Mild, Repetitive Chronic Brain Injury
Here is the abstract from a study on a mouse model of repeated mild brain injuries:
Mild traumatic brain injury (mTBI) is an emerging risk for chronic behavioral, cognitive, and neurodegenerative conditions. Athletes absorb several hundred mTBIs each year; however, rodent models of repeat mTBI (rmTBI) are often limited to impacts in the single digits. Herein, we describe the effects of 30 rmTBIs, examining structural and pathological changes in mice up to 365 days after injury. We found that single mTBI causes a brief loss of consciousness and a transient reduction in dendritic spines, reflecting a loss of excitatory synapses. Single mTBI does not cause axonal injury, neuroinflammation, or cell death in the gray or white matter. Thirty rmTBIs with a 1-day interval between each mTBI do not cause dendritic spine loss; however, when the interinjury interval is increased to 7 days, dendritic spine loss is reinstated. Thirty rmTBIs cause white matter pathology characterized by positive silver and Fluoro-Jade B staining, and microglial proliferation and activation. This pathology continues to develop through 60 days, and is still apparent at 365 days, after injury. However, rmTBIs did not increase β-amyloid levels or tau phosphorylation in the 3xTg-AD mouse model of Alzheimer disease. Our data reveal that single mTBI causes a transient loss of synapses, but that rmTBIs habituate to repetitive injury within a short time period. rmTBI causes the development of progressive white matter pathology that continues for months after the final impact.
In simpler terms, mice showed a pattern of inflammation in the brain after repeated mild injuries (severe enough to cause momentary loss of consciousness but no more) that differed from the changes seen after a single injury. In the first injury, there is a loss of some dendritic spines (projections on the cell surface) that is repaired in 24 hours; the injury is mild enough that there is no death of nerve cells, inflammation, or axon (signaling end) injury. In contrast, after repeated injuries suffered on a daily basis, thirty times, there is pathology seen in the brain layer that carries the signalling projections consisting of inflammation and increases in the number of active supporting cells (microglia). These findings, in mice, show that repeated injuries without sufficient recovery time cause inflammation in the brain, not a sign of Alzheimer’s disease but equally serious. Individuals with this type of injury have difficulty keeping their balance and clumsiness.
This is only an experiment with mice, but it shows that pathologically serious damage in the brain can be caused by repeated blows to the head that are relatively minor by themselves. There is no reason to suspect that humans are any more resistant to microtrauma than mice.
Zika Virus and the Olympics in Brazil
May 2015: Zika virus is first detected in Brazil. Zika is a new mosquito-borne virus spreading across South America which has infected at least 1.5 million Brazilians.
August 5-12, 2016, Rio de Janeiro, Brazil: the Olympics, held every four years, a series of athletic contests in a nearly comprehensive range of sporting disciplines.
The CDC has announced an emergency in relation to the Zika virus, which is spreading rapidly across Brazil. The Center recommends against pregnant women travelling to the areas affected by the spread of the virus, notably Brazil and the island of Tobago. Anyone who does travel to these areas should take special precautions against mosquito bites, including restricting travel to air-conditioned hotels and wearing repellent on exposed skin.
Further detail on the CDC’s announcement that nine pregnant women had tested positive for Zika virus: they were in a group of 257 women who had requested testing, and represented three percent of them. Of those nine, one had Zika symptoms during her first trimester, and gave birth to a severely microcephalic child. Two had Zika symptoms late in pregnancy, and gave birth to normal babies. Five others had Zika symptoms during the first trimester, and all but one had miscarriages or abortions; the last one is continuing in utero (still pregnant.) One more woman who had Zika symptoms late in pregnancy is still pregnant.
Tentatively, one may offer the suggestion that Zika infection during the first trimester is likely to cause severe disability, but infection late in pregnancy is less likely to be dangerous.
