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• Beginning to Understand the Effect of the Human Microbiome on Health
• Picosecond Laser Tattoo Treatment
• Hunting for "the" MS Autoantibody
• Dalfampridine (4-aminopyridine) Poses Seizure Risk for Multiple Sclerosis Patients
• CDC: Trained Pharmacists Must Be Involved in Dividing Single-use Vials
• Obesity's Effects on Duration of Labor
• Effect on Resting Energy Expenditure of Three Maintenance Diets
• New Position Statement for Managing Type 2 Diabetes
• Natural History of Subclinical Hypothyroidism in Older Adults
• Moderate Alcohol Consumption Is Associated with Lower Risk for Rheumatoid Arthritis
• Assisted Reproductive Technology: Cumulative Live-Birth Rates Offer Hope to
Infertile Couples
• Silymarin Is Ineffective for Chronic Hepatitis C Virus Infection
• Long-Term Cure Rates from Fecal Transplantation for C. Difficile Infection
• Does Dog or Cat Exposure Protect Against Respiratory Tract Infections During the
First Year of Life?
• Guillain-Barré Syndrome After Influenza Vaccination
• Dark Chocolate Affirmed as Brain-Booster
MM: We have been touting the benefits of probiotics for well over a decade. It seems that probiotic research has finally become completely mainstream. This article states, rather well, how important probiotics are to our daily life as well as to the numerous disease states that we as humans are potentiallty subject to. Unfortunately there will be many who will try to take advantage of the public by providing limited or incorrect information to consumers about probiotics. This is an area that has tremendous opportunity for abuse. My staff, colleagues and I have, and will, strive to inform, educate and protect our patients and the public in general from misinformation and disinformation regarding probiotics.
Nature 2012 Jun 14; 486:207
Beginning to Understand the Effect of the Human Microbiome on Health
Each of us harbors 10 times more microbial cells than human cells in our bodies — Can we live in peace?
From shortly after we are born, each of us lives with 10 times as many microbial cells as human cells in our bodies. The metabolism of human cells influences that of microbial cells and vice versa. For that reason, the collection of microbial genes (the microbiome) has been called "the second human genome."
The microbiome has been implicated as a cofactor in diseases as diverse as obesity (JW Gen Med Jan 2 2007), inflammatory bowel disease (JW Gen Med Jun 19 2008), cancer (JW Gen Med Nov 3 2011), psoriasis, nonalcoholic fatty liver disease, insulin resistance and type 2 diabetes, asthma, and even autism.
The advent of rapid and relatively inexpensive genome sequencing (JW Gen Med Oct 4 2005) fueled international efforts to study the microbiome. The Human Microbiome Project collected repeated samples from 18 body sites of 242 healthy adults in the U.S. and reported its findings in 17 newly published reports, 2 of which are summarized here.
Along with roughly 20,000 human genes, 5 to 8 million bacterial genes exist in the microbiome. The greatest number and variety of microbes are found in the mouth and gut, and the smallest variety is found in the vagina. Different species dominate in each body niche. Microbial species are influenced by body weight, ethnic and racial background, and geographical location (e.g., developed vs. developing world).
Comment: These studies are just building a foundation for a huge new field in biology and medicine. Researchers haven't proved yet how the human microbiome affects normal human physiology or leads to disease, and some skeptics doubt they ever will. But if they do, these papers will be regarded as landmarks in the history of human biology.
— Anthony L. Komaroff, MD Published in Journal Watch General Medicine July 24, 2012
Citation(s): The Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature 2012 Jun 14; 486:207.
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MM: This is very exciting stuff. Over the past 25 years I have had dozens of people come into the pharmacy in agony from the painful removal of tattoos that they obtained earlier in their lives. Previous processes have led to discomfort, scarring and many repeatitive treatments. This new process appears much less painful and much more effective. More advancement will be needed to take care of a greater variety of tattoo removal but this certainly changes the game for now.
Arch Dermatol 2012 Jul; 148:820
Picosecond Laser Tattoo Treatment
A new laser effectively fades blue and green ink.
Tattoos are in great demand, but the desire to get rid of them is also great. The Q-switched lasers in current use have pulse durations in the 10–100 nanosecond range; for tattoo removal, many treatments are required for successful fading. The authors of this case series report their experience with a new 750–900-picosecond pulse duration, 755-nm alexandrite laser. The new laser was used to treat 12 multicolored tattoos, 10 previously untreated and 2 recalcitrant after at least 10 prior Q-switched laser treatments. Eleven patients underwent one treatment, and one patient underwent two treatments, under topical or local anesthesia with energy fluences of 2.0–2.8 J/cm2.
At the 1 month follow-up, 11 tattoos had greater than 75% clearance of blue and green pigment after only one treatment; more than two thirds had almost 100% fading of these colors. A 12th, all-green tattoo had greater than 75% fading after a second treatment. Better than 75% fading of purple pigment was also noted, but other colors faded 25% or less. On a scale of 1 to 10, patients gave the treatment an average pain score of 1.08. No prolonged pigmentary changes or scarring were observed.
Comment: Using shorter pulse durations in the picosecond range seems to dramatically accelerate tattoo pigment fading. How colors respond depends on laser wavelength; 755 nm is especially effective for blue, green, and purple ink — some of the most resistant colors with current technology. With the significantly lower energy fluences needed for the shorter pulse durations, the pain of treatment also seems to be far less. This is the first new technological development in tattoo treatment in 2 decades, but to be truly useful, additional wavelengths will be needed to deal with the multitude of colors that make up many tattoos.
— George J. Hruza, MD Published in Journal Watch Dermatology July 27, 2012
Citation(s): Brauer JA et al. Successful and rapid treatment of blue and green tattoo pigment with a novel picosecond laser. Arch Dermatol 2012 Jul; 148:820
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N Engl J Med 2012 Jul 12; 367:115.
Hunting for "the" MS Autoantibody
An antibody to a glial potassium channel was present in almost half of a cohort of patients with MS and resulted in inflammation when injected into mice.
Multiple sclerosis (MS) is thought to be an autoimmune disease, but the pathogenetic autoantibody has not been identified. In search of such an autoantibody, researchers isolated immunoglobulin G (IgG) antibodies from the serum of 12 individuals with MS. The antibodies were enriched for antigenicity against central nervous system membranes, separated by isoelectric focusing, and analyzed by gel electrophoresis and mass spectrometry.
One electrophoresis spot contained KIR4.1, a potassium channel on astroglia thought to affect myelin development and axonal signal transduction. Among 397 people with MS who were tested, 186 (46.9%) had antibodies to KIR4.1, compared with 3 of 329 (0.9%) with other neurological diseases and none of 59 healthy controls. Anti-KIR4.1 was also found in the cerebrospinal fluid of 19 of 30 patients with MS, with evidence of intrathecal antibody synthesis in 2 of the 19. No correlation was found between anti-KIR4.1 positivity and disease subtype or clinical characteristics. When the researchers injected human IgG KIR4.1 antibodies into mice, the mice demonstrated altered glial fibrillary acidic protein expression, loss of KIR4.1 expression, and complement deposition.
Comment: The cause of MS remains unknown. MS is thought to be caused by complex and heterogenous interactions of environment and genes. Here, investigators identified and validated an autoantibody that appears to be present in almost half of patients with MS. The antibody results in altered glial expression and complement deposition when injected into mice. Whether anti-KIR4.1 antibody production is one of the inciting events toward MS development is unclear, but its discovery provides a clue to disease pathogenesis and is a potential target for therapeutic manipulation. Although there may not be a "the" autoantibody in MS, the KIR4.1 protein may be an important part of the puzzle and will help incite new lines of research into MS pathogenesis, disease initiation, and propagation.
— Robert T. Naismith, MD Published in Journal Watch Neurology July 24, 2012
Citation(s): Srivastava R et al. Potassium channel KIR4.1 as an immune target in multiple sclerosis. N Engl J Med 2012 Jul 12; 367:115.
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Dalfampridine (4-aminopyridine) Poses Seizure Risk for
Multiple Sclerosis Patients
Ampyra was approved to improve walking in patients with MS. Seizures are a known side effect of Ampyra, and seizure risk increases with higher blood levels of the drug. The majority of seizures happened within days to weeks after starting the recommended dose and occurred in patients having no history of seizures. The FDA is updating the Ampyra drug label to clarify recommendations. Ampyra should be discontinued permanently if a seizure occurs.
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MM: Mark Drugs has been a leader in the aseptic preparation of products for sterile and surgical use throughout Chicagoland for more than 20 years. Many hospitals, clinics and physicians have turned to Mark Drugs and continue to use our services to help provide drugs that are in short supply to their patients. Whether this means making sterile products from the raw ingredients or re-packaging existing inventory, it is imperative to patient safety that "splitting vials" of single dose vials into multiple smaller unit doses be done in a proper environment with properly trained technicians or pharmacists. Mark Drugs has the expertise, training and skill to perform these tasks in our labs. Please contact us for more information so that we may help meet your institution's needs.
CDC: Trained Pharmacists Must Be Involved in Dividing Single-use Vials
Following two outbreaks of Staphylococcus aureus infection in 10 patients being treated for pain in outpatient clinics, the CDC is strongly urging providers faced with drug shortages to avoid using single-dose vials (SDVs) or single-use medications for more than one patient unless the formulation is prepared by a "high-quality" pharmacy. In both cases, the clinics reported that they were unable to obtain smaller vial sizes needed by patients either because of drug shortages or because the smaller size wasn't being manufactured.
