 14-year-old in these pictures from Wikipedia show the paralysis that's typical of severe botulism. Although he appears dead, he was actually fully conscious, yet unable to move. His eyelids were drooping and his eyes were paralyzed, and the pupils were fixed and dilated. We hope he made a full recovery--Wikipedia doesn't tell us how his story turned out--but even if he did, it would require a long, slow, difficult path to rehabilitation.

 

"A 14-year-old with botulism. Note the bilateral total ophthalmoplegia [paralyzed eyes] with ptosis [drooping eyelids] in the left image and the dilated, fixed pupils in the right image. This child was fully conscious."

Source: http://upload.wikimedia.org/wikipedia/commons/b/b4/Botulism1and2.JPG accessed 3 October 2012

 

From 1950 to 1997, 105 confirmed outbreaks of foodborne botulism involving 214 persons occurred in Alaska (there were no confirmed cases during 1947-1949)...All cases occurred in Alaska Natives. The average annual incidence among Alaska Natives increased from 3.5 cases/100,000 population during 1950-1954 to 10.7 cases/100,000 during 1995-1997 [in other words, right about 3 times as many cases as you'd expect, based on history].--State of Alaska Public Health Epidemiology Report: Botulism in Alaska--A Guide for Physicians and Health Care Providers, 1998 Update accessed 3 October 2012

 

Source: State of Alaska Public Health Epidemiology Report: Botulism in Alaska--A Guide for Physicians and Health Care Providers, 1998 Update http://www.epi.hss.state.ak.us/pubs/botulism/fig_1.gif accessed 3 October 2012

 

The Rose Urban Rural Exchange, in its own words, "aims to strengthen relationships between urban and rural Alaskans by building mutual respect and understanding, and fostering a statewide sense of community through cross-cultural immersion.".

They have a website where they promote cross-cultural understanding by presenting pictures and reports of daily life, festivals, and other events.

In a post, "The Best of the Whale", one of their writers, Bogdan, presents pictures from Ilisagvik Inupiaq Culture Camp, where elders and others share a meal of traditional foods.

Notice the blue plastic container, and the Ziploc plastic bags--we're going to get back to those in a moment.

 

Source: http://ecci-2012.s3.amazonaws.com/thumbs/20120814_ecc_grp_iic_awi_70_502ab33f88f97.JPG.poster.jpg accessed 3 October 2012

 

Bogdan describes the scene:

The most desirable food served at the blanket toss festival is fermented whale meat and blubber (mikiaq). Elders particularly like mikiaq, because it is easy to chew. To keep the audience interested and at the site, mikiaq is served last, after all the other food items have been distributed.

 

Mikiaq is

raw whale blubber that has been left to soak and ferment in the whale's blood.

 

Fermentation occurs when, under anaerobic conditions (reduced or no oxygen), you convert sugars (carbohydrates containing carbon [C], hydrogen [H], and oxygen [O] atoms as building blocks) like the kinds of glucose here:

Source: http://upload.wikimedia.org/wikipedia/commons/0/06/DL-Glucose.svg accessed 3 October 2012

 

 

 

into ethanol, the kind of alcohol in drinks such as beer, wine, and spirits, a process which rearranges those atoms into this arrangement:

Source: http://upload.wikimedia.org/wikipedia/commons/3/37/Ethanol-2D-flat.png accessed 3 October 2012

 

Greenlandic to English Dictionary

nuna iterssaliorpâ: digs a hole in the ground, p. 180 (Old orthography)

qasaerdlâq: a seal which has been put by whole and left to ferment, p. 211 (Old orthography)

 

Back in the old days, fermenting the mikiaq was accomplished by digging a hole in the ground, and leaving it there for as long as it took the process to occur naturally.

Nowadays, just like most of the rest of us reading this, circumpolar peoples have access to modern conveniences like the blue container and the Ziploc bags you saw in the photo from the festival.

Plastic bags, containers, and utensils, no matter how bad they are for the environment, have some convenient qualities that make them so widespread in food preparation. One of those properties is the ability to keep food fresh for longer periods of time.

It does this by sealing the food away from exposure to air that would cause it to decay faster. In other words, it promotes an anaerobic environment.

And that's where the connection to the increased cases of botulism lies.

This is caused by the traditional Eskimo practice of allowing animal products such as whole fish, fish heads, walrus, sea lion, and whale flippers, beaver tails, seal oil, birds, etc., to ferment for an extended period of time before being consumed. The risk is exacerbated when a plastic container is used for this purpose instead of the old-fashioned, traditional method, a grass-lined hole, as the botulinum bacteria thrive in the anaerobic conditions created by the air-tight enclosure in plastic.--Wikipedia, "Fermentation: Risks of consuming fermented foods accessed 3 October 2012

 

Fermentation in a grass-lined hole, while still an anaerobic process, is less efficient at keeping the oxygen out, since air will circulate in and out of the hole and between the blades of grass. The C. botulinum bacteria have to overcome the deadly oxygen in that air, if they are going to establish a strong enough foothold to produce enough neurotoxin to make the mikiaq dangerous to the people who eat it.

A plastic container, on the other hand, does a much better job of keeping out the oxygen. Less oxygen in the container means a more welcoming environment for C. botulinum, where they can start to churn out neurotoxin.

As plastics have come into wider and wider use in the general population, and as they have made their way to more remote areas, where the convenience appealed to people, they took the existing risk of botulism, and--by providing a better anaerobic environment--sent the cases of botulism much higher than had been the case when mikiaq used to be fermented in the traditional grass-lined hole.

 

What all this means is that--contrary to what you may have heard--evidence-based practice does not mean that you have to give up traditional practices just because they are traditional, and adopt modern practices just because they are modern.

It means that instead of a top-down simplistic rule-based approach (either "Old = Good! New = Bad!": the "Argument from antiquity" fallacy, or the other way around, "Old = Bad! New = Good!": the "Argument from modernity" fallacy), we take a bottom-up approach of examining the evidence itself, and then deriving more nuanced and accurate rules that we can turn around and apply. Which, in turn, means that everything, traditional and modern alike, gets examined to find out:

  • what works in the way it claims to,
  • what doesn't work in the way it claims to, and
  • the mechanisms for why that is the case.

 

Once we better understand the answers to those questions, we can better decide which practices fit better into our client-centered model of service, and why they do so. This example was a perfect demonstration of how sometimes evidence supports the traditional practice as objectively better, as measured on the basis of outcomes (number of cases of botulism), than the modern practice.

 

Source: http://upload.wikimedia.org/wikipedia/commons/e/e2/PSM_V37_D324_Greenland_eskimo.jpg accessed 3 October 2012

Part 1: Foundational concepts--anatomy, physiology, life, levels of organization, and regulation

Submitted by RST on Sun, 09/30/2012 - 14:03
Posted in

 

What we are going to do in this course is this: for validated scientific anatomical knowledge, we are going to create and make openly available anatomical knowledge organization templates (KOTs), based on the original Anatomical Knowledge Organization Templates developed by my teacher, Cornelius Rosse.

 

 

KOT here

 

 

 

 

 

 

 

 

 

 

 

 

http://sig.biostr.washington.edu/education/resources/KOTorgan.html

 

sections of NCETMB and NCETM that we address here

 

 

Examples:

 

anatomy: gross, histology, microscopic, comparative ==> levels of analysis

 

physiology: how do the anatomical parts actually work, how do their structure and orientation and location influence what they can do, how body systems work together, and how they influence each other ==> regulation, emergent properties, systems science

 

can we always separate those questions? mouse prostate example

 

 

but most of the things we are dealing with will be much more straightforward than that. when it's harder, we'll flag it.

 

 

 

 

 

============================================

 

How do we study anatomy and physiology?

 

Anatomy is easier to visualize with our eyes, with dissections, and instruments like microscopes: "learning to see what we're trying to understand".

 

Physiology is processes: we need to know how to approach more complicated visualizations

 

what we can see and touch on dissections: gross anatomy (and you can imagine the jokes punning off of "gross")--formalin smell

 

histology: study of tissues, built up of cells (cytology)--uses microscope in order to understand how tissues can work (physiology), we have to understand structure of cells on microscopic level (anatomy)

 

neural tissue made up of neural cells can support memory because their structure can carry electric signal. other types of tissue cannot because they cannot carry electrical signal. so if you see claims that body cells carry emotional memory, you have to choose between that and histology. What we see inside the cell, how the cells are arranged in relationship to each other, how much space is between the cells--all of these material physical anatomical aspects of cells influence what physiological functions the tissues made up of those cells are able to carry out

 

microscopic anatomy: looking at cells and tissues under a microscope/histology

 

cytology

 

we are getting into levels of analysis here

 

two resources that we will draw upon here as necessary are embryology (developmental biology) and comparative anatomy--together, they are called evo-devo

 

you won't be tested on these subjects. but the knowledge they contain will support our reasoning about the anatomy that we *are* responsible for knowing, so we'll take them into account in order to more fully understand the subject.

 

comparative anatomy: why do humans have 1 prostate and mice have 5? why do bears have anucleate cells? the answers to these questions provide valuable information about human anatomy, in a (metaphorically) similar way to how learning a foreign  language can help us better understand why our native language does things in the way it does. this is one of the bases for comparative medicine: MIN

 

model organism examples: in-depth understanding

 

levels of analysis:

 

(smaller ones we haven't talked about yet)

cellular anatomy and histology

gross anatomy

(larger ones we haven't talked about yet)

 

notice that the levels of analysis are very different from each other. MIN

this will become important when we look at how people try to talk about massage and quantum physics. when we get to that, it will be your job to decide whether what they say makes sense. To do that, you need to be aware of what it means to talk about different levels of analysis, and how structures and functions of the same thing at one level of analysis can be very different from structures and functions of that same thing at a different level of analysis

 

 

look at one level of analysis, and understand how it leads to supporting structure and function at the next level of analysis

 

"system by system and connect the dots"

 

anatomy: how do we use our "eyes, microscope, and imagination" to develop a good, solid, and in-depth understanding of anatomy and physiology that will support us in providing high-quality, client-centered care?

 

 

physiology: how do we use our "anatomy knowledge, logical thinking, and basic knowledge of chemistry and cell biology" to develop a good, solid, and in-depth understanding of anatomy and physiology that will support us in providing high-quality, client-centered care?

