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NXaVLXSZdEw | making money it's also about being responsible for others as a child I wanted to become a film director that was always my dream it still is today you might be thinking no I don't want him to be a director I want him in the company so I said well go ahead and become a director but being a director of such a big company is also exciting I didn't manipulate him a beauty goddess | 1,445 | 1,483 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1445s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | but boy if you could fly off and asked whether I feel competitive toward my father and sure he built up this big company that I'll only take over but it's really difficult to keep something going these days the founding period has its own challenges and just having the idea of founding a self-service drugstore was hugely innovative but the fight to survive has gotten tougher and | 1,483 | 1,502 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1483s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | that's the one I'm in a coma also now as a thought everyone in my family wants to be good at sports my father and I battle each other in tennis we all compete with one another and that's also shaped our view of life or mine at least as a tumulus miner despite their competitiveness the Osmond family reached a harmonious agreement with regard to succession cling against | 1,502 | 1,545 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1502s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | Rommel wipes me out I normally prefer playing doubles that's much more appropriate for men my age I'm starting to worry a bit about you you worry about me with your inheritance I wouldn't worry I'd be looking forward to it selecting heirs and successes is usually not quite as amicable as at the Hoffman's christiane fan base time has seen many inheritance disputes in rich families | 1,545 | 1,572 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1545s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | it's his job to preserve the family's assets and protected from all sorts of dangers maintaining a family fortune over several generations is incredibly difficult because it's under threat from being divvied up through inheritance from wealth disputes from expropriation from wars or simply from stupidity most families will have one or all of these happen to them only a handful of | 1,572 | 1,600 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1572s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | families have managed to stay more or less afloat over centuries but those right on top have been switched out again and again when based on time speaks from personal experience his own family's history dates back 900 years I have a horribly long name at least on my birth certificate there's my six given names Christian Lawton Ludwig William and Maria as a good Catholic followed by BA horn phone | 1,600 | 1,630 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1600s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | Malkin Haim Jane and beshte Simon what at work are normally called mr. Phan Bettelheim and at social events baron or lord baron baron from back home is an indirect successor of the figures the richest family in German history when does wealth begin for you if you're asking me at what point I consider someone to be truly right I would say over a hundred son I am definitely not rich I've | 1,630 | 1,672 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1630s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | escaped nakute but I'm comfortable you and our family is comfortable and I'm certainly not complaining when you have a family history as long as mine your family has seen everything near bankruptcy years overflowing with money inside and years when a lot was lost on the one wall news he takes us to the hunting lodge of the best horse hime family in Turlington it | 1,672 | 1,704 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1672s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | looked like the Lord had been lost forever during the division of Germany the house was built in 1892 was a hunting lodge for my great-great grand uncle's it's been in the family ever since except for a short interval it was expropriated in 1952 and then restituted in 1992 and since then I've owned it the family's hunting lodge survived expropriation and socialism without much | 1,704 | 1,740 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1704s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | damage today from bechtolsheim also owns hundreds of hectares of forest nearby and regularly invites business acquaintances for hunts that'll say many of the trophies are mine but several also come from my father some from my great grand uncle leopard down there I didn't shoot him that was my great grand uncle and then my dogs chewed off his ears so he no longer has his former | 1,740 | 1,770 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1740s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | beauty but he's too precious not to keep as we're sharpen a recurring topic in the special issues of the manager magazine are the super-wealthy snit works this gift goes alongside there are larger and smaller networks and there are a lot of them and most even we journalists don't know about in high society there are certain typical hobbies horse racing hockey okay a bit | 1,770 | 1,796 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1770s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | of tennis though that's almost old-school he'll meet in the boxes at major football stadiums because of course they're all football fans and football is huge of that a lot of networking happens there that's like their marketplace they mingle and meet there more than its so-called parties for the rich as of zuga nantan i [Applause] Dork oh yeah good we always have a lot of employees here | 1,796 | 1,833 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1796s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | we have a lot of friends in the box because Jim Pfeifer is here today Germany's most famous