The outbreaks are a reminder of the serious consequences that can result when SDVs are used for more than one patient. If SDVs must be used for more than one patient, full adherence to United States Pharmacopeia standards is critical to minimize the risks that be associated with of "multipatient use."
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Obstet Gynecol 2012 Jul; 120:130
Obesity's Effects on Duration of Labor
Obese women took longer to progress from 4-cm to 6-cm cervical dilation.
Maternal obesity is a risk factor for cesarean delivery, complications of which affect obese women disproportionately. In a retrospective cohort study designed to estimate the effects of obesity on labor progression, investigators compared duration of labor as a function of body-mass index (BMI) among women with full-term, singleton pregnancies who completed the first stage of labor.
Among 5204 women, 53.6% were obese (BMI 30 kg/m2) and 10.8% had BMIs >40. Obese women were older, had higher gravidity and parity, were more often black, and had more medical comorbidities than normal-weight women. After adjusting for parity, labor induction, race, and birth weight >4000 g, median time to progress from 4 cm to complete dilation was longer for obese than for nonobese women (4.7 hours versus 4.1 hours). When assessed in 2-cm intervals, the greatest difference between groups was during the latent phase (i.e., progression from 4 cm to 6 cm; 2.2 hours vs. 1.9 hours). No difference was found after 6-cm dilation.
Comment: The relation between obesity and first-stage labor progression seems to be strongest during the latent phase. The authors comment that existing criteria for normal labor progression might need to be changed to accommodate obese women. Their findings suggest that standard definitions of labor arrest may be especially inappropriate for obese women, possibly leading to unnecessary cesarean deliveries. Interestingly, others have suggested that, in general, the definition of active labor should be adjusted to reflect current patterns of progression (JW Womens Health Dec 16 2010).
— Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC Published in Journal Watch Women's Health July 26, 2012
Citation(s): Norman SM et al. The effects of obesity on the first stage of labor. Obstet Gynecol 2012 Jul; 120:130.
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JAMA 2012 Jun 27; 307:2627
Effect on Resting Energy Expenditure of Three Maintenance Diets
A low-carbohydrate diet, even if higher in fat, produced the best results.
Patients who diet often regain all or part of lost weight, possibly because calorie restriction induces a decline in resting energy expenditure (REE). Whether the composition of the maintenance diet affects this decrease in REE was assessed in 21 overweight and obese adults (mean age, 30; mean body-mass index, 34 kg/m2).
After a run-in period of 12 weeks on a high-protein diet that resulted in a mean weight loss of 14.3 kg (13.6% of baseline body weight), participants were assigned to a random sequence of three different diets for 4 weeks each. The three test diets were low-fat (60% carbohydrate), moderate-carbohydrate (40% carbohydrate), and very low-carbohydrate (10% carbohydrate, 30% protein, 60% fat). REE was measured for each diet and compared with pre–weight-loss measures. The decline in REE was greatest for the low-fat diet (205 kcal/day), least for the very low-carbohydrate diet (138 kcal/day), and intermediate for the moderate-carbohydrate diet. Changes in several metabolic parameters (leptin, HDL cholesterol, triglycerides, and insulin sensitivity) also were more favorable for the very low-carbohydrate diet.
Comment: In the short term, a low-carbohydrate diet might be more effective for both weight loss and for improving several metabolic parameters, even if high in fat content. However, the best maintenance diet that leads to favorable clinical outcomes in the long term is unclear.
— Thomas L. Schwenk, MD Published in Journal Watch General Medicine July 10, 2012
Citation(s): Ebbeling CB et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 2012 Jun 27; 307:2627.
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Diabetes Care 2012 Jun; 35:1364
New Position Statement for Managing Type 2 Diabetes
A one-size-fits-all approach is rejected.
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have published a new position statement entitled, "Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach." The document outlines basic elements of lifestyle modification, oral agents, noninsulin injectable agents, and insulin, and provides management tips that even experienced clinicians might find helpful. Two aspects of the report are particularly noteworthy:
- Acknowledging "mounting concerns about . . . potential adverse effects [of drug therapies] and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications," the authors emphasize a patient-centered approach with individualized targets for glycemic control. For example, they recommend more-stringent control (e.g., glycosylated hemoglobin [HbA1c] target, <7%) for motivated patients with new-onset diabetes and long life expectancies, and less-stringent control (e.g., HbA1c goal, 8% or even higher) for less-motivated patients with longstanding diabetes, limited life expectancies, and high risk for adverse outcomes from hypoglycemia.
- Because the authors reject a one-size-fits-all approach, they make this important statement: "Utilizing the percentage of diabetic patients who are achieving an HbA1c <7% as a quality indicator, as promulgated by various health care organizations, is inconsistent with the emphasis on individualization of treatment goals."
Comment: Many clinicians talk about getting their patients with type 2 diabetes "to goal," as if a single, evidence-based target was applicable to every patient. Others talk about being "dinged" by real or imagined organizations if their patients' HbA1c levels are not in a certain range. In contrast, this position statement supports a more-reasoned approach that involves shared decision making and flexible goals. In a worthwhile accompanying editorial, the author describes the process that resulted in this position statement. One note: Nine of the 10 authors of the statement each have financial ties to numerous pharmaceutical companies.
— Allan S. Brett, MD Published in Journal Watch General Medicine July 24, 2012
Citation(s): Inzucchi SE et al. Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012 Jun; 35:1364.
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MM: It is not unusual for patients of all ages who are exhibiting symptoms of subclinical hypothyroidism to show reversals of these symptoms when presented with supplements such as iodine, selenium, zinc, vanadium and the B vitamins. The Licensed Dietitian or Pharmacists at Mark Drugs can provide you with more information and guidance to assess if any of these nutritional products may be appropriate for you or a loved one.
J Clin Endocrinol Metab 2012 Jun; 97:1962
Natural History of Subclinical Hypothyroidism in Older Adults
Some people revert back to euthyroid status.
Because thyroid testing is performed widely in older adults, clinicians often encounter cases of subclinical hypothyroidism (i.e., elevated serum thyroid-stimulating hormone [TSH] and normal serum free thyroxine [T4] levels). According to the authors, this U.S. study is the largest longitudinal cohort study of the natural history of subclinical hypothyroidism in older community-dwelling adults. About 3600 people (age, 65; mean age, 75) were tested at baseline; those with subclinical hypothyroidism (TSH level 4.5 mIU/L) were retested at 2 and 4 years.
At baseline, 13 of every 100 people exhibited subclinical hypothyroidism. The figure shows outcomes for 13 hypothetical participants with subclinical hypothyroidism at 2 and 4 years. Participants moved back and forth between the euthyroid and subclinical hypothyroid categories. Higher baseline TSH levels (e.g., 7–10 vs. 4.5–6.9 mIU/L) and baseline presence of antithyroid peroxidase antibodies predicted a lower likelihood of reverting to euthyroidism. Relatively few people progressed to overt hypothyroidism.
Comment: These data provide estimates that clinicians might find useful in following older patients with subclinical hypothyroidism; in a nontrivial proportion of such patients, subsequent TSH levels revert to the euthyroid range. However, the study doesn't address the controversial issue of whether early thyroid supplementation benefits older patients with persistent subclinical hypothyroidism.
— Allan S. Brett, MD Published in Journal Watch General Medicine July 24, 2012
Citation(s): Somwaru LL et al. The natural history of subclinical hypothyroidism in the elderly: The Cardiovascular Health Study. J Clin Endocrinol Metab 2012 Jun; 97:1962.
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BMJ 2012 Jul 10; 345:e4230
Moderate Alcohol Consumption Is Associated with Lower Risk for Rheumatoid Arthritis
In a prospective study, risk was 40% to 50% lower in older women who weren't teetotalers.
Alcohol consumption lowers production of proinflammatory molecules, and an inverse relation between alcohol consumption and risk for rheumatoid arthritis (RA) has been observed previously in case-control studies. To test this association prospectively, researchers conducted a population-based cohort study of more than 34,000 Swedish women (age, 39 in 1987). Participants provided data on alcohol consumption in 1987 and 1997.
During follow-up from 2003 until 2009, 197 new cases of RA were identified. The multivariable adjusted relative risk for RA during follow-up was 37% lower in women who drank >4 glasses of alcohol (1 glass = 15 g of ethanol) weekly in 1997 than in women who drank <1 glass of alcohol weekly. Similarly, adjusted risk for RA was 52% lower in women who drank >3 glasses of alcohol weekly in both 1987 and 1997 than in never drinkers.
Comment: This prospective study affirms that moderate alcohol consumption is associated with lower risk for rheumatoid arthritis in women. The investigators note that their results are consistent with the known inverse relation between alcohol consumption and coronary heart disease risk (JW Gen Med Mar 15 2011) and "add to the evidence that moderate alcohol consumption is not harmful and can be protective against" chronic disease.
— Paul S. Mueller, MD, MPH, FACP Published in Journal Watch General Medicine July 26, 2012
Citation(s): Di Giuseppe D et al. Long term alcohol intake and risk of rheumatoid arthritis in women: A population based cohort study. BMJ 2012 Jul 10; 345:e4230.
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N Engl J Med 2012 Jun 28; 366:2483
Assisted Reproductive Technology: Cumulative Live-Birth Rates Offer Hope to Infertile Couples
Cumulative live-birth rates can approach those arising from spontaneous conception.