 

"anatomy is very visual"

 

you can't understand how body parts and systems work (physiology) if you don't understand the anatomy where physiology happens (and, later, pathology--abnormal functioning)

 

 

logical thinking: "a lot of physiology is connecting dots, step-by-step" -- how these parts work together

 

 

basic chemistry and cell biology that you need to understand to make physiology make sense: plausibility

 

 

"Complementary principles

 

Function cannot occur without structure

 

Functions are often dictated by form" MIN

 

you need physiology to stay alive. dead bodies can have anatomy.

 

"interconnected: you need both to stay alive, and you need a good knowledge of both to be successful" this is a bridge or an obstacle to integration

 

 

"What is life"

Always an interesting question to ponder

Schrödinger's paradox--order comes from disorder

Socrates--objects are a reminisce of previous objects

Hooke & Schwann cell theory (more later)"

 

 

when we say we practice massage because we want to make a difference in people's lives, what is the implicit knowledge that we are drawing upon to ground what we say

 

 

many viewpoints on this: philosophical, Socrates, "The Republic", the Cave--we're shadows of former objects

 

science: order comes from disorder==?chemical reactions, cells, movements of molecules and ions into and out of cells--"there needs to be some kind of chaos on the molecular level for us to stay alive"

 

chaos: sperm in water, hormones rather than vasculature in fish

 

 

cell theory (what is a theory), then modern cell theory==life cannot occur

without cell, cell is functional unit that drives life--this is why viruses are not considered alive to understand what it means to be alive, we need to understand levels of organization--at what level does life actually begin?

 

we have to talk about matter--matter is anything that takes up space and has mass--some kind of physical presence

 

atoms--smallest simplest forms of matter in nature, can't see, have various behaviors--examples C, H, O,N, K+, various behaviors

 

molecules/compounds--combinations of atoms; glucose, protein, lipid, hormone, chemical message, structural protein like cell membrane--is a protein or a sugar alive? they don't have a metabolism

 

organelles--look at a cell, as we will next week, see distinct parts, nucleus, ER, Golgi apparatus, ribosome: sacs with enzymes that drive biochemical reactions--can a fuel factory be alive? no, separate and not organized

 

cells--organized organelles, start to see life take place--nucleus, DNA inside can start to use all other organelles for chemical reactions--this is where life begins, at cellular level--political implications, pro-life,

pro-choice

 

tissues--put cells of different varieties into organized tissues

 

organs--organized tissues of different types

 

organ systems--11

 

organism

 

population systems--how long can you go without any human contact? how well

could you survive on your own? we need each other to survive. everyone is

different in levels of need, but we need each other

 

fractal: population system, analogies with organ systems and with cells

 

image of levels of organization

 

where does life begin? at cellular level

 

"Interrelationships of organ systems

cells rely on organ systems to maintain life

cells drive the function of organ systems

the interrelationship of these two concepts drive life"

 

MIN

 

we have to go all way down to cellular level for good understanding of

physiology

 

good part of physiology n day 2 day level is keeping cells alive: example

respiration

 

bridge to pathophysiology

 

what are the pathological changes that occur at the cellular level--what drives disease to happen? what cellular changes occur that make the tissue go awry?

 

cells drive live; most of our physiology is spent keeping life going at the cellular level

 

"Requirements for life

 

boundaries

movement

responsiveness

digestion

metabolism

excretion

reproduction

growth and change

 

what organ systems drive each of these functions?"

 

 

physical boundaries; borders between tissues, organs, cells, internal ve

external--skin is major outer boundary, connective tissue serve as boundaries inside

 

why do we need movement? get meal, look at animals who don't get blood clots in hibernation—musculoskeletal responsiveness to changes--changes in environment (int or ext) occur all the time--we need to be able to adapt to them, and if we can't, we will die--

nervous, endocrine--homeostasis later

 

digestion--breaking food down into simplest building blocks so that we can absorb it and make use of it--1, eat the food 2, break it down 3, absorb it 4, excrete it what don't absorb when finished--if you understand these concepts, then you can understand diseases like Crohn's disease or diarrhea

 

metabolism--what is metabolism? burning calories? digesting food? only 1/2 the equation--metabolism is about all chemical reactions that occur in body--certain systems help regulate, nervous, endocrine--life-giving chemical reactions occur within cell itself--building up and breaking down molecules in the chemical reactions that sustain life

 

excretion--where there is metabolism, there has to be excretion, because there are waste products left over--CO2, for example. respiratory system--urinary system, kidneys, waste filtering organs--without kidneys, won't live very long--skin can sweat out some waste, digestion--kidneys biggest one,

cells constantly excreting waste products (lymph)--constantly producing waste products, must be removed--remove organic waste products

 

reproduction--permits continuity of life--extremely important organ system--we are reproducing faster than we are dying off--panda bears--poaching is a problem--big mammals in general take a long time to reach sexual maturity, so vulnerable to poaching--when are we readily physically to reproduce--puberty--8-13 years after we're born. physiologically, not

psychologically. we as a species not threatened enough to get us to point where repro is big issue for us.

 

growth and evolution--growth necessary for life to take place. compare birth. grow to self-sustainable, mature organism. evolution as well--evolution is just change--adapting to environments and surviving--we need to evolve to changes in environment as well--and animal or plant that does not evolve will not survive--

 

"survival needs

 

oxygen

nutrition

water

normal temperature

pressure"

 

oxygen big part of making ATP and cellular energy--big metabolic deal

 

nutrition--calories, fuel, making energy, protein to make plasma proteins, need structure--protein deficient people look very wasted away because digesting own muscles--vitamins, minerals, proteins  fats for energy storage, structural purposes, driving metabolic reactions

 

water main transport medium, bulk of body is water--most people have ~40 liters of water in blood and tissues, helps drive chemical reactions, thrermoregulator

 

temp--is big, 98.6, but without temp, metabolism going to go nuts, ability to circ O2, metabolism, going to die if hindered --too high or too low

 

pressure--why pressure? important for breathing, transport--no one ever talks about BP in good context, always hypertension--BP necessary because without it, how would we circ blood, filter nutrients out of capillaries into tissues

 

respiration--must be enough pressure to drive oxygen out of air, into our tissues,

 

"homeostasis

 

maintenance of a stable internal environment, i.e., balance

 

dynamic equilibrium--we operate around various set points that fluctuate when exposed to various stimuli

 

if we fail to return back to our normal set points, disease and sickness ensue"

 

what constitutes life, what life is, homeostasis is a big, not well-understood concept

 

we strive for on day to day basis==

 

phys balance

 

dyn equil. -- 98.6F your temp goes up and down, all during the day

 

go outside in cold weather, your body tem goes down

 

body water levels maintained by monitoring sodium levels, if osmolarity drops below certain point, body salts get too high, we get dehydrated, and need to get fluid back into our system--

 

certain set points that we need to survive=-homeostasis maintains balance around those certain set points how do we know what those points are?

 

always fluctuate around set points, but if we fluctuate too far, and don't get back to the set point, that's some form of disease

 

98.6F--temp goes down in cold air, so physiological mechanisms protect us, and help us reverse the drop in temp

 

body water level by monitoring sodium levels, osmolarity drops, salt too high, dehydrate, have to get water back in system

 

how do we know what a "normal" body temperature is, what a normal sodium level is, set points correspond to lab values among other things

 

nutrient levels, metabolism, what organ system is responsible for constant monitoring of this?

 

the most important system in human body is nervous system. some systems self-regulate to some degree, but regulation of body systems is the nervous system's job

 

 

if we fail to return back to normal set points, sickness occur--BP goes up and down, sit, stand, walk run move around, BP up to meet increased demand on body, as we age, BP tends to rise. we have mechanism that tend to compensate, but if those mechanisms fail, that's high BP

 

if our own systems fail, that's where medical intervention comes in

 

if body can't regulate BP, pills prescribed--bring in Olney at this point--if we need help to get physiology back to normal

 

maintain balance through feedback loops

 

"maintenance of homeostasis

 

always exposed to internal and external stimuli

 

requires constant monitoring by the nervous system

 

main form of regulation is through feedback loops

 

two loops: negative and positive feedback"

 

 

some organs do kind of self-regulate, like pancreas self-regulates insulin secretion, for most part in general, nervous system regulates everything

 

when nervous system detects changes in body, it needs to "figure out" (metaphorically) how to return to normal.

 

uses feedback loops

 

"negative feedback loop

 

three components: receptor, control center, effecter organ"

 

loop: something circular

 

negative most common regulatory mechanism in human body

 

receptor, control center, effecter organ

 

neg feedback begins with receptor, specialized cell or group of cells in nervous system, whose job is to detect changes--stimuli--stimulus, singular--factors that upset or disrupt physiology, changes in environment

 

all these receptors do is constantly wait for a stimulus

 

receptor detects a change, generate impulses to control center--main

control center in body is brain--central nervous system is brain and spinal

cord. receptors pick up on changes, send info about changes to control

center. control center (CNS) "develops" "plan of attack" for bringing situation back to normal (xref with innervation)

 

communicates with effector organ. effector organ carries out right response to get us back to normal set point, receptors, control center, effectors

shut off, because continuing to correct would over compensate, and take us in the wrong direction (tacking in a sailboat)

 

example: classical example: thermostat. cold air comes into house, thermostat set at 70F. 0F air comes in for 3 minutes. cold air came in, now house temperature of kitchen lower. as a result, something picks up on this, thermostat is receptor as well. temp to 65F, thermostat detects.

thermostat sends signal to heater, turns heater on. heater starts pouring out heat, only until gets back to 70F. then shuts off so house doesn't get too hot above 70F

 

 

overheating compared to hyperthyroidism. if we don't shut off response, that could kill us, oversecrete hormone while trying to get back to normal.

 

BP: say BP goes up from 120/80, 145/86 mm Hg. we need to get it back down.

if exercising, ok, but don't want it that high at rest. there is a baroreceptor (baro means heavy or pressure). the baro receptors are in carotid arteries in neck in carotid sinuses, sensitive only to changes in BP

 

 

 

 

BP up, baroreceptors detect it, communicate with control center. control center in this case is brainstem. effector organs in this system are heart and blood vessels (arteries).

 

heart rate will respond to high BP by going down, output of blood volume pumped out will go down. are we going to increase dilate or constrict decrease diameter of arteries down HR and dilated arteries with less pressure will make BP go down dilated arteries easier blood flow, then entire response shuts off at reset to 120.80

 

what happens if gets too low? pass out, bc brain not getting enough oxygen

 

carotid sinus massage

 

 

vasovagal syncope response to high-stress situations.

 

orthostatic hypotension

 

negative feedback is most common regulatory mechanism in body why is it called negative?