criminologist sometimes you live for someone from politics comes by Christian Wulff and Bettina are part of my close circle of friends so there's always lots going on here [Applause] in villain avinash allah is opening a new club a new branch of his fitness empire shallow also has become a member | 1,833 | 1,867 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1833s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | in the network of important people from the sports business and entertainment industries true it's a closed circle that's hard to get into sure money attracts success and success attracts money I do believe that I've experienced myself how you can suddenly connect with people previously out of reach I am in a different position the hot scene at Bouchon field for independence | 1,867 | 1,918 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1867s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | [Applause] Derk horseman is ready to leave his box he wants to celebrate the victory with his friend the Berlin air and hearing aid company owner Martin Kent Kent is also co-owner and president of Hannover 96 his box is located on the other end of the exclusive VIP area I told you we'd win today I told him that if we didn't win he'd pay 10 million that was the bet | 1,918 | 1,949 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1918s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | right - halfway decent many networks are important for business but do the rich also have political clout can political influence be bought in Germany bingo is life lost in the best way available for rich or super rich people in Germany to exert influence is the number of employees working in their companies someone who owns a company with a hundred thousand employees or let's say | 1,949 | 1,983 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1949s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | less maybe fifteen thousand employees can go to business associations and say finally go ahead and pass that law but that will cost me or an even better argument is that will cost you two thousand jobs in that area but there are no super rich people who regularly call up the ministers or ms merkel and say what needs to happen next which tax laws they'd like and so on | 1,983 | 2,007 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=1983s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | that's not how things work here in Germany the deadline for the special issue is approaching the heart of it is the ranking of the 1001 richest Germans what do the rich think of this ranking is a ranking suit those rankings are for entertainment all their scraped together sometimes using stock market quotations but they aren't reliable in any real way and five Gunson fontana giving and visit | 2,007 | 2,046 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2007s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | roughly and also craft as each house I don't think much of these rankings and I didn't want to be included because it creates this impression of rich people being like Scrooge McDuck that they have these money bins in which they wallow in their coins the fact that I'm at the top of the rankings including of the wealthiest Germans does make me feel proud and Finnish naturally rich noise | 2,046 | 2,069 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2046s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | it is it's well read manager magazine every now and then but I've never read the rank I don't know whether I'm in it I don't need that I have other goals one of these is that Highness Allah now wants to open the world's largest Fitness Centre in North rhine-westphalia and let me write the Mariah's Japanese and means the future we think it's a perfect fit for the whole concept and | 2,069 | 2,096 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2069s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | vision because what we want to create here is truly unique and has never been done before our goal is to become the world's fitness center fitness center embed bite severity Shanna thinks he's found the perfect location to realize his vision in Oberhausen he's rented an old factory complex at the moment the space is still being used to make steel parts but before long thousands of | 2,096 | 2,127 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2096s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | customers will be exercising here the emergency exits path will be here and the offices on top seanny experienced his most traumatic experience to date in the area in 2010 21 people died and 54 were injured in a stampede at the Love Parade in duisburg shala had been the parade's organizer the cause of the panic has still not been conclusively determined how does an | 2,127 | 2,156 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2127s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | entrepreneur in the fast lane deal with that kind of tragedy an event like that will haunt you always for the rest of your life I've got a moral responsibility I was the organizer if I could turn back time I would do it immediately before the scale of what happened but you can't make it undone you have to try to deal with what happened in the Musa Dagh Mitzvah Zulu once again dick Hoffman has | 2,156 | 2,184 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2156s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | also seen setbacks and crises in the 90s we expanded dramatically hinted the Czech Republic Hungary and Poland I was also speculating on the stock markets a little too much and neglecting the company then in 1996 we suddenly had a loss of 12 million Deutschmarks the banks don't joke around if you're highly indebted and then you come in with huge losses that was critical and then I had | 2,184 | 2,209 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2184s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | a heart attack in 96 but everyone knows that life can get tough and things got very tough back then incurred odd nights what is saying so I dialed back a bit including stock speculation I sold them all and thought the only thing