Comments on Homelessness in San Francisco
These comments were left in response to a New York Times article on homelessness in San Francisco:
Sue McCormack
SF Bay Area
Up through the 80’s downtown SF had a lot of SRO (single residential occupancy) hotels. Many of these rooms were lost to redevelopment and gentrification. Many developers, in exchange for higher residential density, made mitigation payments to the city or county. If any low income housing was built it was generally on the periphery in areas far from mass transit and employment opportunities. Some of the homeless would benefit from a stable environment in order to manage mental and physical health issues. Some comments seems to consider the condition of homelessness to be a moral failure on the part of an individual. I believe that the failure is institutional. State mental hospitals were closed in the 70’s before local services could be built. We have two generations of veterans with untreated PTSD who did not receive honorable discharges due to their undiagnosed condition and are now excluded from veteran’s benefits. There are people with drug and alcohol dependency issues that have no place to go after detox. The on-going problem is also institutional, whether it be a lack of political will or a fear that the grant gravy train will come to an end. We can talk about job training, updating skills, resume workshops, etc. But if you don’t have a warm dry place to lay your head, with running water to keep clean and a toilet so you don’t have to use the street, all of the job training or education won’t matter.
Cheri
Tucson
I spent a good deal of time in San Francisco during the early years of this century. Homelessness was barely noticeable. Now it appears to be a huge problem. There is a similar situation in Seattle. The downtown area is filled with aggressive homeless people who accost tourists and commuters alike. They expect handouts and get belligerent if it is not forthcoming. The entire area around Pike’s Market and south towards the big ballfields smells of human waste.
It ought to be clear to everyone there is no monolithic group of homeless. They are essentially divided into two groups. There are those who were a paycheck away from losing their homes, and when the paychecks stopped coming they were on the street. These are the people who use the services and shelters available to them and their families. They are the people who would stop being homeless in a heartbeat if they got those paychecks back. The other group is made up of the emotionally unstable, drug addicts, and chronic alcoholics. They choose to live on the street. It is sad but true that no amount of money is going to help these people. They need to be dealt with differently. If necessary, they need to be involuntarily committed or arrested. They pose huge safety risks to themselves and those who come into contact with them. It is clear that be looking the other way, the authorities in San Francisco have made the city a more dangerous place to live and work. They are enabling, not helping, this group of homeless.
An Observer
Alta, Utah
I just spent the fall in San Francisco for work. The social stratification there — a putatively liberal city — is reminiscent of India (where I have also spent time recently). Here in conservative Utah — and I am a strong Democratic voter — we have done much better. The secret of solving homelessness is homes. But in San Francisco, no one wants to sacrifice space for the unfortunate, the poor, or these days even the middle class. The situation in San Francisco is a disgrace, and emblematic of what’s wrong with our country.
JefferyK
San Francisco
I moved to San Francisco in 1989 and lived there for 26 years. San Francisco has always been an incredibly wealthy city. It was always expensive to live there — you paid a federal income tax, then a state income tax, and then a high local sales tax. City Hall ought to be rolling in dough. But I could never figure out where my money went. The streets and sidewalks were dirty, the buses were filthy, the transit stations were coated with grime. I was shocked when I moved to Seattle — even the alleys here are spotless. Don’t blame the homeless. San Francisco has had a serious leadership and management vacuum in City Hall for decades. Unless this changes, the quality of life there will never improve, for anyone.
Homelessness is particularly visible and repulsive in San Francisco, where the mild climate year-round allows people without residences to exist on the streets. According to the comments, the city government is to blame for allowing the problem to become so extensive; it would appear that a large city program to house these people and/or supply them with safe bathrooms and places to sleep away from the tourists is needed. The loss of single-occupancy hotel rooms is a good example of how expensive is the space in the city; government must step in and alleviate this problem by whatever means necessary.
I suggest that provision of adequate short-term housing and laws that criminalize sleeping in the open within city limits are necessary. With adequate housing, the police can pick up anyone who appears to be without a place to stay and deliver them to the housing space without delay. As it is, there is no place to put these people, so the police have no alternatives to imprisonment. Putting people in prison for being homeless is absurd and inhumane, but at present there is no place for them to go.
Zika Virus in Pregnant US Travellers
Morbidity and Mortality Weekly Report (MMWR) has released a report about nine pregnant travellers from the US who had Zika virus. Of these, one child was born with severe microcephaly. Two live births were normal. Two pregnancies are continuing and appear normal. The rest were terminated, either spontaneously early in pregnancy (two cases), or by elective abortion(two cases). Evidence of Zika infection was found in the tissue examined after one spontaneous abortion. In one case, the fetus was found to have brain atrophy by ultrasound at 20 weeks gestation; this pregnancy was terminated by abortion and evidence of active Zika virus replication was found in the tissue.