 

negates or changes a stimulus--back to normal and then shut off when get back to set point.

 

 

"positive feedback loop

 

can be life-threatening"

 

this is what we call an amplifying cycle

 

positive feedback is good but can be life-threatening as well, because it just keeps getting greater and greater and greater over time--there is no automatic shutoff valve, like there is on a negative feedback system

 

like neg, has to be some kind of stimulus that triggers it to begin

 

here's the difference

 

example childbirth--once uterus stretches to certain point, it starts generating active nervous potentials to brain, and the brain is going to respond by releasing hormone called oxytocin

 

uterus got stretch, stimulus is baby in this situation that stretched uterus, oxytocin makes smooth muscle of uterus start to contract, it's a labor contraction, what happens with labor contractions over time, they get worse, more intense, they do not get more pleasant over time, intensity goes up, and the amount of time in between the contractions goes down.

 

start out 20-30 minutes apart, by the time it's time to give birth, they're about 20-30 seconds apart. so there's a stimulus that activated the response, but the response continued to enhance, it got greater and greater and greater over time.

 

 

the only thing that's going to shut off a positive feedback loop is when the stimulus--in this case, the baby--is removed from the body

 

 

removal of stimulus turns off positive feedback

 

fever another example, this can be threatening,

 

you have pathogen within you

 

big initial spike in body temp, maintain high body temp, or slowly rises,

if body temp gets too high, it can kill you

 

if body temp gets too high, requires medical intervention, or it will kill you

 

my fever story

 

blood clotting mechanisms is pos feedback mechanism--too many clots stuck in circulation can impeded blood flow to essential organism somewhere

 

my blood clotting story

 

 

problem is, if too intense of stick around too long, can threaten our life, but it is a kind of feedback loop

 

you have the stimulus (stretch receptors in uterus picking up on presence of baby_

 

communicating with control center of brain on this

 

 

the difference here is the brain is continuing to amplify an amplify and amplify, making the response greater and greater and greater until the stimulus is gone

 

neg--stimulus triggers response to get back to certain set point, then stops--you can't get rid of body temperature or body water, can['t get rid of stimulus itself

 

pos & neg fb--we use these to maintain and regulate homeostasis--physiological balance

 

this is what our everyday life revolves around--keeping ourselves balanced, keeping all our set points in check to keep ourselves alive

 

topics and concepts you need to understand

 

understand difference in levels of analysis, claims about "balance", what has been shown and what hasn't, semantics

Closer...closer... (#31/31)

Submitted by RST on Fri, 08/31/2012 - 15:25
Posted in

In mathematics, an asymptote (From Ancient Greek term ἀσύμπτωτος asúmptôtos, “not falling together”, from ἀ "not" + σύν "together" + πτωτός "fallen" Wiktionary, "Asymptote" accessed 31 August 2012) is a line that a curve continues to get closer and closer to, but never meets.

In this image, the blue line is the asymptote that the red curve approaches but never touches.

 

That image is a good visual metaphor for scientific knowledge.

Sometimes, people think science provides certain knowlege: in metaphorical terms, it intersects or touches the line representing perfection or certainty.

But science never does provide certainty. It can get awfully close--for example, it can be 99.99% certain--which, in practical terms, functions much like certainty does.

For example, it's pretty close to certain at this point that body cells don't carry emotional memory--there is just so much accumulated anatomical, physiological, biochemical, and neuroscientific evidence that goes against that claim that the probability of upsetting the weight of all that evidence in the future is something like hitting the lottery.

There's nothing to stop you from betting on that happening, of course. But you probably wouldn't bet all the money you own against something that close to certain.

But there is always a small window of uncertainty--an acknowledgment that scientific knowledge is always provisional and contingent, and that we are open to revising it if better evidence comes along in the future.

Understanding that--and understanding that there are varying degrees of uncertainty, some wide open and others all but certainly already resolved--will take you a long way in the development of your research literacy.

Everyday science in the world around us: Making chocolate (#24/31)

Submitted by RST on Thu, 08/23/2012 - 12:17
Posted in

There is no better, there is no more open door by which you can enter into the study of natural philosophy than by considering the physical phenomena of a candle.--Michael Faraday, The Chemical History of a Candle

 

Michael Faraday was right. Everywhere we look, the world around us contains so many possibilities for understanding natural philosophy (the old name for science), because we use it in our lives in so many ways every day.

Faraday was focused on the numerous processes at work in a candle; we're going to take the same approach in a somewhat different venue. And if, in addition to reading along, you replicate the steps described here, at the end, you're going to have a treat to reward yourself with.

Interestingly, you can find chocolate massage at some spas, so there is actually an even more direct connection between chocolate and massage than we're exploring here.

Source: http://thedailybasics.com/wp-content/uploads/2012/02/chocolate-massage-tineye-marriot.jpg accessed 24 August 2012

 

Our connection to it here in this post is just as a very nice part of the larger material physical universe that we're engaged in; maybe we'll talk about chocolate massage some other time.

 

 

Making vanilla-cream-infused chocolate balls

To make chocolate balls, we have to decide what we're going to do about their inside and their outside.

For this recipe, we're going to have a ganache inside--a smooth, soft mixture of chocolate and cream, infused with fresh vanilla.

The outside will be, for simplicity's sake, premade hollow chocolate shells. The reason I'm going premade on this is that I don't want to discuss tempering chocolate yet--that's a big enough topic that I want to treat it later on its own.

Here are all the ingredients that I'm going to use in this recipe.

The cream in the background, and the chocolate buttons in plastic bags and the vanilla pod lying on a saucer in the foreground are going to become the inside of the chocolate balls.

 

The hollow chocolate shells lined up in plastic trays in the center of the picture are going to become the outside of the balls. I buy mine at a nearby chocolate store; depending on where you live, this may or may not be an option.

Later, we're going to talk about how to make them entirely from scratch. But as I mentioned, there is enough to learn about that process that I want to get back to it later, so that we can quickly get to making some confections now.

Ingredients to start:

  • 8 ounces chocolate buttons or other kinds of chips or shaved or chopped chocolate for the ganache
    • Either dark or milk is ok, whichever you prefer. White may work every bit as well as milk or dark does, but since I don't have very much experience with white chocolate, I can't speak to it out of real experience.
    • You don't have to seek out buttons, but you do want as much surface area (the "amount" of exposed surface [Wolfram MathWorld, "Surface Area" accessed 24 August 2012]) as possible exposed, so that when you add the boiling cream, it melts reasonably evenly. You don't want to pour boiling cream over a chocolate slab. If you start with a block of chocolate, chop it or shave it so that you have lots of smaller pieces, exposing more surface area for the cream to contact.
    • You'll have ganache left over from this much chocolate for other uses--more chocolate balls, cake frosting, other treats.
  • 2 ounces extra chocolate for sealing off the filled chocolate balls
  • 1 cup pasteurized heavy whipping cream
    • This proportion of cream to chocolate is not absolute. When you try it, see what you think about the resulting ganache. If you find it too liquidy, you can fix that by adding more chocolate. If it's too stiff for your taste, you can make it more liquid by adding more cream to  the mixture. This proportion is a good first approximation, but feel free to vary the proportions to get the ganache to be the way you like it.
  • 63 hollow 3/4" chocolate shells
    • 3/4" inch is a very good size, since we're putting a creamy filling inside a crisp chocolate shell. If the person eating the chocolate eats it in two bites, the filling has the potential to leak out (especially later, when we're going to be doing other, very liquid, fillings, such as liqueurs). This small size is convenient for people to just pop in their mouths and eat in one bite, so there's no danger of the filling leaking out uncontrolled.
  • 1 vanilla pod
Microbiology of this photograph

The chocolate in the center and the foreground, for all practical purposes, do not support microbes, and are safe for storing at room temperature. They're best used within 18 months from manufacture, for the sake of taste, but as long as they're stored in a hygienic way, straight chocolate is a very safe food.

The biologicals in this photo, the vanilla pod and the cream, are where any practical risk of food spoilage is going to come in. Before it's been used in cooking, the dried vanilla pod can be stored at room temperature in a dark place out of direct sunlight for at least 6 months--some sources say for up to a year. If it dries out, or has visible signs of stinky mold, then you have a problem, but most of the time, it should stay moist and workable for 6 months.

After you've used it to make a ganache, you can reuse it a few more times, but it needs to be fairly soon--the cream that it is boiled in will determine its remaining shelf life. Before it's ever used, you should store it at room temperature; after boiling it in cream, you should store it in the refrigerator, and any reuse should take place soon after.

The cream is a good source of bacterial growth, because it's a great food source for them, but we're going to thwart that by boiling it, killing any microbes that may have been in it. Of course, others can establish themselves later, so we'll definitely practice safe food handling practices with it. The cream is the most immediate weak link in the food safety chain of chocolate confections, and it's the one around which we'll plan our safe food handling.

The reason I put such emphasis on safe food handling is this: Not only is it a matter of professional ethics; it is also one of respect.

A couple of years ago, I read of a benefit being put on at the Dkhw’Duw’Absh (Duwamish tribe) longhouse cultural center, to raise funds for their legal struggle for federal recognition of their tribal status.

The tribe is suing the federal government for recognition--asking to reverse a 2001 Bureau of Indian Affairs decision that the tribe had gone extinct.

--Duwamish tribe, "Duwamish Fight for Federal Recognition" accessed 24 August 2012

 

I emailed them to ask if they'd be interested in having me set up my massage chair at the event, and donating all money I earned from massage there to the legal fund that the benefit was set up for. They liked the idea, and so I showed up at the agreed-upon day and time.

While setting up my massage chair and learning my way around the center, I talked to others working at the event.

The woman managing the kitchen mentioned that they often used the longhouse dining room to put on philanthropic and other service events, but no matter what the event, anyone working in the kitchen has to have a food-service license that shows they are trained in the basics of safe food-handling. No exceptions.

Even if it's charity, anyone eating there has the right to expect that the people serving them a meal are doing it at a professional level of standards. No one, even at a charitable event, is expected to settle for less-than-professional quality of service.

As the woman explained, "It's a matter of respect.".

It's out of that spirit of respect for anyone that we served food to that I present the food-safety information here. Taste and enjoyment are very important, but keeping each other safe to continue to enjoy it is a foundational principle.

 

 

 

Step 1: Prepare the vanilla for infusion

Vanilla pods are really fruits of the vanilla orchid. The shiny textured pods contain the tiny black seeds of the orchid. We're going to include both the contents of the pod and the pod itself in our infusion.