on my table now is pulling the rossmann drugstore business through and dumped death it was the right move to focus on one thing and not do so many different | 2,209 | 2,238 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2209s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | things horsemen emerged from that crisis stronger than ever he started speculating again but so he assures us only with his private wealth so let's see where gas promise I don't have a laptop I normally do this via NTV text 254 yeah here it says gas promised it 375 I could already sell those now I bought 250,000 of those so 250,000 times 20 cents that would give me 50,000 euros | 2,238 | 2,279 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2238s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | profit but I won't sell I think it's gonna rise to 4 euros sometimes it works sometimes it doesn't but I enjoy that's why I don't play the lottery because I find that boring can a large fortune also be a burden the hoped it does I'd say that for most people although they wouldn't voluntarily give away their money the fact that they wanted to grow can be a burden they are | 2,279 | 2,315 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2279s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | controlled by their own assets for example they'll move to Switzerland or somewhere to save on taxes and give up their entire circle of friends and basically become a slave to their fortune in my opinion that's absurd considering the conditions we currently have in German Finland conditions in Germany are currently more favorable than ever for the rich they pay significantly less tax than they did | 2,315 | 2,346 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2315s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | 25 years ago only minority still feels compelled to emigrate abroad article 14 of the german constitution states property entails obligations its use shall also serve the public good do the rich in Germany live up to this responsibility you finish fish dish I think it is important if you're successful if you're lucky enough to have reached a certain level of | 2,346 | 2,377 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2346s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | prosperity and wealth to give something back to society Michele Otto is one of Germany's biggest donors his money helps fund the environmental cultural and social sectors like most rich people he prefers to decide himself what he spends his money on rather than leave that to the state Otto like many wealthy Germans donated millions for the construction of the air fill ammonia in Hamburg in | 2,377 | 2,405 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2377s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | Germany wealthy people like to donate and this makes important contributions to society and public life but generally they're against the proposal of redistributing wealth by a higher taxes for the rich in film German businesses would yield to all the demands of let's say miss varnish to the left party then millions of people would be happy and things would be good for a while because | 2,405 | 2,432 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2405s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | millions of people would have more money I know but a true redistribution of wealth has never led to more social justice in the long term not in any of the political systems that tried it it led to the impoverishment of these countries the landowner foot Christiana fund bechtolsheim sees higher taxes on the rich as dangerous as a philosopher I don't think much about this so-called | 2,432 | 2,455 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2432s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | rich tax for two reasons firstly if the terminology alone is stigmatizing and we in Germany should avoid that and secondly the rich tax wouldn't do any good on the contrary it would cut into the backbone of the German economy because the typical German rich person is a media sighs business owner they make up the backbone of the German economy and if we want to destroy that we have no one to | 2,455 | 2,478 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2455s | Germany: The discreet lives of the super rich | DW Documentary | |
NXaVLXSZdEw | blame but ourselves the special issue is ready things have basically stayed the same the rich have a few billion more the richest 1% of Germans now has personal wealth worth a quarter of the country's assets while a quarter of adults have no wealth or are in debt for this report we never really got access to the world of the wealthiest Germans they prefer to | 2,478 | 2,507 | https://www.youtube.com/watch?v=NXaVLXSZdEw&t=2478s | Germany: The discreet lives of the super rich | DW Documentary | |
Y6RRHw9uN9o | hey guys and welcome to another fun and easy machine learning video on support vector machines so the other day I was walking through the park where I saw a lot of people with their pets dogs as well as cats and then I came across this strange creature just really challenging for me to tell whether it was a dog or get but I eventually figured it out that it was a cat groom like a dog now if it | 0 | 25 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=0s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | was challenging for me to figure out imagine how difficult and challenging it would be for a computer to precisely classify between a dog and a cat a really great algorithm for these types of applications is the support vector machine algorithm or SVM it looks at the extremes of the data sets and draws a decision boundary also known as a hyperplane near the extreme points in | 25 | 47 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=25s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | the data set so essentially the support vector machine algorithm is a frontier which best segregates the two classes so how does it work to understand SVM Zapatera let's first take a look at why they called support vector machines so say we got some sample data over here of features that classify whether an observed picture