prompt_front: Now, answer the following question based on the text below, only give me the answer and do not output any other words.

Question: What happens to the high resolution of what we focus on at dawn or dusk?

Read the following text and answer briefly.

Context 1: Inner Reality Unveiled
Inner Reality Unveiled
by DragonFly on April 18th, 2018, 10:54 pm
There is no direct (literal) view of the actual reality 'out there'  Our inner viewport is ever only that of the model (qualia) of inner and outer reality built by the brain  We see/sense nothing but this model made inside the brain 
We don't see across a room or any scene but only across the model of the room/scene  We don't look through a microscope at an actual object but only look at a model of that object  You get the idea  A reflective color spectrum is used to make it look like that more distinctive color is a surface property of an object modeled 
The brain doesn't model everything, as a lot of it would be clutter, and for what remains as useful to portray the brain still doesn't have the resources to model everything at high resolution and so thus whatever we focus on gets all the high res detail put into it just in the nick of time when we look/focus  At dawn or dusk this high resolution becomes a bit less on what we focus on so that what's off to the left or right can be better noted in the dim light 
So far, nothing astounding here to us, although maybe to everyday folk that we only ever see the inside of the head/brain—the model 
Of course, the shocks get worse, such as that our intentions cannot be those of first cause, self-made people, but from prior causes that we weren't able to choose and be responsible for  What is left, in short, is the freedom of action for these inbuilt intentions to operate, at least when not prevented by the weather or any other controlling factors, which 'freedom of action' amounts to compatibilism 
Other notes on the above are that while we can never know if everything is deterministic, although we know that a lot is, whatever is indeterminate diminishes our modeling and our consistency 
Re: Inner Reality Unveiled
by DragonFly on April 20th, 2018, 3:14 pm
To continue, many feel that the model/qualia is very rich, but there's not anything to compare it to  Some creatures have a fourth primary color to work from and some have more smells and better hearing  Our colors (reflective spectrum) go through some averaging because of the various close frequencies about, but they still have a lot of pop to them  The model seems to be super real, where it has the focused detail, meaning better than real, or super real or surreal; surely colors win out over a bunch of waves (if they could be seen), these colors being very distinctive, which high contrast is what the model seems to be about  Away from the center of focus, the model has to be worse than cartoonish 
Other qualia properties are intense, too, such as pain being able to be very painful, to the max, and such 
Qualia are based on initial isomorphic maps, meaning topographical, when representing the territory  For sounds, the map is for tones from the air vibrations, and for smell it is scents from the molecule shapes; for touch it is a body map  The isomorphism may get carried through even three levels of models, whereafter it seems to become more symbolic and less isomorphic, perhaps indicating that the information is ready to turn into qualia, the point at which the 'hard problem' manifests  It is thought that at least four levels of modules are required for the 'magic' of phenomenal transformation to occur; we have the problem surrounded but not yet solved  Perhaps it is enough to have a truth in lieu of its proof—that there is ontological subjectivity, meaning that it exists, although it may not be fundamental or miraculous 
So, in sum so far, direct realism is an illusion, but is a very useful illusion, which we might better call a fine representation by the model, since the word 'illusion' is more about what's wrong as not really showing its object as substantial and really being behind it  Dreams, then, would be better called illusions; further they demonstrate the power of the structure of the model  When we inspects objects in dreams they look just as good as when we see them awake, although backgrounds come and go inconsistently and there are narrative gaps (all of a sudden we are driving a vehicle without ever having gotten into it, plus the controls are a mystery )
Another illusion is the feeling of having all of the information in a qualia scene as instantly available, as well as feeling that it is all happening in real time, plus that one is directing it all right then and there 
by mitchellmckain on April 21st, 2018, 4:33 am
Yes and all those security cameras in the banks and stores must be a joke because anybody watching cannot see us but only see images on a display screen 
by DragonFly on April 21st, 2018, 12:05 pm
mitchellmckain » April 21st, 2018, 3:33 am wrote: Yes and all those security cameras in the banks and stores must be a joke because anybody watching cannot see us but only see images on a display screen 
You forgot that what the brain maps and models is a reliable representation of what's out there and in here 
by mitchellmckain on April 21st, 2018, 12:16 pm
DragonFly » April 21st, 2018, 11:05 am wrote:
I was being sarcastic in order to point out this very fact  Whether images on a display screen or human consciousness, they are reliable representations and that means they do see what is really out there  The fact that this is indirect is not without logical implications, but not to the extent that you can say we do not apprehend an objective reality 
by TheVat on April 21st, 2018, 12:29 pm
The evolutionary argument is a strong one, also, for the accuracy of our sensory representations of the external world  If you think a tiger's tail is a pretty flower, and try to pluck it, you won't be around long to reproduce 
I invite anyone who thinks that bus hurtling down the street is nothing but a model in the brain to step in front of it 
Your impression of the bus may be indirect, but it has a direct causal chain of connections to the actual bus out there  You are a photon collector, absorbing photons bounced off a bus  That way, it doesn't have to be you that's bounced off the bus 
by DragonFly on April 21st, 2018, 2:19 pm
Mentally healthy responders need not worry about any unreliable representations due to there being no direct realism  As I showed, the representations are even improvements that bring out what is distinctive and important, as well as my indicating of an 'out there'  (The sarcasm thus fell doubly flat, run over by the bus, either because that mode is the nature of the person or this short thread wasn't read well )
The world out there indeed comes to us (we don't reach out and probe it but for such as feeling our way in the dark), via photons for sight, and similarly comes to us in other ways for the other 'distance' senses  That the brain projects the objects back out there where they are, with depth (objects whose radiation came into us) is very useful  This trivia is mentioned here for completeness, for non scientific readers, but all the like herein is not contested 
Back on track now, with derailment attempts ever unwelcome, but actual meaty posts extremely welcome, many neurologists note that awake consciousness doesn't easily get snuffed out, for a people may have many and various brain impairments yet they remain conscious, which, in short, without going through them all, indicates that there probably isn't any one 'Grand Central Station' where consciousness originates but that it may arise from any suitable hierarchy of brain modules 
Consciousness, like life, requires embodiment, and is now thought to have been around in some form since the Cambrian explosion  As evolution proceeds via physical processes it rather follows that consciousness does too  Billions of years of small steps from a stable organism platform can acculuminate into what otherwise seems a miracle, but then again, miracles are instant  When extinction events wipe everything out, the process just starts up again, and probably has, several times over 
Since qualia are structured, such as I described, plus healing the blind spot and more that wasn't put here, this again suggest that qualia have to be constructed from parts the brain has made from interpretations via physical processes 
How the phenomenal transform springs out remains as the central mystery of all  We think that there are larger mysteries, such as if there is any ultimate purpose to Existence, but this one is easy, for it can be shown that there can be no ultimate purpose  (There can be local and proximate purpose ) More an this another time or place 
by mitchellmckain on April 21st, 2018, 4:00 pm
I shall interpret the above as a request for a detailed point by point response to the OP 
DragonFly » April 18th, 2018, 9:54 pm wrote: There is no direct (literal) view of the actual reality 'out there'  Our inner viewport is ever only that of the model (qualia) of inner and outer reality built by the brain  We see/sense nothing but this model made inside the brain 
But this is wrong, derived from delusional semantics as if "seeing" meant absorbing the objects themselves into our brain and mind  Of course, "seeing" means no such thing  "Seeing" means gathering data to construct a mental model of an external reality  We don't, in fact, "see" this inner model at all  This "model" is a product of speculation and abstraction in meta-conscious process of self-reflection 
Our inner viewport is thus one of looking out at the outer reality and not one of looking at the model  We do see across a room -- USING a mental model  We do not see the mental model except by speculative imagination  The most we can say is that by using such a process of mental modeling in order to see, there can be deviations due to a variety of neurological and mental processes being involved, including the role of beliefs in our interpretations  Thus our perceptions cannot be fully separated from our beliefs and our access to the world is fundamentally subjective  The objective can only be fully realized by a process of abstraction through communication with others 
DragonFly » April 18th, 2018, 9:54 pm wrote: The brain doesn't model everything, as a lot of it would be clutter, and for what remains as useful to portray the brain still doesn't have the resources to model everything at high resolution and so thus whatever we focus on gets all the high res detail put into it just in the nick of time when we look/focus  
DragonFly » April 18th, 2018, 9:54 pm wrote: Of course, the shocks get worse, such as that our intentions cannot be those of first cause, self-made people, but from prior causes that we weren't able to choose and be responsible for  What is left, in short, is the freedom of action for these inbuilt intentions to operate, at least when not prevented by the weather or any other controlling factors, which 'freedom of action' amounts to compatibilism 
Your philosophical conclusions here will not be mistaken for scientific observations  Your interpretations are based on your own presumptions which I reject as incorrect  The process of human intention and action is certainly a complex one but the fact remains that the first causes do exist  People may be capable of simply watching much of their life pass by as an minimally participating observer (with all sorts of fatalistic and compatibilist dodges and delusions of objectivity), but others choose to take ownership of the first causes within them as a fully responsible participants in their own life 
Also as I have mentioned numerous times before, there is nothing absolute or guaranteed about this freedom of will  It can certainly be greatly diminished by a great number of things such as drugs, illness, habits, and even beliefs  This just means that we are ill advised to judge others according to our own perception and choices 
DragonFly » April 18th, 2018, 9:54 pm wrote: Other notes on the above are that while we can never know if everything is deterministic, although we know that a lot is, whatever is indeterminate diminishes our modeling and our consistency 
We can know that the experimental results show that there are events not determined by any hidden variables within the scientific worldview  People are free to ignore these results and stubbornly cling to presumptions to the contrary but they are being unreasonable if they expect other people to accept the conclusions which they are deriving from such willfulness 
And to head off the typical strawmen, I am not claiming that determinism has been disproven any more than the scientific evidence for evolution disproves divine intelligent design  Science is not a matter of proof, but of accepting that what the evidence and experimental results show us are the basis of what is reasonable to accept until there is evidence to the contrary 
mitchellmckain » April 21st, 2018, 3:00 pm wrote: But this is wrong, derived from delusional semantics as if "seeing" meant absorbing the objects themselves into our brain and mind  Of course, "seeing" means no such thing  "Seeing" means gathering data to construct a mental model of an external reality  We don't, in fact, "see" this inner model at all  This "model" is a product of speculation and abstraction in meta-conscious process of self-reflection 
Yes, the view point is within the model  We don't literally 'see' across a room  The model gets 'viewed' and navigated and noted and whatnot  The outer reality is not able to be viewed directly but is usefully "looked out at" through a representation  Do you directly see wave frequencies air vibrations, and molecule shapes? I didn't mean 'seeing' in the sense of eye stuff, but I note the word problem 
mitchellmckain » April 21st, 2018, 3:00 pm wrote:
Yes, I was reading a large road sign with many words and the words at the bottom didn't come into focus until I got down to them  Our computers have many more terabytes than the brain has 
mitchellmckain » April 21st, 2018, 3:00 pm wrote: Your philosophical conclusions here will not be mistaken for scientific observations  Your interpretations are based on your own presumptions which I reject as incorrect  The process of human intention and action is certainly a complex one but the fact remains that the first causes do exist  People may be capable of simply watching much of their life pass by as an minimally participating observer (with all sorts of fatalistic and compatibilist dodges and delusions of objectivity), but others choose to take ownership of the first causes within them as a fully responsible participants in their own life 
Total libertarians do claim that they are first cause, self made people at every instant  How does this work? A theory of conscious intentions happening without any underlying physical processes ('you') behind them is the toughest sell of all proposals on the will, so it's no wonder that this 'being free of the will' can't be shown  Plus, why does one want this? Perhaps a distaste for having a will that wills things in the subconscious dark  These trillions of connections firing are not portrayed in consciousness, thank goodness 
Yes, as I said, some is indeterminate, so there is no ignoring  (You don't seem to read well, even when seeing it again when you quote it ) The more indeterminacy the worse we are able to carry our our ability to operate, which minimal and trivial capability is called 'freedom of action'  So be it  We have learned something  People want more than this, though, and so they will have to show that that's possible while still retaining the self/will  How is responsibility gained at any point when one was never responsible for prior causes toward one's being/self that couldn't be chosen?
So, prison time need not be assigned for retribution only, more compassion can be granted for those who did as they had to, and we come to better understand our place in the universe  Life is great for experiencing and living, and fatalism isn't recommended, for it could work against the enjoyment 
P S  There is no point at which ultimate purpose/intention could have been applied to what is eternal, as well as none to be applied to something springing from nothing (which, though impossible, I include for completeness, for the "springing" capability would still be an eternal 'something' )
It's fine with me if you want a fully formed Being with a system of intelligence to be there First, amid nothing else, but to stick to the template of ID, then a Higher ID had to be behind it, etc , or we could just forget about the one-off usage golden template of ID  The universe looks to be tuned, if it is, for mostly a lot of hydrogen gas in endless sparse spaces  It took ten billion years for us to be able to persist a bit in our rarity amid the waste  [/quote]
DragonFly » April 21st, 2018, 3:57 pm wrote:
Yes, as I said, some is indeterminate, so there is no ignoring 
Incorrect  You did not say "some is indeterminate " So either you do not write well, cannot understand the logic of your own words, or you make up things as an excuse to attack other people  In fact, this can be identified with a logical fallacy  "Whatever is indeterminate diminishes our modeling" means our modeling is diminished IF there is anything indeterminate  If A then B does not allow you affirm A, so by equating these two you have committed a logical fallacy  Furthermore it is amazing how far out on a limb you go to concoct such an attack  You said, "we cannot know if everything is deterministic," which is utterly inconsistent with a clam that "some is indeterminate," because if some is indeterminate then you would know that it is NOT deterministic 
DragonFly » April 21st, 2018, 3:57 pm wrote: Total libertarians do claim that they are first cause, self made people at every instant 
The philosophers who claim that we have free actions are called libertarians  The radical opposition that libertarians pose to the determinist position is their acceptance of free actions  Libertarians accept the incompatibility premise that holds agents morally responsible for free actions  Incompatibilism maintains that determinism is incompatible with human freedom  Libertarians accept that there are free actions, and in doing so, believe that we are morally responsible for some of our actions, namely, the free ones 
The libertarian ONLY claims that we do have free will actions and affirm the incompatibility of determinism with free will  There is no claim here that free will is absolute, inviolable, and applies to every action and thus that people are "self made at every instance "
Thus in the following it is clear you are burning an absurd strawman 
DragonFly » April 21st, 2018, 3:57 pm wrote: How does this work? A theory of conscious intentions happening without any underlying physical processes ('you') behind them is the toughest sell of all proposals on the will, so it's no wonder that this 'being free of the will' can't be shown  Plus, why does one want this? Perhaps a distaste for having a will that wills things in the subconscious dark  These trillions of connections firing are not portrayed in consciousness, thank goodness 
Someone only claims the opposition is selling something absurdly silly because they want to make something only slightly less absurd and silly sound reasonable by comparison  But to make sure you understand   
1  Nobody HERE is selling a theory of conscious intention without any underlying physical processes 
2  Nobody HERE is claiming any "being free of the will"
These are indeed nonsense 
1  As a physicalist with regards to the mind-body problem I oppose the idea of conscious intention without any physical processes  Nor would I assert that there are no unconscious processes underlying our conscious intentions  But as I explained in another thread just because there are such processes does not mean we have no responsibility for them or that our intention does not constitute a conscious cause of our action 
2  As a libertarian it is absurd to think free will means freedom from the will  What we reject is the attempt to separate the self from desires and will as if these were some external thing forcing people to do things  This is nothing but pure empty rhetoric on the part of the opposition  Freedom from the will is the OPPOSITE of free will  If you are not acting according to your desire then this is an example of actions without free will 
DragonFly » April 21st, 2018, 3:57 pm wrote: The more indeterminacy the worse we are able to carry our our ability to operate, which minimal and trivial capability is called 'freedom of action' 
Incorrect  This is only because you equate freedom with control  It is not the same thing  Besides the indeterminacy in the laws of physics is only with respect to a system of mathematical laws  It doesn't really say that nothing causes the result, but only that there are no variables to make the exact result calculable 
DragonFly » April 21st, 2018, 3:57 pm wrote: How is responsibility gained at any point when one was never responsible for prior causes toward one's being/self that couldn't be chosen?
Again it is because free will does not equal control  Free will only means you choose how to respond to the situation  It does require an awareness of alternatives, but it does not require an ability to dictate exactly what will happen in the future 
DragonFly » April 21st, 2018, 3:57 pm wrote: So, prison time need not be assigned for retribution only, more compassion can be granted for those who did as they had to, and we come to better understand our place in the universe  Life is great for experiencing and living, and fatalism isn't recommended, for it could work against the enjoyment 
While imprisonment may be an improvement over the old English law, the inadequacies are legion  It was indeed invented as a means of reforming the convicted even if it fails to accomplish this very well  To be sure, "retribution" is a lousy basis for a system of justice  But the point of "mercy" isn't just compassion but to acknowledge the fact that mistakes are part of the process by which we learn  Therefore, coming down on people like a load bricks for any mistake is counterproductive  On the other hand, we would be foolish not to consider whether a person in question is showing any ability to learn from their mistakes  If not, a change of environment/circumstances is probably called for, even if today's prisons largely fail to be environment needed 
