My my, we've come a long way. I'm actually pretty surprised we've made it this far, and I want to thank my readership for sticking with me and checking in now and again. Unfortunately, with finals season upon us, I'm going to have to take a little bit of a hiatus to help my significant other with her studies. When I have free time, I'll continue to work on the blog, and we'll be resuming regularly scheduled content by 5/16/14, so be sure to check back in by then. As I head into the break, I'd like to take this opportunity to step outside of my typical bounds and share some thoughts; no evidence, no citations.
Working as a Paramedic, I, along with my co-workers, see people living at the very extremes of life. A common day for us involves several worst days of other people's entire lives, be it simply due to back pain, or due to a stroke permanently disabling a loved one in one swift, unpredictable moment of terror. I'm getting very near to my four year anniversary working in this field, and I feel that's long enough to be able to share some thoughts and observations on the field.
The list of observations could, if allowed, occupy several posts, elaborating on various phenomena such as the observation that it's only ever the bad guys that want a hug after something goes down. I could speak about all the people that imagine our jobs as being as bloody and violent as a frontline deployment (really, it's best described as hours or boredom peppered with moments of sheer, unadultered terror), the people who ask me if I've ever seen people die, or simply assume that I see it on a daily basis. Today, we're only going to focus on one, the one that I, personally, find the scariest- silence.
A lot of people imagine our scariest scenes being those that are filled with flames, screaming, and blood. The truth is that, in general terms, if you're healthy enough to be screaming and writhing in pain, you'll live to see the hospital. Really, there's a profound terror that can be found in walking into a scene that should be loud, people should be screaming at you, but they're silent. Imagine, if you will, a little old lady gasping for air, and making no sound; a child hit by a truck, not screaming, but moaning; a middle aged man, complaining of chest pain earlier, now silent and slumped forward on the couch; approaching a middle aged woman involved in a car crash who's silent and not moving. These are all just tastes of the kind of terror that silence can bring in the prehospital field.
Sometimes, it's not the presence of something that serves to terrify, sometimes it's the absence. On that note, we'll see you back here on 5/16. Feel free to leave questions, comments, and concerns here, I'll be happy to read them.
Friday, April 25, 2014
Friday, April 18, 2014
Don't fear the NEIDL
The National Emerging Infectious Diseases Laboratory (NEIDL) is a $200 million dollar public health laboratory in Boston, Mass, operated by Boston University. They preform research on multiple pathogens of significant concern to public health, including Tuberculosis, which is a mounting problem in the face of the HIV and antibiotic resistance epidemics. The only problem with their laboratory is that a whole section of it- the Biohazard Safety Level 4 (BSL 4) lab- has never operated in its designed capacity due to multiple legal hurdles the NEIDL had to clear in order to prove that it was safe. First, they were required to prove that their operation was safe, and their security and biosafety measures were deemed effective by an outside company. After that, the NEIDL won a legal suit, in which a judge deemed that their biosafety measures were adequate for safe operation in south Boston. For a better idea of their security and biosafety measures, you can watch a video tour of the BSL-4 facilities at link [1]. At a glance, however, this should give you some idea of their security- if there's a fire, the fire department doesn't get in without being stopped at the gates and individually ID'd and cross-referenced to their list of Boston city firemen. If the power goes out and the negative pressure system fails, all air from the lab is drawn through multiple custom HEPA filters to remove any particulate. On top of the security and engineering controls, the facility operates under the direct supervision of the Boston Public Health, and the CDC.