The child who was born with microcephaly was discharged to home with a gastrostomy (feeding tube inserted in the stomach.) The mother gave a history indicating that she had been infected with Zika virus symptoms at around 8 weeks gestation. It is not known if there is a vulnerable period during pregnancy, or if the fetus is vulnerable regardless of gestational age when the mother is struck by the virus.
It is very important to determine the likelihood of fetal infection and brain damage when the pregnant mother is infected with Zika virus. So far, although the risk is significant, no definite number can be attached to that risk. Of the approximately 250 women who were evaluated for Zika virus, all but nine were found to be uninfected. Those infected, listed above, had variable outcomes, but of those, at least three of the nine had fetal involvement, and four were spared. With risks of this magnitude, the availability of elective abortion for women whose fetuses are involved is crucial to humane survival for these women.
In addition, it must be noted that children who are born apparently normal may be at increased risk of later mental disorders according to a New York Times report, including autism, schizophrenia, and learning disorders. For all of these reasons, the development of a vaccine against Zika is important to long-term protection of women and children.
According to the New York Times Deal Book, Dow has changed its legal strategy and announced that it would settle a decade-long lawsuit for a payment of almost $1 billion. The change in strategy is said to be prompted by the death on Antonin Scalia and the likelihood of at least a 4-4 split on the Supreme Court for the foreseeable future.
So, despite the obstruction of the Republicans in the Senate, the death of Scalia is having the expected effect: far-right “conservative” positions will be less likely to receive support even if there is no ninth Justice.
Chris Christie Endorses Donald Trump
Chris Christie came out for Donald Trump Friday afternoon with a love-fest for the press. Although the two have had words in the past, the exchanges have been forgotten, and today Donald was effusive in his praise of Christie while Christie called Donald the perfect President.
There is a nightmare quality to the serial endorsements that have just occurred. First Sarah Palin, now Chris Christie, favor Donald Trump. What would government look like if Trump won the presidency and awarded Christie with an administrative post like Attorney General? Could Sarah Palin be Surgeon General?
It is time for “Fear and Loathing on the Campaign Trail” to be resurrected. There is no more suitable mood in which to view the proceedings, especially on the Republican side.
Parry Aftab, a lawyer who leads the Internet safety group WiredSafety, said Mr. Trump’s behavior was a textbook example of cyberbullying.
In particular, she said his methods were characteristic of “mean-girl cyberbullying” because he enlists others to mimic his attacks. She said his conduct resembled the violent and abusive language her organization can often get removed from Facebook and Twitter.
via To Fight Critics, Donald Trump Aims to Instill Fear in 140-Character Doses – The New York Times.
It’s official. Donald Trump is a “mean-girl cyberbully” who enlists others to mimic and amplify his attacks.
There’s no precedent for this in a serious Presidential candidate. Donald Trump will trash anyone significant who criticizes him or refuses to endorse him. The criticism can be extremely mild and the reaction may include sexual harassment, slander, and threats– with the worst abuses coming not from Trump himself but one of his six million followers.
NBC news reported today that the CDC has stated there are now fourteen suspected cases of sexual transmission of Zika virus in the United States. Since there are 30 to 40 million travellers who visit Central and South America each year and return to the US, the potential for this method of transmission is very great. Zika is transmitted primarily by the Aedes mosquito, which also transmits dengue fever and chikungunya, two much more severe diseases that are endemic to South America. Only a fifth of people infected with Zika show symptoms, and it is not known whether an asymptomatic infected pregnant woman can transmit serious disease to her fetus.
Each of the cases of suspected sexual transmission occurred in a couple, the male partner travelling to South America, returning with symptoms of virus infection and having contact with the female partner within two weeks of returning. Several of the suspected cases have occurred in pregnant women. The Zika virus is known to be present during infection in semen, saliva, blood, and urine, although the only known cases of interpersonal infection have occurred through sexual intercourse. The virus has been spreading through South America and the Caribbean after jumping across the Pacific in the last four years, with stops in Yap and Easter Island. Before this spread, the virus had only been known in Asia and Africa after being discovered in a monkey in 1947.