Observe that this analysis of justice and mercy has nothing whatsoever to do with free will  The government of a free society should be founded upon what can be objectively established and free will is not one of these things  In the above consideration of justice and mercy, the question of whether a person truly has free will is completely irrelevant 
DragonFly » April 21st, 2018, 3:57 pm wrote: It's fine with me if you want a fully formed Being with a system of intelligence to be there First, amid nothing else, but to stick to the template of ID, then a Higher ID had to be behind it, etc , or we could just forget about the one-off usage golden template of ID  The universe looks to be tuned, if it is, for mostly a lot of hydrogen gas in endless sparse spaces  It took ten billion years for us to be able to persist a bit in our rarity amid the waste 
I consider Intelligent Design to be attack upon science -- shoving theology into a place where it clearly does not belong  Nor do I agree with intelligent design even in theology, for I think that evolution is more compatible with a belief in a loving God (because of the philosophical problem of evil)  Frankly, I consider design to be incompatible with the very essence of what life is 
DragonFly liked this post
Great post, Mitch 
I'm referring to "a lot is determinate", leaving room that some is indeterminate since QM finds this, and some brain doings may be at the micro-macro boundary and be affected, this degrading our ability to operate our intentions 
Here's a "libertarian" example/definition that may fit better:
“Hard Determinism and Libertarianism
Probing further into the free will-debate, we meet two different kinds of incompatibilist positions: hard determinism, which holds that determinism is true and that free will is not compatible with determinism, and libertarianism, which holds that we do have free will and that determinism is false  Given that these positions agree about the definition of determinism, we here actually have a genuine disagreement over fundamental ontological matters – a disagreement about whether determinism is true or not  This is a peculiar question to have strong disagreements about, however, since we know the final answer that we will ever get concerning the truth of determinism: that the state of the world is caused to be the way it is by its prior state at least to some degree, but to what degree exactly can never be known 
The libertarian position has often been criticized with the argument that even if determinism is not true, we still do not have free will, since our actions then simply are the product of a combination of deterministic and indeterministic events that we still do not ultimately choose ourselves, a view referred to as hard incompatibilism  Libertarians do not necessarily accept that this argument shows that we do not have free will, and the reason, or at least a big part of it, should not surprise anyone at this point: they simply define free will differently  According to libertarians, such as Robert Nozick and Robert Kane, one has free will if one could have acted otherwise than one did, and if indeterminism is true, then it may be true that we could have “acted” differently than we did under the exact same circumstances, and that we thereby might have free will in this sense  It should be pointed out, though, that critics of libertarianism are“rightly skeptical about the relevance of this kind of free will  First of all, the free will that libertarians endorse is, unlike what many libertarians seem to think, not an ethically relevant kind of freedom, and it does not have anything to do with the freedom of action that we by definition want  Second, the hard incompatibilist is right that no matter what is true about the degree to which the universe is deterministic, our actions are still caused by prior causes ultimately beyond our own control, which few of those who identify themselves as libertarians seem to want to acknowledge  And lastly, the fact that our actions are caused by causes ultimately beyond our own control does, if we truly appreciated, undermine our intuition of retributive justice, an intuition that libertarians generally seem to want to defend intellectually  So, as many have pointed out already, libertarians are simply on a failed mission 
Together with the want to defend retributive blame and punishment, what seems to be the main motivation for people who defend a libertarian notion of free will seems to be a fear of predeterminism, a fear of there being just one possible outcome from the present state of the universe, which would imply that we ultimately cannot do anything to cause a different outcome than the one possible  Libertarians and others with the same fear have artfully tried to make various models to help them overcome this fear, for instance so-called two-stage models that propose that our choices consist of an indeterministic stage of generation of possible actions, and then our non-random choice of one of them  (It should be noted, in relation to such models, that even if this is how our choices are made, our choice to choose one of these “alternative possibilities” will still be caused by prior causes that are ultimately completely beyond our own control  Nothing changes this fact, again because decision-making is the product of complex physical processes; it is not an uncaused event ) It is generally unclear what the purpose of such models is  Are they a hypotheses we should test? They do not seem to be  Generally, these models most of all seem like an attempt to make the world fit our preconceived intuitions, which most of all resembles pseudoscience 
Fortunately, there is plenty of relief available to the libertarians and other people who have this fear, and it does not involve any unscientific models – neither two-stage, three-stage, nor any other number of stages  The source of this relief is the simple earlier-mentioned fact that we can never know whether there is just one or infinitely many possible outcomes from the present state of the universe  This simple fact gives us all the relief we could ask for, because it reveals that there is no reason to be sure that there is just one possible outcome from the present state of the universe  And, to repeat an important point, we are then left with the conclusion that the only reasonable thing to do is to try to make the best impact we can in the world, which is true no matter whether there is just one possible outcome from the present state of the universe or not, since our actions still have consequences and therefore still matter even in a fully deterministic universe 
Some, especially libertarians, might want to object to the claim that we can never know whether determinism is true or not, and even claim that we in fact now know, or at least have good reasons to believe, that indeterminism is true  Here is neuroscientist Peter Tse expressing something along those lines: “Henceforth, I will accept the weight of evidence from modern physics, and assume ontological indeterminism to be the case ” (Tse, 2013, p  244)  Making this assumption is, however, to take a position on an unanswerable question  Again, rather than making strong claims about this question, we should stick to what we in fact know, namely that we do not know ”
Excerpt From: Magnus Vinding  “Free Will: An Examination of Human Freedom ” iBooks  https://itunes apple com/us/book/free-w     3363?mt=11
To extend the OP's implications of physical processes/causes dominating…
There are still real values in an existence with no ultimate purpose, this 'value' meaning good and bad valences and actions  It would be of great value to lessen suffering and improve well-being in humans and in all species  (Fixed wills are dynamic, simply meaning that they can learn and thus change to a better fixed will )
As for our model of reality, this is consciousness and it is ever our only view point inside the head in a brain, being what it is like to experience the world from the inside out 
by RJG on April 22nd, 2018, 1:07 am
Direct realism is not possible  We humans can only experience 'experiences' (sensations; sense data), not the 'real' things or objects themselves  Furthermore, we have no way of knowing if these experiences represent 'real' objects, or are just simply products of illusion; hallucination, delusion, dream, mirage, etc 
For this reason, solipsism is a possibility (i e  it is just as plausible as it is not), and true self-awareness is not possible (i e  we don't experience objects, including those called 'self')
DragonFly wrote: There is no direct (literal) view of the actual reality 'out there'  Our inner viewport is ever only that of the model (qualia) of inner and outer reality built by the brain  We see/sense nothing but this model made inside the brain 
Braininvat wrote: I invite anyone who thinks that bus hurtling down the street is nothing but a model in the brain to step in front of it 
Isn't it possible to dream or hallucinate stepping out in front of a bus hurtling down the street? This does not mean that the bus (in the dream/hallucination) is actually 'real' 
One does not normally step out in front of a bus (even in dreams) because they think it is not real, - it is the 'fear' (that it might be real, and) being smashed by it, that compels one not to step in front of it 
Braininvat wrote: Your impression of the bus may be indirect, but it has a direct causal chain of connections to the actual bus out there 
Not necessarily  You are assuming there is an "actual" bus out there (instead of a possible "hallucinated" bus)  We have no way of knowing the cause of our mental impressions 
by wolfhnd on April 22nd, 2018, 3:31 am
A bus that we do not step in front of is an extremely low resolution concept of what a bus is  Only the people who design and maintain the bus really know what a bus is at a relatively high resolution  Even then the designer doesn't really know the bus on the street because a bus is not just a collection of parts but takes it's meaning from an even more complex social and physical environment 
If you're a realist you assume that the bus can in theory be defined down to it's subatomic particles and a high resolution image of what it is can be created  The problem is that human perspective such an approach strips meaning from the image 
The other problem is that the kind of truth that a purely scientific approach provides tends to confuse the thing itself with it's mathematical model  The kind of absolutism that math provides is always subjective first because the parameters are always finite but the environment from our perspective is practically infinite and second because the model is an approximation even if 2+2 is always 4  A reductionist approach is a practical necessity that doesn't satisfy the evolutionary imperative for meaning 
The old view that everything can be reduced to cause and effect is itself challenged by the accepted view that determinism itself breaks down at tiny scales  Myself I'm not bothered by the indeterminate because I'm a pragmatist and close enough seems to satisfy practical solutions, scientific issues and philosophical questions  The philosophers goal is to determine what constitutes close enough to preserve life and meaning 
mitchellmckain wrote: If you are not acting according to your desire then this is an example of actions without free will 
If you act according to your desires, then you are it's slave  There is no free-will in slavery 
We don't control our desires  Our desires control us 
by DragonFly on April 22nd, 2018, 10:40 am
“This distinction between subject and object is not just an interesting oddity  It begins at the level of physics in the distinction between the probability inherent in symbolic measurements and the certainty of material laws  The distinction is later exemplified in the difference between a genotype, the sequence of nucleotide symbols that make up an organism’s DNA, and phenotype, its actual physical structure that those symbols prescribe  It travels with us up the evolutionary layers to the distinction between the mind and the brain ”
“These concepts will help us see how neural circuits are structures with a double life: they carry symbolic information, which is subject to arbitrary rules, yet they possess a material structure that is subject to the laws of physics ”
Excerpt From: Michael S  Gazzaniga  “The Consciousness Instinct ” iBooks  https://itunes apple com/us/book/the-co     3607?mt=11
by Neri on April 22nd, 2018, 11:13 am
On this topic, I should like to associate myself with the views of Mitch and BIV and will only add s few additional comments 
The question is not whether our experience is equivalent in every way to what lies outside of us, for such a thing is impossible 
[A perception cannot be exactly the same as a material object, for the former depends upon a sentient being for its existence, whereas the latter does not  Further, it is impossible to know everything that may be predicated of any material object by merely perceiving it ]
The real question is: Do sense impressions correspond to material objects in such a way that they are effective in preserving us from dangers that lie outside of us?
This question veritably answers itself  Only a madman would deny the evidence of his own senses 
It is essential to understand that the correspondence of which I speak depends on the reality of motion [from which we derive the ideas of time and space] 
To keep ourselves safe, it is necessary that we have the ability to know when a material object is moving closer or further from us and to be able to recognize an object as a danger  This, the senses give us, for perceptions like all other experiences are memories [are preserved over time] 
An object is recognized as a danger through prior sensory experiences preserved as long-term memories 
In order to be recognized and remembered as a danger, a material object must have the power to produce a particular human experience of it 
That power is part of the nature of the object and is thus truly reflected in the perception of it—even though there may be more to the object than its power to yield a human perception 
To the reasonable mind, the above comments may properly be seen as statements of the obvious  The curious fact, however, is that a whole school of western philosophy has labored mightily to deny the obvious 
I agree; I'm only delving into the inner experience to see how it works and what may become of that 
by TheVat on April 22nd, 2018, 11:57 am
RJG, this tablet ate the quoted part of your post and somehow hid the submit button, so sorry about the missing comment    
No, I was not assuming the in-the-moment knowledge, but rather that facts about buses are physically verifiable when science is applied  It is not difficult to verify that I was neither dreaming nor hallucinating  We are saved from solipsism by the multiplicity of observers and their reports  We can open a book and read complex prose (something that can't be done in dreams) that reveals areas of knowledge utterly unknown to us and beyond our previous experiences  We have senses enhanced by instruments that can show us photons leaving the photosphere of the sun and bouncing off solid objects like buses in particular and regular patterns, etc  Inner phenomenal reality and external reality are seamlessly connected and interacting - it is only big cranium apes like us who erect a wall of demarcation between them  Or drugs or pathological conditions that disrupt the causal connections 
To say that sensory data is incomplete is not equivalent to saying that it is deceptive  We are deceived only if we imagine that our impressions are complete  Our brains are engineered to find relevant data, not complete data  ("engineered" probably needs quotes)
by TheVat on April 22nd, 2018, 12:00 pm
Had to use Quick Reply window to post the above  Anyone else losing the submit button after Full Editor has been open for a couple minutes?? I will try to make sure this doesn't happen to anyone 
by DragonFly on April 22nd, 2018, 1:58 pm
What else, for now:
“Finally, affective consciousness—emotionally positive and negative feelings—has its own brain circuits, it does not require isomorphic mapping, and it may be experienced as mental states rather than mental images (figure 2 5B; chapters 7 and 8)  Thus, isomorphic maps are only one part of the creation and evolution of subjectivity and “something it is like to be”; many other special and general features (table 2 1) are required to create sensory consciousness and ontological subjectivity ”
“Consciousness-associated attention has several subtypes, including bottom-up (exogenous) versus top-down (endogenous) attention 48 Bottom-up attention is driven by the importance of the incoming stimuli and leads to the animal orienting to things that happen suddenly in the environment  Top-down attention, on the other hand, involves proactive anticipation, maintaining attention by concentration and focusing on goals 
Excerpt From: Todd E  Feinberg  “The Ancient Origins of Consciousness ” iBooks  https://itunes apple com/us/book/the-an     6953?mt=11
by RJG on April 22nd, 2018, 2:58 pm
Neri wrote: The real question is: Do sense impressions correspond to material objects in such a way that they are effective in preserving us from dangers that lie outside of us?
Firstly, we are not consciously aware of the actual causers (the supposed 'real' objects themselves) of these "sense impressions"  We are only consciously aware of the actual "sense impressions" (i e  the actual physical bodily reactions; experiences) themselves,    and of course this is only after they occur (after they impact our body) 
Secondly, we all assume that these "sense impressions" are the result of something 'real' out-there  Whether from a misfiring (hallucinating) brain, or from sensory signals emanating from a real object itself, it is still nonetheless 'real'  We all assume these "sense impressions" are the automatic reaction/response from some 'real' stimuli 
Thirdly, what "preserves us from danger" is NOT the conscious awareness of our sense impressions, but instead, it is the body's automatic RESPONSE to this danger (STIMULI) that "preserves us from danger",    and not the conscious awareness of said response 
Fourthly, if the body auto-responds in a particular way then the likelihood of survivability is enhanced, and if the response is otherwise then it may be diminished 
Neri wrote: To keep ourselves safe, it is necessary that we have the ability to know when a material object is moving closer or further from us and to be able to recognize an object as a danger 
Not so  It is NOT the "knowing" or "recognizing" of the dangerous moving object that "keep ourselves safe"  It is the body's automatic reaction/response to this moving object (stimuli) that "keep ourselves safe" 
Remember, we can only be conscious of (i e  know or recognize) actual bodily reactions/events, and not of other 'external' events  We don't consciously know/recognize how we responded until 'after' we (our body) responds  Our consciousness (knowing/recognizing) is wholly dependent upon our bodily reactions/responses,    NOT the other way around 
Without something (e g  sense impressions; bodily reactions) to be conscious of, then there is no consciousness (   no knowing or recognizing!) 
Braininvat wrote: No, I was not assuming the in-the-moment knowledge, but rather that facts about buses are physically verifiable when science is applied 
Can't one hallucinate they are doing verifiable science?
Braininvat wrote: It is not difficult to verify that I was neither dreaming nor hallucinating   
   We can open a book and read complex prose (something that can't be done in dreams) that reveals areas of knowledge utterly unknown to us and beyond our previous experiences 
I'm not so confident/convinced of this  Have you seen the movie "A Beautiful Mind"?    or have had family members with mental issues?
Braininvat wrote: We are saved from solipsism by the multiplicity of observers and their reports   
   We have senses enhanced by instruments that can show us photons leaving the photosphere of the sun and bouncing off solid objects like buses in particular and regular patterns, etc  Inner phenomenal reality and external reality are seamlessly connected and interacting - it is only big cranium apes like us who erect a wall of demarcation between them 
Isn't it possible to hallucinate these "multiple observers and their reports",    and their "instrumentation" results?
Other than by 'blind faith', how can one really know that their perceptions are the 'true' representations of reality?    I think it is not possible,    I think we can only 'hope' that our personal view is of reality itself 
We can't perceive beyond our current ("suspect") perceptions 
How about that the 'knowing' is done by the brain that built the qualia showing the danger, for the brain thus already has the information available, in whatever form it uses to 'know' 
by TheVat on April 22nd, 2018, 4:50 pm
Isnt it possible to hallucinate these "multiple observers and their reports",    and their "instrumentation" results?
- RJG
For me, that level of arch-skepticism is an epistemic doldrums zone  As David Hume famously observed about a conference on epistemology on Europe, "on finishing their discussion, the participants all departed by means of the doors  " (or similar; don't have exact quote handy ATM)
Whenever I write numbers in dreams they change as I write them and when I read it often fills up with garbage 
I've been lucidly inspecting my dreams  Some flaws are that bugs appear as triangles  Yesterday, I was going to eat in a cafeteria but you had to bring your own plates from home, so I already suspected something  I did find a pile of plates and took one, but I was soon somehow holding the whole pile, which then happened again and again, so, as in these stuck cases, I clench my whole body and that wakes me up  Other times, for lesser problems or to be sure of the dream state, I am able to open one eye and see the window and then go back to the dream  And sometimes the dream perfectly shows an entire scene in fabulous detail, such as a mid summer dusk, with even those whirly things floating through the air 
by mitchellmckain on April 23rd, 2018, 4:00 am
DragonFly » April 20th, 2018, 2:14 pm wrote: The model seems to be super real,
To me, that seems like a completely nonsensical thing to say to  "Seems real" compared to what? By the only standard we have, it is real, for it is the only standard which we have for making such a measurement  What you say is practically Platonic in the implied imagination of some greater reality somewhere else 