is a dog or cat so we can for example look at the snout length | 47 | 74 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=47s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | or the ear geometry if we assume that dogs generally have longer snouts and gets have much more pointy ear shapes so how would we decide where to draw our decision boundary well we can draw it over here or here or like this any of these would be fine but what would be the best if you do not have the optimal decision boundary we could incorrectly classify a dog with a cat so if we draw | 74 | 104 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=74s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | an arbitrary separation line and we use intuition to draw it somewhere between this data point for the dhoklas and this point for the cat glass these points are also known as support vectors which are defined as data points that the margin pushes up against all points that are close to the opposing glass so the algorithm basically implies that only support vectors are important | 104 | 128 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=104s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | whereas training examples are ignore an example of this is so that if we have in our case of a dog that loser cat or get that is chrome like a dog we want our classifier to look at the extremes and set our margins based on these support vectors so we have D plus which is the shortest distance to the closest positive point and D minus which is the shortest distance to the closest | 128 | 152 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=128s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | negative point and then we have the margin of a separating hyperplane which is the positive plus the negative the line or decision boundary that segregates the two classes is commonly referred to as a hyperplane because s VMs can be used in multi dimensional data sets and the data points are referred to as vectors as they have coordinates within the space of data so | 152 | 176 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=152s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | what we discussed so far is also known as linear support vector machines or L SVM because the class are linearly separable but what happens if we have a dataset that is not linear separable so say we are presented with data that looks like this where it looks almost impossible to use a single line to separate the two classes we can use a function to transform our data into high dimensional | 176 | 201 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=176s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | space so you can see over here we go from one dimensional to two dimensional space we can apply a simple polynomial function to get a parabola and now you can easily see how we can draw our hyperplane we can do the same for this data set where it's easy to draw the hyperplane or line but for a machine will use a function to transform our data from two-dimensional to three | 201 | 224 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=201s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | dimensional feature space now the only problem with transformation into higher dimensional feature space is that it's computationally expensive we can use a kernel trick to reduce the computational costs a function that takes as inputs vectors in the original space and returns the dot product of the vectors in the feature space is called a kernel function also referred to as kernel | 224 | 248 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=224s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | trick using a kernel function we can apply the dot product between two vectors so that every point is mapped into a high dimensional space via some transformation so essentially we use it to transform a non linear space into a linear space if you look at some popular kernel types here are some popular kernel types that you can use transform our data into high dimensional | 248 | 271 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=248s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | feature space there are polynomial kernel radial basis function RPF or RBF kernel sigmoid kernel amongst others unfortunately choosing the correct kernel is a non-trivial task and may depend on specific task at hand no matter which kernel you choose you need to tune the kernel parameters to get good performance from a classifier a popular parameter tuning technique | 271 | 296 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=271s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | includes k-fold cross-validation you'll deal some of these parameters in our Python labs so the advantages of support vector machines are that they are effective in high dimensional spaces they are so effective in cases where a number of dimensions is greater than the number of samples they use a subset of training points in the decision function or support vectors so it's also memory | 296 | 319 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=296s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | efficient suppose factors are first down so different kernels can be specified for the decision function common kernels are provided but it's also possible to specify custom kernels we can add kernel functions together to achieve even more complex hyperplanes the disadvantages however of sports vector machines include if the number of features is greater than the number of samples the | 319 | 343 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=319s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | method is likely to give poor performance support vector machines do not directly provide probability estimates these are calculated using an expensive five fold cross validation if you take a look at the applications of support vector machines the support vector machine algorithm has numerous applications and can be a quite popular alternative to artificial neural | 343 | 364 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=343s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | networks or a ends here are some