 

The first step is to slice open on side of the pod and flatten it out. Then you can scrape out the seeds and other contents of the pod. They're seen on the right side of this saucer, beside the knife.

 

The seeds and the pod are going to go into the cream to bring to a boil on top of the stove.

Once the pod is used in this way, it still retains a great deal of flavor. You can reuse the pod 5 or 6 more times, but remember that--now that you have cooked it in cream--you need to store it in the refrigerator, rather than at room temperature, and you need to use it sooner than the 6-month-or-more shelf life a dried pod would have.

 

This is also your opportunity to put other flavorings in the ganache. I've just suggested vanilla here, but you're certainly not limited to that--you can put in other herbs and flavorings, to suit your taste. Your imagination is the limit here, as long as it's something you can safely eat or drink.

 

 

VERY IMPORTANT SAFETY NOTE: Never use essential oils of any quality less than food-grade essential oils for flavoring, whether you're making chocolate or any other food.

Because I as an MT, as well as the MTs in the reading audience, work with essential oils, it is critical that we be very clear on that distinction. We may often use the term "essential oils" to refer to topical products that we apply to clients' skin.

We must always make sure not to confuse the essential oils we use in massage with food-grade essential oils that we use in cooking or other ways of making food--no exceptions at all.

Many of the essential oils that we use in massage or aromatherapy are actively harmful or toxic if eaten or drunk.

Never, ever eat or drink any essential oil unless you are absolutely positive that it is a food-grade essential oil and nothing else. When purchasing it, unless you are absolutely positive from the label, never hesitate to feel free to ask the merchant you are purchasing from if it is food-grade essential oil, and safe to use in food and drinks.

 

 

 

 

Step 2: Infuse the flavorings in the cream

Put the seeds and the pod in the cream (plus any other flavorings if you've decided to use them), and bring them to a boil on top of the stove.

 

 

When the cream comes to a boil, we're going to pour them over the chocolate, so have the chocolate nearby and ready to go when the cream is ready.

 

Step 3: Melt the chocolate in the boiling cream

When the cream is boiling, pour it over the chocolate and stir to mix it thoroughly.

 

 

As the chocolate begins to melt, you'll see small chunks start to appear in the cream.

 

It will get browner and more evenly spread out as the hot cream comes into contact with the surface area of all the chocolate, melting it more and more.

 

When it's thoroughly melted, and you can't see any more white cream visible, then--if all has gone well--the shiny glossy surface of the mixture tells you that an emulsion of liquid melted chocolate suspended (or dispersed) in liquid cream is present.

This emulsion is the completed ganache.

 

Put the ganache aside to cool. Chocolate has a very low melting point; you've probably experienced having chocolate melt from just holding it in your hand. Chocolate's melting point is very close to human body temperature, so you don't want to put this hot chocolate in the chocolate shells right away.

 

Step 4: Fill chocolate shells with ganache

Once the chocolate has cooled to the temperature that you want to work with it at, you'll fill the chocolate shells with the ganache.

 

How do you know that the ganache is at the right temperature? You want it to be cool enough to put in the chocolate shells without melting them, yet not so cool that it becomes solid, stiff, and difficult to work with.

As you're working, you may find that the chocolate grows colder and becomes harder to work with than you want. You can always pop it in the microwave for 15-20 seconds, to make it more liquid again without heating it up too much.

What do you fill the shells with? You can using a frosting piping bag (my teacher's preferred method) or a food-grade syringe (my preference).

Fill up the shell's interior, but only up to the interior rim. You don't want to fill them up all the way, because you need to leave room to add a solid chocolate barrier to seal the creamy ganache inside.

 

 

 

Step 5: Sealing off the chocolate balls

Melt the remaining 2 ounces of chocolate to use to seal off the hole in the ganache-filled chocolate balls.

You can apply the chocolate with a piping bag or syringe to close off the balls in the same way you filled the balls, if you like, but I like to do this part by hand.

Of course, I make sure to wash and scrub my hands thoroughly before this step--20 seconds (time to sing the "Happy Birthday" song twice) under warm water, washing, scrubbing, and rinsing all exposed surface areas of the hand, shows care and respect for the well-being of the people to whom you're going to present these chocolates.

Dry your hands thoroughly before dipping them into the chocolate--not only is that an important part of handwashing hygiene, but you don't want to introduce water into your chocolate.

It sounds funny to say that melted chocolate is a very dry liquid--it sounds like a contradiction in terms. And yet, if you think about what "wet" means, it starts to make sense.

Melted chocolate is the same material as solid chocolate--it has just changed physical state, but there has been no chemical change. It's still exactly the same material.

When it was solid, it didn't have water in it. Adding heat to melt it gives the chocolate molecules energy to get further apart from each other. Because they don't hold on to each other as tightly as they did when it's a solid, it's softer and more pliable. But there's still no water in it, any more than there was when it was solid.

But if you add water to the melted chocolate, a chemical change occurs. It's no longer the same compound as it was, and it's not going to work the same way it did before the water was added.

Joe Pastry's blog shows what chocolate looks like when it seizes.

Source: Joe Pastry, "How to 'Un-Seize' Chocolate" accessed 24 August 2012

 

You can avoid this problem by not letting water get into your melted chocolate.

However, if water does get in, don't panic and throw away perfectly good chocolate!

It can't go on to become tempered chocolate or anything like that, but you can make chocolate syrup out of it by adding more liquid (more water, cream, and so forth). Seized chocolate changes from its original form, but it can be salvaged.

Joe Pastry's blog shows what the process looks like, and you can find detailed directions at the blog itself.

Source: Joe Pastry, "How to 'Un-Seize' Chocolate" accessed 24 August 2012

 

But let's try not to need to salvage the chocolate by not getting water in it in the first place.

After you've melted the 2 ounces of chocolate, you can dip your clean, dry finger in it to dab melted chocolate onto the open hole of the filled shells.

Dab enough melted chocolate to close the hole completely.

 

Remember, pure chocolate doesn't support microbial life. The cream, on the other hand, does, although it's temporarily free enough of microbes, since we boiled it. But other microbes can live in it after it cools, so sealing it off from the outside world, using pure chocolate, protects it from that possibility.

If you seal the ganache off totally, these chocolate balls can be stored safely at room temperature for several days.

 

The melted chocolate used to seal off the chocolate balls wil grow solid as it cools. If you're in a hurry, though, you can take advantage of the fact that changes in temperature can accelerate changes in physical state. You can stick them in the refrigerator or freezer to accelerate the melted chocolate turning solid.

You'll notice that there is unevenness and asymmetery in the finished balls, where I dabbed them with my finger to close them. That's fine; they're homemade--they shouldn't look as perfectly spherical as ball bearings, or as machine-produced chocolates.

 

 

As soon as the chocolate seal is solid, you can eat them, although some people prefer to wait a day or so, as the infusion continues to diffuse flavor in the ganache.

The best flavor is within 1-3 days of making them, although as mentioned, they'll actually last longer than that--either at room temperature, or in the refrigerator.

For serving them, though, the plastic tray the shells come in is very floppy, and can lead to dropping the chocolates.

Before moving the filled and sealed chocolate balls anywhere (whether to the refrigerator to speed up the sealing, or to the table for serving), I always slip a baking tray or other support under the plastic tray, or else I transfer the chocolates to a serving plate. I don't try to move the plastic tray unsupported, as that always ends in tears.

If you try this, I hope you enjoy it, and that you let us know in the comments how it turned out for you.

 

 

 

What flavorings do you like in chocolate?

Did you try making these chocolates?

Please tell us in the comments.

 

 

Littoral interpretation (#18/31)

Submitted by RST on Sat, 08/18/2012 - 19:20
Posted in

Water, water, every where,

And all the boards did shrink;

Water, water, every where,

Nor any drop to drink.

--Wikipedia, "The Rime of the Ancient Mariner", Samuel Taylor Coleridge, 1798 accessed 18 August 2012

 

The poem on the surface explores violation of nature and its resulting psychological effects on the Mariner, who interprets the fates of his crew to be a direct result of his having shot down an albatross.----Wikipedia, "The Rime of the Ancient Mariner: Interpretations", Samuel Taylor Coleridge, 1798 accessed 18 August 2012

 

Spoiler alert! (although there's a decent chance you already had to read this poem in elementary school, so in that case, you already know what happens to the Ancient Mariner and his crew).

The Ancient Mariner is a sailor who commits an unnecessary act of cruelty, even a crime in Coleridge's estimation--with his bow and arrow, he shoots the albatross (a water bird, like a seagull) who had led his lost ship out of dangerous waters.

With his cruel bow he laid full low
The harmless Albatross.

 

After the killing of the bird, more bad things continue to happen to the ship and crew. All the other crew members are eventually killed, but his punishment is to remain alive, tormented, and to wander the earth telling his story as a warning to others.

He partially redeems himself when--seeing the sea creatures that he had earlier despised, he recognizes how beautiful they really are. He wanders the earth eternally, trying to reach others with his lesson before it's too late for them to learn from it.

There is a metric boatload of things we could discuss about this poem, anywhere from conservation biology, history, psychology, and literature aspects, just to scratch the surface--but I want to talk about my trip to Padilla Bay estuary today, and what living in a littoral environment means for kidney function in animals--and Coleridge's observation about water is the perfect jumping-off point for that discussion.

 

 

 

 

An estuary is a body of water where fresh water from rivers and oceanic saltwater come together and mingle. So it's a complex transition zone, and organism functions that work one way in fresh water and another way in saltwater have to be covered in both cases there.

The littoral zone is the area of a body of water closest to the shoreline. So in an estuary, the littoral zone is where the fresh water and the saltwater mix--it's saltier than the fresh water is, but it's also less salty than the ocean water.

You probably know that, if you're ever lost on a boat on the ocean, you shouldn't drink seawater--not even a little bit, not even if you're very, very thirsty.

The reason is that your body tries to maintain a balance between the concentration of solutions (like dissolved salt) inside your cells and outside of them. Globetrooper has some good diagrams of what the process looks like, both when it's going right and when it's not.

Globetrooper's diagram shows what it looks like when things are balanced inside the cell and outside of it: a situation called "isotonic": the "same pressure" by water on the cell membrane from both sides.