Assisted reproductive technology has helped infertile couples build families for more than 20 years, yielding almost 4 million births worldwide. Just how successful is this approach, and under what conditions is it most apt to result in babies? Registries worldwide commonly refer to "per cycle" pregnancy rates, but what matters to the individual patient is her own likelihood of having a baby. U.S. investigators used the nationwide database of the Society for Assisted Reproductive Technology from 2004 through 2009 to link cycles to individual women, thereby estimating cumulative live-birth rates per cycle. Conservative rates were calculated on the assumption that women who did not return for subsequent treatment would not experience live birth; optimal rates assumed that women who did not return for treatment would experience live-birth rates similar to those who continued treatment.
Data were derived from 246,740 women who underwent 471,208 cycles resulting in 140,859 live births. Live births occurred in 30% of cycles and 57% of women; rates were highest in women younger than 31 and fell with advancing maternal age. After three cycles, conservative and optimal live-birth rates with autologous oocytes in women younger than 31 were 63.3% and 74.6%, respectively. These rates were only 18.6% and 27.8%, respectively, in women aged 41 or 42 and were 6.6% and 11.3% in those 43 or older. When donor oocytes were used, conservative and optimal rates were >60% and >80%, respectively, regardless of recipients' maternal age.
Comment: If only it were this simple! Although live-birth rates with assisted reproductive technology have improved impressively, procedures remain stressful and costly, and discontinuation rates are high (in this study, 25% of women discontinued treatment after unsuccessful first cycles and 33% after subsequent cycles). Still, this study confirms just how much these procedures have advanced; furthermore, the findings make a strong case for encouraging use of donor oocytes in infertile women who are 43 or older.
— Robert W. Rebar, MD Published in Journal Watch Women's Health June 27, 2012
Citation(s): Luke B et al. Cumulative birth rates with linked assisted reproductive technology cycles. N Engl J Med 2012 Jun 28; 366:2483.
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MM: It's important to constantly review data irrespective of whether it coincides with the conventional paradigm or if it is in opposition. This is the only way that we can learn and grow. This study is large and appears well structured yet its results fly in the face of other studies that have shown conflicting results. I wouldn't give up on the use of milk thistle as it may have a synergistic effect on the use of other conventional products. After all, conventional medicine has little to offer at this time for HCV so I'm keeping my eyes and mind open.
JAMA 2012 Jul 18; 308:274
Silymarin Is Ineffective for Chronic Hepatitis C Virus Infection
In the most rigorous trial to date, oral silymarin was not superior to placebo in decreasing disease activity.
Silymarin is a botanical extract of milk thistle commonly used by patients with liver disease. In vitro studies have demonstrated antiviral, anti-inflammatory properties of silymarin in hepatitis C virus (HCV) replicon systems. However, the few efficacy studies conducted in patients with chronic HCV infection have produced mixed results.
In a new multicenter, double-blind, placebo-controlled efficacy trial, investigators randomized 154 patients (median age, 54; 71% men) with chronic HCV infection who previously failed interferon-based therapy to receive 420 mg of silymarin, 700 mg of silymarin, or placebo three times daily for 24 weeks. The two oral doses of pure silymarin were determined by earlier dose finding studies and were three to five times higher than concentrations used in previous studies. The primary endpoint was a serum alanine aminotransferase (ALT) level of 45 U/L or a 50% reduction from baseline ALT to a level <65 U/L. Secondary endpoints included HCV RNA levels and quality-of-life indicators.
After 24 weeks of treatment, only two patients in each group achieved the primary endpoint. The mean decline in ALT levels at the end of treatment, the mean change in HCV RNA levels, and the quality-of-life indicators did not differ among the three groups.
Comment: This trial definitively demonstrates that silymarin, even at three to five times the typical dose, is ineffective in treating patients with chronic HCV infection. Unlike previous trials, this study used a pure, quantifiable formulation of silymarin and well-defined outcomes, its cohort was large and representative of the patient population, the treatment period was sufficiently long, and both medication and visit adherence rates were high. Clinicians should quote this study when addressing patients' questions regarding the use of milk thistle for treating HCV infection.
— Atif Zaman, MD, MPH Published in Journal Watch Gastroenterology July 27, 2012
Citation(s): Fried MW et al. Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: A randomized controlled trial. JAMA 2012 Jul 18; 308:274
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MM: We've visited this topic several times in the past in these article lists. Historically, it has been considered by conventional, allopathic medicine as unique and has been typically rejected as "too alternative" or irresponsible. It appears that once again, what was extremely new and revolutionary a short while ago may find a place in conventional allopathic medicine. As we become more wary across society of the flagrant use and subsequent failure of antibiotics we will continue to look for other economic options that will not coome back and bite us further down the road. This may not be the complete answer. Time will tell, but like probiotics, I will not be surprised if we see more and more of this treatment finding its way into hospitals and GI clinics across the country.
Am J Gastroenterol 2012 Jul; 107:1079
Long-Term Cure Rates from Fecal Transplantation for C. Difficile Infection
Symptoms were resolved for at least 90 days in 91% of patients.
Recent studies have described the benefits of fecal transplantation in patients with recurrent Clostridium difficile infections (JW Gastroenterol Mar 30 2012 and JW Gastroenterol Jun 4 2010).
To study the long-term effects of fecal transplantation, investigators conducted a multicenter follow-up study of 77 adults (mean age, 65; 73% women) who underwent the procedure for refractory C. difficile colitis. On average, patients had experienced diarrhea symptoms for 11 months and had failed to respond to five antimicrobial regimens prior to fecal transplantation.
Results were as follows:
- Diarrhea symptoms resolved in 74% of patients in 3 days.
- Diarrhea symptoms resolved in 82% of patients and improved in 17% within an average of 5 days (range, 1–60 days).
- The primary cure rate (resolution of symptoms without recurrence within 90 days) was 91%.
- Of seven patients who did not respond to treatment or experienced recurrence of symptoms within 90 days, four were treated successfully with vancomycin with or without probiotics, two failed to respond to vancomycin but did respond to repeat transplant, and one died in hospice care of unknown cause without undergoing treatment for recurrence.
- The secondary cure rate (resolution of symptoms after an additional course of vancomycin with or without repeat transplant) was 98%.
- Of all patients, 53% stated they would use fecal transplant as their preferred first-line therapy for another recurrence.
- No definite complications occurred, but four patients developed new medical conditions, including peripheral neuropathy, Sjögren syndrome, idiopathic thrombocytopenic purpura, and rheumatoid arthritis.
Comment: These data provide additional support for the use of fecal transplantation in patients with refractory C. difficile infections.
— Douglas K. Rex, MD Published in Journal Watch Gastroenterology July 27, 2012
Citation(s): Brandt LJ et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol 2012 Jul; 107:1079.
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MM: We have had dogs since I was a small child. My kids have been raised with a dog always nearby and my brother swears by his cats. Whatever the pet is, we, as humans will benefit. Our kids have been blessed with few infections and very few prescriptions for antibiotics. Have the pets helped with this? Perhaps. In any case, I wouldn't give up the added benefits that my children have had to train, take care of and receive the love and affection that they have received from these four legged housemates.
Pediatrics 2012 Jul 9
Does Dog or Cat Exposure Protect Against Respiratory Tract Infections During the First Year of Life?
In this prospective study, dog contact was more protective than cat contact, but the results leave the question unresolved.
Upper respiratory tract infections are common during the first year of life, and numerous studies have identified factors that either increase (e.g., day care attendance) or decrease (e.g., breast-feeding) risk. The role of animal exposure in early respiratory tract infections is less certain. In this study, researchers examined the effect of dog and cat contact on respiratory symptoms in a prospective birth cohort of 397 children in Finland.
The children were followed for 1 year, and parents completed weekly diary questionnaires about symptoms, antibiotic use, and amount of contact with dogs or cats at home. In univariate analysis of 17,124 diary weeks, children who were exposed to dogs or cats at home had significantly fewer weeks with cough, rhinitis, and otitis symptoms and fewer courses of antibiotics than children who had no contact. In adjusted multivariate analysis, children who had contact with a dog had significantly more healthy weeks (adjusted odds ratio, 1.31; 95% confidence interval, 1.13–1.52; P<0.001) and used fewer antibiotics (aOR, 0.71; 95% CI, 0.52–0.96; P=0.03) than children without dogs at home. Cats did not have a significant protective effect in multivariate analysis.
Comment: As an animal lover, I would like to believe that dogs and cats in the home protect against respiratory illness during the first year of life. However, this prospective study showed only a modest benefit and did not account for day care attendance. It's probably safe to conclude that as far as respiratory infections are concerned, having a dog or cat at home at least does no harm.
— Peggy Sue Weintrub, MD Published in Journal Watch Pediatrics and Adolescent Medicine July 25, 2012
Citation(s): Bergroth E et al. Respiratory tract illnesses during the first year of life: Effect of dog and cat contacts. Pediatrics 2012 Jul 9; [e-pub ahead of print].
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JAMA 2012 Jul 11; 308:175.
Guillain-Barré Syndrome After Influenza Vaccination
The potential risk for GBS warrants vigilance but should not discourage vaccination.
Guillain-Barré Syndrome (GBS) is an acute immune-mediated inflammatory polyradiculoneuropathy that may follow triggering events such as infections and vaccination. The relative risk for GBS ("extensive" paresis or paralysis) after administration of the 1976–1977 inactivated swine influenza A (H1N1) vaccine was significantly increased, ranging from 4.0 to 7.8 for the 6-week period following vaccination. Studies of influenza vaccination in subsequent years, however, have found either no increase in risk (for the years 1978–1988; N Engl J Med 1981; 304:1557 and Am J Epidemiol 1991; 133:952) or an increase of about one case of GBS per million vaccinations (for 1992–1994; N Engl J Med 1998; 339:1797). To assess the potential association between vaccination against the 2009 pandemic influenza A (H1N1) virus and GBS, researchers conducted a population-based cohort study, following vaccination against this strain in 57% of the 7.8 million residents in Quebec.