applications from published journal papers so we can use support vector machines in medical imaging there's one application for SVM based regression models to study the Equality in urban areas in the city of Oviedo in Spain support vector machines is also used for image interpolation as well as medical classification tasks in the financial | 364 | 389 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=364s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | industry support vectors are used for time series predictions as well as financial and there's one paper on the application of neural networks mixed with support vector machines in coding theory and practice there's also for pattern recognition for machine volts diagnosis which also uses support vector machines as well as page ranking algorithm and Dex an object correct | 389 | 412 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=389s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
Y6RRHw9uN9o | mission okay so that is it for me please don't forget to Like subscribe and share look at a lifeline if you'd like to see more machine learning tutorials and please don't forget to support us on patreon if you'd like to download the script to this video please click the link down below and download for free so stay tuned to the next lecture where we will implement a support vector machine | 412 | 431 | https://www.youtube.com/watch?v=Y6RRHw9uN9o&t=412s | Support Vector Machine (SVM) in 7 minutes - Fun Machine Learning | |
qoGBO3q5ikI | thank you it's a pleasure to be here I will give a talk for probably only about 30 minutes and we're really going to talk primarily about the basics of stroke and then I want to leave plenty of time for people to ask questions about topics of their interest stroke is a very broad topic lots of different research going on so hard to summarize it all in a short talk but be happy to | 0 | 22 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=0s | Stroke: The Basics | |
qoGBO3q5ikI | address anything that's that's on your mind so you heard a little bit about me I actually came to Stanford first in 1984 right after graduating Medical School came up here for my internal medicine neurology training and then a stroke fellowship so I've spent my entire career thirty years here at Stanford have never looked for a job elsewhere because I love being here it's | 22 | 48 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=22s | Stroke: The Basics | |
qoGBO3q5ikI | a great place to interact with other physicians and have a team approach to taking care of patients as well as doing research and as was mentioned we formed the Stanford Stroke Center in 1992 I began on the faculty after finishing my training in 89 at the same time that Gary Steinberg who's a neurosurgeon was just finishing up and starting as a new faculty member and neurosurgery with an | 48 | 74 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=48s | Stroke: The Basics | |
qoGBO3q5ikI | interest in stroke and Michael marks was a young guy who was interested in putting catheters up into the brain to try to treat stroke so he was a radiologist I was a neurologist and Gary was a neurosurgeon and the typical approach to stroke back then was that those three groups did their own thing that they didn't work together that they worked independently with what they | 74 | 95 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=74s | Stroke: The Basics | |
qoGBO3q5ikI | could offer and the idea that we had is that it would be a novel approach to work together as a comprehensive type of team where we could try to use the approach of the the team rather than the individual to treat patients and Stanford Hospital was very welcoming to that idea to give it a try gave us some funding to try to start the program together and all three of us | 95 | 117 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=95s | Stroke: The Basics | |
qoGBO3q5ikI | have stayed around for all this time because we really enjoy doing stroke research taking care of patients and trying to Train individuals who want to do make a difference in stroke so we've have medical students residents fellows who are training to be strokes about and now they've moved on to different places to start stroke programs and now it's in vogue to do comprehensive Stroke | 117 | 141 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=117s | Stroke: The Basics | |
qoGBO3q5ikI | Center to have multi collaborative approaches and they're doing accreditation now for comprehensive stroke centers so we were very happy to be the first in the country to be chosen as a accredited comprehensive Stroke Center so that's the background on the center and now what I want to do is just give a bit of an overview about stroke how to prevent it how to treat it | 141 | 164 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=141s | Stroke: The Basics | |
qoGBO3q5ikI | and then we'll end with a case example of somebody who recognized a stroke and alerted us to it right away so that we were able to to treat her husband and you can kind of look at the the different impression of a stroke in somebody who's having one versus somebody who's watching one and hopefully by at the end you guys will be ready so that if you see somebody who's | 164 | 188 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=164s | Stroke: The Basics | |
qoGBO3q5ikI | having a stroke you're gonna know what to do alright so stroke is a big problem it used to be the third leading cause of death it is now the fourth leading cause of death but death is really the least of the problems with stroke because most people with strokes don't die but most people with strokes are disabled so what people typically fear most about stroke is not | 188 | 210 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=188s | Stroke: The Basics | |
qoGBO3q5ikI | that they're gonna die from it but it's going to be disabling and that they're going to wind up in a nursing home or not be able to do the things that they like to do before because of the injury to the brain stroke continues to be very common it's become a little bit less common because of the treatments that we've had for risk factors particularly high blood pressure as we'll talk about | 210 | 233 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=210s | Stroke: The Basics | |
