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social, health, political imagery through the lens of George J Huba PhD © 2012-2017

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03[Guess you didn’t learn to spell before forming an opinion on Obamacare. See picture at bottom.]

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[What about Darth Sebelius?]

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[Weirdest thing Miley Cyrus has done this year to date. Or is the Speaker trying to be Miley?]

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[Yup. Giving the masks away for free, too.]


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[I get to keep the Butterfingers.]

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[Make sure to only give the candy to people with teeth.]


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[Nice Abe, even shorter than the original.]

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[Boehner as Miley Cyrus is worse.]

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[I see they have a culturally appropriate version for the guy with the trucker’s hat at the beginning of this post.]

To summarize …

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[Hard to believe you are sicker than our healthcare system has become during your time running DHHS and Boehner’s tenure as Speaker of the House. The two of you are dancing a very weird tango.]

In the past few days I have posted about using mind maps and similar tools to “fight back” against cognitive impairment and then in a follow up post discussed some of the tools that can be used to potentially improve your ability to deal with cognitive impairment.

Today I am posting about paying some attention to the methods you use to communicate and remember and make decisions and express approval and make other appropriate reactions to others. What will YOU do If your mind fails due to a degenerative condition, a disease, the luck of the genetic draw, or because you are so dumb you refused to wear a helmet while riding your bicycle or motorcycle, or even due to playing football and huge traumatic blows to the brain while wearing a clearly inadequate helmet over the course of decades.

You are told (but probably tune it out like I do) that you should plan for disasters ranging from total disability or an earthquake or a hurricane or the election of a Tea Party President to such things as the day your dog needs hospitalization.

Did anyone ever tell you that you should considering learning some alternate ways of thinking and organizing your memories and planning than the ones you have used for most of your life.

What’s more important to you, having a few bottles of water in your basement in case there is a hurricane or earthquake in the neighborhood or learning new ways of thinking or remembering or making decisions that you might want to use now or after your memory starts to fail.

Consider yourself being told to look into this before somebody hits you with a car while you are weaving through urban traffic on your bicycle without a helmet or you learn that you lost the genetic lottery and have early stage X or Y or Z or xx or yy or etc.

I am not suggesting that you abandon the way you have thought for the bulk of your life if that style ia effective for you. I am suggesting that in case you have brain trauma from an accident or sports involvement or disease or start cognitive decline due to a brain anomaly, you know some alternate ways to think and store–retrieve information and make decisions using simple techniques.

I have a very well developed set of skills that has allowed me to have a great career. If one of those parts of my brain that produces good results for me is damaged, I want to make sure that I can switch out the bad memory drive (symbolically) in my head for another one. Or I can replace the logic program that got corrupted by damage to certain parts of the brain with a different method of doing the same thing utilizing other parts of the brain.

So here’s the deal. Take a look at the mind map below and see if it helps you recognize that you should start to take stock of all that wonderful data and hardware for processing it that lies in your brain and figure out how you are going to change the logic board and memory drives if you are unlucky and you need to try to make repairs.

Click on the image to expand it.

why you might want to start using cognitive-behavioral tools now and not after significant cognitive decline

Started up Google and typed WEATHER. Up came the current five day forecast for my zip code. At the bottom of the forecast, in the usual font I can’t read was the credit to The Weather Channel, Weather Underground, and AccuWeather.

weather oct 30

Nice day today although kinda cloudy.

weather underground? Weather Underground? WEATHER UNDERGROUND!!!

Where are they today?

Who’s their (alleged) friend?

I assume there was no intention for the company to name themselves after an American terrorist organization (although some of those working at Fox News probably would say that the radical organization has infiltrated the American psyche with a corporate news service distorting our perceptions of whether it will rain today and thus disrupting our society).