DragonFly » April 20th, 2018, 2:14 pm wrote: So, in sum so far, direct realism is an illusion, but is a very useful illusion, which we might better call a fine representation by the model, since the word 'illusion' is more about what's wrong as not really showing its object as substantial and really being behind it 
In philosophy of mind, naïve realism, also known as direct realism or common sense realism, is the idea that the senses provide us with direct awareness of objects as they really are  Objects obey the laws of physics and retain all their properties whether or not there is anyone to observe them [1] They are composed of matter, occupy space and have properties, such as size, shape, texture, smell, taste and colour, that are usually perceived correctly 
In contrast, some forms of idealism claim that no world exists apart from mind-dependent ideas, and some forms of skepticism say we cannot trust our senses  Naïve realism is known as direct as against indirect or representative realism when its arguments are developed to counter the latter position, also known as epistemological dualism;[2] that our conscious experience is not of the real world but of an internal representation of the world 
There is nothing of illusion in direct realism  There is only the foolish rhetoric implying that "direct" in "direct realism" means absorbing the actual object rather than data from those objects  The data IS from actual objects and does provide awareness of actual objects obeying the laws of physics  The implication that anyone is confusing the awareness of an object with the object itself is just ridiculous  Instead you can say that the process of perception is what makes illusions possible  Because we are interpreting data, then it is entirely possible for similar data to suggest something other than what is the case, such as the impression of water from a mirage -- at least until we learn the distinctions 
When you consider the philosophical alternative, plastering the word "illusion" on direct realism implies that idealism is the reality beneath it  And that is an implication I would refute most heatedly  As for indirect realism, as I explained above, I think it is carrying things too far to say that we are experiencing the model instead of reality  Instead I would limits the validity only to the idea that we use a model in the process of perception  In that sense you could say my position is in-between that of direct realism and indirect realism 
DragonFly » April 20th, 2018, 2:14 pm wrote: Dreams, then, would be better called illusions; further they demonstrate the power of the structure of the model  When we inspects objects in dreams they look just as good as when we see them awake, although backgrounds come and go inconsistently and there are narrative gaps (all of a sudden we are driving a vehicle without ever having gotten into it, plus the controls are a mystery )
I think it is unwise to make generalizations about dreams in such a manner  That is not my experience of dreams at all  My impression is that dreams consist of a mental (linguistic) narrative using memory to fill in the details  The only uniqueness in such experiences are the irrational combinations and discontinuities  Because of this, I have no sense this is anywhere near as good as when we see things awake, when we are interpreting fresh new sensory data  For me, this imparts a considerably dim character to the dream experience 
For me dreams are rather comparable to when I envision scenarios for my books  I see them in my mind's eye but not in a manner that is remotely comparable to my experience of reality through the senses  I am not suggesting that everyone experiences dreams this way  On the contrary, the phenomenon of schizophrenia suggests to me that some people can see things in their minds eye with the same vividness of the senses, for otherwise, how can they not know the difference?
DragonFly » April 20th, 2018, 2:14 pm wrote: Another illusion is the feeling of having all of the information in a qualia scene as instantly available, as well as feeling that it is all happening in real time, plus that one is directing it all right then and there 
Calling this illusion is a gross exaggeration  At most it is simply approximation 
by DragonFly on April 23rd, 2018, 11:37 am
'Imagination' (say, of things to happen in a book,) uses the model, too, but the scenes are about 90% transparent, probably so they don't get in the way of the real scenes about 
by DragonFly on April 23rd, 2018, 2:51 pm
Boggling idea of the Subject/Object Cut…
“The Schnitt and the Origins of Life
Physicists refer to the inescapable separation of a subject (the measurer) from an object (the measured) as die Schnitt  (What a great word!) Pattee calls “this unavoidable conceptual separation of the knower and the known, or the symbolic record of an event and the event itself, the epistemic cut 
There is a world of actions that exists on the side of the observer with the observer’s record of an event  There is also a separate world of actions on the side of the event itself  This sounds confusing, but think of the explanatory gap between your subjective experience of an event (I had so much fun body-surfing) and the event itself (A person went swimming in the ocean)  Alternately, you can think of the explanatory gap between the same subjective experience (This is fun) and the goings-on within the brain (Some neurons fired while a person was swimming in the ocean)  These are all just versions of the subject/object complementarity seen in physics  Here is the really wild part: Who’s measuring the events? To examine the difference between a person’s subjective experience and objective reality, do we need a scientist? Who’s measuring the scientist?
Pattee points out that neither classical nor quantum theory formally defines the subject, that is, the agent or observer that determines what is measured  Physics, therefore, does not say where to make the epistemic cut 4 Quantum measurement does not need a physicist-observer, however  Pattee argues that other things can perform quantum measurements  For example, enzymes (such as DNA polymerases) can act as measurement agents, performing quantum measurement during a cell’s replication process  No human observer is needed 
For Schrödinger, the joke was on us  He was trying to point out that there is something missing in our understanding  Pattee got it (in high school) and buckled down to attack the problem  Where should we put the cut, the gap, die Schnitt? With his consuming interest in the origins of life, he came to realize that human consciousness was way too high a layer in the architecture of all living organisms to put the epistemic cut between the observer and the observed, between the subjective experience and the event itself  There are umpteen layers between subatomic particles and human brains  There are plenty of layers between subatomic particles and brains in general (cat or mouse or fly or worm)  Putting the major epistemic cut that high led to the nonsense of Schrödinger’s cat existing as a quantum system  There was no pussyfooting around for Pattee: “I have taken the point of view that the question of what constitutes an observation in quantum mechanics must arise long before we reach the complexity of the brain  In fact, I propose … that the gap between quantum and classical behavior is inherent in the distinction between inanimate and living matter 
There you have it  Pattee proposes that the gap resulted from a process equivalent to quantum measurement that began with self-replication at the origin of life with the cell as the simplest agent  The epistemic cut, the subject/object cut, the mind/matter cut, all are rooted to that original cut at the origin of life  The gap between subjective feeling and objective neural firings didn’t come about with the appearance of brains  It was already there when the first cell started living  Two complementary modes of behavior, two levels of description are inherent in life itself, were present at the origin of life, have been conserved by evolution, and continue to be necessary for differentiating subjective experience from the event itself  That is a mind-boggling idea ”
by mitchellmckain on April 24th, 2018, 1:06 pm
The "like" on the above post is not to be construed as complete agreement with conclusions, but rather more with an abundant approval of the questions and issues raised 
DragonFly » April 23rd, 2018, 1:51 pm wrote: Boggling idea of the Subject/Object Cut…
Absolute agreement here! I have always considered quantum interpretations linking quantum decoherence with human consciousness to be absurd -- with one exception  The one interpretation which makes this link and is not absurd is the Everett Interpretation  THOUGH, I would not count this in its favor! Furthermore, it isn't actually necessary to the Everett Interpretation, for it is quite possible to shift the locus of the decoherence in this interpetation to agree with other interpretations 
DragonFly » April 23rd, 2018, 1:51 pm wrote: For Schrödinger, the joke was on us  He was trying to point out that there is something missing in our understanding 
Agreed! That is how I have always understood the Schrödinger cat thought experiment  It was not to seriously propose the existence of dead-alive cats but to highlight the absurdities which come from the way that quantum physics was usually being presented 
DragonFly » April 23rd, 2018, 1:51 pm wrote: Pattee got it (in high school) and buckled down to attack the problem  Where should we put the cut, the gap, die Schnitt? With his consuming interest in the origins of life, he came to realize that human consciousness was way too high a layer in the architecture of all living organisms to put the epistemic cut between the observer and the observed, between the subjective experience and the event itself  There are umpteen layers between subatomic particles and human brains  There are plenty of layers between subatomic particles and brains in general (cat or mouse or fly or worm)  Putting the major epistemic cut that high led to the nonsense of Schrödinger’s cat existing as a quantum system  There was no pussyfooting around for Pattee: “I have taken the point of view that the question of what constitutes an observation in quantum mechanics must arise long before we reach the complexity of the brain  In fact, I propose … that the gap between quantum and classical behavior is inherent in the distinction between inanimate and living matter 
And here is where we have a disagreement  While I totally appreciate pushing many things such as consciousness, learning, and creativity down to the lowest levels of the divide between the living and nonliving, I personally do not believe that this has anything whatsoever to do with the quantum measurement problem 
DragonFly » April 23rd, 2018, 1:51 pm wrote: There you have it  Pattee proposes that the gap resulted from a process equivalent to quantum measurement that began with self-replication at the origin of life with the cell as the simplest agent 
Furthermore, I think this focus on self-replication as the divide between the living and non-living may be a little behind the times  Metabolism first theories of abiogenesis and the study of prebiotic evolution strongly suggest that key features of the life process are located way before the development of self-replicating molecules such as RNA and DNA  On the other hand, perhaps this idea of self-replication can be extended to processes in prebiotic evolution in which there is a catalysis of chemical reactions which replenish the chemical components  After all, self-maintenance is a definitive feature of the life process and would suggest that any life process must include the regeneration of its components 
DragonFly » April 23rd, 2018, 1:51 pm wrote: The epistemic cut, the subject/object cut, the mind/matter cut, all are rooted to that original cut at the origin of life  The gap between subjective feeling and objective neural firings didn’t come about with the appearance of brains  It was already there when the first cell started living  Two complementary modes of behavior, two levels of description are inherent in life itself, were present at the origin of life, have been conserved by evolution, and continue to be necessary for differentiating subjective experience from the event itself  That is a mind-boggling idea ”
This would only work if you can make a logical connection with this definitive feature of life in a process of self maintenance  I have already suggested a connection between this and consciousness by pointing out that self maintenance requires some kind of awareness of self, both as it is and as it "should be " Without some sort of "should be" in some form there can be no self-maintenance  It should be noted that there are numerous quantitative features to this, such as the clarity with which this goal of self as it "should be" is represented, the determination/flexibility with which it is adhered to (or in other words the range of circumstances which can be handled in holding to this goal) 
by TheVat on April 24th, 2018, 1:52 pm
It seems likely a paramecium does no representing to a self, and is pretty much a cellular machine lacking sentience 
A paramecium is not full of Schnitt  It is not measuring or having goals or anything else  It is an automaton  To think otherwise would be to invite some sort of Bergsonian "elan vital" or other dualistic essence 
The problem with the term "observation" is that it's prejudicial in common parlance  It implies some sort of sentient observer  It implies a subjective aspect  So a more neutral term would be needed when a microbe registers a chance in its environment and contracts or expands or fires up the cilia or dumps the vacuoles or whatever  Or when a Bose Einstein condensate loses its coherence in a wet noisy puddle 
Braininvat » April 24th, 2018, 12:52 pm wrote: It seems likely a paramecium does no representing to a self, and is pretty much a cellular machine lacking sentience 
But it is not a machine for the simple reason that it is not a product of design  The only reasons for which it does things are its own reasons  It is a product of self organization, and the learning process which is evolution 
I certainly agree with the term "biological machinery," which is to say that there is no reason to distinguish things simply on the basis that one uses the interactions of organic chemistry  Thus I think the locus of difference between the living organism and the machine has to do with origins whether it is by design or by learning, evolution, and self-organization 
Braininvat » April 24th, 2018, 12:52 pm wrote: The problem with the term "observation" is that it's prejudicial in common parlance  It implies some sort of sentient observer  It implies a subjective aspect  So a more neutral term would be needed when a microbe registers a chance in its environment and contracts or expands or fires up the cilia or dumps the vacuoles or whatever 
But the problem with this is that the prejudice in language goes both ways with the presumption of an uncrossable divide between the sentient and the non-sentient, when all the evidence points to a continuum going all the way from the non-living to the living to the sentient  And this is not a linear continuum but a rapidly branching tree with many capabilities somewhat arbitrarily (or rather anthropomorphically) lumped into this term "sentience "
Context 2: Do you know the difference between V T  and T V?
Like any exclusive club, heart disease has its own jargon, understandable only by other members of the club, particularly by cardiac care providers  For example, I remember lying in my CCU bed (that’s the Coronary Intensive Care Unit), trying to memorize the letters LAD (that’s the Left Anterior Descending, the large coronary artery whose 99% blockage had caused my MI (myocardial infarction – in my case, the so-called ‘widowmaker’ heart attack) 
To help others needing simultaneous translation of this new lingo in your research or in your own medical records, here’s a helpful list of some of the most common acronyms/terms you’ll likely find around the cardiac ward 
NOTE from CAROLYN: This entire patient-friendly, jargon-free glossary (all 8,000 words!) is also part of my book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, November 2017) 
AA – Anti-arrhythmic: Drugs used to treat patients who have irregular heart rhythms 
Ablation – See Cardiac Ablation 
ACE Inhibitor – Angiotension Converting Enzyme inhibitor: A drug that lowers blood pressure by interfering with the breakdown of a protein-like substance involved in regulating blood pressure 
ACS – Acute Coronary Syndrome: An emergency condition brought on by sudden reduced blood flow to the heart  The first sign of acute coronary syndrome can be sudden stopping of your heart (cardiac arrest) 
AED – Automatic External Defibrillator: A portable defibrillator for use during a cardiac emergency; it can be used on patients experiencing sudden cardiac arrest by applying a brief electroshock to the heart through electrodes placed on the chest 
AF or Afib – Atrial Fibrillation: An irregular and often rapid heart rate that can cause poor blood flow to the body  Afib symptoms include heart palpitations, shortness of breath, weakness or fainting  Episodes of atrial fibrillation can come and go, or you may have chronic atrial fibrillation 
AFL – Atrial Flutter: A type of arrhythmia where the upper chambers of the heart (the atria) beat very fast, causing the walls of the lower chambers (the ventricles) to beat inefficiently as well 
A-HCM – Apical Hypertrophic Cardiomyopathy: Also called Yamaguchi Syndrome or Yamaguchi Hypertrophy, a non-obstructive form of cardiomyopathy (a disease of the heart muscle that leads to generalized deterioration of the muscle and its pumping ability) in which a portion of the heart muscle is hypertrophied (thickened) without any obvious cause although there may be a genetic link  It was first described in individuals of Japanese descent 
AI – Aortic Insufficiency: A heart valve disease in which the aortic valve does not close tightly, leading to the backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (a chamber of the heart) 
AIVR – Accelerated Idioventricular Rhythm: Ventricular rhythm whose rate is greater than 49 beats/min but less than 100 beats/min, usually benign  (Ventricles are the two main chambers of the heart, left and right) 
Angina (stable) – A condition marked by distressing symptoms typically between neck and navel that come on with exertion and go away with rest, caused by an inadequate blood supply to the heart muscle typically because of narrowed coronary arteries feeding the heart muscle  Also known as Angina Pectoris  Unstable angina (UA) occurs when fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, blocking or reducing flow through a narrowed artery, suddenly and severely decreasing blood flow to the heart muscle  Unstable angina is not relieved by rest; it’s dangerous and requires emergency medical attention 
Antiplatelet drugs – Medications that block the formation of blood clots by preventing the clumping of platelets (examples: Plavix, Effient, Brillinta, Ticlid, etc)  Heart patients, especially those with implanted stents after PCI, are often prescribed dual antiplatelet therapy (DAPT) which includes one of these prescribed meds along with daily low-dose aspirin 
Aorta – The main artery of the body, carrying blood from the left side of the heart to the arteries of all limbs and organs except the lungs 
Aortic Stenosis: A disease of the heart valves in which the opening of the aortic valve is narrowed  Also called AS 
Aortic valve – One of four valves in the heart, this valve allows blood from the left ventricle to be pumped up (ejected) into the aorta, but prevents blood from returning to the heart once it’s in the aorta 
AP – Apical Pulse: A central pulse located at the apex (pointy bottom) of the heart 
Apex – the lowest (pointy) tip of the heart that points downward at the base, forming what almost looks like a rounded point 
Apical Hypertrophic Cardiomyopathy (A-HCM): Also called Yamaguchi Syndrome or Yamaguchi Hypertrophy, a non-obstructive form of cardiomyopathy (a disease of the heart muscle that leads to generalized deterioration of the muscle and its pumping ability) in which a portion of the heart muscle is hypertrophied (thickened) without any obvious cause  There may be a genetic link  It was first described in people of Japanese descent 
Arrhythmia – A condition in which the heart beats with an irregular or abnormal rhythm 
AS – Aortic Stenosis: A disease of the heart valves in which the opening of the aortic valve is narrowed 
ASD – Atrial Septal Defect: See Septal Defect 
Atrial Flutter – A heart rhythm problem (arrhythmia) originating from the right atrium, most often involving a large circuit that travels around the area of the tricuspid valve (between the right atrium and the right ventricle (this is called typical atrial flutter)  Less commonly, atrial flutter can also result from circuits in other areas of the right or left atrium that cause the heart to beat fast (called atypical atrial flutter) 
Atrial Septum, the membrane that separates the left and the right upper chambers of the heart (the atria) 
Atrium – A chamber of the heart that receives blood from the veins and forces it into a ventricle or ventricles  Plural: atria 
AV – Atrioventricular: A group of cells in the heart located between the upper two chambers (the atria) and the lower two chambers (the ventricles) that regulate the electrical current that passes through it to the ventricles  Also Atrioventricular Block: An interruption or disturbance of the electrical signal between the heart’s upper two chambers (the atria) and lower two chambers (the ventricles)  Also Aortic valve: The valve that regulates blood flow from the heart into the aorta 
AVNRT – Atrioventricular Nodal Re-entry Tachycardia: a heart rhythm problem that happens when there’s an electrical short circuit in the centre of the heart, one of the most common types of SVT, most often seen in people in their twenties and thirties, and more common in women than in men 
BAV – Bicuspid Aortic Valve: The most common malformation of the heart valves in which the aortic valve has only two cusps instead of three 
BB – Beta Blocker: A blood pressure-lowering drug that limits the activity of epinephrine, a hormone that increases blood pressure 
BBB – Bundle Branch Block: – A condition in which parts of the heart’s conduction system are defective and unable to normally conduct the electrical signal, causing an irregular heart rhythm (arrhythmia) 