Active surveillance identified 25 cases of GBS within 8 weeks after vaccination; most cases (19 of 25) occurred within 4 weeks after vaccination. Another 58 cases occurred in individuals considered unexposed. All cases were confirmed by medical record review. Compared with the unexposed group, the vaccine-exposed group had a significantly higher relative risk for GBS at both 4 and 8 weeks (2.75 and 1.80, respectively). The number of GBS cases attributed to vaccination was approximately two cases per 1 million vaccine doses, with the excess risk confined to people older than 50.
Comment: Concerns about the potential association between influenza vaccination and GBS have persisted for almost 30 years, despite repeated studies showing either no increased risk or a marginal increase. The observations made in Quebec following the 2009 influenza A (H1N1) vaccination campaign are of interest for a few reasons. An increased risk for GBS was observed, and the increased risk was evident only in the 4-week period following vaccination and only in those older than 50. By contrast, in the 1992–1994 period, the excess risk was confined to those younger than 65.
The combined epidemiological data suggest that the risk for GBS following influenza vaccination varies from year to year (probably as a function of the different immunogenic composition of the vaccine each year), that the age group at risk cannot easily be predicted, and that we should remain vigilant. These data, however, do not suggest that the potential increased risk for GBS should discourage people from seeking influenza vaccination.
— Michael Benatar, MD, MS, PhD Published in Journal Watch Neurology July 24, 2012
Citation(s): De Wals P et al. Risk of Guillain-Barré syndrome following H1N1 influenza vaccination in Quebec. JAMA 2012 Jul 11; 308:175.
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Dark Chocolate Affirmed as Brain-Booster
Official French evidence review concludes that dark, antioxidant-rich chocolate or cocoa can protect or improve brain function and mood
by Craig Weatherby
Headlines touting the health benefits of raw cocoa – and extra-dark chocolate bars made from it – aren't just hype. While limited, the clinical evidence for dark chocolate's artery-health and blood-flow benefits is almost entirely positive … and its plausibility is supported by bountiful lab evidence.
Earlier this month, the famously hard-nosed European Food Safety Authority approved this health claim for extra-dark (80% cocoa) chocolate: "cocoa flavanols help maintain endothelium-dependent vasodilation which contributes to normal blood flow." The EFSA's approval was based on evidence that daily intake of 200mg of cocoa flavanols – which include epicatechins and procyanidins – promotes optimal blood circulation. This amount of cocoa flavanols can be gotten from 2.5 grams (about one-tenth ounce) of "raw," non-Dutched cocoa powder or 10 grams (about one-third ounce) of 80% extra-dark chocolate.
(Most cocoa brands treat their cocoa with alkali – the process known as "Dutching" – which destroys some 90 percent of its healthful flavanols.)
Some chocolate is made with Dutched, low-flavanol cocoa, while some brands – including Vital Choice – use non-Dutched, high-flavanol cocoa. More recently, clinical research has linked cocoa's flavanols to enhanced brain health.
For example, see "Extra-Dark Chocolate Eased Memory Tasks", "Cocoa May Boost Eyes and Brain", and related articles in the Cocoa, Tea & Coffee section of our news archive. And those indications have just been affirmed in an evidence review from the French Medical Research Institute (INSERM) … which is that nation's counterpart to the U.S. National Institutes of Health.
French evidence review sees evidence of chocolate's brain benefits
The evidence review was authored by functional neurochemist Astrid Nehlig, Ph.D., of INSERM. She analyzed the many studies submitted to the European Food Safety Authority and found the evidence in them sufficient to support the idea that cocoa flavanols boost basic thinking functions. As Dr. Nehlig wrote, "Cocoa powder and chocolate contain a large percentage of flavonoids that display several beneficial actions on the brain." (Nehlig A 2012) She noted evidence that cocoa flavanols keep brain cells alive by enhancing the supply of blood to capillaries in the brain, and help create new blood vessels. Specifically, Dr. Nehlig concluded that epicatechin – the main flavanol in cocoa, which also occurs in green and white tea – was the major reason for these benefits.
She hypothesized that regular consumption of flavanol-rich chocolate or cocoa might reduce stroke risk and help prevent or delay age-related cognitive decline and dementia. As Dr. Nehlig put it, "… [cocoa] flavonoids preserve cognitive abilities during aging in rats, [and] lower the risk for developing Alzheimer's disease and … stroke in humans." (Nehlig A 2012) Finally, she observed that "Chocolate also induces positive effects on mood ... in part because eating it stimulates the release of endorphins." (Nehlig A 2012)
Choose your cocoa and chocolate carefully
The epicatechin content of chocolate rests largely on two factors: use of non-Dutched cocoa and moderate roasting temperatures. The cocoa butter (cocoa fat) used to make chocolate is high in saturated fat, but it's of a type (stearic acid) that does not harm heart health. And extra-dark chocolate is relatively low in sugar compared with milkier, low-cocoa bars. Dr. Nehlig concluded that the evidence is clear on one key point: "On the basis of the present knowledge, it appears that the benefits from moderate cocoa or chocolate consumption likely outweigh the possible risks."
Source: Nehlig A. The neuroprotective effects of cocoa flavanol and its influence on cognitive performance. Br J Clin Pharmacol. 2012 Jul 10. doi: 10.1111/j.1365-2125.2012.04378.x. [Epub ahead of print]
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Posts Tagged 'Unknown'
Visions of tomorrow
As I've mentioned here before, one of my few real regrets about Astounding is that I wasn't able to devote much room to discussing the artists who played such an important role in the evolution of science fiction. (The more I think about it, the more it seems to me that their collective impact might be even greater than that of any of the writers I discuss, at least when it comes to how the genre influenced and was received by mainstream culture.) Over the last few months, I've done my best to address this omission, with a series of posts on such subjects as Campbell's efforts to improve the artwork, his deliberate destruction of the covers of Unknown, and his surprising affection for the homoerotic paintings of Alejandro Cañedo. And I can reveal now that this was all in preparation for a more ambitious project that has been in the works for a while—a visual essay on the art of Astounding and Unknown that has finally appeared online in the New York Times Book Review, with the highlights scheduled to be published in the print edition this weekend. It took a lot of time and effort to put it together, especially by my editors, and I'm very proud of the result, which honors the visions of such artists as H.W. Wesso, Howard V. Brown, Hubert Rogers, Manuel Rey Isip, Frank Kelly Freas, and many others. It stands on its own, but I've come to think of it as an unpublished chapter from my book that deserves to be read alongside its longer companion. As I note in the article, it took years for the stories inside the magazine to catch up to the dreams of its readers, but the artwork was often remarkable from the beginning. And if you want to know what the fans of the golden age really saw when they imagined the future, the answer is right here.
Astounding Stories #22: None But Lucifer
Note: This is the latest entry in a series in which I highlight works of speculative fiction that deserve to be rediscovered, reappraised, or simply enjoyed by a wider audience. You can read the earlier installments here.
None But Lucifer, a short novel by H.L. Gold and L. Sprague de Camp that appeared in the September 1939 issue of Unknown, opens with its lead character figuring out a foolproof way of getting whatever he wants—and it isn't a fantasy. The story begins with its protagonist, Hale, living in deliberate poverty in a tenement in New York, and within the space of a few pages, merely as an experiment, he talks his way into a lucrative job, a beautiful apartment, and a luxurious lifestyle, mostly just to prove that he can. Hale's system depends on aiming absurdly high while showing as much apparent contempt for his true goal as possible. As he explains to an incredulous listener:
I can get anything I want any time I want it…Moreover, anybody can use my system…I go after what I want obliquely, by seeming to aim at something else, but grabbing sideways at what I really want…I can be aiming at money, fame, love, an easy life, or influence—but I wouldn't show which one I really wanted. You'd have to guess…The main thing is to keep your mouth shut about what you really want. The next most important thing is to get out of your social class. You can depend on your own class or the one just above it to defeat you…But if you break out of your class, the one you're crashing isn't sure of your aims, and can't crush you so effectively.
He concludes: "If you're trying to get a job as a clerk, your objective is pathetically simple to figure out. You want to eat. But if you go after a hundred-thousand-a-year position, with a crack at the boss's daughter, it gets tougher to analyze your goal." And that's particularly true if you manage to break through the barriers that your social class has imposed.
As a list of commandments for con artists and other hustlers—you keep your motives hidden, avoid your own social class, and show as much contempt for possible for what you really want—this approach is as valid as ever, and there are times when it reminds me queasily of Neil Strauss's The Game. But Gold and de Camp have larger ambitions of their own. The man to whom Hale is describing his strategy isn't an ordinary human being at all. It's Lucifier himself, who has been quietly running the world for thousands of years in the guise of an unassuming businessman named Mr. Johnson. Hale has figured out the sinister truth, which is that our world is Hell, and we're all being punished without our knowledge for sins that we committed in a previous lifetime. (Hale's first clue came from a line from the novelist Arnold Bennett: "Of all the inhabitants of the inferno, none but Lucifer knows that hell is hell." Or as Eleanor Shellstrop memorably realized: "This is the Bad Place!") With this information in hand, Hale approaches Lucifer with an ultimatum. He wants to be an equal partner in the management of Hell, or he'll tell the world about his system for getting whatever you want, which will upset the delicate balance of suffering. Lucifer agrees, and he takes Hale under his wing. And while we reasonably suspect that there's more to the deal than meets the eye, for the moment, we're more interested in hearing Lucifer expound on his methods of keeping mankind in an ideal state of misery. For instance:
Running Hell on an efficient basis happens to be my business, and I run it the same as any other businessman runs his business, by practical, common-sense methods…I'm immortal, of course. Hence I can control the world's money simply by investing a little and waiting for the interest charges to pile up. Outside of that, I can run the world merely by a magnificent system of obtaining information, an understanding of men's desires, and a knowledge of how to use pivot men. And, of course, the ability to start and stop the flow of money. In most cases the last can be done without a penny.