The main reason for concern and for the CDC’s declaration of a public health emergency is the appearance of microcephaly and other fetal anomalies in the offspring of women who were pregnant when they became ill with acute Zika virus infection. In addition to microcephaly, there are suspicions that prenatal Zika exposure is associated with schizophrenia, autism, and other mental disorders later in life. The association with microcephaly has not actually been proven according to Koch’s postulates, but it is unlikely that these criteria will ever be fulfilled in the case of Zika.
This leads to an editorial in the New England Journal of Medicine (NEJM) which appeared on February 10, 2016. The editorial enlarges on a case description which appeared in NEJM contemporaneously: a European woman who had been working in northeast Brazil returned to Europe with a history of Zika virus infection contracted when she was thirteen weeks pregnant. An ultrasound performed late in the pregnancy showed microcephaly and intracranial calcifications similar to those that had been seen in other Zika cases. She consulted with national and hospital ethics boards and chose to have a late-term “termination” (abortion.)
The fetus had a very small brain with complete absence of the cerebral gyri (forebrain.) The ventricles (fluid-filled spaces in the brain) were grossly enlarged, there were calcifications in what little cerebral tissue was present, and the brain stem and spinal cord were hypoplastic (shrunken.) Electron microscopy showed particles consistent with Zika virus, and large amounts of viral RNA (genetic molecules that carry instructions for assembling the virus) were found in the brain but nowhere else.
The editorial opined that these findings do not satisfy “Koch’s postulates”, the rules laid down by Robert Koch in the nineteenth century for determining if a disease is caused by a specific organism, whether a bacterium or a virus. However, it is unlikely that these rules will ever be satisfied in this case. The rules are: a specific organism must be isolated from a patient with the disease. The organism must be transmitted by inoculation into a healthy patient. The new patient must then show similar symptoms of disease. Finally, the organism must be isolated again from the second patient.
These postulates were critical during the early days of the development of the science of infectious disease. They were usually satisfied by using laboratory animals rather than humans. In this case, however, performing the experiment in monkeys would take a long time and be very expensive. Waiting for confirmation of Zika as the cause of this devastating birth defect would be unreasonable because the virus is spreading “explosively” through South and Central America right now, and many millions of young women are at risk in these areas.
The editorial in NEJM asks for the rapid development of specific tests that will confirm the presence of Zika and immunity to the disease. The only test available at present that is sufficiently specific is RNA polymerase chain reaction, which detects the presence of the virus itself in blood or tissue. Tests that confirm antibodies to Zika are not specific enough because they cross-react strongly with antibodies to dengue fever and other related flaviviruses endemic to South America. We need a serologic (serum) test that will confirm past infection with Zika specifically enough to distinguish it from dengue.
The editorial also describes the need for really effective measures to control the Aedes mosquito, the vector of not only Zika but dengue, malaria, and yellow fever. To date, there has not been deployed an effective control measure, although new developments show considerable promise. The use of genetic “engineering” devices to create sterile mosquitoes and other advanced techniques offer hope for eventual destruction of Aedes.
The other measure that is desperately needed is effective birth control, prenatal care, and abortion for affected women. These matters are especially difficult considering the deep penetration of Catholic control in many of the countries affected. There is even controversy in countries where abortion is readily available during the first trimester because infection and fetal damage is likely to occur during the second trimester and not be detected until the third trimester. Late-term abortion is controversial even in societies that condone the practice in the first trimester. The damage of microcephaly and multiple fatal fetal anomalies frequently will not be apparent until after the fetus is theoretically viable.
To prevent the tragedy of late-term abortion or the delivery of a dead or severely retarded microcephalic child, a vaccine against Zika virus may be the best answer. We will hope for a really effective vaccine before the Zika virus spreads to southern Europe.