BMI – Body mass index: A number that doctors use to determine if you’re overweight  BMI is calculated using a formula of weight in kilograms divided by height in meters squared (BMI =W [kg]/H [m2])  Better yet, just click here to figure out your own BMI 
BNP blood test – BNP (B-type Natriuretic Peptide) is a substance secreted from the ventricles or lower chambers of the heart in response to changes in pressure that happen when heart failure develops and/or worsens  The level of BNP in the blood increases when heart failure symptoms worsen, and decreases when the heart failure condition is stable 
BP – Blood Pressure: The force or pressure exerted by the heart in pumping blood; the pressure of blood in the arteries  See also hypertension 
BrS – Brugada Syndrome: Brugada syndrome is a genetic heart disease that is characterized by distinctively abnormal electrocardiogram (EKG/ECG) findings and an increased risk of sudden cardiac arrest 
CAA – Coronary artery anomaly: A congenital defect in one or more of the coronary arteries of the heart 
CABG – Coronary Artery Bypass Graft: A surgical procedure that reroutes blood flow around a diseased or blocked blood vessel that supplies blood to the heart by grafting either a piece of vein harvested from the leg or the artery from under the breastbone 
CA – Coronary Artery: The arteries arising from the aorta that arch down over the top of the heart and divide into branches  They provide blood to the heart muscle 
CAD – Coronary Artery Disease: A narrowing of the arteries that supply blood to the heart  The condition results from a plaque rupture/blood clot or spasm and greatly increases the risk of a heart attack 
Cardiac Ablation – A procedure performed by an Electrophysiologist (EP) – a cardiologist with specialized training in treating heart rhythm problems – that typically uses catheters — long, flexible tubes inserted through a vein in the groin and threaded to the heart — to correct structural problems in the heart that cause an arrhythmia  Cardiac ablation works by scarring or destroying the tissue in your heart that triggers an abnormal heart rhythm 
Cardiac Arrest – Also known as Sudden Cardiac Arrest: The stopping of the heartbeat, usually because of interference with the electrical signal that regulates each heartbeat (often associated with coronary heart disease)  Can lead to Sudden Cardiac Death 
Cardiac Catheterization – An invasive procedure in which a catheter is inserted through a blood vessel in the wrist/arm or groin with x-ray guidance  This procedure can help provide information about blood supply through the coronary arteries, blood pressure, blood flow throughout the chambers of the heart, collection of blood samples, and x-rays of the heart’s ventricles or arteries  It’s typically performed in the cath lab during angiography 
Cardiac Resynchronization Therapy (CRT) also called bi-ventricular pacemaker: an electronic pacing device that’s surgically implanted in the chest to treat the delay in heart ventricle contractions that occur in some people with heart failure 
Cardiac Tamponade – Pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium)  Also called Tamponade 
Cardiomyopathy – a chronic disease of the heart muscle (myocardium), in which the muscle is abnormally enlarged, thickened, and/or stiffened 
Cardioversion – A medical procedure in which an abnormally fast heart rate (tachycardia) or cardiac arrhythmia like atrial fibrillation is converted to a normal rhythm using electricity or drugs  Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart at a specific moment in the cardiac cycle  Chemical cardioversion uses medications to convert to normal rhythm 
Cath lab – the room in the hospital/medical clinic where cardiac catheterization procedures take place (for example, when a stent is implanted into a blocked coronary artery) 
CCB – Calcium Channel Blocker: A drug that lowers blood pressure by regulating calcium-related electrical activity in the heart 
CDS – Cardiac Depression Scale: A scale that can help assess the effects of depression occurring as a result of a heart disease diagnosis 
CHF – Heart Failure (also called Congestive Heart Failure): A condition in which the heart cannot pump all the blood returning to it, leading to a backup of blood in the vessels and an accumulation of fluid in the body’s tissues, including the lungs 
CM – Cardiomyopathy: A disease of the heart muscle that leads to generalized deterioration of the muscle and its pumping ability 
CO – Cardiac Output: The amount of blood the heart pumps through the circulatory system in one minute 
Collateral arteries – These extra coronary blood vessels are sometimes able to bypass a blockage in an artery in order to supply enough oxygenated blood to enable the heart muscle to survive when in danger of being damaged because of blockage(s) 
Collateral arteries – Blood vessels that provide an alternative arterial supply of blood to an area of the heart that’s in danger of being deprived of oxygenated blood because of one or more blocked arteries 
Congenital heart defect – one of about 35 different types of heart conditions that happen when the heart or the blood vessels near the heart don’t develop normally before a baby is born (in about 1% of live births)  Because of medical advances that treat babies born with heart defects, there are now for the first time more adults with congenital heart disease than children 
Congestive heart failure (CHF) – a chronic progressive condition that affects the pumping power of your heart muscle  Often referred to simply as heart failure, CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently 
COPD – Chronic Obstructive Pulmonary Disease: A lung disease defined by persistently poor airflow as a result of breakdown of lung tissue (known as emphysema) and dysfunction of the small airways Often associated with smoking, it typically worsens over time 
Coronary Microvascular Disease – A heart condition that causes impaired blood flow to the heart muscle through the small vessels of the heart  Also called Microvascular Disease or Small Vessel Disease 
Coronary Reactivity Test – An angiography procedure specifically designed to examine the blood vessels in the heart and how they respond to different medications  Physicians use these images to distinguish different types of blood vessel reactivity dysfunction (such as Coronary Microvascular Disease) 
Costochondritis– the cause of severe chest pain, but NOT heart-related; it’s an inflammation of the cartilage that connects a rib to the breastbone 
Coumadin – A drug taken to prevent the blood from clotting and to treat blood clots  Coumadin is believed to reduce the risk of blood clots causing strokes or heart attacks  See also Warfarin 
Cox Maze procedure – A complex “cut-and-sew” surgical procedure done to treat atrial fibrillation through a complicated set of incisions made in a maze-like pattern on the left and right atria (the upper chambers of the heart) to permanently interrupt the abnormal electrical signals that are causing the irregular heartbeats of Afib  See also: Mini-Maze 
CP – Chest Pain (may also be felt as squeezing, pressure, fullness, pressure, heaviness, burning or tightness in the chest) 
CPR – Cardiopulmonary Resuscitation: An emergency procedure in which the heart and lungs are made to work by manually compressing the chest overlying the heart and forcing air into the lungs, used to maintain circulation when the heart stops pumping during Cardiac Arrest  Current guidelines suggest hands-only CPR  See also AED 
CQ10 – Co-enzyme Q10: A dietary supplement sometimes recommended for heart patients taking statin drugs 
CRP – C-reactive protein: A byproduct of inflammation, produce by the liver, found in the blood in some cases of acute inflammation 
CRT – Cardiac Resynchronization Therapy also called bi-ventricular pacemaker: an electronic pacing device that’s surgically implanted in the chest to treat the delay in heart ventricle contractions that occur in some people with heart failure 
CT – Computed tomography (CT or CAT scan): An x-ray technique that uses a computer to create cross-sectional images of the body 
CTA – Computerized Tomographic Angiogram: An imaging test to look at the arteries that supply the heart muscle with blood  Unlike a traditional coronary angiogram, CT angiograms don’t use a catheter threaded through your blood vessels to your heart but instead rely on a powerful X-ray machine to produce images of your heart and heart vessels 
CV – Coronary Vein: One of the veins of the heart that drain blood from the heart’s muscular tissue and empty into the right atrium 
CV – Cardiovascular: Pertaining to the heart and blood vessels that make up the circulatory system 
DBP – Diastolic blood pressure: The lowest blood pressure measured in the arteries  It occurs when the heart muscle is relaxed between beats 
DCM – Dilated Cardiomyopathy: A disease of the heart muscle, primarily affecting the heart’s main pumping chamber (left ventricle)  The left ventricle becomes enlarged (dilated) and can’t pump blood to your body with as much force as a healthy heart can 
DDI – Drug-drug interaction: A situation in which a medication affects the activity of another medication when both are administered together 
DIL – Diltiazem: A calcium channel blocker drug that acts as a vasodilator; used in the treatment of angina pectoris, hypertension, and supraventricular tachycardia 
Diuretic – A class of drugs used to lower blood pressure  Also known as “water pills” 
Dobutamine stress echocardiography: This is a form of a stress echocardiogram diagnostic test  But instead of exercising on a treadmill or exercise bike to stress the heart, the stress is obtained by giving a drug that stimulates the heart and makes it “think” it’s exercising  The test is used to evaluate your heart and valve function if you are unable to exercise  It is also used to determine how well your heart tolerates activity, and your likelihood of having coronary artery disease (blocked arteries), and it can evaluate the effectiveness of your cardiac treatment plan  See also TTE and Stress Echocardiogram 
Dressler’s syndrome – Happens to a small number of people three to four weeks after a heart attack  The heart muscle that died during the attack sets the immune system in motion, calling on lymphocytes, one of the white blood cells, to infiltrate the coverings of the heart (pericardium) and the lungs (pleura)  It also starts generating antibodies, which attack those two coverings  Chest pain (CP) is the predominant symptom; treated with anti-inflammatory drugs 
Dual Antiplatelet Therapy – Medications that block the formation of blood clots by preventing the clumping of platelets (examples Plavix, Effient, Brillinta, Ticlid, etc ) are often prescribed along with aspirin as part of what’s known as dual antiplatelet therapy, especially to patients who have undergone PCI and stent implantation 
DVT – Deep Vein Thrombosis: A blood clot in a deep vein in the calf 
ECG / EKG – Electrocardiogram: A test in which several electronic sensors are placed on the body to monitor electrical activity associated with the heartbeat 
Ectopic beats – small changes in an otherwise normal heartbeat that lead to extra or skipped heartbeats, often occurring without a clear cause, most often harmless 
EF – Ejection Fraction: A measurement of blood that is pumped out of a filled ventricle  The normal rate is 50-60% 
EKG/ECG – Electrocardiogram: A test in which several electronic sensors are placed on the body to monitor electrical activity associated with the heartbeat 
Endothelium: A single-cell layer of flat endothelial cells lining the closed internal spaces of the body such as the inside of blood vessels  Endothelial dysfunction affects the ability of these cells to help dilate blood vessels, control inflammation or prevent blood clots  The endothelium is associated with most forms of cardiovascular disease, such as hypertension, coronary artery disease, chronic heart failure, peripheral vascular disease, diabetes, chronic kidney failure, and severe viral infections 
Enhanced External Counterpulsation – EECP is an FDA-approved non-invasive, non-drug treatment for angina  It works by promoting the development of collateral coronary arteries  The therapy is widely used in prominent heart clinics such as the Cleveland Clinic, Mayo Clinic and Johns Hopkins – especially for patients who are not good candidates for invasive procedures such as bypass surgery, angioplasty or stenting 
EP – Electrophysiologist: A cardiologist who has additional training in diagnosing/treating heart rhythm disorders 
EPS – Electrophysiology Study: A test that uses cardiac catheterization to study patients who have arrhythmias (abnormal hear rhythm)  An electrical current stimulates the heart in an effort to provoke an arrhythmia, which is immediately treated with medications  EPS is used primarily to identify the origin of the arrhythmia and to test the effectiveness of medications used to treat abnormal heart rhythms 
EVH – Endoscopic Vessel Harvesting: To create the bypass graft during CABG open heart surgery, a surgeon will remove or “harvest” healthy blood vessels from another part of the body, often from the patient’s leg or arm  This vessel becomes a graft, with one end attaching to a blood source above and the other end below the blocked area  See CABG 
Exercise stress test – An exercise test (walking/running on a treadmill or pedalling a stationary bike) to make your heart work harder and beat faster  An EKG is recorded while you exercise to monitor any abnormal changes in your heart under stress, with or without the aid of drugs to enhance this assessment  See also: MIBI, Echocardiogram, Nuclear Stress Test 
Familial hypercholesterolemia (FH) – A genetic predisposition to dangerously high cholesterol levels  FH is an inherited disorder that can lead to aggressive and premature cardiovascular disease, including problems like heart attacks, strokes, or narrowing of the heart valves 
Femoral Artery: a major artery in your groin/upper thigh area, through which a thin catheter is inserted, eventually making its way into the heart during angioplasty to implant a stent; currently the most widely used angioplasty approach in the United States, but many other countries now prefer the Radial Artery access in the wrist 
FFR – Fractional Flow Reserve: A test used during coronary catheterization (angiogram) to measure pressure differences across a coronary artery stenosis (narrowing or blockage) defined as as the pressure behind a blockage relative to the pressure before the blockage 
HC – High Cholesterol: When fatty deposits build up in your coronary arteries 
HCTZ – Hydrochlorothiazide: A drug used to lower blood pressure; it acts by inhibiting the kidneys’ ability to retain water  Used to be called “water pills” 
Heart Failure – a chronic progressive condition that affects the pumping power of your heart muscle  Sometimes called Congestive Heart Failure (CHF) 
Holter Monitor – A portable monitoring device that patients wear for recording heartbeats over a period of 24 hours or more 
HTN – Hypertension: High blood pressure, the force of blood pushing against the walls of arteries as it flows through them 
Hypokinesia – Decreased heart wall motion during each heartbeat, associated with cardiomyopathy, heart failure, or heart attack  Hypokinesia can involve small areas of the heart (segmental) or entire sections of heart muscle (global)  Also called hypokinesis 
ICD – Implantable Cardioverter Defibrillator: A surgically implanted electronic device to treat life-threatening heartbeat irregularities 
IHD – Ischemic Heart Disease: heart problems caused by narrowing of the coronary arteries, causing a decreased blood supply to the heart muscle  Also called coronary artery disease and coronary heart disease 
INR – International Normalized Ratio: A laboratory test measure of blood coagulation, often used as a standard for monitoring the effects of the anti-coagulant drug, warfarin (coumadin) 
IST – Inappropriate sinus tachycardia: A heart condition seen most often in young women, in which a person’s resting heart rate is abnormally high (greater than 100 bpm), their heart rate increases rapidly with minimal exertion, and this rapid heart rate is accompanied by symptoms of palpitations, fatigue, and/or exercise intolerance 
Interventional cardiologist – A cardiologist who is trained to perform invasive heart procedures like angiography, angioplasty, percutaneous coronary intervention (PCI), implanting stents, etc 
IVS – Interventricular Septum: The stout wall that separates the lower chambers (the ventricles) of the heart from one another 
IVUS – Intravascular Ultrasound: A form of echocardiography performed during cardiac catheterization in which a transducer (a device that can act as a transmitter (sender) and receiver of ultrasound information) is threaded into the heart blood vessels via a catheter; it’s used to provide detailed information about the blockage inside the blood vessels 
LAD – Left Anterior Descending coronary artery: One of the heart’s coronary artery branches from the left main coronary artery which supplies blood to the left ventricle 
LAFB – Left Anterior Fascicular Block: A cardiac condition,distinguished from Left Bundle Branch Block because only the anterior half of the left bundle branch is defective and more common than left posterior fascicular block 
LAHB – Left Anterior Hemiblock: The Left Bundle Branch divides into two major branches – the anterior and the posterior fascicles  Occasionally, a block can occur in one of these fascicles 
Left Circumflex Artery – The artery carries oxygenated blood from the heart to the body; it’s a branch of the Left Main Coronary Artery after the latter runs its course in between the aorta and the Main Pulmonary Artery 
Left Main Coronary Artery – The artery that branches from the aorta to supply oxygenated blood to the heart via the Left Anterior Descending Artery (LAD) and the Left Circumflex Artery 
Lipids – fat-like substances found in your blood and body tissues; a lipid panel is a blood test that measures the level of specific lipids in blood to help assess your risk of cardiovascular disease, measuring four types of lipids: total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides 
Lipoprotein-a or Lp(a) – molecules made of proteins and fat, carrying cholesterol and similar substances through the blood  A high level of Lp(a) is considered a risk factor for heart disease; detectable via a blood test 
Long QT syndrome (LQTS): A heart rhythm disorder that can potentially cause fast, chaotic heartbeats that may trigger a sudden fainting spell or seizure  In some cases, the heart may beat erratically for so long that it can cause sudden death 
LV – Left Ventricle – One of four chambers (two atria and two ventricles) in the human heart, it receives oxygenated blood from the left atrium via the mitral valve, and pumps it into the aorta via the aortic valve 
LVAD – Left ventricular assist device: A mechanical device that can be placed outside the body or implanted inside the body  An LVAD does not replace the heart – it “assists” or “helps” it pump oxygen-rich blood from the left ventricle to the rest of the body, usually as a bridge to heart transplant 
LVH – Left Ventricular Hypertrophy: A thickening of the myocardium (muscle) of the Left Ventricle (LV) of the heart  
Lumen – The hollow area within a tube, such as a blood vessel 
Main Pulmonary Artery – Carries oxygen-depleted blood from the heart to the lungs 
MIBI – Nuclear Stress Test/Cardiac Perfusion Scan/Sestamibi: tests that are used to assess the blood flow to the heart muscle (myocardium) when it is stressed by exercise or medication, and to find out what areas of the myocardium have decreased blood flow due to coronary artery disease  This is done by injecting a tiny amount of radionuclide like thallium or technetium (chemicals which release a type of radioactivity called gamma rays) into a vein in the arm or hand 
Microvascular disease – a heart condition that causes impaired blood flow to the heart muscle through the small blood vessels of the heart  Symptoms mimic those of a heart attack  Also called Coronary Microvascular Disease or Small Vessel Disease  I live with this diagnosis and have written more about it here, here and here 
Mini-Maze – a surgical procedure to treat atrial fibrillation, less invasive than what’s called the Cox Maze III procedure (a “cut-and-sew” procedure), and performed on a beating heart without opening the chest 
Mitral Valve: One of four valves in the heart, the structure that controls blood flow between the heart’s left atrium (upper chamber) and left ventricle (lower chamber)  The mitral valve has two flaps (cusps)  See also MV and/or Valves 
Mitral valve prolapse: a condition in which the two valve flaps of the mitral valve don’t close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium; also known as click-murmur syndrome, Barlow’s syndrome or floppy valve syndrome 
MR – Mitral regurgitation: (also mitral insufficiency or mitral incompetence) a heart condition in which the mitral valve does not close properly when the heart pumps out blood  It’s the abnormal leaking of blood from the left ventricle, through the mitral valve and into the left atrium when the left ventricle contracts 
MRI – Magnetic Resonance Imaging: A technique that produces images of the heart and other body structures by measuring the response of certain elements (such as hydrogen) in the body to a magnetic field  An MRI can produce detailed pictures of the heart and its various structures without the need to inject a dye 
MS – Mitral Stenosis: A narrowing of the mitral valve, which controls blood flow from the heart’s upper left chamber (the left atrium) to its lower left chamber (the left ventricle)  May result from an inherited (congenital) problem or from rheumatic fever 
MUGA – Multiple-Gated Acquisition Scanning: A non-invasive nuclear test that uses a radioactive isotope called technetium to evaluate the functioning of the heart’s ventricles 
Murmur – Noises superimposed on normal heart sounds  They are caused by congenital defects or damaged heart valves that do not close properly and allow blood to leak back into the originating chamber 
MV – Mitral Valve: The structure that controls blood flow between the heart’s left atrium (upper chamber) and left ventricle (lower chamber) 
Myocardial Infarction (MI, heart attack) – The damage or death of an area of the heart muscle (myocardium) resulting from a blocked blood supply to the area  The affected tissue dies, injuring the heart