This is a terrific premise for a story, although None But Lucifer—which de Camp rewrote from Gold's initial draft, with uncredited contributions from John W. Campbell—doesn't quite live up to its opening. The middle sags a bit, and it doesn't follow through completely on its promise. But it's deliciously quotable throughout, and I can hardly imagine the effect that it must have had on the impressionable teenagers who bought it for twenty cents in 1939. Here, for example, is Lucifer on the efficiency of his strategies for causing pain, which don't involve tracking every last person on earth, but just a few crucial people: "It's enough to keep track of trade and production and social, political, and economic movements, with the key figures in each category, their influence, their motives and objectives, and what effect certain…uh…stimuli will have on their own categories and on society in general…No black magic—just detailed information and a knowledge of human nature." A few pages later, Lucifer explains his attitude toward war:
Except in unusual cases, I never concentrate on tormenting a single person. That would be inefficient…The chronic state of crisis, never quite reaching war, which I have labored incessantly to create, is kept simmering. The world was growing apathetic, but now there is a very gratifying turmoil. Millions of people have been made afraid and unhappy. Others have had their hopes raised. At the proper moment those hopes will be dashed, and they, too, will be unhappy.
When Lucifer poses the problem of what should be done as humanity proceeds toward an inevitable global conflict, Hale gives the correct answer: "I guess I'd try to prevent war…To keep the world frightened for as long as possible." Lucifer praises his insight, but he adds a reminder: "Even though the war crisis is our most absorbing problem at the moment, we must never cease using the smaller torments."
None But Lucifer was written before the outbreak of war in Europe, and it was on newsstands when Hitler invaded Poland. Typically, in a later issue, Campbell was quick to play up the coincidence: "None But Lucifer was begun last spring, worked out in detail last summer, bought and started on the process of being set in type late last summer. And it was on the stands at the time Europe was busily proving for the world that Lucifer does rule this planet." Yet there are few points in history when its insights wouldn't seem relevant. Reading it over recently, I was most struck by the passage in which Hale marvels at the universal state of suffering:
Millions out of work; increase in the relief budget attacked by the economy lobby—and effectively, since they were now so powerful; hunger marches, riots, strikes, lockouts, freezing of credit. Out of all that torment and strife there should have been a little happiness. The isolationists and the economizers should have felt jubilant. But actually they were as frightened as the rest of the country…It seemed that people were unhappy no matter what you did.
Throughout the story, Hale wonders what the world's inhabitants could possibly have done in a previous life to deserve such torment, and he never really finds out. In a closing twist, however, he finds that the very worst sinners are given the darkest punishment of all—in the next life, they're doomed to become Lucifer himself. "Evidently we—those of us who are doomed, from time to time, to the supreme torment of indeterminate immortality as manager of Hell—committed the most unspeakable crimes in some other existence," Lucifer explains before handing over the reins to the newly reluctant Hale. "While Hell would no doubt supply plenty of torment without our help, a manager is evidently required to assure the most efficient and economical distribution of misery."
I'll be appearing tonight at the Tuesday Funk reading series at Hopleaf Bar at 5148 N. Clark St. in Chicago at 7:30pm. Hope to see some of you there!
The Men Who Saw Tomorrow, Part 3
By now, it might seem obvious that the best way to approach Nostradamus is to see it as a kind of game, as Anthony Boucher describes it in the June 1942 issue of Unknown Worlds: "A fascinating game, to be sure, with a one-in-a-million chance of hitting an astounding bullseye. But still a game, and a game that has to be played according to the rules. And those rules are, above all things else, even above historical knowledge and ingenuity of interpretation, accuracy and impartiality." Boucher's work inspired several spirited rebukes in print from L. Sprague de Camp, who granted the rules of the game but disagreed about its harmlessness. In a book review signed "J. Wellington Wells"—and please do keep an eye on that last name—de Camp noted that Nostradamus was "conjured out of his grave" whenever there was a war:
And wonder of wonders, it always transpires that a considerable portion of his several fat volumes of prophetic quatrains refer to the particular war—out of the twenty-odd major conflicts that have occurred since Dr. Nostradamus's time—or other disturbance now taking place; and moreover that they prophesy inevitable victory for our side—whichever that happens to be. A wonderful man, Nostradamus.
Their affectionate battle culminated in a nonsense limerick that de Camp published in the December 1942 version of Esquire, claiming that if it was still in print after four hundred years, it would have been proven just as true as any of Nostradamus's prophecies. Boucher responded in Astounding with the short story "Pelagic Spark," an early piece of fanfic in which de Camp's great-grandson uses the "prophecy" to inspire a rebellion in the far future against the sinister Hitler XVI.
This is all just good fun, but not everyone sees it as a game, and Nostradamus—like other forms of vaguely apocalyptic prophecy—tends to return at exactly the point when such impulses become the most dangerous. This was the core of de Camp's objection, and Boucher himself issued a similar warning:
At this point there enters a sinister economic factor. Books will be published only when there is popular demand for them. The ideal attempt to interpret the as yet unfulfilled quatrains of Nostradamus would be made in an ivory tower when all the world was at peace. But books on Nostradamus sell only in times of terrible crisis, when the public wants no quiet and reasoned analysis, but an impassioned assurance that We are going to lick the blazes out of Them because look, it says so right here. And in times of terrible crisis, rules are apt to get lost.
Boucher observes that one of the best books on the subject, Charles A. Ward's Oracles of Nostradamus, was reissued with a dust jacket emblazoned with such questions as "Will America Enter the War?" and "Will the British Fleet Be Destroyed?" You still see this sort of thing today, and it isn't just the books that benefit. In 1981, the producer David L. Wolper released a documentary on the prophecies of Nostradamus, The Man Who Saw Tomorrow, that saw subsequent spikes in interest during the Gulf War—a revised version for television was hosted by Charlton Heston—and after the September 11 attacks, when there was a run on the cassette at Blockbuster. And the attention that it periodically inspires reflects the same emotional factors that led to psychohistory, as the host of the original version said to the audience: "Do we really want to know about the future? Maybe so—if we can change it."
The speaker, of course, was Orson Welles. I had always known that The Man Who Saw Tomorrow was narrated by Welles, but it wasn't until I watched it recently that I realized that he hosted it onscreen as well, in one of my favorite incarnations of any human being—bearded, gigantic, cigar in hand, vaguely contemptuous of his surroundings and collaborators, but still willing to infuse the proceedings with something of the velvet and gold braid. Keith Phipps of The A.V. Club once described the documentary as "a brain-damaged sequel" to Welles's lovely F for Fake, which is very generous. The entire project is manifestly ridiculous and exploitative, with uncut footage from the Zapruder film mingling with a xenophobic fantasy of a war of the West against Islam. Yet there are also moments that are oddly transporting, as when Welles turns to the camera and says:
Before continuing, let me warn you now that the predictions of the future are not at all comforting. I might also add that these predictions of the past, these warnings of the future are not the opinions of the producers of the film. They're certainly not my opinions. They're interpretations of the quatrains as made by scores of independent scholars of Nostradamus' work.
In the sly reading of "my opinions," you can still hear a trace of Harry Lime, or even of Gregory Arkadin, who invited his guests to drink to the story of the scorpion and the frog. And the entire movie is full of strange echoes of Welles's career. Footage is repurposed from Waterloo, in which he played Louis XVIII, and it glances at the fall of the Shah of Iran, whose brother-in-law funded Welles's The Other Side of the Wind, which was impounded by the revolutionary government that Nostradamus allegedly foresaw.
Welles later expressed contempt for the whole affair, allegedly telling Merv Griffin that you could get equally useful prophecies by reading at random out of the phone book. Yet it's worth remembering, as the critic David Thomson notes, that Welles turned all of his talk show interlocutors into versions of the reporter from Citizen Kane, or even into the Hal to his Falstaff, and it's never clear where the game ended. His presence infuses The Man Who Saw Tomorrow with an unearned loveliness, despite the its many awful aspects, such as the presence of the "psychic" Jeane Dixon. (Dixon's fame rested on her alleged prediction of the Kennedy assassination, based on a statement—made in Parade magazine in 1960—that the winner of the upcoming presidential election would be "assassinated or die in office though not necessarily in his first term." Oddly enough, no one seems to remember an equally impressive prediction by the astrologer Joseph F. Goodavage, who wrote in Analog in September 1962: "It is coincidental that each American president in office at the time of these conjunctions [of Jupiter and Saturn in an earth sign] either died or was assassinated before leaving the presidency…John F. Kennedy was elected in 1960 at the time of a Jupiter and Saturn conjunction in Capricorn.") And it's hard for me to watch this movie without falling into reveries about Welles, who was like John W. Campbell in so many other ways. Welles may have been the most intriguing cultural figure of the twentieth century, but he never seemed to know what would come next, and his later career was one long improvisation. It might not be too much to hear a certain wistfulness when he speaks of the man who could see tomorrow, much as Campbell's fascination with psychohistory stood in stark contrast to the confusion of the second half of his life. When The Man Who Saw Tomorrow was released, Welles had finished editing about forty minutes of his unfinished masterpiece The Other Side of the Wind, and for decades after his death, it seemed that it would never be seen. Instead, it's available today on Netflix. And I don't think that anybody could have seen that coming.