In 1968 I was a freshman (now fortunately known as “first year” as we have cleaned our language up as the world has changed for the better) in college. Around October, Rolling Stone magazine had this weird advertisement in which the non-selling record (yup vinyl) of a new artist named Randy Newman was highlighted as a real bummer (not sure anymore if that term had entered American culture by the 60s) and the record label was giving copies for free (yup, not even any postage) and since I could not afford to purchase records at the age of 17, I sent in the coupon for the “loser’s” record. Came in a few days later, hated it first but played it to death and came to love it. The best song on the album was “I Think It’s Going to Rain Today). The song never became a hit, but Newman hung around and kept recording (perhaps it did not hurt that his dad and uncle were both famous composers of film scores for some of Hollywood’s biggest movies). Second chances are a great thing for everybody, although I am ambivalent about the Weathermen.

[Comment: The juxtaposition of the Weather Underground and Randy Newman does not imply any relationship between Randy Newman and either the weather forecasting company or the terrorist organization from the 1960s. To the best of my knowledge, Mr Newman does not discuss his political views (although I guess from his lyrics that is a very peace-oriented man) nor do I know where he gets information whether it is going to rain on his outdoor concerts. I do know that Mr Newman worked in humanitarian relief efforts after the New Orleans hurricane.]

Recently I discussed fighting backing against cognitive aging with mind mapping, a cognitive-behavioral technique.

Lets take a look at the how and why.

  1. Most neurodegenerative diseases that cause dementia have no cure nor particularly effective way of controlling the symptoms of the disease.
  2. Most individuals use notes and checklists and reminders and calendars — fancy or simple — to help deal with loss of memory or the ability to make decisions or prioritize tasks and remember people.
  3. There are better ways to take notes and manage calendars and enhance-stimulate memory and other cognitive functions. I think mind mapping (Buzan-style) is the best way to perform these tasks.
  4. Although better note-taking will not cure brain degeneration, it may increase quality of life and the ability to remain independent or mildly dependent for a longer time. Even a few better days in a month is a huge improvement for individuals with neurodegenerative diseases and something to be treasured.

Click on image to expand.

Cognitive-Behavioral Tools for Fighting Cognitive Decline

As is said (albeit in a quite different context) “use it or lose it.”

You age and people tell you to start doing crossword puzzles (I’ve never liked them) or to do simple arithmetic on an iPad (hhmmm… I prefer advanced mathematics) or to get your pictures together in a box (I prefer slide shows from a high-end photo processing app).

Use it or lose it.

Why start doing baby mental exercises as you get older? Why not use a better way of organizing information, planning, making decisions, and actively thinking about things around you, your life, or advancing a new intellectual hobby (mine are visual thinking research and great mandolin and ukulele players of the world)?

Use it or lose it.

Many people look at mind maps and think they are pretty pictures or formatted outlines. In fact many so-called “mind mappers” pass off work that is not mind mapping as mind mapping.

One of the most frequently ignored or missed parts of Tony Buzan’s seminal writings on mind mapping is that mind mapping requires active thinking. It is not a passive process of formatting an outline of the same-old, same-old, same-old information.

Mind mapping is really a combination of using the pretty tools in mind mapping programs to facilitate active thinking about something and to develop actively a summary model of how all the thoughts go together.

Do you think active learning through mind mapping is a better way of thinking that for many older adults is new and novel and might be a way to “use it and not lose it?”

I think so. Use it and don’t lose it.

An example. Click on image to expand.

3G Organized Thinking with Mind Maps

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Also see, “Running Away to the Circus”

Also see “Cognitive and Behavioral Tools for Dealing with Cognitive Decline: A #MindMap”

Sending out a graphic and colorful SIMPLE visual agenda by email really helps a conference call move along and keep the big picture in sight.

Keeping the map simple allows individual participants to take their notes by making additional (sub-)branches. Try it. Works!

[People spend less time on their end of the speaker phones reading email and cleaning their desks and more time actually thinking creatively.]

An example. Click image to expand.

Goals Meeting

I will be reviewing many of the current crop of free and paid iPad apps found under the search titles Dementia or Alzheimer’s. There are at least 30 of these and I downloaded all I could find. I am also looking at Caregiver apps of which there appear to be about 20. i will be trying to make sense of it all over the next month. Many of the apps appear to be small reworkings of materials whose parentage is questionable while others appear to be innovative and to have research support. As I go through these apps, I urge relevant professional associations to sponsor reviews of these apps by their skilled members. So far as I can see, many of the apps could be helpful to selected groups while may produce no benefit or in the worse case work against established practice standards.

