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Mindfulisland Group

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Ilya Tretyakov
Ilya Tretyakov

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Dr. Boockvar is internationally known for his surgical expertise and for providing patients with safe, effective and minimally invasive treatment for brain tumors, skull base disorders and disorders of the spine. His surgical expertise is in benign and malignant brain tumors, skull base and endoscopic pituitary surgery, spinal and peripheral nerve tumors, minimally invasive spinal surgery, and complex spinal disorders.

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Dr. Boockvar currently co-directs the Laboratory for Brain Tumor Biology and Therapy at the Feinstein Institutes for Medical Research. His laboratory interests have focused on adult human neural stem cell biology as it relates to brain tumor formation and resistance to therapy. Dr. Boockvar is a world expert on blood brain barrier disruption to improve the delivery of therapeutics to the human brain. Dr. Boockvar is the principal investigator of several cutting-edge clinical trials using blood brain barrier disruption to deliver high-dose chemotherapy for patients with malignant brain tumors who have been featured in The New York Times and Wall Street Journal. Dr. Boockvar has served as editor-in-chief of the journal Current Stem Cell Research and Therapy and is an editorial board member of the Journal of Neuro-Oncology, Neurosurgery, Journal of Neurosurgery, and Recent Patents on Anti-Cancer Drug Discovery. Dr. Boockvar directs the Brain Tumor Biotech Center at the institute that seeks to bridge the translational gap between basic and clinical science for patients with malignant brain tumors. Dr. Boockvar's laboratory has been funded by the National Institutes of Health, and he was recently awarded the American Association of Neurological Surgeons Pinnacle Partners Award for his research in brain tumors. He has also won research awards from Voices Against Brain Cancer, the American Brain Tumor Association, the Starr Foundation, Anspach Companies, and the Adelson Foundation.

"Hans Rosling, an expert in public health from Sweden, does an amazing job in this presentation bringing the data to life. If you want to know how he did all those graphics, go to It's all there. Hans is saying the problem is not the data. The data is there. But it's not accessible to most people for three reasons: (1) For researchers and journalists, teachers, etc. it is too expensive. (2) For the media, it is too difficult to access. (3) For the public, students, and policy makers, it is presented in a boring way. His solution is to make the data free, let it evoke and provoke an 'aha' experience, or a 'wow!' experience for the public. I loved the way he got involved with the data, virtually throwing himself into the screen. He got his point across, no question about it."

Edward Tufte is a leading expert in the data analysis and data visualization space. His books are classics and required reading for anyone interested in understanding how best to display quantitative information. I read his books just after I left Apple in 2003 to become a college professor in Japan. His books are foundational. I've talked about Tufte in my own books and on this website going back to at least this post in 2005. I have not seen him speak recently, so I was happy to see this 50-minute presentation by Dr. Tufte which took place at the Microsoft Machine Learning & Data Science Summit 2016 held this past September. Microsoft's David Smith introduced Dr. Tufte at the 2:30 mark.