ground_truth: It becomes a bit less so that what's off to the left or right can be better noted.

prompt_front: Now, answer the following question based on the text below, only give me the answer and do not output any other words.

Question: What is the purpose of an ICD?

Read the following text and answer briefly.

Context 2: 
Myocardium – The muscular tissue of the heart 
New Wall-Motion Abnormalities – Results seen on an echocardiogram test report (see NWMA, below) 
Nitroglycerin – A medicine that helps relax and dilate arteries; often used to treat cardiac chest pain (angina)  Also called NTG or GTN 
NSR – Normal Sinus Rhythm: The characteristic rhythm of the healthy human heart  NSR is considered to be present if the heart rate is in the normal range, the P waves are normal on the EKG/ECG, and the rate does not vary significantly 
NSTEMI – Non-ST-segment-elevation myocardial infarction: The milder form of the two main types of heart attack  An NSTEMI heart attack does not produce an ST-segment elevation seen on an electrocardiogram test (EKG)  See also STEMI 
Nuclear Stress Test – A diagnostic test that usually involves two exercise stress tests, one while you’re exercising on a treadmill/stationary bike or with medication that stresses your heart, and another set while you’re at rest  A nuclear stress test is used to gather information about how well your heart works during physical activity and at rest  See also: Exercise stress test, Nuclear perfusion test, MIBI 
Open heart surgery – Any surgery in which the chest is opened and surgery is done on the heart muscle, valves, coronary arteries, or other parts of the heart (such as the aorta)  See also CABG 
Pacemaker – A surgically implanted electronic device that helps regulate the heartbeat 
PAD – Peripheral Artery Disease: A common circulatory problem in which narrowed arteries reduce blood flow to the limbs, usually to the legs  Symptoms include leg pain when walking (called intermittent claudication) 
PAF – Paroxysmal Atrial Fibrillation: Atrial fibrillation that lasts from a few seconds to days, then stops on its own  See also Atrial Fibrillation 
Palpitations – A noticeably rapid, strong, or irregular heartbeat due to agitation, exertion or illness 
Paroxysmal Atrial Fibrillation – An unusual heart arrhythmia of unknown origin, at one time believed to be associated with an unusual sensitivity to alcohol consumption 
PDA – patent ductus arteriosus: A persistent opening between two major blood vessels leading from the heart  The opening is called ductus arteriosus and is a normal part of a baby’s circulatory system before birth that usually closes shortly after birth  But when it remains open, it’s called a patent ductus arteriosus  If it’s small, it may never need treatment, but a large PDA left untreated can allow poorly oxygenated blood to flow in the wrong direction, weakening the heart muscle and causing heart failure or other complications 
Pericardium: two thin layers of a sac-like tissue that surround the heart, hold it in place and help it work 
PET – Positron Emission Tomography: A non-invasive scanning technique that uses small amounts of radioactive positrons (positively charged particles) to visualize body function and metabolism  In cardiology, PET scans are used to evaluate heart muscle function in patients with coronary artery disease or cardiomyopathy 
PFO – Patent Forman Ovale: An opening between the left and right atria (the upper chambers) of the heart  Everyone has a PFO before birth, but in 1 out of every 3 or 4 people, the opening does not close naturally as it should after birth 
Plaque – A deposit of fatty (and other) substances in the inner lining of the artery wall; it is characteristic of atherosclerosis 
POTS – Postural Orthostatic Tachycardia Syndrome: A disorder that causes an increased heart rate when a person stands upright 
PPCM – Post-partum cardiomyopathy: A form of cardiomyopathy that causes heart failure toward the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure 
Preeclampsia – a late-pregnancy complication identified by spikes in blood pressure, protein in the urine, possible vision problems  Women who experience pregnancy complications like preeclampsia are at significantly higher risk for heart disease 
Prinzmetal’s Variant Angina – Chest pain caused by a spasm in a coronary artery that supplies blood to the heart muscle 
PSVT – Paroxysmal Supraventricular Tachycardia: – An occasional rapid heart rate (150-250 beats per minute) that is caused by events triggered in areas above the heart’s lower chambers (the ventricles)  “Paroxysmal” means from time to time  See also supraventricular tachycardia (SVT) 
Pulmonary Valve: One of the four valves in the heart, located between the pulmonary artery and the right ventricle of the heart, moves blood toward the lungs and keeps it from sloshing back into the heart 
PV – Pulmonary Vein: A vein carrying oxygenated blood from the lungs to the left atrium of the heart 
PVC – Premature Ventricular Contraction: An early or extra heartbeat that happens when the heart’s lower chambers (the ventricles) contract too soon, out of sequence with the normal heartbeat  In the absence of any underlying heart disease, PVCs do not generally indicate a problem with electrical stability, and are usually benign 
RA – Right Atrium: The right upper chamber of the heart  The right atrium receives de-oxygenated blood from the body through the vena cava and pumps it into the right ventricle which then sends it to the lungs to be oxygenated 
Radial Artery: the artery in the wrist where a thin catheter is inserted through the body’s network of arteries in the arm and eventually into the heart during a procedure to implant a stent  Doctors may also call this transradial access, the transradial approach, or transradial angioplasty  Because it’s associated with fewer complications, this is increasingly considered the default access approach in most countries, except in the U S  where the traditional Femoral Artery (groin) approach is still the most popular access 
RBBB – Right Bundle Branch Block: A delay or obstruction along the pathway that electrical impulses travel to make your heart beat  The delay or blockage occurs on the pathway that sends electrical impulses to the right side of your heart  See also Left Bundle Branch Block 
RCA – Right Coronary Artery: An artery that supplies blood to the right side of the heart 
Restenosis – The re-closing or re-narrowing of an artery after an interventional procedure such as angioplasty or stent placement  Sometimes called “stent failure” 
RHD – Rheumatic Heart Disease: Permanent damage to the valves of the heart caused especially by repeated attacks of rheumatic fever 
RM – Right Main coronary artery: A blood vessel that supplies oxygenated blood to the walls of the heart’s ventricles and the right atrium 
RV – Right Ventricle: The lower right chamber of the heart that receives de-oxygenated blood from the right atrium and pumps it under low pressure into the lungs via the pulmonary artery 
SA – Sinus node: The “natural” pacemaker of the heart  The node is a group of specialized cells in the top of the right atrium which produces the electrical impulses that travel down to eventually reach the ventricular muscle, causing the heart to contract 
SB – Sinus Bradycardia: Abnormally slow heartbeat 
SBP – Systolic Blood Pressure: The highest blood pressure measured in the arteries  It occurs when the heart contracts with each heartbeat  Example: the first number in 120/80 
SCAD – Spontaneous Coronary Artery Dissection: A rare emergency condition that occurs when a tear forms in one of the blood vessels in the heart, causing a heart attack, abnormalities in heart rhythm and/or sudden death  SCAD tends to strike young healthy women with few if any cardiac risk factors 
SD – Septal defect: A hole in the wall of the heart separating the atria (two upper chambers of the heart) or in the wall of the heart separating the ventricles (two lower chambers) 
Sestamibi stress test – See MIBI 
Short QT intervals (SQT): An abnormal heart rhythm where the heart muscle takes a shorter time to recharge between beats  It can cause a variety of complications from fainting and dizziness to sudden cardiac arrest 
Sick Sinus Syndrome (also known as sinus node dysfunction) is caused by an electrical problem in the heart; a group of related heart conditions that can affect how the heart beats, most commonly in older adults, although it can be diagnosed in people of any age  “Sick sinus” refers to the sinoatrial node (see below)  In people with sick sinus syndrome, the SA node does not function normally 
Sinoatrial node (SA): also commonly called the sinus node; it’s a small bundle of neurons situated in the upper part of the wall of the right atrium (the right upper chamber of the heart)  The heart’s electrical impulses are generated there  It’s the normal natural pacemaker of the heart and is responsible for the initiation of each heartbeat 
Spontaneous Coronary Artery Dissection (SCAD) – A rare emergency condition that occurs when a tear forms in one of the blood vessels in the heart, causing a heart attack, abnormalities in heart rhythm and/or sudden death  SCAD tends to strike young healthy women with few if any cardiac risk factors 
SSS – Sick Sinus Syndrome: The failure of the sinus node to regulate the heart’s rhythm 
ST – Sinus Tachycardia: A heart rhythm with elevated rate of impulses originating from the sinoatrial node, defined as greater than 100 beats per minute (bpm) in an average adult  The normal heart rate in the average adult ranges from 60–100 bpm  Also called sinus tach or sinus tachy 
Statins – Any of a class of drugs that lower the levels of low-density lipoproteins (LDL) – the ‘bad’ cholesterol in the blood – by inhibiting the activity of an enzyme involved in the production of cholesterol in the liver  Examples of brand name statins: Lipitor, Crestor, Zocor, Mevacor, Levachol, Lescol, etc  Also available as a cheaper generic form of the drug 
STEMI – ST-elevation heart attack (myocardial infarction)  The more severe form of the two main types of heart attack  A STEMI produces a characteristic elevation in the ST segment on an electrocardiogram (EKG)  The elevated ST segment is how this type of heart attack got its name  See also NSTEMI 
Stent – An implantable device made of expandable, metal mesh (looks a bit like a tiny chicken wire tube) that is placed (by using a balloon catheter) at the site of a narrowing coronary artery during an angioplasty procedure  The stent is then expanded when the balloon fills, the balloon is removed, and the stent is left in place to help keep the artery open  TRIVIA ALERT: the coronary stent was named after Charles Stent (1807-1885), an English dentist who invented a compound to produce dentures and other things like skin grafts and hollow tubes (essentially what a metal coronary stent is)  His real claim to fame occurred when he suggested using his material to coat underwater trans-Atlantic cable, which had broken several times as a result of corrosion by seawater  You’re welcome 
Stint – a common spelling mistake when what you really mean is the word “stent” (see above) 
Stress Echocardiography – A standard echocardiogram test that’s performed while the person exercises on a treadmill or stationary bicycle  This test can be used to visualize the motion of the heart’s walls and pumping action when the heart is stressed, possibly revealing a lack of blood flow that isn’t always apparent on other heart tests  The echocardiogram is performed just before and just after the exercise part of the procedure  See also TTE 
Sudden Cardiac Arrest – The stopping of the heartbeat, usually because of interference with the electrical signal (often associated with coronary heart disease)  Can lead to Sudden Cardiac Death 
Takotsubo Cardiomyopathy – A heart condition that can mimic a heart attack  Sometimes called Broken Heart Syndrome, it is not a heart attack, but it feels just like one, with common symptoms like severe chest pain and shortness of breath  It sometimes follows a severe emotional stress  Over 90% of reported cases are in women ages 58 to 75  Also referred to as Broken Heart Syndrome, stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome 
TAVR – Transcatheter aortic valve replacement: A minimally invasive procedure to repair a damaged or diseased aortic valve  A catheter is inserted into an artery in the groin and threaded to the heart  A balloon at the end of the catheter, with a replacement valve folded around it, delivers the new valve to take the place of the old  Also called TAVI (Transcatheter aortic valve implantation) 
Tetralogy of Fallot – A rare condition caused by a combination of four heart defects that are present at birth, affecting the structure of the heart and causing oxygen-poor blood to flow out of the heart and into the rest of the body  Infants and children with Tetralogy of Fallot usually have blue-tinged skin because their blood doesn’t carry enough oxygen  Often diagnosed in infancy, but sometimes not until later in life depending on severity 
Tg – Triglycerides: The most common fatty substance found in the blood; normally stored as an energy source in fat tissue  High triglyceride levels may thicken the blood and make a person more susceptible to clot formation  High triglyceride levels tend to accompany high cholesterol levels and other risk factors for heart disease, such as obesity 
TIA – Transient Ischemic Attack: A stroke-like event that lasts only for a short time and is caused by a temporarily blocked blood vessel 
TEE – Transesophageal echocardiogram: This test involves an ultrasound transducer inserted down the throat into the esophagus in order to take clear images of the heart structures without the interference of the lungs and chest 
Treadmill Stress Test – See Exercise Stress Test 
troponin – a type of cardiac enzyme found in heart muscle, and released into the blood when there is damage to the heart (for example, during a heart attack)  A positive blood test that shows elevated troponin is the preferred test for a suspected heart attack because it is more specific for heart injury than other blood tests, especially the newer high sensitivity troponin tests (hs-cTnT) 