The Men Who Saw Tomorrow, Part 2
In the early forties, William Anthony Parker White—who used the pen name "Anthony Boucher"—was a successful mystery novelist, a noted Sherlockian, and a member in good standing of the Mañana Literary Society of Los Angeles. On May 12, 1941, he submitted an article to John W. Campbell that he hoped their mutual friend, Robert A. Heinlein, had been "kind enough to mention." In his cover letter, Boucher wrote:
This is an attempt to interpret Nostradamus in the light of present events and to go even further and take a chance on the immediate future…It is (so far as I know) the only completely honest contemporary interpretation of the prophecies. The film shorts and the popularizers have cheated right and left—misquoted, mistranslated, cut, transposed, amalgamated, and what have you. It's startling enough without cheating, and a damned sight more impressive.
By "film shorts," Boucher was presumably referring to such newsreels as "More About Nostradamus," produced by Metro-Goldwyn-Mayer, which loosely applied the French seer's prophecies to the ongoing war in Europe. Boucher, not unreasonably, thought that he could do better. He proposed that the article run under his real name, but Campbell evidently saw his background in mystery fiction as a selling point, and on the cover of the issue in which the piece ran, the editor made the connection clear: "Nostradamus the Prophet…named names and places—and has been proven incredibly accurate. What specific prophecies did he make concerning our time? A famous author of detective stories does a little analyzing of the clues Nostradamus left."
The result was "On a Limb," a witty article that appeared in the October 1941 issue of the magazine that was then known as Unknown Worlds. Like Campbell, Boucher evokes "time travel" as one possible explanation for Nostradamus's alleged gifts, and he has an interesting response to the objection of why no one has been able to take advantage of these prophecies to change events before they happen:
The essence of true prophecy is that it must be disbelieved or misinterpreted. If it can be circumvented, it will be false. Cassandra, whom Apollo blessed with prophecy and cursed with an incredulous public, is the perfect archetype of the prophet. Nostradamus realized this. He had first written his prophecies, we gather, clearly and in sequence. Then, foreseeing the impossible contradiction of this procedure, he cast them into cryptic quatrains, in the damnedest French you ever read, and shuffled them out of all time order. As a result, they can usually be interpreted only after the event. Attempts at reading the future result in such catastrophes as Bouys's confident proof to Napoleon that Nostradamus promised him victory forever, including a satisfactory invasion of England.
And in an editor's note in the June 1942 issue, Campbell drew a clever comparison: "It was customary, then, to publish a scientific discovery in code, in anagram, in horribly confused allegory, or by depositing a sealed description of the discovery with some trusted friend. That way, while the "publication" didn't do anybody any good, the discoverer was able, later on when it became general knowledge, or was discovered by someone else, to give the key to his code, anagram, or what have you, and prove that the had been the first discoverer."
The obvious consequence of such obscurity, as Boucher notes, is that Nostradamus is all but useless when it comes to forecasting events in advance. As a result, the second half of the article, which consists of specific prophecies about what the war will bring, takes the author out on "a long and shaky limb." ("File this copy of Unknown Worlds away carefully," Boucher writes dryly. "It may make good reading in another year or two.") And in retrospect, the results are about as accurate as you might expect. Boucher's most specific prophecy, based on the line "Because of war, the king will abandon his realm," was that George VI would flee to Canada after the fall of his prime minister, which is about as wrong as it gets. And Boucher's claim that one phrase—"la matiere du pont"—refers to armaments produced by the DuPont company seems to have been too much even for Campbell, who wrote in a closing note:
The foregoing article on the prophecies of Nostradamus is thoroughly incredible. Nostradamus' prophecies were thoroughly incredible—in the degree of their accuracy. Somehow it seems easier to believe that a man might successfully predict the movements and broad sweeps of the histories of nations than that one, two, or four centuries before it happens, the individual directly involved can be named…That seems, somehow, beyond the realm of prophecy. That Nostradamus could name…a particular corporation, specifying one of the products of that corporation, seems even more improbable…Anagrams and puns do exist in Nostradamus; to read from his quatrains the names and exact circumstances seems much as though the interpreter were finding in them things the author had not put there.
But what really caught my eye is the italicized section above. At precisely the same time that Campbell was editing Boucher's article, he was discussing psychohistory with Isaac Asimov, who was about to write in the original story "Foundation": "A great psychologist such as [Hari] Seldon could unravel human emotions and human reactions sufficiently to be able to predict broadly the historical sweep of the future." And I strongly suspect that Campbell's treatment of prediction in Unknown affected its much more famous incarnation in Astounding. As I've noted before, in "Foundation," psychohistory is presented less as a specific method than as a claim about results. We aren't told the first thing about how it works, and not even the characters seem especially clear on the concept. (As one says blandly to another: "Seldon was the greatest psychologist of our time…It seems reasonable to assume that he used his science to determine the probable course of the history of the immediate future." And that's all we get, apart from the flat assertion that Seldon "could easily have worked out the historical trends of the future by simple psychological technique.") Since the claim had to stand on its own, it had to be plausible in itself—which means that it could only apply to "the broad sweep" of events, and it couldn't be too specific. As Campbell understood about Nostradamus, a system that was able to generate names and dates seemed to fall outside the realm of credible science. And Nostradamus certainly wasn't useful in the way that psychohistory was supposed to be. In the June 1942 issue, Boucher granted that most of his earlier prophecies had been wrong, or remained unfulfilled, and he reminded readers of a point that he had made earlier:
Prophecy is of no practical value. Its interest lies solely in its appeal to intellectual curiosity and in its possible use as evidence of some extrasensory power latent in mankind. Interpreting prophecies concerning the past is a task for an abstract scholar. Attempting to apply prophecies to the future is nothing but a game.
But the game wasn't quite over yet. Tomorrow, I'll be talking about two more players who appeared at slightly different stages. One was L. Sprague de Camp. The other was Orson Welles.
The Men Who Saw Tomorrow, Part 1
If there's a single theme that runs throughout my book Astounding, it's the two sides of the editor John W. Campbell. These days, Campbell tends to be associated with highly technical "hard" science fiction with an emphasis on physics and engineering, but he had an equally dominant mystical side, and from the beginning, you often see the same basic impulses deployed in both directions. (After the memory of his career had faded, much of this history was quietly revised, as Algis Burdrys notes in Benchmarks Revisited: "The strong mystical bent displayed among even the coarsest cigar-chewing technists is conveniently overlooked, and Campbell's subsequent preoccupation with psionics is seen as an inexplicable deviation from a life of hitherto unswerving straight devotion to what we all agree is reasonability.") As an undergraduate at M.I.T. and Duke, Campbell was drawn successively to Norbert Wiener, the founder of cybernetics, and Joseph Rhine, the psychologist best known for his statistical studies of telepathy. Both professors fed into his fascination with a possible science of the mind, but along strikingly different lines, and he later pursued both dianetics, which he originally saw as a kind of practical cybernetics, and explorations of psychic powers. Much the same holds true of his other great obsession—the problem of foreseeing the future. As I discuss today in an essay in the New York Times, its most famous manifestation was the notion of psychohistory, the fictional science of prediction in Asimov's Foundation series. But at a time of global uncertainty, it wasn't the method of forecasting that counted, but the accuracy of the results, and even as Campbell was collaborating with Asimov, his interest in prophecy was taking him to even stranger places.
The vehicle for the editor's more mystical explorations was Unknown, the landmark fantasy pulp that briefly channeled these inclinations away from the pages of Astounding. (In my book, I argue that the simultaneous existence of these two titles purified science fiction at a crucial moment, and that the entire genre might have evolved in altogether different ways if Campbell had been forced to express all sides of his personality in a single magazine.) As I noted here the other day, in an attempt to attract a wider audience, Campbell removed the cover paintings from Unknown, hoping to make it look like a more mainstream publication. The first issue with the revised design was dated July 1940, and in his editor's note, Campbell explicitly addressed the "new discoverers" who were reading the magazine for the first time. He grandly asserted that fantasy represented "a completely untrammeled literary medium," and as an illustration of the kinds of subjects that he intended to explore in his stories, he offered a revealing example:
Until somebody satisfactorily explains away the unquestionable masses of evidence showing that people do have visions of things yet to come, or of things occurring at far-distant points—until someone explains how Nostradamus, the prophet, predicted things centuries before they happened with such minute detail (as to names of people not to be born for half a dozen generations or so!) that no vague "Oh, vague generalities—things are always happening that can be twisted to fit!" can possibly explain them away—until the time those are docketed and labeled and nearly filed—they belong to The Unknown.
It was Campbell's first mention in print of Nostradamus, the sixteenth-century French prophet, but it wouldn't be the last. A few months later, Campbell alluded in another editorial to the Moberly-Jourdain incident, in which two women claimed to have traveled over a century back in time on a visit to the Palace of Versailles. The editor continued: "If it happens one way—how about the other? How about someone slipping from the past to the future? It is known—and don't condemn till you've read a fair analysis of the old man's works—that Nostradamus, the famous French prophet, did not guess at what might happen; he recorded what did happen—before it happened. His accuracy of prophecy runs considerably better, actually, than the United States government crop forecasts, in percentage, and the latter are certainly used as a basis for business." Campbell then drew a revealing connection between Nostradamus and the war in Europe:
Incidentally, to avoid disappointment, Nostradamus did not go into much detail about this period. He was writing several hundred years ago, for people of that time—and principally for Parisians. He predicted in some detail the French Revolution, predicted several destructions of Paris—which have come off on schedule, to date—and did not predict destruction of Paris for 1940. He did, however, for 1999—by a "rain of fire from the East." Presumably he didn't have any adequate terms for airplane bombs, so that may mean thermite incendiaries. But the present period, too many centuries from his own times, would be of minor interest to him, and details are sketchy. The prophecy goes up to about the thirty-fifth century.