qoGBO3q5ikI | so that the chance of a given individual to have a stroke is actually less now than it was a few years ago because of risk factor control but the population of course is getting older baby boomer boomers like myself are starting to head up into the stroke prone age groups so that means that even though we have a little bit better control of the risk factors the number of strokes that we | 233 | 254 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=233s | Stroke: The Basics | |
qoGBO3q5ikI | anticipate over the next two decades is very high and that we're going to go well above the 780,000 strokes that occur right now in the US every year so this is a huge problem and I suspect that all of you have had your lives touched by stroke in one way or the other because you're here but even if you go to a general audience you'll find that most people usually about one | 254 | 278 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=254s | Stroke: The Basics | |
qoGBO3q5ikI | out of every three individuals has had their life touched by stroke either because it's a family member for them themselves or somebody very close to them so incredibly common and this is one of the things that that drew me to stroke that it was not treatable at all when I started and that this was such a common problem that it was something that could really get excited about | 278 | 297 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=278s | Stroke: The Basics | |
qoGBO3q5ikI | trying to make a difference so let's look at a little bit of the prognosis after stroke as I mentioned stroke is not a major problem in terms of given individual who's having a stroke is relatively unlikely to die from it even though it's the fourth leading cause of death it's only about a 15 percent chance that you'll die from the stroke the type of strokes that are most likely | 297 | 322 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=297s | Stroke: The Basics | |
qoGBO3q5ikI | to cause mortality are the bleeding type of strokes the hemorrhages and we'll talk about that the strokes that also can cause mortality or where you have a very large ischemic stroke and we'll will discuss that as well but usually what we're looking at is rehabilitation recovery and that the the brain can rewire itself which again is something new that we didn't realize | 322 | 346 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=322s | Stroke: The Basics | |
qoGBO3q5ikI | when I was in training is that the brain has the potential for rewiring and that with patients and with therapy that most patients will make a lot of improvement particularly in the first several months after a stroke but the improvement can go on for many years after the stroke stroke is one of the most costly medical diseases not just because it's expensive | 346 | 366 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=346s | Stroke: The Basics | |
qoGBO3q5ikI | when somebody's in the hospital and they may be in the hospital for many days or even weeks with a stroke but it's because stroke can hit at any age and even though it's more common in older patients many people of a stroke are still working so when you're looking at not only the cost of the stroke itself but you're looking at the cost of the lost productivity permit from the person | 366 | 387 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=366s | Stroke: The Basics | |
qoGBO3q5ikI | and people who have major stroke with major disabilities and you're looking at nursing home care so it really adds up to being one of the most expensive medical conditions that we have okay so time for some audience participation who can give me a definition of what a stroke is right here okay that's a good definition loss of oxygen to the brain is what was said anybody want to add to | 387 | 414 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=387s | Stroke: The Basics | |
qoGBO3q5ikI | that or take a little different approach a blood clot in the brain that certainly can cause a stroke any other definitions yeah that's one of the things that stroke is going to do cause paralysis so hemorrhage absolutely bleeding in the brain is in addition to a blood clot going up into the brain and blocking off the blood flow a blood vessel rupturing and causing hemorrhage is a stroke so | 414 | 452 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=414s | Stroke: The Basics | |
qoGBO3q5ikI | you can start to get the feeling from the responses that stroke is not totally straightforward and it is complicated so the definition that I like is that stroke is the brain injury that occurs when there is an abrupt disruption of the blood flow to the brain so that abrupt disruption of the blood flow to the brain can cause for two major reasons and you guys hit on both of them | 452 | 474 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=452s | Stroke: The Basics | |
qoGBO3q5ikI | one is that the blood flow is blocked by a clot that a clot comes from somewhere or it's formed in the Blayne and it prevents the blood from flowing into the brain the other cause of stroke is a blood vessel that ruptures so then you either get bleeding into the brain or around the surface of the brain and you can imagine those are very different problems right a blood vessel that's | 474 | 498 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=474s | Stroke: The Basics | |
qoGBO3q5ikI | blocked up with a clot we're going to approach that very differently than we would approach a blood vessel that has ruptured and now has blood spilling into her around the brain so two major problems which one do you think is more common absolutely absolutely this is much more common so we're going to focus on this but we'll talk briefly about some of the ruptured arteries so | 498 | 524 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=498s | Stroke: The Basics | |
qoGBO3q5ikI | ruptured arteries there's two major flavors here one is that it's a blood vessel within the substance of the brain that ruptures and this is a CT scan which is an x-ray picture this white blob is blood bleeding into the brain patient didn't make it and you can see the blood here in the center of the brain so this is a blood vessel that's piercing into the brain which | 524 | 545 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=524s | Stroke: The Basics | |