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Missed patients appointments represent a major wasted cost within the healthcare system.

Huge amounts of resources are wasted when patients miss appointments. Expensive healthcare providers in expensive medical office space with expensive equipment and expensive staff are not utilized to their fullest resulting in a loss to the overall system.

To deal with missed patient appointments, clinics often schedule a few more patients than they have time slots in order to compensate for the number of patients who may not arrive or may arrive later than scheduled.

If everybody actually shows up at appointments in the compensatory, over-booked environment, several things happen; doctors and staff get stressed because they have to squeeze patients into the schedule and patients get pissed off their doctor cannot be in their examination room on time or earlier.

So the system needs to get patients into healthcare clinics on the correct day at the correct time. A number of strategies are typically used.

Do you think that the average elderly or cognitively challenged individual (and caregiver) understands and remembers those reminder messages left on their voice mail or those short telephone communications from an obviously harried staff member?

Do you think that the small type, too many words, black-and-white business letter does the trick? Do you think the letters get opened? Do you think that aging folks can all read small fonts or understand a packed letter without white space?

Do you want to increase the rate of patients showing up for appointments? Look at this general framework and the example I provide below.

Use a mind map, improve patient care and help make the service system more efficient.

Click on images to expand.

Reminder  [optional use of name]

Reminder Jill Brown

chapel hill ambulatory

A clerical staff member should review the completed form with a patient or caregiver.

Personally I would send the mind map home (or in the mail) with a few brightly colored refrigerator magnets (with my phone number on them) suggesting that the patient or caregiver put the appointment mind map on the door. I would also send a second copy to be put wherever these things usually go, or to share with the caregiver. Refrigerator magnets are very inexpensive and if printed with your name and phone number will increase the number of times patients will call to reschedule rather than just skip the appointment because they cannot find your phone number (and guess what percentage of elderly or cognitively challenged or disabled or practicing physician adults might not be able to find the business card and did not enter your office phone number into their smartphones?).

Oh, and even if the form slips off the refrigerator and is whisked off to recycling by a rushed and harried house cleaner, the refrigerator magnets will still be there so the patient can call to get the scheduling information.

Try something like this. If it works you save a lot of wasted time and loss of income and frustration. Your patients get better healthcare because they remember to see you when it is medically desirable to do so. The caregivers will like it because it makes their jobs easier.

And if it doesn’t work better than the same-old, same-old, you have only lost a few hours of clerical time spent implementing a system of mind map appointment reminders.

I drew this mind map in 2011 when I was disgusted with the lack of a organized process to develop a national consensus on what was needed for meaningful healthcare reform. I think this as true in 2013 as it was in 2011. Stylistically, I could redraw this map better now than in 2011. But everybody has to start somewhere, so I resisted that impulse.

I would note that some (all) of these scientist “types” are found in the US Congress (whether scientists or not).

Everybody in Congress wants the peanuts and bananas and too many act like King Kong.

Also note that I have been on consensus panels with all of these types.

Scientific Consensus Panel on Healthcare at the Zoo

I was sitting in the office of an individual designated as an “essential” federal employee at mid-morning on November 14, 1995. We were meeting at the US Department of Health and Human Services, Health Resources and Services Administration main offices in the Parklawn Building in Rockville, MD.

My federally funded Evaluation and Technical Support Center for a HRSA Initiative on Implementing the zidovudine protocol for preventing HIV transmission from HIV-positive mother to her child during birth was meeting with 10 federal grantees the next day in Baltimore. The meeting was mandated by the HRSA funding agreements.

Each project had at least three staff in transit to Baltimore (most by air) for the meeting the next day. At least one representative of each project was a woman living with HIV/AIDS; this was mandated.

The bell rang at noon in the Parklawn Building. The loudspeakers had started squawking earlier reminding all non-essential employees that they must exit the building by noon. Guards came through the building reminding people to leave. It was eerie to be in the second-largest US federal office building with almost no other people around.