And the timing was highly significant. Earlier that year, Campbell had published the nonfiction piece "The Science of Whithering" by L. Sprague de Camp in Astounding, shortly after German troops marched into Paris. De Camp's article, which discussed the work of such cyclical historians as Spengler and Toynbee, represented the academic or scientific approach the problem of forecasting, and it would soon find its fictional expression in such stories as Jack Williamson's "Breakdown" and Asimov's "Foundation." As usual, however, Campbell was playing both sides, and he was about to pursue a parallel train of thought in Unknown that has largely been forgotten. Instead of attempting to explain Nostradamus in rational terms, Campbell ventured a theory that was even more fantastic than the idea of clairvoyance:
Occasionally a man—vanishes…And somehow, he falls into another time. Sometimes future—sometimes past. And sometimes he comes back, sometimes he doesn't. If he does come back, there'd be a tendency, and a smart one, to shut up; it's mighty hard to prove. Of course, if he's a scholarly gentlemen, he might spend his unintentional sojourn in the future reading histories of his beloved native land. Then, of course, he ought to be pretty accurate at predicting revolutions and destruction of cities. Even be able to name inconsequential details, as Nostradamus did.
To some extent, this might have been just a game that he was playing for his readers—but not completely. Campbell's interest in Nostradamus was very real, and just as he had used Williamson and Asimov to explore psychohistory, he deployed another immensely talented surrogate to look into the problem of prophecy. His name was Anthony Boucher. I'll be exploring this in greater detail tomorrow.
Note: Please join me today at 12:00pm ET for a Twitter AMA to celebrate the release of the fantastic new horror anthology Terror at the Crossroads, which includes my short story "Cryptids."
The unknown future
During the writing of Astounding, I often found myself wondering how much control an editor can really have. John W. Campbell is routinely described as the most powerful and influential figure in the history of science fiction, and there's no doubt that the genre would look entirely different if he were somehow lifted out of the picture. Yet while I never met Campbell, I've spoken with quite a few other magazine editors, and my sense is that it can be hard to think about reshaping the field when you're mostly just concerned with getting out the current issue—or even with your very survival. The financial picture for science fiction magazines may have darkened over the last few decades, but it's always been a challenge, and it can be difficult to focus on the short term while also keeping your larger objectives in mind. Campbell did it about as well as anyone ever did, but he was limited by the resources at his disposal, and he benefited from a few massive strokes of luck. I don't think he would have had nearly the same impact if Heinlein hadn't happened to show up within the first year and a half of his editorship, and you could say much the same of the fortuitous appearance of the artist Hubert Rogers. (By November 1940, Campbell could write: "Rogers has a unique record among science fiction artists: every time he does a cover, the author of the story involved writes him fan mail, and asks me for the cover original.") In the end, it wasn't the "astronomical" covers that improved the look of the magazine, but the arrival and development of unexpected talent. And much as Heinlein's arrival on the scene was something that Campbell never could have anticipated, the advent of Rogers did more to heighten the visual element of Astounding than anything that the editor consciously set out to accomplish.
Campbell, typically, continued to think in terms of actively managing his magazines, and the pictorial results were the most dramatic, not in Astounding, but in Unknown, the legendary fantasy title that he launched in 1939. (His other great effort to tailor a magazine to his personal specifications involved the nonfiction Air Trails, which is a subject for another post.) Unlike Astounding, Unknown was a project that Campbell could develop from scratch, and he didn't have to deal with precedents established by earlier editors. The resulting stories were palpably different from most of the other fantasy fiction of the time. (Algis Budrys, who calls Campbell "the great rationalizer of supposition," memorably writes that the magazine was "more interested in the thermodynamics and contract law of a deal with the devil than with just what a 'soul' might actually be.") But this also extended to the visual side. Campbell told his friend Robert Swisher that all elements, including page size, were discussed "carefully and without prejudice" with his publisher, and for the first year and a half, Unknown featured some of the most striking art that the genre had ever seen, with beautiful covers by H.W. Scott, Manuel Rey Isip, Modest Stein, Graves Gladney, and Edd Carter. But the editor remained dissatisfied, and on February 29, 1940, he informed Swisher of a startling decision:
We're gonna pull a trick on Unknown presently. Probably the July issue will have no picture on the cover—just type. We have hopes of chiseling it outta the general pulp group, and having a few new readers mistake it for a different type. It isn't straight pulp, and as such runs into difficulties because the adult type readers who might like it don't examine the pulp racks, while the pulp-type reader in general wouldn't get much out of it.
The italics are mine. Campbell had tried to appeal to "the adult type readers" by running more refined covers on Astounding, and with Unknown, his solution was to essentially eliminate the cover entirely. Writing to readers of the June 1940 issue to explain the change, the editor did his best to spin it as a reflection of the magazine's special qualities:
Unknown simply is not an ordinary magazine. It does not, generally speaking, appeal to the usual audience of the standard-type magazine. We have decided on this experimental issue, because of this, in an effort to determine what other types of newsstand buyers might be attracted by a somewhat different approach.
In the next paragraph, Campbell ventured a curious argument: "To the nonreader of fantasy, to one who does not understand the attitude and philosophy of Unknown, the covers may appear simply monstrous rather than the semicaricatures they are. They are not, and have not been intended as, illustrations, but as expressive of a general theme." Frankly, I doubt that many readers saw the covers as anything but straight illustrations, and in the following sentence, the editor made an assertion that seems even less plausible: "To those who know and enjoy Unknown, the cover, like any other wrapper, is comparatively unimportant."
In a separate note, Campbell asked for feedback on the change, but he also made his own feelings clear: "We're going to ask your newsdealer to display [Unknown] with magazines of general class—not with the newsprints. And we're asking you—do you like the more dignified cover? Isn't it much more fitting for a magazine containing such stories?" A few months later, in the October 1940 issue, a number of responses were published in the letters column. The reaction was mostly favorable—although Campbell may well have selected letters that supported his own views—but reasonable objections were also raised. One reader wrote: "How can you hope to win new readers by a different cover if the inside illustrations are as monstrous, if not more so, than have any previous covers ever been? If you are trying to be more dignified in your illustrations, be consistent throughout the magazine." On a more practical level, another fan mentioned one possible shortcoming of the new approach: "The July issue was practically invisible among the other publications, and I had to hunt somewhat before I located it." But it was too late. Unknown may have been the greatest pulp magazine of all time, but along the way, it rejected the entire raison d'être of the pulp magazine cover itself. And while I can't speak for the readers of the time, I can say that it saddens me personally. Whenever I'm browsing through a box of old pulps, I feel a pang of disappointment when I come across one of the later Unknown covers, and I can only imagine what someone like Cartier might have done with Heinlein's The Unpleasant Profession of Jonathan Hoag, or even Hubbard's Fear. Unknown ran for another three years with its plain cover, which is about the same amount of time that it took for Astounding to reach its visual peak. It might have evolved into something equally wonderful, but we'll never know—because Campbell decided that he had to kill the cover in order to save it.
The Worlds of If
As I prepare for my upcoming presentation this weekend at the Grappling With the Futures conference, I've been thinking a lot about the evolution of psychohistory, the fictional science that figures prominently in Isaac Asimov's Foundation series. When it comes to describing how psychohistory is actually supposed to work in practice, however, the original stories aren't much help. At first, the definition of the field might seem clear enough. If you initially encountered the trilogy in book form, it's right there in the text, in an entry from the Encyclopedia Galactica:
Psychohistory: …Gal Dornick, using nonmathematical concepts, has defined psychohistory to be that branch of mathematics which deals with the reactions of human conglomerates to fixed social and economic stimuli…Implicit in all these definitions is the assumption that the human conglomerate being dealt with is sufficiently large for valid statistical treatment.
This seems fairly straightforward. But it wasn't added to the series until the hardcover edition published by Gnome Press in 1951, for which Asimov wrote a new opening chapter called "The Psychohistorians." When the novelette "Foundation" originally appeared in the May 1942 issue of Astounding, the word "psychohistory" was used only once. We're informed that Hari Seldon is "the greatest psychologist of all time," and that he has the ability "to unravel human emotions sufficiently to be able to predict broadly the historical sweep of the future" using "simple psychological technique." But we aren't told how—just what. Psychohistory isn't a method here, but a claim about results.
It's also possible that Asimov himself had only a vague idea about it. As I've noted elsewhere, psychohistory seems to have been largely the brainchild of John W. Campbell, who was more interested in what it could do than in how it would work. The year before, in the nonfiction article "The Science of Whithering," L. Sprague de Camp had written in the magazine:
If there were such a science, what would it be like? It would have a body of observable facts, and would overlap with history, anthropology, sociology, economics, vital statistics, and perhaps one or two other sciences. Students of the science should be able to observe uniformities among these facts, deduce laws from these uniformities, and from the laws make predictions that are later borne out by observation.