TTE – Transthoracic Echocardiogram: This is the standard echocardiogram, a painless test similar to X-ray, but without the radiation, using a hand-held device called a transducer placed on the chest to transmit high frequency sound waves (ultrasound)  These sound waves bounce off the heart structures, producing images and sounds that can be used by the doctor to detect heart damage and disease 
TV – Tricuspid Valve: One of four one-way valves in the heart, a structure that controls blood flow from the heart’s upper right chamber (the right atrium) into the lower right chamber (the right ventricle) 
UA or USA – Unstable Angina: Chest pain that occurs when diseased blood vessels restrict blood flow to the heart; symptoms are not relieved by rest; considered a dangerous and emergency crisis requiring immediate medical help 
Valves: Your heart has four one-way valves that keep blood flowing in the right direction  Blood enters the heart first through the tricuspid valve, and next goes through the pulmonary valve (sometimes called the pulmonic valve) on its way to the lungs  Then the blood returning from the lungs passes through the mitral (bicuspid) valve and leaves the heart through the aortic valve 
Vasodilator: A drug that causes dilation (widening) of blood vessels 
Vasospasm: A blood vessel spasm that causes sudden constriction, reducing its diameter and blood flow to the heart muscle  See also Prinzmetal’s Variant Angina 
VB – Ventricular Bigeminy: A heart rhythm condition in which the heart experiences two beats of the pulse in rapid succession 
Vena Cava – a large vein that carryies de-oxygenated blood into the heart  There are two in humans, the inferior vena cava (carrying blood from the lower body) and the superior vena cava (carrying blood from the head, arms, and upper body) 
Ventricle – each of the two main chambers of the heart, left and right 
VF – Ventricular Fibrillation: A condition in which the ventricles (two lower chambers of the heart) contract in a rapid, unsynchronized fashion  When fibrillation occurs, the ventricles cannot pump blood throughout the body  Most sudden cardiac deaths are caused by VF or ventricular tachycardia (VT) 
VLDL – Very Low Density Lipoprotein: Molecules made up of mostly triglycerides, cholesterol and proteins  VLDL, also known as the “very bad” cholesterol, carries cholesterol from the liver to organs and tissues in the body  It may lead to low density lipoproteins (LDL), associated with higher heart disease risks  VLDL levels are tricky to measure routinely, and are usually estimated as a percentage of your triglyceride levels  By reducing triglycerides, you are usually also reducing your VLDL levels 
Warfarin – A drug taken to prevent the blood from clotting and to treat blood clots  Warfarin is believed to reduce the risk of blood clots causing strokes or heart attacks  Also known as Coumadin 
Widowmaker heart attack – The type of heart attack I survived, since you asked  A nickname doctors use to describe a severely blocked left main coronary artery or proximal left anterior descending coronary artery of the heart  This term is used because if the artery gets abruptly and completely blocked, it can cause a massive heart attack that will likely lead to sudden cardiac death  Please note the gender imbalance here: despite the number of women like me who do experience this type of cardiac event, doctors are not calling this the widowermaker, after all 
WPW – Wolff-Parkinson-White Syndrome: A condition in which an extra electrical pathway connects the atria (two upper chambers) and the ventricles (two lower chambers)  It may cause a rapid heartbeat 
NOTE FROM CAROLYN: I was very happy when we were able to include this entire glossary in my book, “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, 2017) 
Are we missing any important heart acronyms/terms from this list? Let me know!
Please can someone explain something for me  I am a 53 yr old woman and generally fit and healthy  Had 2 ECG’s due to a one off dizzy spell during a stressful time dealing with my fathers terminal diagnosis  The 2nd ECG request did give me concern as i did not know why i had to have one  On 24/01/19 at my doctors appointment she explained that on 3 the leads it showed inverted T waves  And she explained that it may suggest angina  I was so shocked  Wasn’t expecting that  She gave me a GNT (nitroglycerin) spray in case I do get pain and take 75Mg of aspirin  I’m now waiting for a Cardiology referral 
I am so stressed and consumed by what might be wrong  My maternal grandmother had angina and valve issues  Her 3 brothers all had double bypasses  Could I have inherited this? I am not overweight at 63kg and 5 ft 9  I walk 20-25 miles a week at work and general walking here and there  I started HRT (patches evorol 25 -50) in July as menopause pain was making me feel like I was 90 and was getting me down 
I am worried so much now and analysing every ache/ twinge I get  I feel like a hypochondriac at the moment  I’m worried what will happen at the cardiologist and what the test will entail and tell me  I am waiting on cholesterol test which I had on 25/01/19  Can I have inverted T waves and be fine  Please help I am so scared and crying far too much 
Hello Colleen – the first thing is: please take a big deep breath before you read another word here! I’m not a physician so of course cannot comment on your specific case, but I can tell you generally that the definition of “angina” (as this glossary lists above) is “distressing symptoms”, typically chest pain that gets worse with exertion, and goes away with rest  That’s classic stable angina… typically caused by something that’s reducing blood flow to the heart muscle (causing the chest pain of angina) 
A family history that might make a difference for you personally is only in what’s called your ‘first degree’ relatives: for example, if your mother or sister were diagnosed with heart disease before age 65, or if your Dad or brother were diagnosed before age 55, then doctors would consider that you have a family history as a risk factor for heart disease  There’s little if any scientific evidence that a grandparent or uncle’s heart disease history has any effect on your own risk 
It is a very good thing that you’re having further tests and a referral to a cardiologist, if only to ease your mind  There are many reasons for inverted T-waves, ranging from cardiac issues to completely benign conditions  One way of looking at this is choosing to believe that seeing a cardiologist will ease your mind one way or the other – so this is something to look forward to, not dread  If the cardiologist spots something suspicious, a treatment plan will be created  If not, you can wave goodbye and go back to happily living your life 
Try thinking of this cardiology appointment just as you would if your car were making some frightening noises and you were bringing it to your mechanic for a check up  You could work yourself into a complete state worrying ahead of time if the car trouble is going to be serious, or you could look at this appointment as the solution – at last! – to figuring out what’s wrong so the mechanic can recommend the next step 
Thank you for this list of so many definitions provided in plain English  what a valuable resource this is  THANK YOU, I have been looking for translations FOR PATIENTS not med school graduates– like this for three years 
My family doctor had me wear a 24 hr EKG  After reading the results, she has scheduled a scope to look inside my heart by a specialist  Completely forgoing a stress test  Said I have major changes in the EKG, what type of changes could they be looking at? Had LAD STENT INSERTED 7 YRS AGO – WHAT COULD THEY BE LOOKING FOR?
This is a great wealth of information, Carolyn! I looked and did not see my diagnosis, which is aortic stenosis  I looked under aortic as well as stenosis  Did I just miss it somehow?
I learned some new information, I am a bit familiar now, but not when I had my MI, it was like learning a new language  But, my favorite part was seeing SCAD on this list! Thank you 
Thanks and welcome! I was thinking of editing that SCAD definition actually: I suspect that that it isn’t so much that SCAD is “rare”, but it’s more that it’s “rarely correctly diagnosed” 
I totally agree that SCAD is not as rare as I believed for many years  Once awareness is spread to all medical staff, I believe many lives will be saved  Hoping for a brighter future for all SCAD patients 
I hope so too, Cathy  Perhaps when more SCAD studies (like Mayo Clinic’s) are published and read by more and more MDs, it will no longer be “rarely correctly diagnosed” 
It’s great to see IST on here  I was diagnosed with it 9 years ago and the lack of awareness is frustrating 
What a great resource for heart patients and their families!
Thanks so much, Ashley  I recently updated my original 2011 list after the world-famous Cleveland Clinic tweeted their glossary recently and I noticed that their list had a few glaring omissions (like SCAD and Brugada Syndrome) so this made me wonder what my list might be missing, too  Let me know if there’s anything else you think should be included, okay?
How is your health these days? How are you feeling?
New for me too  I have just been diagnosed with A-HCM: Apical Hypertrophic Cardiomyopathy 
I’ll add that one to my list, Kathleen – thanks!
Just saw this, Carolyn, and you’ve compiled a great resource  One note on A-HCM: Present thinking is that it’s due to a genetic modification  Runs in families though sometimes occurs spontaneously  I have not as yet done genetic testing, though it’s been offered 
Thanks Kathleen – like many cardiac diagnoses, it sounds like a moving target… Good luck to you!
This list is great  I’ve just been diagnosed and am utterly overwhelmed  Even in the WomenHeart online support community, I often have no clue most days what others are talking about with all these initials about their heart tests and specific disease  This is VERY helpful, thank you SO MUCH  Love your website which has been a godsend since my diagnosis 
Context 3: \section{Model equations} \label{sec:equations}

In drift-fluid models the continuity equation
\begin{align}
 \frac{\partial n}{\partial t} + \nabla\cdot\left( n \vec u_E  \right) &= 0 \label{eq:generala} 
\end{align}
describes the dynamics of the electron density $n$  Here
$\vec u_E := (\hat{\vec b} \times \nabla \phi)/B$ gives the electric drift
velocity in a magnetic field $\vec B := B \hat{\vec b}$ and an electric
potential $\phi$  We neglect contributions of the diamagnetic drift~\cite{Kube2016} 




Equation~\eqref{eq:generala} is closed by invoking quasineutrality, i e  the divergence of the ion polarization, 
the electron diamagnetic and the gravitational drift currents must vanish
\begin{align}
  \nabla\cdot\left( \frac{n}{\Omega} \left( \frac{\partial}{\partial t} 
  + \vec u_E \cdot\nabla  \right)\frac{\nabla_\perp \phi}{B}  + n\vec u_d - n\vec u_g\right) &=0
    
 
 
  \label{eq:generalb}
\end{align}
Here we denote 
$\nabla_\perp\phi/B := - \hat{\vec b} \times \vec u_E$, 
the electron diamagnetic drift
$\vec u_d := - T_e(\hat{\vec b} \times\nabla n ) /enB$
with the electron temperature $T_e$,
the ion gravitational drift velocity  
$\vec u_g := m_i \hat{\vec b} \times \vec g /B$
with ion mass $m_i$, and the ion gyro-frequency
$\Omega := eB/m_i$ 

Combining Eq ~\eqref{eq:generalb} with Eq ~\eqref{eq:generala} yields
\begin{align}
 \frac{\partial \rho}{\partial t} + \nabla\cdot\left( \rho\vec u_E \right) + \nabla \cdot\left( n(\vec u_\psi + \vec u_d + \vec u_g) \right) &= 0\label{eq:vorticity}
\end{align}
with the polarization charge density 
$\rho = \nabla\cdot( n\nabla_\perp \phi / \Omega B)$ 
and
$\vec u_\psi := \hat{\vec b}\times \nabla\psi /B$ 
with 
$\psi:= m_i\vec u_E^2 /2e$ 
We exploit this form of Eq ~\eqref{eq:generalb} in our numerical simulations 

Equations~\eqref{eq:generala} and \eqref{eq:generalb} respectively \eqref{eq:vorticity} have several invariants 
First, in Eq ~\eqref{eq:generala} the relative particle number 
$M(t) := \int \mathrm{dA}\, (n-n_0)$ is conserved over time
$\d M(t)/\d t = 0$  
Furthermore, we integrate 
$( T_e(1+\ln n) -T_e \ln B)\partial_t n$
as well as
$-e\phi \partial_t\rho - (m_i\vec u_E^2/2+gm_ix - T_e\ln B)\partial_t n$ 
over the domain to get, disregarding boundary contributions,
\begin{align}
  \frac{\d}{\d t}\left[T_eS(t) + H(t) \right] = 0, \label{eq:energya}\\ 
    \frac{\d}{\d t} \left[ E(t) - G(t) - H(t)\right] =  0,
    \label{eq:energyb}
\end{align}
where we define 
the entropy
$S(t):=\int \mathrm{dA}\, [n\ln(n/n_0) - (n-n_0)]$,  
the kinetic energy 
$E(t):=m_i \int \mathrm{dA}\, n\vec u_E^2/2$ 
and the potential energies
$G(t) := m_i g\int \mathrm{dA}\, x(n-n_0)$
and
$H(t) := T_e\int \mathrm{dA}\, (n-n_0) \ln (B^{-1})$ 
Note that $n\ln( n/n_0) - n + n_0 \approx (n-n_0)^2/2$ for $|(n-n_0)/n_0| \ll 1$ and $S(t)$ thus reduces to the 
local entropy form in Reference~\cite{Kube2016}  

We now set up a gravitational field $\vec g = g\hat x$ and a constant homogeneous background
magnetic field $\vec B = B_0 \hat z$ in a Cartesian coordinate system 
Then the divergences of the electric and gravitational drift velocities $\nabla\cdot\vec u_E$ and $\nabla\cdot\vec u_g$
and the diamagnetic current $\nabla\cdot(n\vec u_d)$ vanish, which makes the 
flow incompressible  Furthermore, the magnetic potential energy vanishes $H(t) = 0$ 

In a second system we model the inhomogeneous magnetic field present in tokamaks as
$\vec B := B_0 (1+ x/R_0)^{-1}\hat z$ and neglect the gravitational drift $\vec u_g = 0$ 
Then, the potential energy $G(t) = 0$  
Note that 
$H(t) = m_i \ensuremath{C_\mathrm{s}}^2/R_0\int\mathrm{dA}\, x(n-n_0) +\mathcal O(R_0^{-2}) $
reduces to $G(t)$ with the effective gravity $g_\text{eff}:= \ensuremath{C_\mathrm{s}}^2/R_0$ with $\ensuremath{C_\mathrm{s}}^2 := T_e/m_i$  
For the rest of this letter we treat $g$ and $g_\text{eff}$ as well as $G(t)$ and $H(t)$ on the same footing 
The magnetic field inhomogeneity thus entails compressible flows, which is 
the only difference to the model describing dynamics in a homogeneous magnetic field introduced above  
Since both $S(t)\geq 0$ and $E(t)\geq 0$ we further derive from Eq ~\eqref{eq:energya} and Eq ~\eqref{eq:energyb} that the kinetic energy
is bounded by $E(t) \leq T_eS(t) + E(t) = T_e S(0)$; a feature absent from the gravitational system with 
incompressible flows, where $S(t) = S(0)$  