Now, having cleared all other hurdles, the NEIDL is coming under fire from Boston city council member Charles Yancey, who wants to pass a city ordinance banning BSL-4 research. After all, who wants that sort of research going on in their back yard? What if there's a release? Of course, this sort of NIMBYism (Not In My Back Yard) fails to account for other sites, such as the CDC campus in downtown Atlanta, that have successfully operated BSL-4 facilities for years without a single problem. In fact, there are six BSL-4 labs in operation across the country right now, with seven more planned or under construction, with no reportable incidents yet. In fact, with about 3,000 Americans dying every year from foodborne illness, you're roughly 3,000 times more likely (more than that, since the number of BSL4 releases in the US is actually zero, not one) to be killed by a pathogen from your local fast food operation than you are to be killed by some exotic disease that somehow managed to slip through the NEIDL's biosafety measures. [3][4]
What's more is that Mr. Yancey is calling for this ban without accepting multiple offers on the NEIDL's part to give him a tour. So, the next question is, could Mr. Yancey actually succeed here? Unfortunately, the answer is yes. In 2002, shortly after the 9/11 attacks and Anthrax bioterrorism incidents, UC Davis attempted to get permission to build a BSL-4 laboratory. This attempt was subsequently rejected by the community, and the attempt was shut down for little more reason than unfounded fear, much like the situation in Boston. [5]
So what do we lose if the NEIDL is shut down? We lose out on another BSL-4 facility that could preform vital, life-saving research on emerging and clinically important pathogens in a safe setting. If we already had two dozen of these labs, it wouldn't be too big of a deal, but the fact is that we've only got six in operation now, so a seventh lab could actually mean a significant increase in clinical progress in treating globally important infections. Tired of big government waste? You're looking at it right here- a multimillion dollar public health lab being threatened because some politicians think these viruses are scary, not for any reason that's evidence based. So, what can you do? You can share this article with your friends (PLEASE share, if you ever share one of my articles, let it be this one), spread the word about what's going on in Boston, and sign this petition. http://petitions.moveon.org/sign/let-the-bsl-4-lab-open
Together, we can save the NEIDL. Together, we can save SCIENCE!
[5]http://daviswiki.org/Biosafety_Level_4_Laboratory
[4]http://www.cdc.gov/foodsafety/cdc-and-food-safety.html
[3]http://www.fas.org/programs/bio/research.html
[2]http://www.bu.edu/today/2014/researchers-cite-experts-findings-of-neidl-safety/
[1]http://www.twiv.tv/threading-the-neidl/
Now, having cleared all other hurdles, the NEIDL is coming under fire from Boston city council member Charles Yancey, who wants to pass a city ordinance banning BSL-4 research. After all, who wants that sort of research going on in their back yard? What if there's a release? Of course, this sort of NIMBYism (Not In My Back Yard) fails to account for other sites, such as the CDC campus in downtown Atlanta, that have successfully operated BSL-4 facilities for years without a single problem. In fact, there are six BSL-4 labs in operation across the country right now, with seven more planned or under construction, with no reportable incidents yet. In fact, with about 3,000 Americans dying every year from foodborne illness, you're roughly 3,000 times more likely (more than that, since the number of BSL4 releases in the US is actually zero, not one) to be killed by a pathogen from your local fast food operation than you are to be killed by some exotic disease that somehow managed to slip through the NEIDL's biosafety measures. [3][4]
What's more is that Mr. Yancey is calling for this ban without accepting multiple offers on the NEIDL's part to give him a tour. So, the next question is, could Mr. Yancey actually succeed here? Unfortunately, the answer is yes. In 2002, shortly after the 9/11 attacks and Anthrax bioterrorism incidents, UC Davis attempted to get permission to build a BSL-4 laboratory. This attempt was subsequently rejected by the community, and the attempt was shut down for little more reason than unfounded fear, much like the situation in Boston. [5]
So what do we lose if the NEIDL is shut down? We lose out on another BSL-4 facility that could preform vital, life-saving research on emerging and clinically important pathogens in a safe setting. If we already had two dozen of these labs, it wouldn't be too big of a deal, but the fact is that we've only got six in operation now, so a seventh lab could actually mean a significant increase in clinical progress in treating globally important infections. Tired of big government waste? You're looking at it right here- a multimillion dollar public health lab being threatened because some politicians think these viruses are scary, not for any reason that's evidence based. So, what can you do? You can share this article with your friends (PLEASE share, if you ever share one of my articles, let it be this one), spread the word about what's going on in Boston, and sign this petition. http://petitions.moveon.org/sign/let-the-bsl-4-lab-open
Together, we can save the NEIDL. Together, we can save SCIENCE!