Source: http://globetrooper.com/notes/wp-content/uploads/isotonic-state.png accessed 18 August 2012

 

The large gray circles represent salt ions (to be more specific, sodium ions and chloride ions), and the small blue circles represent water. The proportion of salt dissolved in the water--the concentration--inside the cell is about the same as the proportion of salt dissolved in the water outside the cells. The inside and the outside of the cell are in equilibrium (isotonic), and there is no pressure from the water either to leave or to enter the cell.

Globetrooper's next illustration shows a situation that is no longer isotonic. Salt ions (the gray circles) are dissolved in the water (the blue circles) inside the cell, but outside the cell, there are no salt ions--the water outside the cell is pure water, with no salt in it. This situation is called a hypotonic solution.

Source: http://globetrooper.com/notes/wp-content/uploads/too-much-fresh-water.png accessed 18 August 2012

 

Since the inside and the outside of the cell are no longer in balance, a process called osmosis occurs--the movement of fluid (in this case, water) across a semipermeable membrane (a membrane that substances can move through) from an area of lower concentration (in this case, of salt) to a area of higher concentration.

The effect is to bring the concentrations more into balance (isotonic).

The green arrow in this figure shows the movement of water (its osmotic pressure) from the area of low salt concentration outside of the cell to the area of higher salt concentration inside the cell. That movement of water into the cell dilutes the salt concentration, making it lower inside the cell.

This is what happens when we drink fresh water.

The opposite situation occurs when the water outside the cell is more salty (has a higher salt concentration: lots of gray circles, very few little blue circles) than the water inside the cell. This situation is called a hypertonic solution.

Source: http://globetrooper.com/notes/wp-content/uploads/too-much-salt-water.png accessed 18 August 2012

 

In a hypertonic solution, water flows out of the cells--the osmotic pressure of the water is toward the higher concentration of salt.

So you see what would happen? If you drank even a little salt water, it would draw water out of your cells. Instead of quenching your thirst, salt water would leave you more dehydrated than you were when you started.

At the cellular level, this is what it would look like:

Source: http://upload.wikimedia.org/wikipedia/commons/7/76/Osmotic_pressure_on_blood_cells_diagram.svg accessed 18 August 2012

 

In the hypertonic solution, the osmotic pressure comes from the water leaving the cells, leaving behind shriveled, badly dehydrated, cells (left side of image).

In the isotonic solution, the osmotic pressure balances out to zero, as equal amounts of water enter and leave the cells. The red blood cells in an isotonic state look normal and healthy with the indentation in the center that is typical of them.

In the hypotonic solution, the osmotic pressure pushes water into the cells, stuffing and waterlogging them--the normal indentation starts to disappear as the cell is too full of water.

These microphotographs of real red blood cells show how they really look, as they react to the different solutions we just described.

Source: http://upload.wikimedia.org/wikipedia/commons/6/62/Human_Erythrocytes_OsmoticPressure_PhaseContrast_Plain.svg accessed 18 August 2012

 

So now that we've discussed how cells behave in different kinds of solutions (hypertonic, isotonic, and hypotonic), does Coleridge's verse

And all the boards did shrink;

 

make even more sense now?

Why is that?

What is he describing, and why did the boards shrink as a result?

 

 

Osmoregulation (the control of osmotic pressure in body fluids, such as blood) is controlled in humans and other vertebrates by the kidneys--that's an important function they have in addition to production and excretion of urine.

Hormones produced by the pituitary gland and the adrenal glands, among others, signal to the kidneys what state the solutions in the blood are--hypertonic, isotonic, or hypotonic--and the kidney responds accordingly by reserving water or by releasing it to restore the balance.

As we are land animals, our kidneys have to respond to fluids we drink or take in in other ways (like an IV solution in the hospital, for example), but that's basically it. Fish, on the other hand, are surrounded by fluid, and their kidneys have to respond to that fluid and balance the water that their cells take in.

Too much water, and the cells swell up and get waterlogged--the hypotonic solution in the previous pictures.

Too little water, and the cells shrink and dehydrate and rupture--the hypertonic solution in the previous pictures.

The fish kidneys have to get the solution just right, and in a situation where the fish is surrounded by fluid of a different concentration.

Freshwater fish adapt to this situation by not drinking very much, and by urinating a lot; ocean fish (except sharks, which are a whole different story for another time) adapt by drinking a lot and not urinating very much.

So freshwater fish and ocean fish have adapted to this problem in pretty much opposite ways--that would seem to make a lot of sense.

But salmon live part of their lives in fresh water, and part of the time in salt water--so how can they have adapted to both, when the adaptations are the opposite of each other?

Salmon have adapted to both lifestyles--they can barely drink and urinate a lot when they live in fresh water, and then change to drinking a lot and barely urinating when they're out in the ocean.

Specialized cells in their body can work in opposite ways, depending on what they need at which stage they are in their lives.

But they can't turn it on a dime--they need days or weeks to make the transition between fresh water and ocean water.

And that's where the importance of the estuarine environment, like Padilla Bay, comes in--as an intermediate zone between the two other environments, it provides a place where salmon can make the transition.

In a region where the salmon can move around in the littoral zone to find the right amount of salt concentration they need, estuaries ensure the survival of those salmon leaving the fresh water where they were born, to go out and spend a large part of their lives in the ocean.

And they also ensure a place where--when it's time to go back up the freshwater river and breed--salmon have a place to adjust back from the ocean to the river environment, so that they can give birth to the next generation, and continue the cycle.

So often, in massage school, we don't have time to teach anatomy this deeply, and that's a real shame. If you just have time to memorize the fact that the kidneys control osmoregulation, so that you can recognize it when the MBLEX or the NCBTMB/NCBTM asks you about it, then that doesn't give you any particular preparation for clinical practice.

But if, at a deeper level, you understand what is going on, and you can draw a line from how the kidneys are involved in salt balance to what happens when that balance gets out of control one way or another, then you can understand what is going on with people living with renal failure or other kidney disease, and you are better equipped to know whether or not it's safe for you to provide massage under the circumstances.

It all depends on what the meaning of "is" is: 05-Augean Stable Song, part 2 (#13/31)

Submitted by RST on Sun, 08/12/2012 - 17:36
Posted in

 

The need

Full disclosure: I'm a member of the research group (the Structural Informatics Group at the University of Washington) who carried out a lot of this work, although my work is different from and in parallel to the work done by other members of the group. I will cite a couple of my own papers here, but most of the work I cite will not be research I carried out myself.

You should bear that affiliation in mind when you read this, to evaluate whether--as I should--I have connected the dots for you without positive bias for people I work with, and have a very high regard for.

In Mejino 2004 (Rosse C, Mejino JL Jr. Symbolic modeling of structural relationships in the Foundational Model of Anatomy. In Proceedings, First International Workshop on Formal Biomedical Knowledge Representation (KR-MED 2004), Whistler Mountain, Canada), the authors first review the situation that anatomical knowledge representation is currently in (as of that writing).

The main objective of the terminologies correlated by UMLS is to serve as repositories of terms that can be reused with consistency by a variety of applications.

 

UMLS is the Unified Medical Language System, developed and maintained by the National Library of Medicine for information-sharing across biomedical disciplines and between individuals and institutions.

 

In general, most of the current biomedical and educational applications are designed to present hard-coded, didactic information, or they support low-level, look-up functions with no, or at best limited, capabilities for inference. The semantic structure of today's controlled medical terminologies (CMTs) as well as of biomedical ontologies seems adequate for the needs of such contemporary applications. (Mejino 2004)

 

Inference is the process of reasoning, of developing new information or knowledge based on extending in a sound and valid way what we already know.

Mejino here is contrasting how contemporary computer medical knowledge sources can retrieve answers to questions for which humans have already done the work,

Example: "name the muscles that make up the quadriceps".

(corresponding roughly to the lowest level of Bloom's learning taxonomy--passively recognizing memorized facts. This is the level at which standardized testing, such as the MBLEX or NCETM/NCETMB, evaluate knowledge.)

 

but are not yet very good at independently figuring out new information that humans have not explicitly put into the knowledge base yet.

Example: "Use the information about the different cell-type lifetimes and replacement rates to figure out an explanation for why cancer patients undergoing radiation often lose their hair and tissue in their esophagus, and explain the reasoning behind your answer".

(corresponding roughly to the higher levels of Bloom's learning taxonomy--application, analysis, synthesis, and evaluation. Standardized testing, such as the MBLEX or NCETM/NCETMB, cannot evaluate knowledge at this level, because it requires original writing from the student, and it requires evaluators who are capable of correctly grading the quality of the student's answers--a very time-intensive process. These are, however, levels of knowledge processing required in clinical practice.)

 

They contrast the status quo with needs on the horizon.

Next-generation applications, however, will have to incorporate increasing levels of intelligence in order to meet the demands of the evolving environment in education, biomedical research and the practice of the various health professions. Such knowledge-based applications call for the representation of much deeper and richer knowledge than that retrievable from today's CMTs and ontologies. (Mejino 2004)

 

As they indicate, the current situation is not going to remain sufficient for much longer, given the rapid changes in the fields that need information from these systems. In the very near future, we are going to need software that can provide the user with much more detailed and sound knowledge than this generation of software is able to provide.

 

Since most of these projects primarily target clinical medicine, they are deficient in basic science concepts necessary to support reasoning. (Mejino 2004)

 

This point may not be immediately obvious, so let's clarify it.

Star Trek and other popular media depictions aside--with a few exceptions in active research areas--computers are really pretty stupid.

"Garbage in, garbage out" as the saying goes--the quality of the information you get out depends directly on the quality of what you or someone else previously put into the computer.

They're like the Sorcerer's Apprentice, except they're not conscious or self-aware.

The Sorcerer's Apprentice (German: Der Zauberlehrling) is a poem by Goethe, written in 1797. The poem is a ballad in fourteen stanzas.

...

The poem begins as an old sorcerer departs his workshop, leaving his apprentice with chores to perform. Tired of fetching water by pail, the apprentice enchants a broom to do the work for him — using magic in which he is not yet fully trained. The floor is soon awash with water, and the apprentice realizes that he cannot stop the broom because he does not know how.

Not knowing how to control the enchanted broom, the apprentice splits it in two with an axe, but each of the pieces becomes a new broom and takes up a pail and continues fetching water, now at twice the speed. When all seems lost, the old sorcerer returns, quickly breaks the spell and saves the day. The poem finishes with the old sorcerer's statement that powerful spirits should only be called by the master himself. Wikipedia, "The Sorcerer's Apprentice" accessed 13 August 2012

Source: http://upload.wikimedia.org/wikipedia/commons/0/05/Tovenaarsleerling_S_B... accessed 13 August 2012

 

(I so dearly wanted to use a still here of Mickey Mouse as the Sorcerer's Apprentice from the animated film Fantasia, but Disney is notoriously litigious about use of its intellectual property, and I really don't need the headache they gave this Florida daycare over it. So I didn't.)