qoGBO3q5ikI | ruptures and why do you think that might happen yeah so an accident usually will cause some injury to the surface of the brain but a blood vessel deep in the brain usually ruptures for a different reason than an accident so an aneurysm is a good reason for a blood vessel to rupture we're going to get to that in the minute the aneurysms usually form at the blood vessels at the base of the | 545 | 573 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=545s | Stroke: The Basics | |
qoGBO3q5ikI | brain but a blood vessel that's piercing deep into the brain typically will rupture because of many years of high blood pressure that many years of high blood pressure pushing against the surface of that blood vessel wall weakens the blood vessel wall and one day it gives way and it starts bleeding so if we could control everybody's blood pressure we would see very few of these | 573 | 597 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=573s | Stroke: The Basics | |
qoGBO3q5ikI | hemorrhages because the vast majority of these deep in the brain hemorrhages are caused by high blood pressure there are some other unusual reasons like having an abnormal cluster of blood vessels in the brain that we call an AV malformation certain drugs like cocaine or amphetamine can cause blood vessels on the brain to rupture but hypertension is the one that that we could really | 597 | 619 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=597s | Stroke: The Basics | |
qoGBO3q5ikI | make a huge difference if we controlled it so the aneurysm which you guys mentioned causes what's known as a subarachnoid hemorrhage so the aneurysms sit actually on the surface of the brain they sit in an area called the Circle of Willis that we're going to talk about in just a few minutes and when they bleed the blood goes all around the surface of the brain so you can imagine this is | 619 | 642 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=619s | Stroke: The Basics | |
qoGBO3q5ikI | something that the brain doesn't like to happen to be covered in blood because blood is very irritating to the surface of the brain so having blood in the brain like in this example or having blood on the surface will cause bad headaches alright so typically somebody who's having a bleeding type of stroke will have a severe headache often the worst headache of their life now that's going | 642 | 665 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=642s | Stroke: The Basics | |
qoGBO3q5ikI | to be very different from the more common types of stroke usually have no headache or very mild headache which are the blood clot blocking off blood flow but these more serious brain hemorrhage are typically going to present with neurologic symptoms and a very very bad headache because of that blood okay let's now shift gears and we're not going to talk so much about the bleeding types because | 665 | 689 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=665s | Stroke: The Basics | |
qoGBO3q5ikI | that's only about 15% of strokes about 85% of strokes or when you have a blood vessel either in the neck or in the brain that's blocked off with a blood clot so we need to know a little bit about the anatomy to understand stroke there's two sets of blood vessels that bring blood to the brain the anterior circulation the front circulation or the carotid arteries and | 689 | 711 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=689s | Stroke: The Basics | |
qoGBO3q5ikI | these are very easily accessible you can feel your own carotid if you put your finger just below the angle of the jaw and don't press too hard there but if you press gently you can feel the carotid artery right here which is pulsing so you've got one on either side going up the front of the neck in the back of the neck you have the vertebral column and you have the vertebral | 711 | 733 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=711s | Stroke: The Basics | |
qoGBO3q5ikI | arteries and if you look at the picture you can see that these blood vessels actually go through little holes in the spine and then the two sets meet together to go up to the brain stem so the carotid arteries are going up to the hemispheres of the brain the vertebral arteries are going in the back towards the brainstem now these two sets of blood vessels come together with what's | 733 | 755 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=733s | Stroke: The Basics | |
qoGBO3q5ikI | called the Circle of Willis so you see this circle here it links the two together and it's very nice if you're born with a good Circle of Willis because what that means is that if you have one blood vessel that's blocked up that you can get help from the other blood vessels that's known as collateral circulation means one blood vessel can help out another one that's blocked up | 755 | 779 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=755s | Stroke: The Basics | |
qoGBO3q5ikI | and some people can block off the whole carotid artery and not have a problem because the other vessels are helping out some people can actually block off both of their carotid arteries the biggest blood supply to the brain slowly blocks off and the other vessels in the back can take over so the Circle of Willis is important then how the blood vessels come together on the | 779 | 801 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=779s | Stroke: The Basics | |
qoGBO3q5ikI | surf to the brain to help each other out is also important these are things that we don't have control over this is how you were born you're either born with a nice Circle of Willis or not and you're born with a nice collateral circulation it doesn't necessarily matter how old you are but how you were born so you can thank your parents for if you had good collaterals or not there's things that | 801 | 824 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=801s | Stroke: The Basics | |