[5]http://daviswiki.org/Biosafety_Level_4_Laboratory
[4]http://www.cdc.gov/foodsafety/cdc-and-food-safety.html
[3]http://www.fas.org/programs/bio/research.html
[2]http://www.bu.edu/today/2014/researchers-cite-experts-findings-of-neidl-safety/
[1]http://www.twiv.tv/threading-the-neidl/
Friday, April 11, 2014
Tapeworms
Right now, you're probably picturing a long, white, segmented, flat worm burrowing into the side of someone's intestines. Some of you probably picture hapless campers eating undercooked fish, or yuppies who don't know any better eating Sushi. Others among you may, perhaps, think that the worms are obtained from eating undercooked beef or pork. Some of you probably even imagine these worms burrowing into someone's brain. None of you are wrong- but then, you're not exactly right, either.
You see, there's not just one tapeworm that can get into people, each with their own special life cycle and possible pathogenic effects. Some of the most common tapeworms found in people are: Bovine tapeworm, Porcine Tapeworm, Fish tapeworm, and Dog tapeworm. The Bovine tapeworm is actually benign in Humans (though quite pathogenic for cattle), except in rare cases where bowel obstruction may occur- the worm, "knowing" that it's in a human, sits in your upper small intestine and simply takes a very small portion of your meals to sustain itself. You won't lose weight, contrary to popular myth, and you will likely never know if you are infested. Occasionally, a worm segment will detach and be shed from your body, ideally shedding the egg-filled segment in a grassy area where the eggs will subsequently be consumed by a cow. Once in the cow, conformational changes in the eggs occur as they pass through each of the cow's four stomachs (which is what prevents them hatching in a human) which cause them to hatch. The juvenile worms then proceed out through the intestinal wall and burrow into the cow's various bodily tissues, including muscle, organ, and brain. Once there, the worms remain dormant until the cow is slaughtered and consumed- in this case, by a human who failed to cook the meat thoroughly enough to kill the juvenile worm- completing the life cycle.[1]
As creepy as Bovine tapeworms are, they're the most benign of the various tapeworms. The next worm we'll look at is the fish tapeworm. As with the cow tapeworm, the fish tapeworm infests its host through ingestion of the juvenile stage in undercooked meat. Disease from the fish tapeworm is rare, but it can cause bowel obstruction and, in very rare cases, liver and gall bladder disease. Also, this is the largest among the tapeworms that can infest humans, growing up to thirty feet in length. Sushi lovers need not despair! The fish tapeworm has only ever been found in freshwater fish, and can be readily killed by freezing the meat. Just cook your freshwater fish, and you'll be fine. [2]
The dog tapeworm is a special cycle, where infestation of humans is a complete accident, as far as we can tell. Taenia Hydatigena, which sheds an infectious stage in canine stool, can be ingested by various mammals- typically sheep- and people. Once consumed, the worm leaves the intestine, and forms a large cyst in the abdominal cavity, where it produces more larvae and hides from the intermediate host's immune system while it's waiting for the host- and therefor, the cyst- to be eaten by a dog. If the cyst is ruptured prematurely, such as by abdominal trauma, many thousands of larvae can be released into the abdominal cavity. In Humans, the immune system can recognize the worm from the initial, infectious encounter, which can lead to the sudden onset of anaphylaxis and death subsequent to the worms' release into the abdominal cavity. Failing the rupture of the cyst, you could live a full and healthy life with this worm and be none the wiser. [3]