 

These systems are developed to the needs of clinical practitioners, who have long ago finished studying basic sciences. The applications are programmed to respond to what the clinician needs in daily practice, not the basic sciences knowledge base.

Since most of these programs are about storing and retrieving information, rather than reasoning to derive new knowledge, this works for short-term needs. If basic science is needed, the user does the cognitive work involved, and stores the pertinent information in the system.

This won't work for more intelligent systems, though. The computer can't use knowledge that is not explicitly stated, even though humans work with each other like that every day.

In order to make all these systems work on the computer, all the information that we've implicitly communicated with other humans--or thought we were communicating, even if we weren't really--needs to be made explicit.

 

Moreover, since relationships between concepts constitute an important dimension of knowledge, next-generation knowledge sources must model comprehensively not only the concepts but also the relationships that characterize a particular field of basic science. (Mejino 2004)

 

"Comprehensively model" means to make all this information explicit, so that all the steps necessary to support reasoning are present and available. They model not only the existence of the entities, but also the relationships among those entities--how they interact with, and relate to, each other.

So comprehensively modeling superficial fascia in a way that promotes sound and valid reasoning about it and other anatomy it's involved with means putting it in the right place in the hierarchy, to make it clear that it's not a sibling of deep fascia, and should not be confused with it.

 

Therefore, there is a need to generate enabling knowledge sources at least in those domains that generalize to diverse fields of education, biomedical research and clinical practice. Anatomy is such a fundamental domain. (Mejino 2004)

 

Absolutely right--getting the anatomy correct is just that important.

How well are we doing at it?

As we're about to see, not that great. But some of our problems are getting fixed, even as we speak--the ones Jacobs indicates, and a host of other ones, as well.

UMLS and the other initiatives in biomedical informatics are intended for creating large and interoperable bodies of knowledge that can communicate with each other, and with people.

Although they're not primarily intended to improve anatomy education, they will inevitably do so as a side effect.

Making knowledge explicit, rather than implicit, and ensuring the validity of the knowledge that is modeled--discarding mistaken information and affirming validated information--will lead to supporting our students as they learn this material, to supporting our teachers as they step up to the challenge of increased teaching competencies, and to supporting our clients as we get better at understanding and communicating about the anatomy that underlies what we have to offer them.

 

Source: http://upload.wikimedia.org/wikipedia/en/7/74/MGM_sorcererhat.jpg accessed 13 August 2012

 

Coming up next: The scope of the problem

It all depends on what the meaning of "is" is: 05-Augean Stable Song, part 1 (#12/31)

Submitted by RST on Sun, 08/12/2012 - 07:31
Posted in

 

Two stories from ancient Greek mythology about jobs that, at first glance, seem impossible.

The twelve labours of Hercules or dodekathlon (Greek: δωδέκαθλον, dodekathlon) are a series of episodes concerning a penance carried out by Heracles, the greatest of the Greek heroes, whose name was later romanised as Hercules. They were later connected by a continuous narrative. The establishment of a fixed cycle of twelve labours was attributed by the Greeks to an epic poem, now lost, written by Peisander, dated about 600 BC.

...

Fifth Labour: Augean stables
Heracles cleaning the Augean stables (mosaic from Roman Spain, 201–250 CE)
Main article: Augeas

The fifth Labour of Hercules was to clean the Augean stables (pronunciation: /ɔːˈdʒiːən/). This assignment was intended to be both humiliating (rather than impressive, as had the previous labours) and impossible, since the livestock were divinely healthy (immortal) and therefore produced an enormous quantity of dung. These stables had not been cleaned in over 30 years, and over 1,000 cattle lived there. However, Hercules succeeded by rerouting the rivers Alpheus and Peneus to wash out the filth.--Wikipedia, "Labours of Hercules" accessed 12 August 2012

 

Source: http://upload.wikimedia.org/wikipedia/commons/9/99/Mosaico_Trabajos_H%C3%A9rcules_%28M.A.N._Madrid%29_05.jpg accessed 12 August 2012

 

 

Psyche searches far and wide for her lover [the god of love: Cupid in Latin, Eros in Greek], finally stumbling into a temple where everything is in slovenly disarray. As Psyche is sorting and clearing the mess, Ceres (Demeter to the Greeks) appears, but refuses any help beyond advising Psyche that she must call directly on Venus [Latin name for the Greek goddess Aphrodite, goddess of beauty and love], who caused all the problems in the first place [because she was jealous of any woman with whom her son fell in love]. Psyche next calls on Juno (Hera to the Greeks [queen of the pantheon of Olympic gods]) in her temple, but Juno gives her the same advice. So Psyche finds a temple to Venus and enters it. Venus [knowing that this is an impossible task] then orders Psyche to separate all the grains in a large basket of mixed kinds before nightfall. An ant takes pity on Psyche, and with its ant companions, separates the grains for her.--Wikipedia, "Cupid and Psyche" accessed 12 August 2012

 

Source: http://upload.wikimedia.org/wikipedia/commons/2/23/Bouguereau-Psyche.jpg accessed 12 August 2012

 

 

 

 

 

The previous post provided access to some powerful tools, with real protential for problem-solving: taxonomic classification and ontological knowledge structures.

There's a common saying that the first step in solving a problem is admitting that it exists.

Does anatomical science have any major structural problems? Jacobs has identified what she considers a very serious one; let's look at the situation and its context to see what we're dealing with here.

Jacobs' problem is this, in her own words:

I had no idea that "fascia" meant, or was synonymous with, anything other than some sort of gluey stuff extruded from sparsely located cells, barely metabolically active except for cranking out vast amounts of sticky molecules, a trick that comes in handy in a heterogenous organism which has some parts hugely expensive to maintain (e.g. nervous system, only 2% of the body but requiring 20% of all the fuel), important for keeping an organism from falling apart, and for giving its more active contractile elements a place to anchor.

My idea of superficial fascia was that it was that fine filamentous spider-webby areolar stuff adhering the hypodermis on to the outside of the body, and to the dense fascia that overlies it. I confess, it was my conjecture, based on what I think is logical.

Now here is Gray's, saying it means hypodermis. Something is definitely wrong on the internet. Something might be seriously wrong in anatomy!

It seems to me Gray's is calling all animals in this layer cows, instead of just some animals. I look at this with jaw resting on floor. I really do think it amounts to a taxonomic error on the part of anatomists. I'm calling them on it, right here.

I think the term "fascia" should be left as a description of a particular connective tissue type, not an assemblage of tissue types that obviously comprise an organ, hypodermis, that has a particular function, i.e. thermoregulation, and through which passes indisputable neural structure which can't be classified with fascia no matter how hard you try to stretch it! (..no pun intended.)

The world of manual therapy is like a spaceship. And I feel like I just discovered the conceptual hole in the hull.

Because of this one single factual misnomer, countless generations of manual therapists have been sucked out into space, have had their minds snapped shut while simultaneously being made to contemplate the bogus idea that they have magical hands that can somehow overcome the logical purpose of fascia, which is to keep the body from coming apart, all because of a careless slip of taxonomic nomenclature stemming from the dissection habit anatomists have of slicing this blubber layer right off so as to get to viscera etc., useless and hindering as it is in a cadaver specimen, not investigating it from the perspective of how it might respond in a living human when touched from the outside, say by a manual therapist, who clearly cannot get his or her hands past the barrier of the heavily innervated outer dermis (not without introducing infection, at least), or past reflexive motor guarding by spinal cord function via autonomic and somatic motor efferent, and visceral afferent neurons. And it has been replicated, as a meme, as an error, by anatomists, apparently with high fidelity.

So, based on this careless anatomical overlook, manual therapists have been taught, carefully, in a stepwise, apparently anatomically acceptable but logically impossible Argument from Authority, a tissue-based myth that they can manually impact "superficial fascia", from the outside in!

To add further insult, this mistake (according to me at least!) has been allowed to sit there uncriticized, confusing generation after generation. When will the madness stop? It could stop immediately, if anatomists, or whoever is in charge of producing anatomical information, would just correct this one tiny assertion/conflation. It would be a necessary and sufficient hull patch.

 

Having worked with this anatomical information issue for some years now, I can assure everyone that it's not really as bad as Jacobs suspects.

It's much, much worse.

 

 

 

To sum up the problem concisely, as we head into the next parts, here's a reasonable (if minimalist) taxonomy of anatomical structures.

As children of the same parent, "Anatomical entity", Anatomical structures and Anatomical spaces have some things in common that they inherit from that parent, and other things that differ from each other, which is why they are different kinds of Anatomical entity.

The same can be said for any subtree part of the larger tree--as children of the same parent, "Organ", Heart and Hypodermis have some things in common that they inherit from that parent, and other things that differ from each other, which is why they are different kinds of Organ. And so forth for different subtrees and branches of the larger ontology.

So far, no problem. What Jacobs perceives, correctly, is that if you replace "Hypodermis" with its synonym, "Superficial fascia", then the potential for serious confusion is introduced, as it looks as if "Superficial fascia" and "Deep fascia" form their own subtree of a parent fascia.

 

 

So it's the same material physical referent--only the name (term) has changed. However, the name has changed to something very confusing, and that confusion cascades into our anatomy education. That's Jacobs' "hole in the hull".

But it's not hopeless, no matter how much it may seem like the ancient legends of the Augean stables and the temple grains.

Like Psyche in the story, we will find help from unexpected sources. How to address this massive, urgent problem is an active and ongoing research area, and others working on this issue have things to offer us that we need without even knowing it.

There is so much to say about the work that is being done, and what it means for the current problems our anatomy education (such as the one Jacobs identified), that this post grew hopelessly long. So I'm splitting it into parts, and will put up each part as it is finished.

It all depends on what the meaning of "is" is: 04-Pandas and raccoons and bears, oh my! (#11/31)

Submitted by RST on Sat, 08/11/2012 - 13:01
Posted in

So that we can take this discussion further, there is a certain amount of foundational background knowledge that we need, and Wikipedia sums it up well enough for our purposes.

Metaphysics is a branch of philosophy concerned with explaining the fundamental nature of being and the world, although the term is not easily defined. Traditionally, metaphysics attempts to answer two basic questions in the broadest possible terms:

"What is there?"