qoGBO3q5ikI | you can do to make the collaterals work less well like smoking cigarettes will block up the collaterals having high blood pressure high cholesterol will block them up but you're kind of born with a set of collaterals so one of the things that you can imagine is since these blood vessels go to different regions of the brain the symptoms of the stroke are going to be quite different | 824 | 843 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=824s | Stroke: The Basics | |
qoGBO3q5ikI | depending on what blood vessel is blocked so we'll talk a little bit about that first we'll show a little bit more detailed picture of what this Sokolov Willis looks like you can see there's a whole bunch of blood vessels that come together to make this circle we can take pictures of that to try to understand when somebody's having stroke what other blood vessels are going to be | 843 | 861 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=843s | Stroke: The Basics | |
qoGBO3q5ikI | available to help out okay so let's get into the symptoms the symptoms depend on what part of the brain is involved symptoms of a stroke are much more complicated than symptoms of a heart attack if we're talking about the stroke that is due to blood clots we refer to that as a scheme 'extra which means there's no bleeding in the brain and if there's no bleeding in the brain it | 861 | 883 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=861s | Stroke: The Basics | |
qoGBO3q5ikI | usually doesn't hurt okay so that's one of the disadvantages for stroke compared to heart attack if it doesn't hurt people are much less motivated to go to the emergency room right stroke also frequently occurs in the middle of the night so you're asleep and you don't notice it because it doesn't hurt yeah I had a heart attack in the middle of the night it would wake you up from sleep | 883 | 904 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=883s | Stroke: The Basics | |
qoGBO3q5ikI | the brain is very complicated so the right side of the brain is going to be doing things that are very different from the left side of the brain so the hemispheres of the brain are primarily fed by the carotid arteries we call that the anterior circulation the brainstem in the cerebellum which is a coordination area are primarily fed by the vertebral we call that the posterior | 904 | 925 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=904s | Stroke: The Basics | |
qoGBO3q5ikI | circulation so depending on what blood vessel is blocked up the symptoms can be incredibly variable so what would you expect might happen if you blocked off the left carotid artery what kind of symptoms yeah so we heard language and that's right most of the language function for both left-handers and right-handers is in the left hemisphere so and then heard numbness so what side of the body would | 925 | 955 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=925s | Stroke: The Basics | |
qoGBO3q5ikI | be numb if you blocked off the blood flow to the left side of the brain right and what in addition to numbness and language trouble what else would be a prominent symptom somebody mentioned it earlier what's that vision yeah vision can be lost because the carotid artery is going to supply the blood supply to the eye on that side so if your left carotid is blocked you may | 955 | 981 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=955s | Stroke: The Basics | |
qoGBO3q5ikI | have some trouble with your left eye it is also supplying so part of the visual areas that look at the right side of the world so you could have be missing vision from the right side of the world or the left eye if your left carotid was blocked well one of the most prominent symptoms is going to be weakness all right people mention that before so it's the right side of the body that's going | 981 | 1,003 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=981s | Stroke: The Basics | |
qoGBO3q5ikI | to be weak if you have trouble in the left hemisphere and the weakness from stroke normally comes on abruptly it's not the type of weakness that builds up slowly over days weeks or months it's a type of weakness where you're absolutely fine one minute and then you can't move the arm the next moment so it's abrupt onset because when that blood clot blocks off the blood flow | 1,003 | 1,024 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=1003s | Stroke: The Basics | |
qoGBO3q5ikI | suddenly the function stops doesn't mean the tissue dies right away but suddenly the function stops so the symptoms come on very quickly so somebody with left carotid stroke may not be able to speak or they may not be able to understand words so they may be able to make no words nonsense words or have trouble getting the words out they may also have trouble understanding what you're saying | 1,024 | 1,048 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=1024s | Stroke: The Basics | |
qoGBO3q5ikI | so when you're talking to them it sounds like you're talking a foreign language so that if you ask them to do something like close their eyes or lift up their arm they won't because they can't understand what you're saying so different language areas in different parts of the left hemisphere can affect the patient differently so it could be very mild where there | 1,048 | 1,069 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=1048s | Stroke: The Basics | |
qoGBO3q5ikI | having trouble finding the right word or saying a few nonsense words all the way to what we call a Broca's aphasia where you can't get any words out you become completely mute okay now on the right side of the brain there's usually no language function some left handers I'll have some language function on the right side but what they will have would be the control of the left body and they | 1,069 | 1,093 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=1069s | Stroke: The Basics | |
qoGBO3q5ikI | have something called neglect particularly if it's kind of the mid portion what we call the parietal lobe which means they don't realize they're having a stroke okay so people who are having a stroke on the left hemisphere usually can't tell you about it very well because they can't talk so they can't call 9:1 and say I'm having a stroke people in the having a stroke on the | 1,093 | 1,113 | https://www.youtube.com/watch?v=qoGBO3q5ikI&t=1093s | Stroke: The Basics |