We now show that the invariants Eqs ~\eqref{eq:energya} and \eqref{eq:energyb} present restrictions on the velocity and
acceleration of plasma blobs  
First, we define the blobs' center of mass (COM) via $X(t):= \int\mathrm{dA}\, x(n-n_0)/M$ and 
its COM velocity as $V(t):=\d X(t)/\d t$  
The latter is proportional to the total radial particle flux~\cite{Garcia_Bian_Fundamensky_POP_2006, Held2016a} 
We assume
that $n>n_0$ and $(n-n_0)^2/2 \leq [ n\ln (n/n_0) - (n-n_0)]n $ to show for both systems 
\begin{align}
  (MV)^2 &= \left( \int \mathrm{dA}\, n{\phi_y}/{B} \right)^2
  = \left( \int \mathrm{dA}\, (n-n_0){\phi_y}/{B} \right)^2\nonumber\\
 
&\leq 2 \left( \int \mathrm{dA}\, \left[n\ln (n/n_0) -(n-n_0)\right]^{1/2}\sqrt{n}{\phi_y}/{B}\right)^2\nonumber\\
 
  &\leq 4 S(0) E(t)/m_i 
 
  \label{eq:inequality}
\end{align}
Here we use the Cauchy-Schwartz inequality and 
$\phi_y:=\partial\phi/\partial y$  
Note that although we derive the inequality Eq ~\eqref{eq:inequality} only for amplitudes $\triangle n >0$  we assume that the results also hold for depletions  This is justified by our numerical results later in this letter  
If we initialize our density field with a seeded blob of radius $\ell$ and amplitude $\triangle n$ as 
\begin{align}
  n(\vec x, 0) &= n_0 + \triangle n \exp\left( -\frac{\vec x^2}{2\ell^2} \right), \label{eq:inita}
 
 
\end{align}
and  
$\phi(\vec x, 0 ) = 0$,
we immediately have $M := M(0) = 2\pi \ell^2 \triangle n$, $E(0) = G(0) = 0$ and 
$S(0) = 2\pi \ell^2 f(\triangle n)$, where $f(\triangle n)$ captures the amplitude dependence of 
the integral for $S(0)$  

The acceleration for both incompressible and compressible flows can be estimated
by assuming a linear acceleration $V=A_0t$ and $X=A_0t^2/2$~\cite{Held2016a} and using 
$E(t) = G(t) = m_igMX(t)$ in Eq ~\eqref{eq:inequality}
\begin{align}
  \frac{A_0}{g} =  \mathcal Q\frac{2S(0)}{M} \approx \frac{\mathcal Q}{2} \frac{\triangle n }{n_0+2\triangle n/9} 
  \label{eq:acceleration}
\end{align}
Here, we use the Pad\'e approximation of order $(1/1)$ of $2S(0)/M $
and define a model parameter $\mathcal Q$ with $0<\mathcal Q\leq1$ to be determined by numerical simulations 
Note that the Pad\'e approximation is a better approximation than a simple 
truncated Taylor expansion especially for large relative amplitudes of order unity 
Eq ~\eqref{eq:acceleration} predicts that $A_0/g\sim \triangle n/n_0$ for small 
amplitudes $|\triangle n/n_0| < 1$ and $A_0 \sim g $ for very large amplitudes $\triangle n /n_0 \gg 1$, 
which confirms the predictions in~\cite{Pecseli2016} and reproduces the limits discussed in~\cite{Angus2014} 

As pointed out earlier for compressible flows Eq ~\eqref{eq:inequality} can be further estimated
\begin{align}
  (MV)^2  \leq 4 T_eS(0)^2/m_i  
  \label{}
\end{align}
We therefore have a restriction on the maximum COM velocity for compressible flows, which is absent for incompressible flows
\begin{align}
  \frac{\max |V|}{\ensuremath{C_\mathrm{s}}} = {\mathcal Q}\frac{2S(0)}{M} \approx \frac{\mathcal Q}{2} \frac{|\triangle n| }{n_0+2/9 \triangle n } \approx \frac{\mathcal Q}{2} \frac{|\triangle n|}{n_0} 
  \label{eq:linear}
\end{align}
For $|\triangle n /n_0|< 1$ Eq ~\eqref{eq:linear} reduces to the linear scaling derived in~\cite{Kube2016}  
Finally, a scale analysis of Eq ~\eqref{eq:vorticity} shows that~\cite{Ott1978, Garcia2005, Held2016a}
\begin{align}
  \frac{\max |V|}{\ensuremath{C_\mathrm{s}}} = \mathcal R \left( \frac{\ell}{R_0}\frac{|\triangle n|}{n_0} \right)^{1/2} 
  \label{eq:sqrt}
\end{align}
This equation predicts a square root dependence of the center of mass velocity 
on amplitude and size  





We now propose a simple phenomenological model that captures the essential dynamics
of blobs and depletions in the previously stated systems  More specifically 
the model reproduces the acceleration Eq ~\eqref{eq:acceleration} with and without
Boussinesq approximation, the square root scaling for the COM velocity 
Eq ~\eqref{eq:sqrt} for incompressible flows as well as the relation between the 
square root scaling Eq ~\eqref{eq:sqrt} and the linear scaling 
Eq ~\eqref{eq:linear} for compressible flows  
The basic idea is that the COM of blobs behaves like 
the one of an infinitely long plasma column immersed in an ambient plasma  
The dynamics of this column reduces to the one of a two-dimensional ball 
This idea is similar to the analytical ``top hat'' density solution for
blob dynamics recently studied in~\cite{Pecseli2016} 
The ball is subject to buoyancy as well as linear and nonlinear friction
\begin{align}
  M_{\text{i}} \frac{d V}{d t} = (M_{\text{g}} - M_\text{p}) g - c_1 V  - \mathrm{sgn}(V ) \frac{1}{2}c_2 V^2 
  \label{eq:ball}
\end{align}
The gravity $g$ has a positive sign in the coordinate system; sgn$(f)$ is the sign function  
The first term on the right hand side is the buoyancy, where 
$M_{\text{g}} := \pi \ell^2 (n_0 + \mathcal Q \triangle n/2)$ 
is the gravitational mass of the ball with radius $\ell$ and 
$M_\mathrm{p} := n_0 \pi \ell^2 $ 
is the mass of the displaced ambient plasma 
Note that if $\triangle n<0$ the ball represents a depletion and the buoyancy term has a negative sign, i e  the depletion will rise  
We introduce an inertial mass 
$M_{\text{i}} := \pi\ell^2 (n_0 +2\triangle n/9)$ 
different from the gravitational mass $M_{\text{g}}$ in order to 
recover the initial acceleration in Eq ~\eqref{eq:acceleration}  
We interpret the parameters $\mathcal Q$ and $2/9$ as geometrical factors 
that capture the difference of the actual blob form from the idealized
``top hat'' solution  
Also note that the Boussinesq approximation appears in the model as a neglect of inertia, $M_{\text{i}} = \pi\ell^2n_0$ 

The second term is the linear friction term with coefficient $c_1(\ell)$, which
depends on the size of the ball 
If we disregard the nonlinear friction, $c_2=0$, Eq ~\eqref{eq:ball} directly yields a 
maximum velocity $c_1V^*=\pi \ell^2 n g \mathcal Q\triangle n/2$ 
From our previous considerations $\max V/\ensuremath{C_\mathrm{s}}=\mathcal Q \triangle n /2n_0$, we thus identify 
\begin{align}
  c_1 = \pi\ell^2 n_0 g/\ensuremath{C_\mathrm{s}}  
  \label{}
\end{align}
The linear friction coefficient thus depends on the gravity and the size of the
ball  

The last term in \eqref{eq:ball} is the nonlinear friction  The sign of the force depends on whether
the ball rises or falls in the ambient plasma  
If we disregard linear friction $c_1=0$, we have the maximum velocity 
$V^*= \sigma(\triangle n)\sqrt{\pi \ell^2|\triangle n| g\mathcal Q/c_2}$, 
which must equal 
$\max V= \sigma(\triangle n) \mathcal R \sqrt{g \ell |\triangle n/n_0|}$ 
and thus
\begin{align}
  c_2 = {\mathcal Q\pi n_0\ell }/{\mathcal R^2} 
  \label{}
\end{align}
Inserting $c_1$ and $c_2$ into Eq ~\eqref{eq:ball}
we can derive the maximum absolute velocity in the form 
\begin{align}
  \frac{\max |V|}{\ensuremath{C_\mathrm{s}}} = 
        \left(\frac{\mathcal R^2}{\mathcal Q}\right) \frac{\ell}{R_0} \left( 
        \left({1+\left( \frac{\mathcal Q}{\mathcal R} \right)^{2} \frac{|\triangle n|/n_0 }{\ell/R_0}}\right)^{1/2}-1 \right)
  \label{eq:vmax_theo}
\end{align}
and thus have a concise expression for $\max |V|$ that captures both the linear
scaling \eqref{eq:linear} as well as the square root scaling \eqref{eq:sqrt} 
With Eq ~\eqref{eq:acceleration} and Eq ~\eqref{eq:sqrt} respectively Eq ~\eqref{eq:vmax_theo} we 
finally arrive at an analytical expression for the time at which the maximum velocity is reached via 
$t_{\max V} \sim \max V/A_0$  Its inverse $\gamma:=t_{\max V}^{-1}$ gives the
global interchange growth rate, for which an empirical expression was
presented in Reference~\cite{Held2016a} 


We use the open source library FELTOR 
to simulate 
Eqs ~\eqref{eq:generala} and \eqref{eq:vorticity} with and without 
drift compression 
For numerical stabilty we added small diffusive terms on the right hand 
sides of the equations 
The discontinuous Galerkin methods employ three polynomial coefficients and a minimum of $N_x=N_y=768$ grid cells  The box size is $50\ell$ in order to mitigate 
influences of the finite box size on the blob dynamics  
Moreover, we used the invariants in Eqs  \eqref{eq:energya} and \eqref{eq:energyb} as consistency tests to verify the code and repeated simulations 
also in a gyrofluid model  
No differences to the results presented here were found  
Initial perturbations on the particle density field are given by Eq ~\eqref{eq:inita},
where the perturbation amplitude $\triangle n/n_0$ was chosen between $10^{-3}$ and $20$ for blobs and $-10^0$ and $ -10^{-3}$ for depletions  
Due to computational reasons we show results only for $\triangle n/n_0\leq 20$  


For compressible flows we consider two different cases $\ell/R_0 = 10^{-2}$ and
$\ell /R_0 = 10^{-3}$  
 For incompressible flows Eq ~\eqref{eq:generala} and \eqref{eq:vorticity}
 can be normalized such that the blob radius is absent from the equations~\cite{Ott1978, Kube2012}  
 The simulations of incompressible flows can thus be used for both sizes  
The numerical code as well as input parameters and output data can be found 
in the supplemental dataset to this contribution~\cite{Data2017} 

\begin{figure}[htb]
    \includegraphics[width=\columnwidth]{com_blobs}
    \caption{
      The maximum radial COM velocities of blobs for compressible and incompressible flows are shown  
      The continuous lines show Eq ~\eqref{eq:vmax_theo} while the 
      dashed line shows the square root scaling Eq ~\eqref{eq:sqrt} with 
      $\mathcal Q = 0 32$ and $\mathcal R=0 85$ 
    }
    \label{fig:com_blobs}
\end{figure}
In Fig ~\ref{fig:com_blobs} we plot the maximum COM velocity for blobs 
with and without drift compression 
For incompressible flows blobs follow the square root scaling almost 
perfectly  Only at very large amplitudes velocities are slightly below
the predicted values  
For small amplitudes we observe that the compressible blobs follow
a linear scaling  When the amplitudes increase there is a transition to the
square root scaling at around $\triangle n/n_0 \simeq 0 5$ for 
$\ell/R_0=10^{-2}$ and $\triangle n/n_0 \simeq 0 05$ for $\ell/R_0=10^{-3}$, which is consistent with Eq ~\eqref{eq:vmax_theo} and Reference~\cite{Kube2016}  
In the transition regions the simulated velocities are slightly larger than the predicted ones from Eq ~\eqref{eq:vmax_theo} 
Beyond these amplitudes
the velocities of compressible and incompressible blobs align  

\begin{figure}[htb]
    \includegraphics[width=\columnwidth]{com_holes}
    \caption{
      The maximum radial COM velocities of depletions for compressible and incompressible flows are shown  
      The continuous lines show Eq ~\eqref{eq:vmax_theo} while the 
      dashed line shows the square root scaling Eq ~\eqref{eq:sqrt} with 
      $\mathcal Q = 0 32$ and $\mathcal R=0 85$ 
      Note that small amplitudes are on the right and amplitudes close to unity are on the left side 
  }
    \label{fig:com_depletions}
\end{figure}
In Fig ~\ref{fig:com_depletions} we show the maximum radial COM velocity 
for depletions instead of blobs 
For relative amplitudes below $|\triangle n|/n_0 \simeq 0 5$ (right of unity in the plot) the velocities
coincide with the corresponding blob velocities in Fig ~\ref{fig:com_blobs}  
 For amplitudes larger than $|\triangle n|/n_0\simeq 0 5$ the 
velocities follow the square root scaling 
We observe that for plasma depletions beyond $90$ percent the velocities 
in both systems reach a constant value that is very well predicted by the
square root scaling  

\begin{figure}[htb]
    \includegraphics[width=\columnwidth]{acc_blobs}
    \caption{
      Average acceleration of blobs for compressible and incompressible flows are shown 
      The continuous line shows the acceleration in Eq ~\eqref{eq:acceleration} 
      with $\mathcal Q=0 32$
      while the dashed line is a linear reference line, which corresponds to the Boussinesq approximation  
  }
    \label{fig:acc_blobs}
\end{figure}
In Fig ~\ref{fig:acc_blobs} we show the average acceleration of blobs 
for compressible and incompressible flows computed
by dividing the maximum velocity $\max V$ by the time  
to reach this velocity $t_{\max V}$  
We compare the simulation results
to the theoretical predictions Eq ~\eqref{eq:acceleration} of our model with and without inertia  
The results of the compressible and incompressible systems coincide and fit very
well to our theoretical values  
For amplitudes larger than unity the acceleration deviates significantly from the prediction with Boussinesq approximation 

\begin{figure}[htb]
    \includegraphics[width=\columnwidth]{acc_holes}
    \caption{
      Average acceleration of depletions for compressible and incompressible flows are shown 
      The continuous line shows the acceleration in Eq ~\eqref{eq:acceleration} 
      with $\mathcal Q=0 32$
      while the dashed line is a linear reference line, which corresponds to the Boussinesq approximation  
    }
    \label{fig:acc_depletions}
\end{figure}
In Fig ~\ref{fig:acc_depletions} we show the simulated acceleration of depletions in the
compressible and the incompressible systems  We compare the simulation results
to the theoretical predictions Eq ~\eqref{eq:acceleration} of our model with and without inertia 
Deviations from our theoretical prediction Eq ~\eqref{eq:acceleration} are visible for amplitudes smaller than $\triangle n/n_0 \simeq -0 5$ (left of unity in the plot)  The relative deviations are small at around $20$ percent  
As in Fig ~\ref{fig:com_depletions} the acceleration reaches a constant values
for plasma depletions of more than $90$ percent 
Comparing Fig ~\ref{fig:acc_depletions} to Fig ~\ref{fig:acc_blobs} the asymmetry between blobs and depletions becomes 
apparent  While the acceleration of blobs is reduced for large 
amplitudes compared to a linear dependence the acceleration 
of depletions is increased  In the language of our simple buoyancy 
model the inertia of depletions is reduced but increased for blobs  



In conclusion  
  we discuss the dynamics of seeded blobs and depletions in a 
  compressible and an incompressible system 
  With only two fit parameters our theoretical results reproduce the 
  numerical COM velocities and accelerations over five orders of magnitude 
  We derive the amplitude dependence of the acceleration of blobs and depletions from 
  the conservation laws of our systems in Eq ~\eqref{eq:acceleration}  
  From the same inequality a linear regime is derived in the compressible system for 
  ratios of amplitudes to sizes smaller than a critical value 
   In this regime 
  the blob and depletion velocity depends linearly on the initial amplitude and 
  is independent of size  The regime is absent from the system with incompressible flows 
  Our theoretical results are verified by numerical simulations for all 
  amplitudes that are relevant in magnetic fusion devices 
  Finally, we suggest a new empirical blob model that captures the detailed dynamics of more complicated models  
  The Boussinesq approximation is clarified as the absence of inertia and a thus altered acceleration of blobs and depletions 
  The maximum blob velocity is not altered by the Boussinesq approximation 

The authors were supported with financial subvention from the Research Council of Norway under grant
240510/F20  M W  and M H  were supported by the Austrian Science Fund (FWF) Y398   The computational
results presented have been achieved in part using the Vienna Scientific Cluster (VSC)  Part of this work was performed on the Abel Cluster, owned by the University of Oslo and the Norwegian metacenter
for High Performance Computing (NOTUR), and operated by the Department for Research Computing at USIT,
the University of Oslo IT-department 
This work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014-2018 under grant agreement No 633053  The views and opinions expressed herein do not necessarily reflect those of the European Commission 



ground_truth: Implantable Cardioverter Defibrillator (ICD) is a surgically implanted electronic device to treat life-threatening heartbeat irregularities.

prompt_front: Now, answer the following question based on the text below, only give me the answer and do not output any other words.