"What is it like?"

A person who studies metaphysics is called a metaphysicist or a metaphysician. The metaphysician attempts to clarify the fundamental notions by which people understand the world, e.g., existence, objects and their properties, space and time, cause and effect, and possibility. A central branch of metaphysics is ontology, the investigation into the basic categories of being and how they relate to each other. Another central branch of metaphysics is cosmology, the study of the totality of all phenomena within the universe.

Prior to the modern history of science, scientific questions were addressed as a part of metaphysics known as natural philosophy. The term science itself meant "knowledge" of, originating from epistemology. The scientific method, however, transformed natural philosophy into an empirical activity deriving from experiment unlike the rest of philosophy. By the end of the 18th century, it had begun to be called "science" to distinguish it from philosophy. Thereafter, metaphysics denoted philosophical enquiry of a non-empirical character into the nature of existence. The study of metaphysics is rejected by natural science.--Wikipedia, "Metaphysics" accessed 11 August 2012

Worthwhile take-home points from this summary, so that we're all operating from the same knowledge base:

  • Metaphysics has been an established branch of philosophy for centuries, and has traditionally treated questions such as "What is there?" and "What is it like?"
     
  • Other uses of the term "metaphysical" came on the scene later.

    Source: "NEW AGE SPIRITUALITY: Metaphysics meets Science and Religion..." http://www.metaphysics-for-life.com/new-age-spirituality.html accessed 11 August 2012

    You can see why mystics and spiritualists use the term--the discipline is about studying what exists, and they are making claims about things that exist in non-material non-physical ways.

    However, there is nothing inherent in the term "metaphysics" itself that means non-material non-physical things have to exist.

    As long as we're clear on that matter, and aware of the fact that people use that same word to mean different things, we can avoid some of the most common misunderstandings.
     
  • Just as philosophy has the "child" metaphysics, metaphysics is itself the "parent" of ontology--the branch of metaphysics that deals with entities (things that exist), the properties or qualities they possess, and the ways they interact with each other.
     
  • Science grew out of philosophy, and eventually split with it, because science developed the scientific method--an empirical, or tangible, way of testing ideas about the material physical universe.

    We've seen several splits like this through history:
    1. the science of chemistry arose from, and then split with, the mystical doctrines of alchemy.
    2. Astronomy's origins lie in astrology, but astronomy does not accept astrology's non-empirical claims of cause and effect.
    3. Geologists William Buckland and Adam Sedgwick set out in 19th-century Britain to find evidence to prove the Biblical story of the Great Flood; based on the evidence they found, they ended up revising their theory to fit their findings, which showed no such evidence.
    And so forth, many times throughout history.
     
  • To say that natural science "rejects" metaphysics sounds harsh--and yet, if it's not empirical, it has nothing to do with science. It can't, because science deals with connecting the dots between entities and their relations in the material physical world. If it's not a physical entity, and it can't be investigated empirically, then it has nothing to do with science.

    How to demonstrate the existence and reality of supernatural entities is a real conundrum--but since it's not in science's scope, scientists don't usually deal with such matters. If someone, scientist or non-scientist, claims to have solved the problem of how you could possibly carry out such a task, the burden of proof is on them to show that they have actually done what they claim to have done.

    Some kinds of metaphysics as practiced by some people accept claims like this at face value--but science does not.


     

Ontology (from onto-, from the Greek ὤν, ὄντος "being; that which is", present participle of the verb εἰμί "be", and -λογία, -logia: science, study, theory) is the philosophical study of the nature of being, existence, or reality, as well as the basic categories of being and their relations. Traditionally listed as a part of the major branch of philosophy known as metaphysics, ontology deals with questions concerning what entities exist or can be said to exist, and how such entities can be grouped, related within a hierarchy, and subdivided according to similarities and differences.--Wikipedia: "Ontology" accessed 11 August 2012


 

Worthwhile take-home points from this summary, so that we're all operating from the same knowledge base:

  • "Ontology deals with questions concerning what entities exist or can be said to exist"

    So, for example, craniosacral therapy's claims of articular mobility, respiratory mechanism, and craniosacral fluid's pulses and rhythms would all be legitimate questions for ontological enquiry.

    As a branch of metaphysics, which does not deal with empirical enquiry, ontology also would not investigate it empirically.

    Natural science, on the other hand, can and does investigate the question of existence empirically.

    Anything for which someone makes a claim that it exists is fair game for ontological and natural science enquiry as to the reality and the nature of that existence.
     
  • "and how such entities can be grouped, related within a hierarchy, and subdivided according to similarities and differences

    "Philosophy is the parent of metaphysics, which is the parent of ontology" and "Ontology is a child of metaphysics, which is a child of philosophy" are examples of relating entities in a hierarchy.
     
  • "subdivided according to similarities and differences" brings the idea of taxonomy into the picture, so we'll put off discussing that aspect of ontology until we've had a chance to introduce taxonomy.

 

 

 

In computer science and information science, an ontology formally represents knowledge as a set of concepts within a domain, and the relationships among those concepts. It can be used to reason about the entities within that domain and may be used to describe the domain.

In theory, an ontology is a "formal, explicit specification of a shared conceptualisation". An ontology renders shared vocabulary and taxonomy which models a domain with the definition of objects and/or concepts and their properties and relations.

Ontologies are the structural frameworks for organizing information and are used in artificial intelligence, the Semantic Web, systems engineering, software engineering, biomedical informatics, library science, enterprise bookmarking, and information architecture as a form of knowledge representation about the world or some part of it. The creation of domain ontologies is also fundamental to the definition and use of an enterprise architecture framework.--Wikipedia, "Ontology (Information science)" accessed 11 August 2012

 

Worthwhile take-home points from this summary, so that we're all operating from the same knowledge base:

  • An "ontology" is a very useful data structure or knowledge structure in information science and knowledge representation. Although its name comes from a subdiscipline of philosophy, it's not the same thing--the two words are homonyms, or two different meanings for words that otherwise look and sound the same.

    Homonyms are going to cause us trouble in clarifying knowledge and communicating that knowledge with each other--knowing that fact in advance will help us handle it when confusion does come up.
     
  • Ontology knowledge structures contain information about the entities that exist in a given domain of knowledge (such as the examples in anatomy and biology that we'll look at here), as well as providing vocabulary about those entities, and about relationships among those entities.
     
  • Ontology knowledge structures are formal--they follow standard forms that they specify--and they are explicit, not leaving important knowledge unsaid or undescribed. In this way, they promote communication, by focusing on the content of the message, rather than forcing the user to figure out unfamiliar structures, or puzzle out what important things have been left unsaid.
     
  • Ontology knowledge structures explicitly draw on taxonomy, so next, we'll treat what that is.

 

By the way, Jacobs is a step ahead of us on this--she already saw taxonomy coming:

I really do think it amounts to a taxonomic error on the part of anatomists. I'm calling them on it, right here.

...

all because of a careless slip of taxonomic nomenclature stemming from the dissection habit anatomists have of slicing this blubber layer right off so as to get to viscera...

 

So let's proceed to taxonomy, so that we're all playing in the same key (cheers, Carol Lynn Chevrier!)

 

 

 

 

Taxonomy (from ancient Greek τάξις taxis, arrangement, and νομία nomia, method) is the academic discipline of defining groups of biological organisms on the basis of shared characteristics and giving names to those groups. Each group is given a rank and groups of a given rank can be aggregated to form a super group of higher rank and thus create a hierarchical classification. The groups created through this process are referred to as taxa (singular taxon).--Wikipedia, "Taxonomy" accessed 11 August 2012

 

Worthwhile take-home points from this summary, so that we're all operating from the same knowledge base:

  • "the academic discipline of defining groups of biological organisms on the basis of shared characteristics and giving names to those groups"

    Defining groups on the basis of existence and shared characteristics and giving names to those groups--the act of taxonomic classification--clearly fits into what we've been discussing about ontology and ontology knowledge structures, but Wikipedia's definition is too narrow here.

    Taxonomy is not limited to biological organisms, although that is an area where it is heavily used.

    For example, trying to figure out whether the giant panda was a bear or a procyonid (raccoon relative, like the red panda**) was a big question in the mid-to-late 20th century, until molecular evidence (such as genes involved in producing hemoglobin) demonstrated that they were definitely bears (Mayr E. Uncertainty in science: is the giant panda a bear or a raccoon? Nature. 1986 Oct 30-Nov 5;323(6091):769-71. PMID: 3774006).



    But taxonomy is not limited to those zoological usages. It is a method that can be used to classify anything--we're going to use it to classify anatomical structures shortly, and we've been using it to classify branches of philosophy as parents and children of each other. We'll finish this post with an example of how a team in Seattle used taxonomy to classify massage techniques, and we'll look at what they gained from that classification.

    So we'll rewrite the definition to make it more accurate and inclusive (and I'll try to remember to let Wikipedia know to update their entry, maybe by becoming an editor, or at least by contacting one):

    "the academic discipline of defining entities on the basis of shared characteristics and giving names to those groups"

    where an "entity" is something that we can deal with scientifically, since we can empirically detect its existence in the material physical universe.

 

Let's finish this post by looking at an example of how taxonomy has already been used in MT, and that should give us a firm footing to proceed from to get back to resolving the anatomy questions that originally kicked off this discussion.


 

** Red pandas are now classified in their own category, separate from raccoons, on the basis of better evidence than we had in the middle of the 20th century, when this question was being hotly contested. The illustration reflects the hierarchy that was in use at that time. In 1995, on the basis of mitochondrial DNA, red pandas were shown to be relatively close to raccoons, yet not in the same family.

 

 

 

 

Sherman's team in Seattle developed a taxonomy for describing massage treatments. Now that we've sync'ed up on taxonomy, the abstract should be pretty straightforward to read.

Sherman KJ, Dixon MW, Thompson D, Cherkin DC. Development of a taxonomy to describe massage treatments for musculoskeletal pain. BMC Complement Altern Med. 2006 Jun 23;6:24. PMID: 16796753 PMCID: PMC1544351 Free PMC Article

BACKGROUND: One of the challenges in conducting research in the field of massage and bodywork is the lack of consistent terminology for describing the treatments given by massage therapists. The objective of this study was to develop a taxonomy to describe what massage therapists actually do when giving a massage to patients with musculoskeletal pain.

METHODS: After conducting a review of the massage treatment literature for musculoskeletal pain, a list of candidate techniques was generated for possible inclusion in the taxonomy. This list was modified after discussions with a senior massage therapist educator and seven experienced massage therapists participating in a study of massage for neck pain.