And the method didn't even need to be scientific. At the time, Campbell was also editing the fantasy magazine Unknown, and on May 6, 1942, he told one of his most valued contributors, Anthony Boucher, that he was considering a standalone issue devoted to prophecy: "The philosophy of prophecy, the record, through the past, of the various classes of prophecy, and the problems of the prophet." He continued:
Second, there would be the main section consisting of prophecy. This would be devoted to several different types of prophecy concerning the present world situation and, specifically, the war. Who'll win (and if the prophets have the sense God gave little green apples, the answer to that one's going to be easy for them to figure out) and, more important, how, by what route, by licking who first, and when. When will Japan be knocked out? When will Italy fold? When's Hitler going down to defeat?
This last statement is remarkably revealing. What Campbell wanted were predictions, specifically ones related to the war. As Hitler rewrote the map of Europe, the anxiety to knew what would come next—which is one to which I think we can all relate these days—became overwhelming, and the source didn't matter, as long as it was "borne out by observation." At this moment of global crisis, Campbell was willing to seek answers from astrology, numerology, and the prophecies of Nostradamus. (The prophecy issue, notably, never appeared, thanks largely to what Campbell characterized as an inability to find "competent fanatics": "Nobody with any reputation or ability in the fields I wanted was willing to name names and date dates." The italics are mine.) Psychohistory was simply a way to express these impulses in language that would feel at home in a science fiction magazine. Even Asimov, who never seems to have been altogether comfortable with Campbell's ideas, was driven by much the same motivation. Decades later, he had a revealing exchange about the origins of the Foundation series in an interview with James Gunn:
Asimov: Mind you, this was also a time when I'd been living through the Hitler era in the 1930s, where no matter what anyone did, Hitler kept winning victories, and the only way that I could possibly find life bearable at the time was to convince myself that no matter what he did, he was doomed to defeat in the end. That he couldn't win.
Gunn: Psychohistory is against it.
Asimov: That's right…I suppose that was my literary response to my own feelings, which have no basis, I suppose, except that it made me feel better.
It was a longing that expressed itself equally well as psychohistory or prophecy, and it was about to assume its most convincing form. Not surprisingly, the science fiction magazines of the period often published stories that presented alternative outcomes for the war, including some that ended with victory for the Axis. Anthony Boucher justified this in a letter to Campbell that was published in Astounding in June 1943:
We are not, thank God, prophets. We don't write what we feel sure is going to happen, but what, under certain circumstances, might happen…Now we aren't expecting an Axis victory, any more than we are expecting worldwide tidal waves or planetary collisions or the invasion of little green men from Alpha Centauri. These disasters are all, with varying probabilities, present in one or more of the possible Worlds-of-If. And the more we write about ingenious ruses by which the Axis secures victory…the less apt those ruses are to succeed, and the more certain we can be that my sons and your daughter will inherit, in deepest truth, the best of all Possible Worlds.
Science fiction, in other words, was a way of generating models of potential outcomes and working through their implications. The real psychohistorians were the science fiction writers and fans, and psychohistory was a veiled way for the genre to talk about itself and its claims for foreseeing the future. Campbell might have been content to leave it there—but he was unable to leave well enough alone. In 1950, the year before the Foundation series appeared in hardcover, another author wrote: "The social organisms which we call states and nations behave and react in every respect as though they were individual organisms…The social organism behaves in a manner which can be graphed on the tone scale." It was L. Ron Hubbard, who called the concept "political dianetics." And he and Campbell were about to start a foundation of their own.


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A few days ago one of our directors bough some assorted stamps from the local post office in Aljezur for Christmas cards that he was sending out. What really surprised him was a stamp for 80c that was included in the mix, and clearly promoted offshore oil and gas exploration, while relegating into the background alternative energy technologies.
Image of Energy promotion Stamp released in September 2015 in selected areas - excluded were Algarve & Alentejo
With our petition against the granting of a TUPEM licence to ENI/GALP consortium just days away from finally (after 18 months) being debated and voted on in the Portuguese parliament by MPs, it is understandable that we are truly cheesed off.
It has been a long road since we started the anti-oil campaign in the Algarve, personally it started for me in 2009, and 8 years on, I look back and realise how much we have achieved in these 8 years. Whatever anyone may say, the fact is that through our efforts we woke-up not only the Algarve but also Portugal to the threat that oil and gas exploration will bring to the country.
So far we have reached over 70,000 people directly, and many more hundreds of thousands indirectly.
During this time, we have also come face to face with people driven by greed, fear as well as the power driven networks that are present in this beautiful country that is Portugal.
We would be totally naïve if we were not aware that powerful interests are at play both at a local level as well as international, and when you add to the mix some of the cultural legacy of Portuguese politics you realise the cesspool that we have been thrown into. It has not been easy; it has not been fun … and at times it has been soul destroying, but our conviction that there is a need to act against this threat remains strong.
Part of their strategy is to wear all of us down. They have resources that we don't have, but on the other hand we have resources they lack – we have compassion, empathy and high doses of emotional stability and stamina. We care …
On the 21 December we will be in Lisbon once again manifesting our position against oil and gas exploration in the Portuguese offshore and onshore.
Below, we lift the veil another little bit, and give you some more background as to why you should join us, and why you should add your voice and be present in this manifestation.
We all have a responsibility to future generations; we have a duty to fight for the preservation of our habitats and planet, because the alternative legacy that we will leave is just devastation and destruction. I am not prepared to leave them that … are you?
Join us on 21 December in Lisbon in front of Parliament – we will be there from 10H00 until 18H00.
A Bit of Background around the Controversial Stamp - Energy
Under the pretext of promoting the "Portuguese Sea" and its "Future", the privatised Portuguese Post Office on the 17 September 2015 launched a subversive campaign coordinated by the late Mário Ruivo, a Portuguese marine scientist that was actively involved in the communist party since the early 50's and was an active player in the 1974 uprising.
It is clear that there was great influence of the oil and gas exploration lobbies supported by the government of the day (PSD/CDS) under the oversight of Assunção Cristas, the Minister responsible for the sea portfolio at the time.
One can assume that it was under the leadership of Assunção Cristas, that this section of the "subversive brainwashing" project was "outsourced" to CTT.
The project comprised of two deliverables – a book and a set of 4 stamps.
- The Book titled "Do Mar Oceano ao Mar Português" (From Ocean Seas to the Portuguese Sea) (ISBN: 978-972-8968-68-7) – was a bilingual publication coordinated by Mário Ruivo, and authored by various specialists - Emanuel J. Gonçalves, Fátima Moura, Fernando J.A.S. Barriga, Joaquim Romero Magalhães, Márcia Marques, Maria Eduarda Gonçalves, Maria Isabel João, Raquel Ribeiro e Telmo Carvalho. 4200 books were printed.
- The 4 stamps represents – tourism (0,45€ with a print run of 155 000); fishing ( 0,62€ with a print run of 110 000); transport (0,72€ with a print run of 145 000 ) and energy (0,80€ with a print run of 115 000) and they were initially distributed only from shops in Restauradores in Lisboa, across Porto district, Zarco in Funchal and Antero de Quental in Ponta Delgada. Absent were all the major areas affected by oil and gas exploration, namely the Algarve, and Alentejo.
The Designer B2 Design
B2 Design is a very well connected Portuguese Creative Designer Agency, with a "who's - Who" list of clients, amongst them you find for example the "Gulbenkian Foundation" the "Luso-American Foundation" and off course "CTT" themselves. When one takes into account what appears to be a close relationship between B2 Design and Gulbenkian (Owner of Partex Oil and Gas) one starts to understand how some interests may be promoted at the oil and gas exploration altar.
B2 Design was commissioned by CTT to conceptualise and design the stamps and other supportive designs.
We now need to take into account that during this period of time, there was already major anti-oil sentiment in the Algarve and Alentejo.
There's no doubt in our minds that the government has gone to great lengths to misinform individuals manifesting their position as being against oil exploration - with statements such as: the intention of government is only to access what resources Portugal has in its offshore, and that Portugal had no intention of drilling at all. It's ONLY "PESQUISA" we where all told, over and over.
We can't but be amazed at the lengths the government took until now to "hogwash" their real intent.
Let's keep in mind that the stamps and book were released in September 2015. Once again, facts come to light that give weight to our anti-oil drilling stance and our continuous warning – it is clear by just looking at the Energy stamp that priority has always been to drill our offshore for oil and gas in spite of continuous denials over the years.
The same way, that it is our intention to continue opposing such actions.
On 21 December political parties represented in the Portuguese Parliament have once again an opportunity to really act responsibly and to finally vote to stop all concessions for oil and gas exploration in Portugal – lets hope that for once they will all act responsibly and stop it once and for all.


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Friday, May 07, 2010
Public Bathroom sinks
You know what I hate? Public Bathrooms at restaurants or the like, where if you try to wash your hands they have either motion sensors or that faucet that you push to get 5 seconds of water out of. Why the hell can't they make it so that the water flows for at least 15 seconds? Is that so goddamn hard? I'm not eating at your restaurant if your sink to wash my hands and ensure cleanliness infuriates me.
From the deranged mind of
reedsolomon.matr1x at gmail.com
1:41 a.m.
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Everyone has a role to play in bullying prevention and response, and to promote a culture of respect, responsibility and resiliency. Parents and families are central to this effort. Please visit these websites for information about what parents and families can do to prevent bullying, and what happens when bullying is reported to the school.
Report an incident
If your child reports that he/she has been bullied, report it to the school teacher, counselor or principal immediately. The principal or designee will initiate an investigation.
Online Resources
- Hawaii Department of Education: What Parents and Families Can Do
Updated: 8/2018