A good book I often recommend is: Yes!: 50 Scientifically Proven Ways to Be Persuasive by Dr. Robert B. Cialdini et al. I first read the book when it came out in 2008. The book is designed for professionals who are interested in becoming better at understanding how to persuade or influence others. The book may also help you understand why you decide to do the things you do. Even if you are a researcher or teacher or a medical doctor, and so on, and not a business person, it's still important to understand how people are (or can be) influenced and persuaded by your words and behaviors. Each chapter focuses on a single question and is no more than 3-5 pages long. If you want to go deeper you can checkout the sources for each chapter in the Notes section. "Yes!" is not a textbook, and it may not go deep enough for some, but for extremely busy professionals, this is a useful book with many clear, quick lessons that will get you thinking. Above: The book on my desk. Each chapter focuses on a question such as what common mistake causes messages to self-destruct, how sticky notes can make your messages stick, etc. Checkout the table of contents here to see all 50 chapters at a glance. If you want a little more depth, I suggest Cialdini's other huge bestsellers Influence: The Psychology of Persuasion and Influence: Science and Practice. These books have sold in the millions by now. Some people may be skeptical about the ethics of trying to persuade and influence others, but remember, it's not just about marketers trying to influence someone to buy something they do not need with money they do not have. Persuasion can be used for good just as it can be used for ignoble reasons. For example, a medical doctor often needs to be effective at persuading patients to comply with her recommendations. Facts, data, and argument are usually not enough to influence a change in behavior.If you do not have enough time to read the Influence books yet, the 12-minute video below will give you a good idea as to the key findings in Cialdini's research. The video presentation covers the six universal principles of persuasion which are scientifically proven, according to the author, to make you more effective at influence and persuasion. (Watch below or on YouTube.) Principles of Persuasion at a glanceIn an ideal world people would use reliable information and sound logic to guide their thinking and decision making, but the reality is people use shortcuts or "rules of thumb" to make decisions. The six shortcuts below, according to the author, are universal rules of thumbs that guide human behavior. The key is to understand these shortcuts and use them in an ethical manner to persuade others. There are many examples in the books, but in the video they can only give one or two. Here are the six principles in brief.(1) Reciprocity. The obligation to give back when you have previously received. The key takeaway: Be the first to give and make it personal and unexpected.(2) Scarcity. People want more of those things which are perceived to be rare or in short supply. It's not enough to tell people about the benefits they will gain, you must also tell them what they stand to lose or miss out on if they do not adopt your idea (or buy your product, or choose your school, etc.).(3) Authority. People will follow the lead of credible, knowledgeable experts. In the presentation space, it's highly desirable to have someone give a short and concise introduction of yourself which highlights why you are an expert worth listening to.(4) Consistency. Asking for small commitments that can easily be made. Then going back and asking for larger commitments later. Sometimes this is called "getting a lot by first asking for a little." People want to be consistent, according to the principle, so if they said yes to you previously they are more likely to do it again.(5) Liking. People prefer to say yes to the people they like. There are three factors in determining whether we like someone (a presenter on stage, for example). We tend to like people (1) who are similar to us, (2) who pay us compliments, and (3) who cooperate with us. For presenters it's important to really know your audience so that you can touch immediately on something shared and personal with the audience.(6) Consensus. People often look to the actions of others to determine their own. So rather than simply hitting people over the head with your logic and data trying to persuade them to accept your idea, you can also elaborate on all the other people who have already accepted your proposal.

Fluoroscopy and TOE are the preferred modalities for procedural imaging for LAA closure. Intracardiac echocardiography (ICE) is gaining popularity and has become standard in some centres, given the convenience of minimal sedation. Some perform LAA closure with fluoroscopy guidance alone, but this practice has been limited to a few experienced centres and cannot be recommended for wide use by others. In extreme cases that can have neither TOE nor CT prior to or during the procedure, these centres have been using distant contrast injection to the LAA during the procedure to exclude LAA thrombus. This practice is also limited to a few expert centres and cannot be recommended for wide use by others.

Table 8 summarises the recommendations for LAA closure imaging according to expert consensus. Preprocedural imaging should be performed with either CCTA or TOE to rule out pre-existing LAA thrombus and anatomic suitability for LAA closure (software for semi-automatic analysis of pre-LAAO CT is available). Procedural imaging should be performed with either TOE or ICE guidance, and in exceptional circumstances may be performed with fluoroscopy alone by experts if pre-imaging was done with CCTA or TOE. LAA closure should not be performed with fluoroscopy alone without pre-screening with CCTA, TOE, or ICE, or a distant contrast medium injection should be performed upon arrival in the left atrium to rule out LAA thrombus. Post-procedural imaging to assess for DRT should be performed at 6-12 weeks post implantation and may be repeated after 12 months. Presence of DRT on the atrial side of the device should be treated with intensified anticoagulation to resolve thrombus.

Although not studied systematically, several registries include patients at extremely high risk for bleeding who were treated with no or only a single antiplatelet (ASA or clopidogrel) for limited periods of time which was then stopped at variable times following the implantation. Although information is scarce about this mode of therapy, it is the consensus of the authors of this document that this approach may be used in individual patients if agreed upon by an expert team. We believe that a period of two to four weeks of antiplatelet therapy should be strived for even in high bleeding risk situations. Patients who are not eligible even for such a short period of antiplatelet treatment may be considered better candidates for epicardial closure (either surgical or using the LARIAT device) in experienced hands. 350c69d7ab


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