RESULTS: The taxonomy was conceptualized as a three level classification system, principal goals of treatment, styles, and techniques. Four categories described the principal goal of treatment (i.e., relaxation massage, clinical massage, movement re-education and energy work). Each principal goal of treatment could be met using a number of different styles, with each style consisting of a number of specific techniques. A total of 36 distinct techniques were identified and described, many of which could be included in multiple styles.

CONCLUSION: A new classification system is presented whereby practitioners using different styles of massage can describe the techniques they employ using consistent terminology. This system could help facilitate standardized reporting of massage interventions.

 

The benefits they envision of an MT taxonomy--standardized reporting of massage interventions--would, if realized, promote communication among MTs and other stakeholders of massage, including clients for communicating expectations and outcomes, other healthcare providers for referrals, third-party reimbursers for demonstrating value of interventions, and more.

Presumably, this clarity of communication could potentially extend to questions of anatomical reasoning as well.

Now that we share a knowledge base about ontology and taxonomy, we'll extend and apply that knowledge base to Jacobs' questions about anatomy.

It all depends on what the meaning of "is" is: 03-Are we even talking about the same thing at all? (#10/31)

Submitted by RST on Sat, 08/11/2012 - 10:55
Posted in

First, to be sure what everyone means in this discussion, we'll review the discussion of "meaning" from the previous discussion, to make sure that we're all on the same page about foundational things:

Meaning has multiple aspects, including:

  • the ideas we have about the universe around us, and the feelings and reactions those ideas draw out of us;
  • the words, or terms, that we use to talk about those ideas; and
  • the material physical things in the universe that those ideas and words refer to.

 

Since all of these aspects interact with and influence each other, we can model them as a triangle, with the three connected corners representing concepts/ideas, words/terms, and material physical referents.

 

Looking at the relationships among components of the Semantic Triangle, it is easy to see how referents can influence concepts: for example, Wilma--a sun bear at Woodland Park Zoo in Seattle, who no one suspected was positively riddled with tumors, but who held on just long enough to wean her twin cubs onto solid food before suddenly dying from the cancer--is a real-life referent whose fortitude while suffering reinforces the concept of "bear as good mother".

Sometimes the referent’s behavior, in addition to influencing concepts associated with a term, can actually influence the chosen or constructed term itself: the Russian for bear, медведь (pronounced "myed-vyed"), comes from the linguistic roots for "honey-eater" (our word "mead" for honey wine, comes from the same root as "мед").

And, like in the English term "bruin" ("the brown one"), it's also an example of intentional misdirection, and an indication of the beliefs behind it--bears can be scary, especially way back in history at the time when we were first deciding on words to describe the world around us.

To the people who came up with these terms, it may well have seemed safer to use taboo avoidance, just to be sure. Taboo avoidance means, in this case, a kind of magical thinking where it seems more prudent to refer to bears by euphemistic terms like "honey-eater (Russian)", "honey-paw (mesikämmen: Finnish)", or "the brown one (English)", rather than to get this scary animal's attention by outright saying "bear" in one of those languages, and running the risk of summoning angry supernatural bears down upon the speaker.

It’s not immediately obvious how influence flows the other way—that is, how concepts and terms can affect real-world referents—but a little thinking about it provides some examples. If someone thinks of bears as dangerous predators, they may lobby for laws allowing bear hunts, with real consequences to the referent bears themselves. However, assigning the term "endangered species" puts bears under particular legal protections, which could prevent their being hunted, saving the lives of actual bears.

So words, concepts, and real material physical referents all influence each other in the meaning we make of this universe around us.

And that meaning that we make, and decisions based on that meaning, influence where in massage practice space we find ourselves.

 

 

Now, with those aspects of meaning in mind, the question is:

Since we are using the same term--fascia--and since we have such different concepts around that term, what does the material physical referent tell us that may help clarify the confusion?

 

Hold that thought; we'll get right back to it...

 

 

Let's digress into intellectual property topics for a moment, in order to make sure that we are all crystal-clear on what I am doing here.

I would not want to give the appearance of impropriety by appearing to steal or plagiarize Gil Hedley's intellectual property, so I will explain why and how I am using it here, and how my usage falls under a recognized legal principle called "fair use".

Hedley has a number of photographs of his work on his Web site. As the owner of those photographs, he owns the "copyrights" to them--the rights to determine how those photographs can be used, and who can make use of them.

Wikipedia explains how, in the United States, the principle of copyright traces back to the Constitution of the United States:

The Copyright Clause of the United States Constitution (1787) authorized copyright legislation: "To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries." That is, by guaranteeing them a period of time in which they alone could profit from their works, they would be enabled and encouraged to invest the time required to create them, and this would be good for society as a whole. A right to profit from the work has been the philosophical underpinning for much legislation extending the duration of copyright, to the life of the creator and beyond, to his heirs.--Wikipedia: "Copyright" accessed 11 August 2012

 

Although a large body of case law extending and refining the general principle has been built up over the centuries, the fundamental principle that Hedley owns the rights to his works and that he alone can decide who uses them and how they are used, almost without exception, goes back (in America, at least) to the US Constitution.

The major exception is called "fair use". As Wikipedia explains it,

Fair use is a limitation and exception to the exclusive right granted by copyright law to the author of a creative work. In United States copyright law, fair use is a doctrine that permits limited use of copyrighted material without acquiring permission from the rights holders. Examples of fair use include commentary, criticism, news reporting, research, teaching, library archiving and scholarship. It provides for the legal, unlicensed citation or incorporation of copyrighted material in another author's work under a four-factor balancing test.--Wikipedia: "Fair Use" accessed 11 August 2012

 

At his site, Hedley states his intellectual property stance and exercises his right to copyright over the images contained there:

All images from The Integral Anatomy Series are copyrighted by Gil Hedley, and may be used only with my expressed written permission.--Gil Hedley Gallery Anatomy Stock Cadaver Photos accessed 11 August 2012

 

To avoid the appearance of impropriety, and to avert any mistakes someone else might make in good faith--like assuming that, since I used this photo from Gil's site, that it's ok for you to do so to promote your practice or products as well--I'll state explicitly that my limited use of one photograph falls under the fair use exemption to copyright, and so I do not need to secure Hedley's position to use it.

I'm using one photo  from his page here for the purposes of commentary, criticism, research, teaching, and scholarship, which makes it noncommercial and fair use.

By publishing his work in print, selling his classes as anatomical science, posting claims on the Internet, and otherwise participating in the marketplace of ideas, he has opened up those ideas to examination and review in the best academic tradition. This is my examination and review of those ideas he is asserting.

If, on the other hand, you want to use his photographs for marketing or other commercial purposes, you absolutely do need to get his express written permission to do so. He's made that perfectly clear on his website, and he has tons of case law on his side to reinforce his right.

Now that we're all clear on the IP issues involved here, let's get back to the main topic of meaning, and what it tells us in this discussion of superficial fascia.

 

 

 

We left off at the question:

Since we are using the same term--fascia--and since we have such different concepts around that term, what does the material physical referent tell us that may help clarify the confusion?

 

I think that Hedley and I are referring to the same thing when we say "superficial fascia", and that one of the problems in discussing this issue is that Jacobs means something entirely different by it.

According to Hedley's site, this is what he means by "superficial fascia":

Source: http://www.gilhedley.com/ghgallery.php#1 accessed 11 August 2012

 

and that is consistent with what I am referring to as well.

Because Jacobs and I were both using the term "superficial fascia", I assumed we were referring to the same material physical referent, and because I assumed wrongly, I was kind of stuck on why the discussion had stalled at that point.

She resolves that problem, and gets us unstuck, when she notices:

I had no idea that "fascia" meant, or was synonymous with, anything other than some sort of gluey stuff extruded from sparsely located cells, barely metabolically active except for cranking out vast amounts of sticky molecules, a trick that comes in handy in a heterogenous organism which has some parts hugely expensive to maintain (e.g. nervous system, only 2% of the body but requiring 20% of all the fuel), important for keeping an organism from falling apart, and for giving its more active contractile elements a place to anchor.

My idea of superficial fascia was that it was that fine filamentous spider-webby areolar stuff adhering the hypodermis on to the outside of the body, and to the dense fascia that overlies it. I confess, it was my conjecture, based on what I think is logical.

 

Ok, one problem solved--we simply weren't talking about the same thing when we used the term "superficial fascia".

On that level, the communication problem's solved now.

But on another level, we've just opened a whole other major can of worms, one that will take a lot of time and patience to examine.

Why did we have such wildly different understandings of what the term meant? That is a HUGE question.

She writes:

Now here is Gray's, saying it means hypodermis. Something is definitely wrong on the internet. Something might be seriously wrong in anatomy!

It seems to me Gray's is calling all animals in this layer cows, instead of just some animals. I look at this with jaw resting on floor. I really do think it amounts to a taxonomic error on the part of anatomists. I'm calling them on it, right here.

...

The world of manual therapy is like a spaceship. And I feel like I just discovered the conceptual hole in the hull.

Because of this one single factual misnomer, countless generations of manual therapists have been sucked out into space, have had their minds snapped shut while simultaneously being made to contemplate the bogus idea that they have magical hands that can somehow overcome the logical purpose of fascia, which is to keep the body from coming apart, all because of a careless slip of taxonomic nomenclature stemming from the dissection habit anatomists have of slicing this blubber layer right off so as to get to viscera etc., useless and hindering as it is in a cadaver specimen, not investigating it from the perspective of how it might respond in a living human when touched from the outside, say by a manual therapist, who clearly cannot get his or her hands past the barrier of the heavily innervated outer dermis (not without introducing infection, at least), or past reflexive motor guarding by spinal cord function via autonomic and somatic motor efferent, and visceral afferent neurons. And it has been replicated, as a meme, as an error, by anatomists, apparently with high fidelity.

So, based on this careless anatomical overlook, manual therapists have been taught, carefully, in a stepwise, apparently anatomically acceptable but logically impossible Argument from Authority, a tissue-based myth that they can manually impact "superficial fascia", from the outside in!

 

I do not disagree with her--in resolving why we could have such wildly different understandings, we are going to get at the heart of a major and thriving research problem, one that has not been solved, but is still ongoing.

We have a lot of work to do in upcoming posts, but I think you will find that work to be very rich, rewarding, and--no pun intended**--full of meaning.

 

 

** Oh, who do I think I'm kidding? I totally intended that pun.

 
Syndicate content