I met with the essential employee, the head of a very large program on HIV/AIDS treatment. She could not tell me whether to have the meeting the next day. While she could guarantee that the representatives from the projects would have their travel reimbursed she could not tell me whether the scheduled meeting rooms, scheduled food service, and other costs would be covered although she would allow me to pay for costs already agreed to through contracts with the hotel. She did note that we could not use use the meeting room we had paid for nor eat any of the food we had pre-paid. The meeting would no longer be a federal meeting. Everybody there was just a private citizen meeting because they wanted to be there after being stranded by having flown to a mandatory federal meeting that was cancelled without notice. No federal employee, however, could be at the meeting because they were not working and they were not allowed to go to any activity that could be construed as federal “work” since they might then demand payment for their time.

I had to tell this to about 50 attendees at 9 am on Wednesday morning. The Maryland Dept of Health agreed to let the group use space at their offices 15 or so blocks away. Everyone walked over there in freezing rain. Maryland made available a conference room that could seat about 12 comfortably, about 25 uncomfortably, and the rest squeezed in and stood. The State Director (part of the group) lent us her personal 10 cup Mr Coffee to brew coffee. In trying to make enough coffee for 50, I broke it, and when I returned to California, I sent her another one by FedEx because I was a little annoyed that she got very upset that I had dropped the $20 machine and had announced to 50 people that I was the reason there was no coffee.

After about an hour or so of chaos and having everybody totally upset — as they should have been — about having about 15 women with HIV (many with advanced stage AIDS) in an overheated claustrophobic facility along with another 35 people in an overheated claustrophobic facility, I decided that the company I owned would personally guarantee the costs for the meeting facilities and food that had already been paid — if the government asked for the money back from anyone because I had decided that those who had come to Baltimore in good faith could meet in the rooms already paid for and eat prepaid food that was going to be thrown out. As I recall this was probably close to $5,000 or more. Fortunately no one ever asked me for the money back and since I over-ran our budget by far more than $20,000 (which we never billed) in part because the feds had totally screwed up the process, that we were even. And, no woman with HIV had fainted or otherwise hurt herself during the meeting because we did not have healthy conditions.

The grantees were — as would be expected — totally pissed off. The initiative ran for several more years, but in a fairly “inefficient” way. Chaos. The feds went back to work after Thanksgiving, but then went out again for more than a month starting in mid-December when Newt Gingrich and Bill Clinton still would not do their jobs. When the budget was settled in mid-January, the government announced it would pay all of the federal employees for all days they had been sitting at home in Maryland and Virginia and the District playing in the snow and worrying about their personal finances.

A demotivated, angry workforce went back to work to deal with a number of demotivated, angry contractors and grantees. It wasn’t the same for another two years.

Obamacare was passed by a majority of the US Congress, all of whom had been elected by the majority of their constituents. It was signed into law by a President elected by the majority of the US electoral voters as specified in the Constitution. When the Constitutionality of Obamacare was challenged by those who did not like it, the majority of the Supreme Court Justices, each confirmed when appointed by a majority of the US Senate, decided that Obamacare was constitutional.

Each step of passing Obamacare into law was done according to the specifics of the US Constitution.

Those attempting to derail Obamacare by using certain procedural technicalities in ways never intended and just plain silly, are acting in opposition to the approved Affordable Care Act passed by the Congress and approved by the President and the Supreme Court according to the procedures specified in the US Constitution.

Are those in Congressional representatives holding the budget hostage Congressional “Leaders” or (in words attributed to Al Gore) “terrorists?”

Today, I hope that the US government will decide to “feed” those sitting around waiting for their US Congress and Executive Branch to meet their Constitutionally assigned responsibilities that the elected officials of the United States have sworn to uphold. Fortunately World War II vets in wheel chairs were allowed to look at the barricaded World War II memorial on the federal mall today (the barriers were lifted by Congress members in front of TV cameras); my further hope is that all of the veterans in VA hospitals get fed dinner tonight whether or not the TV crews are parked in front of the facilities.

Those elected officials who claim that their Tea Party is as much against “taxation without representation” as the founders were in 1776, obviously have not read the Constitution resulting from the actions in 1776.  Thankfully, a majority of the Supreme Court justices and the President were in school that day.

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ELIMINATING AIDS FROM THE PLANET  G J HUBA PHD  JULY 2012