Question: What is the relationship between the maximum velocity and the amplitude of the blob or depletion?

Read the following text and answer briefly.

Context 4:  Far from being safe and non-addictive, OxyContin carried the same addiction risk as morphine, and was every bit as potent 
But that was six years away  In 2001, towns in Maine reported an alarming uptick in crime tied to OxyContin  The first of several congressional hearings was ramping up  Critics and parents who lost children were piling on  Reporters were starting to write stories 
In November, Florida Attorney General Bob Butterworth appeared poised to take on the company  Calling OxyContin street sales “a major threat to public health,” Butterworth told a state Board of Medicine committee that Purdue should consider temporarily taking the drug off the market  It wasn’t only traffickers concerning Butterworth  It was the sales pitch 
In late 2001, Butterworth called a young assistant attorney general into his office and gave him a magazine article on OxyContin and an assignment: Look into Purdue marketing  Former Florida Attorney General Bob Butterworth and Palm Beach County State Attorney Dave Aronberg  The young lawyer, now-Palm Beach County State Attorney Dave Aronberg, said he knew nothing about OxyContin  But he didn’t like what he read 
During the yearlong inquiry, 589 Floridians died after taking oxycodone  Nothing criminal was found, Aronberg later said  Instead, Butterworth and Purdue struck a settlement  As part of a $2 million deal, Purdue would pay to establish a prescription monitoring database, the same silver bullet sought by Bush  After Florida’s computerized system was up and running, the same system would be free to any other state  The entire country, not just Florida, would benefit 
It could have been a groundbreaking deal  There was one catch  State lawmakers had to vote to create the prescription monitoring program by 2004, or Purdue would keep its money 
Marco Rubio Kills The Anti-Oxy Rx Bill
A political gight killed the program  “And there was one person who was responsible,” said former state Sen  Burt, now an Ormond Beach insurance executive  “And it was Marco Rubio ”
A rising state lawmaker in 2002, now-U S  Sen  Marco Rubio had the clout to make or break the legislation  He had been one of two state House majority whips and was on the fast track to becoming House speaker 
Rubio didn’t kill the 2002 bill out of opposition to prescription monitoring—it was politics “as usual” yet nobody blamed Rubio for the resulting opioid crisis that seems to have started in his political backyard and flourished beyond belief  
U S  Sen  Marco Rubio, R-Fla , was a leader in the Florida House in 2002 when he blocked a vote on prescription monitoring  That year, Rubio favored a bill changing the Miami-Dade County charter, which failed to pass because of a single “no” vote in the Senate  Burt cast the vote 
Angered by what he saw as Burt’s betrayal, Rubio killed the prescription drug monitoring bill  “When I found out he broke his word, it made the choice easy,” Rubio told The Miami Herald 
It’s not certain that the full Legislature would have passed the bill had it made it to a floor vote  Rubio was the first, not the last, in a line of state legislative leaders over years who would refuse to seriously consider the bill  Most cited privacy concerns 
But prescription monitoring databases in Florida and other states free to use Florida’s model would have pinpointed rogue doctors, would-be pill mills and doctor-shoppers across the country, just as all three were beginning to converge  In doing so, it could have curbed a national opioid epidemic when it was just an emerging problem, not the monster it would become 
Only weeks after the 2002 bill was killed, Bush suppressed a sob as he discussed his daughter’s arrest for forging a prescription  Court-ordered to drug treatment and then briefly to jail, Noelle Bush survived her pill addiction  The 2004 deadline for greenlighting a monitoring system passed  So did Purdue’s million-dollar obligation to pay for it 
Between 2002, the year Rubio killed the database that could have identified doctor-shoppers, and late 2011, when the database finally came online, more than 20,800 Floridians died after taking prescription opioids, including OxyContin, annual Florida Medical Examiners’ reports show  “Not getting that bill through the Legislature resulted in Florida becoming the pill mill capital of the United States,” said Burt 
“There was heartache for thousands of families beyond measure and it didn’t have to happen ”
Florida Officials Were Told Of The Oxy Express
The East Kentucky hills and valleys of Greenup County suit Keith Cooper, a long-haired undercover cop-turned-sheriff: “It’s a backwater  I tell people all the time I am a hick sheriff from a hick location, and by 2011, the rural county and its sheriff had big city problems 
Greenup is near the stretch of interstate highways that provided drug traffickers and users with a straight shot to Palm Beach and Broward pill mills  It’s less than an hour’s ride to Huntington Tri-State Airport, where a $27 flight to Fort Lauderdale was a popular draw for dealers hoping to stock up 
Arrests for Florida pills soon eclipsed local arrests for pot 
“When we locked ’em up, we take all their pill bottles and all their paperwork, and we found maps to the doctors offices and everything,” recalled Cooper 
“I called the (Florida) medical board and gave them a big list of doctors,” Cooper said  He called the state pharmacy board, too  He got no response 
“So then I called the Attorney General’s Office and the Governor’s Office  I was calling them all, the whole state  Of course, I was talking to the state police the entire time  “I told them, all of the profits were down there  And all of the pain’s up here ” Nothing happened  Florida’s oxycodone pipeline continued to flow 
On the other side of the law in Greenup, Mikey Frazier was banking on it 
The Oxy Express
Frazier was on a scholarship to play baseball at his junior college in Chicago when he suffered a torn rotator cuff  Doctors prescribed Percocet, a pill containing oxycodone, in 2002  When doctors cut him off, he bought it on the street  In 2006, he moved to OxyContin, nearly pure oxycodone  In 2007, he gave his friends money to go to Florida and bring him back pills 
“My buddy had a minivan and he would actually go down one week and take two to three people with him, and then the following week I’d go,” said Frazier  He still remembers the route: “I’d take 64 East to 77 South to 95 South  And it’s just a straight shot ”
Others followed suit  “What got everyone started was because the doctors around here won’t write a strong enough prescription,” he recalled  OxyContin and generic oxycodone still could be had — just not in Kentucky, which had a prescription drug monitoring database 
In Florida, “there was none of that … stuff that they check and find out what doctor you’ve been to,” said Frazier 
“And one person does it, and then they tell a friend, and then they go do it, and that’s how it all really got started here ”
MEDICAID-MEDICAIRE PAID MILLIONS FOR OXY
Tallahassee wasn’t just ignoring the epidemic, It was financing it 
Before her office was raided by law enforcement in December 2001, Asuncion M  Luyao’s patients would wait in a line in the rain to get prescriptions from the Port St  Lucie internist and acupuncturist  She was one of the most prolific prescribers of OxyContin in the state 
And hundreds of thousands of those pills were being paid for by Medicaid, Florida’s taxpayer-financed health program for the state’s poorest and sickest citizens  Between 1999 and 2001, Medicaid shelled out $935,634 for OxyContin prescriptions written by Luyao  That was just OxyContin  Luyao was prescribing an array of addictive drugs  In the 12 months leading up to the clinic raid, Medicaid paid roughly $1 million for 7,000 prescriptions, only about 17 percent of them for OxyContin 
Nor did the raid slow her down  Between the raid and her arrest on trafficking charges four months later, Luyao wrote another 282 OxyContin prescriptions billed to Medicaid  She was not an outlier  In 24 months, taxpayers footed the bill for more than 49 million doses of pills containing oxycodone, even though there were only 1 36 million Medicaid patients  Half were children 
The sheer volume of pills might have been a tipoff that the drugs were not all intended for legitimate use  So were arrest reports dating to 2001  One man had used his 7-year-old son’s Medicaid number to doctor-shop for OxyContin  A Miramar pharmacist who billed Medicaid $3 7 million for OxyContin pills was charged with paying Medicaid patients $150 each to use their IDs 
Medicaid paid for more than $300,000 to fill Dr  James Graves’ OxyContin prescriptions  The Florida Panhandle physician was the first doctor in the nation convicted of killing patients by overprescribing OxyContin 
Addiction risk for people taking high doses of oxycodone begins climbing after just three days, a recent study concluded  And most people on Florida Medicaid getting oxycodone prescriptions in 2011 were getting much more than a few days worth  They were getting an average of nine months worth of pills, state officials said 
Pill mill doctors prescribed 1 million of those pills:
Doctors working for the George twins’ trafficking empire prescribed at least 102,081 oxycodone pills billed to Medicaid before the ring collapsed in 2010 
Working out of a Delray Beach pain clinic founded by a convicted drug smuggler, Zvi Harry Perper, son of the Broward County medical examiner, was arrested on trafficking charges, but not before he wrote prescriptions to Medicaid patients for 115,977 doses of oxycodone in 90 days 
In Lake Worth, Cesar Deleon was arrestedas part of a DEA pill mill sweep and charged with 55 counts of illegally distributing drugs  Deleon wrote orders for 20,302 oxycodone pills for Medicaid patients 
Miami internist Dr  Selwyn Carrington authorized 32,411 doses of oxycodone for Medicaid patients in just two years  He was busted for signing his name to hundreds of prescriptions 
Further, Florida wasn’t in any hurry to stop doctors linked to pill mills 
Carrington was arrested for overprescribing in March 2011  The state’s emergency order to suspend his license was signed months after he had pleaded guilty in 2012 
Perper was busted at a Delray Beach pill mill operated by a former felon in 2011  The state did not act against his license until 2014 
Joseph M  Hernandez was writing prescriptions from his car, a veritable pill mill on wheels, when he was busted in February 2010 on one count of trafficking in oxycodone 
 Florida’s Department of Health didn’t file paperwork to restrict his license for almost 18 months 
During that time, Hernandez wrote oxycodone prescriptions for Medicaid patients totaling 258,940 doses representing a taxpayer-footed bill of $130,165 
Purdue Pharma’s Profits Before Patients Creed
Kelly Skidmore is exactly the type of person Purdue Pharma’s OxyContin marketing was intended to reach: Diagnosed with juvenile arthritis, the former state legislator’s struggle with chronic pain began at age 4 
Skidmore was wary of opioid painkillers, though, one reason her willingness in 2009 to work with Purdue was surprising  But she did it to get Florida’s dormant drug monitoring database up and running 
Then a state representative in a district straddling Palm Beach and Broward counties, Skidmore recalled that, “They came to me and said, ‘Could you help get it across the finish line?’ ”
OxyContin and prescription opioids, a serious problem in 2002, had evolved into a full-blown crisis in the ensuing seven years  Broward alone had more pain clinics than it had McDonald’s  Deaths tied to oxycodone had exploded, up by 263 percent since the prescription monitoring database had first been proposed and killed  Overdoses from prescription opioids were claiming more than seven lives a day 
“By God, if we had had seven dolphins a day dying and washing up on Florida beaches, we would have been appropriating money and solving it,” Skidmore said 
Skidmore believed a database wasn’t going to resolve the underlying addiction crisis  Still, it was a start  Not a silver bullet, but “maybe silver buckshot,” she said  The database law passed with gaping loopholes  No health care professional would have to report opioid prescriptions or check the database before prescribing more, and the state refused to pay for it 
“Just to get that one little piece … took nine years of filing bills and then it had no teeth,” Skidmore said  “And it should have been the easiest piece ”
Where Was The DEA and Everyone Else?
The DEA all but wrung its hands over Florida’s lethal inaction  The agency ticked off a devil’s brew of regulatory loopholes: Florida’s Health Department regulated health care professionals but not pain clinics  The state’s Agency for Health Care Administration regulated pain clinics that accepted insurance, but pill mills were most often on a cash-only basis  And the prescription monitoring database, mired in a vendor dispute, remained stalled 
In early 2011, when Gov  Rick Scott took office, just one drug — oxycodone — was tied to six fatal overdoses a day  Deaths tied to all drugs claimed 25 a day  In the handful of Appalachian states where traffickers were bringing back South Florida pills, it was worse 
Ohio’s death rate for oxycodone and similar opioids had doubled in 24 months, federal records show  Kentucky’s was up by more than 50 percent  And in West Virginia, home to hard-hit Huntington, death rates tied to pill mill drugs such as oxycodone and Opana had climbed by 341 percent 
The DEA formally pinpointed Palm Beach, Broward and Miami-Dade counties as the nation’s single biggest hub for trafficking pills across state lines  Within weeks of being sworn in, Scott abolished Florida’s Office of Drug Control, eliminating the state drug czar position, announced plans to drive a final stake in the heart of the database and rebuffed Purdue Pharma’s renewed offer to help pay for it 
Scott, a tea party conservative, cited privacy concerns, expressed skepticism the monitoring program would work and raised the possibility taxpayers would be left with a $500,000-a-year bill to operate it 
Attorney General Pam Bondi had also ridden the tea party wave to her position  She shared many of Scott’s conservative convictions  Unlike Scott, the former prosecutor relentlessly lobbied to keep the database alive  Florida’s failure to adopt the drug monitoring database was so out of step with the rest of the country that it began spawning conspiracy theories on both sides of the law 
Everyone knew prescription monitoring was going to kill the pill smuggling business, said a corrupt Florida Highway Patrol trooper as he drove a load of pills out of Florida, according to a federal lawsuit  Talking to the confidential informant in the seat next to him, the trooper speculated someone in Tallahassee must have a piece of the action, “because (Scott) was so adamant about not putting that system in place  Right?”
In Greenup, an infuriated Cooper told a reporter, “In my opinion, (Scott’s) getting money from somewhere  He has to be ” A few days later, recalled Cooper, “A lieutenant with the state police I’d been talking to down there called me, said, ‘Man, just a head’s up: I wouldn’t come to Florida ’” In states on the receiving end of the Florida pill pipeline and among federal officials, Scott’s resistance triggered outrage 
In Kentucky, where as much as 60 percent of the illicit oxycodone in that state flowed from Florida, Lt  Gov  Daniel Mongiardo proposed erecting billboards at the Florida line: “Welcome to the Oxy Tourism Capital of the World ”
U S  House Appropriations Chairman Hal Rogers, also from Kentucky, twice wrote Scott  “Canceling Florida’s prescription drug monitoring program is equal to firing firefighters while your house is ablaze,” he wrote 
Gil Kerlikowske, director of the White House Office of National Drug Control Policy, asked to meet with Scott  So did DEA Administrator Michele Leonhart 
Three U S  senators — New York’s Chuck Schumer, West Virginia’s Joe Manchin and Rhode Island’s Sheldon Whitehouse — joined Florida’s Bill Nelson in pointing out that the pills weren’t just a Florida problem: There were “serious ramifications for the rest of the country,” wrote Nelson of Scott’s reluctance to crack down  This is a perfect example of how political rhetoric, in-fighting and contrived agendas prevented an early stop to the emerging opioid crisis many years ago 
WHY DIDN’T THE DEA, DRUG DISTRIBUTORS AND PHARMACIES TAKE NOTICE BEFORE THE OPIOID CRISIS SPREAD ACROSS THE COUNTRY LIKE WILDFIRE? WAS IT BECAUSE OF THE BILLIONS IN PROFITS, QUARTERLY BONUSES AND DIVIDENDS? STOCK OPTIONS CASHED IN BY BOARDROOMS AT EVERY OPIOID BIG PHARMA COMPANY? STAY TUNED FOR HOW “PROFITS BEFORE PATIENTS” BECAME THE NORM
(article excerpts and quotes have been taken from publicly available media sources and court records)



ground_truth: The maximum velocity scales with the square root of the amplitude.