Real World Economics– A Web Site that Exposes the Truth About Economics (by George H. Blackford PhD)
We live in a country in which many people, if not the vast majority, hold beliefs about the federal budget that are demonstrably inconsistent with the facts that exist in the real world. The extent to which this is so is easily seen by considering how many people would be surprised to discover that the size of the federal budget as a fraction of our economy—that is, as a percent of gross domestic product (GDP)—in the 2000s was about where it was in the 1970s and was actually slightly smaller in 2000 and 2001 (17.6%) than it was in 1961 through 1964 (17.8%-18.2%). How many people would be shocked to discover that there were more federal government employees in 1967 (2.85 million civilians plus 3.45 million military) than there were in 2013 (2.77 million civilians plus 1.53 million military)? How many would also be shocked to find that federal employees as a fraction of the civilian labor force has fallen by more than 50% since the 1960s? And how many know that Americans are one of the least-taxed people among the advanced countries in the world?
These are all simple and easily verifiable, real-world facts that most people would find almost impossible to believe given the deluge of disingenuous, antigovernment rhetoric that is designed to encourage us to believe otherwise.
The above is the introduction to a web site that is produced by George H. Blackford, Ph.D., who calls himself an economist at large. The site contains an enlightening series of lessons about recent economic history and an excerpt from a book that Dr. Blackford has written called “Where has all the Money Gone?” The excerpt from the book goes through the history of the American economic situation since about 1913 (when comprehensive statistics began to be kept.) Much of the detail should be familiar to those who have been following this blog as well as those who have been reading the columns of Dr. Paul Krugman. The bottom line is that we are spending less per person and we have fewer employees per citizen than we have had in years past, and we are paying even less in taxes than we have in years past.
For those who have not been following along, this site will give much-needed information about how and why we got into this mess, and why the Republicans (as well as many Democrats) are liable to make thing even worse than they are already. One significant point: “Federal Outlays relative to the size of the economy in 2013 (20.8% of GDP) were below where they were in 1980 (21.1% of GDP).” In other words, Reagan was responsible for much of the disaster that has befallen us; Clinton is responsible for another part, by deregulating financial markets in 1999.
Dr. Blackford’s thesis, supported by many, many numbers, is that we must increase taxes in order to balance the budget. There is no way to cut services or reduce spending, by cutting programs or by reducing fraud and waste, or by any other sleight of hand. Any reduction in the budget, by cutting services, will hurt someone who desperately needs help or put someone out of a job. The only mature way to run our government without hurting citizens is to increase taxes, and the only mature way to increase taxes is to do raise taxes on the well-to-do.
I won’t make the effort to justify Dr. Blackford’s conclusions because he does such a good job of laying them out in a straightforward way. Read his website if you have any doubts.
Absurd Products– Example One
There is a product “on the market” so to speak, of which I was fortunate enough to examine a sample, which is known as an “Earthing Device.” The basic product comes in a foil package like that used to dispense freeze-dried food, and is priced on the package at $19.99; the package art is attractive and lists the many benefits that this device can bestow. Inside is an instruction book, a three-way plug with three LED lights on the other end, a six-foot electrical cord insulated in white vinyl, and several pads of adhesive skin electrodes like those used to attach electrical leads when performing an EKG. There is also a five-by-five foot sheet of foil-like material with a snap fixture for the wire lead. The “business end” of the cord ends in a round plug that fits snugly into the third hole in a three-way electrical outlet.
The instruction book explains how to insert the three-pronged plug device and observe which lights are illuminated. If the two yellow lights are lit and the red light is not, then the electrical outlet is properly wired. Otherwise, various combinations of error are noted by the lights that illuminate. The most important point is that the neutral light should not be lit, as this is the one you will want to plug in to. This three-pronged device is in fact identical to a commercially available device that confirms a three-way socket is correctly wired, except that it is a fetching bright white instead of electrical yellow.
The instruction book is mostly filled with testimonials from about a dozen satisfied users who explain the multifarious benefits of the device: relief of pain, fatigue, swellings, general well-being, and so on. The adhesive electrodes are applied to specific spots on the body for localized pain, and the sheet is to be put on one’s bed to sleep on. Both are hooked to the ground pole on the electrical outlet, so the device simply “grounds” whatever site it is applied to.
The notion that this device could provide any benefits of any type, medical or otherwise, is absurd. Nonetheless, it is offered for sale, and someone must be buying it. This product is absurd.