The Piece de Resistance here is the porcine tapeworm- Taenia Solium. The intent of the porcine tapeworm's life cycle is suspected to be much like that of the bovine worm's, in that the worm exists as a cyst-encased juvenile stage in the various tissues of a pig's body, waiting for consumption by a human. Once consumed, the juvenile develops into a fully fledged worm in the intestines of a human, and sheds eggs to be consumed by pigs. The really scary part about this worm is one of the few things that we'll go over here that's genuinely terrifying- the worm's eggs cannot tell the difference between a human gut tract and a porcine gut tract. If you were to eat bovine tapeworm eggs, no disease would develop. If, however, you were to consume porcine tapeworm eggs because, say, a restaurant chef who is infested didn't wash their hands after they had a stool, the eggs would hatch, and you would develop Cysticercosis (the juvenile stage of the worm in your various tissues). One famous form of this is Neurocysticercosis, where you actually develop juvenile stage worm cysts in your brain, potentially with pathogenic effects, including seizures, headaches, confusion, excess fluid on the brain, difficulty maintaining balance, and death (severity dependent on the number of cysts). What makes it scary is that its epidemiology is subtle and hard to avoid- it's not somebody sneezing, pouring blood out of every pore, or eating undercooked meat; it's as easy as someone else not washing their hands.[4][5][6]
So what can you do? WASH YOUR FILTHY MEAT HOOKS. Washing your hands regularly and after you use the bathroom is how you can help prevent the spread of almost every transmissible disease. There are medications you can take that will treat tapeworm infestation, so see your practitioner if you suspect that you're infected. Make sure that you cook all your meat thoroughly before consumption. As always, you can help by sharing what you've learned here (and sharing the facebook post it rode in on), doing your own research, and supporting those who support science! If you have any questions, comments, or concerns, feel free to leave them on the blog here, or ask me on the facebook post.
[1]http://bioweb.uwlax.edu/bio203/s2009/temanson_caro/Life%20Cycle.htm
[2]http://www.cdc.gov/parasites/diphyllobothrium/
[3]http://www.vetsonline.com/publications/veterinary-times/archives/n-43-46/cysticercosisa-a-controlling-tapeworm-in-dogs-and-sheep.html
[4]http://www.cdc.gov/parasites/taeniasis/biology.html
[5]http://www.cdc.gov/parasites/cysticercosis/disease.html
[6]http://www.cdc.gov/parasites/cysticercosis/
You see, there's not just one tapeworm that can get into people, each with their own special life cycle and possible pathogenic effects. Some of the most common tapeworms found in people are: Bovine tapeworm, Porcine Tapeworm, Fish tapeworm, and Dog tapeworm. The Bovine tapeworm is actually benign in Humans (though quite pathogenic for cattle), except in rare cases where bowel obstruction may occur- the worm, "knowing" that it's in a human, sits in your upper small intestine and simply takes a very small portion of your meals to sustain itself. You won't lose weight, contrary to popular myth, and you will likely never know if you are infested. Occasionally, a worm segment will detach and be shed from your body, ideally shedding the egg-filled segment in a grassy area where the eggs will subsequently be consumed by a cow. Once in the cow, conformational changes in the eggs occur as they pass through each of the cow's four stomachs (which is what prevents them hatching in a human) which cause them to hatch. The juvenile worms then proceed out through the intestinal wall and burrow into the cow's various bodily tissues, including muscle, organ, and brain. Once there, the worms remain dormant until the cow is slaughtered and consumed- in this case, by a human who failed to cook the meat thoroughly enough to kill the juvenile worm- completing the life cycle.[1]
As creepy as Bovine tapeworms are, they're the most benign of the various tapeworms. The next worm we'll look at is the fish tapeworm. As with the cow tapeworm, the fish tapeworm infests its host through ingestion of the juvenile stage in undercooked meat. Disease from the fish tapeworm is rare, but it can cause bowel obstruction and, in very rare cases, liver and gall bladder disease. Also, this is the largest among the tapeworms that can infest humans, growing up to thirty feet in length. Sushi lovers need not despair! The fish tapeworm has only ever been found in freshwater fish, and can be readily killed by freezing the meat. Just cook your freshwater fish, and you'll be fine. [2]
The dog tapeworm is a special cycle, where infestation of humans is a complete accident, as far as we can tell. Taenia Hydatigena, which sheds an infectious stage in canine stool, can be ingested by various mammals- typically sheep- and people. Once consumed, the worm leaves the intestine, and forms a large cyst in the abdominal cavity, where it produces more larvae and hides from the intermediate host's immune system while it's waiting for the host- and therefor, the cyst- to be eaten by a dog. If the cyst is ruptured prematurely, such as by abdominal trauma, many thousands of larvae can be released into the abdominal cavity. In Humans, the immune system can recognize the worm from the initial, infectious encounter, which can lead to the sudden onset of anaphylaxis and death subsequent to the worms' release into the abdominal cavity. Failing the rupture of the cyst, you could live a full and healthy life with this worm and be none the wiser. [3]
The Piece de Resistance here is the porcine tapeworm- Taenia Solium. The intent of the porcine tapeworm's life cycle is suspected to be much like that of the bovine worm's, in that the worm exists as a cyst-encased juvenile stage in the various tissues of a pig's body, waiting for consumption by a human. Once consumed, the juvenile develops into a fully fledged worm in the intestines of a human, and sheds eggs to be consumed by pigs. The really scary part about this worm is one of the few things that we'll go over here that's genuinely terrifying- the worm's eggs cannot tell the difference between a human gut tract and a porcine gut tract. If you were to eat bovine tapeworm eggs, no disease would develop. If, however, you were to consume porcine tapeworm eggs because, say, a restaurant chef who is infested didn't wash their hands after they had a stool, the eggs would hatch, and you would develop Cysticercosis (the juvenile stage of the worm in your various tissues). One famous form of this is Neurocysticercosis, where you actually develop juvenile stage worm cysts in your brain, potentially with pathogenic effects, including seizures, headaches, confusion, excess fluid on the brain, difficulty maintaining balance, and death (severity dependent on the number of cysts). What makes it scary is that its epidemiology is subtle and hard to avoid- it's not somebody sneezing, pouring blood out of every pore, or eating undercooked meat; it's as easy as someone else not washing their hands.[4][5][6]
So what can you do? WASH YOUR FILTHY MEAT HOOKS. Washing your hands regularly and after you use the bathroom is how you can help prevent the spread of almost every transmissible disease. There are medications you can take that will treat tapeworm infestation, so see your practitioner if you suspect that you're infected. Make sure that you cook all your meat thoroughly before consumption. As always, you can help by sharing what you've learned here (and sharing the facebook post it rode in on), doing your own research, and supporting those who support science! If you have any questions, comments, or concerns, feel free to leave them on the blog here, or ask me on the facebook post.
[1]http://bioweb.uwlax.edu/bio203/s2009/temanson_caro/Life%20Cycle.htm
[2]http://www.cdc.gov/parasites/diphyllobothrium/
[3]http://www.vetsonline.com/publications/veterinary-times/archives/n-43-46/cysticercosisa-a-controlling-tapeworm-in-dogs-and-sheep.html
[4]http://www.cdc.gov/parasites/taeniasis/biology.html
[5]http://www.cdc.gov/parasites/cysticercosis/disease.html
[6]http://www.cdc.gov/parasites/cysticercosis/
Friday, April 4, 2014
Humanity
The tides of real life have kept me pretty occupied lately, so instead of completely compromising on the quality of an article, I'm going to share something that I think everyone needs to watch in order to be a citizen of the world. At the time, Charlie Chaplain was trying to urge the US government to abandon its policy of appeasement towards Nazi Germany with his movie "The Great Dictator", but his words remain just as applicable today. Enjoy the video, please share it with a friend, we'll see you next week.
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