Tuesday, April 29, 2008
Saturday, April 26, 2008
Have a Great Day !
I hope that you're having a great day!!! Don't forget to smell the flowers along the way.
Friday, April 25, 2008
Traumatic Brain Injury in Military Personnel
During my graduate studies I took a neuroethics class. This is an excerpt of my paper on Traumatic Brain Injury in Military Personnel. I know the content and vocabulary may be a bit complex, but I believe it is well worth the effort to read.
Due to the prevalence of undiagnosed traumatic brain injury (TBI) in military personnel, proactive screening utilizing established tests employed in other applications would best identify those suffering from TBI. I suggest three readily available and portable tests (Stroop Task, Virtual Water Maze and Field Sobriety Test) currently employed in other applications that could potentially be most efficient in detecting traumatic brain injury in military personnel in the field.
Traumatic brain injury can lead to a diverse range of neuropsychological deficits, including attention, memory, processing speed, and executive functioning (Axelrod, Fichtenberg, Liethen, Czarnota, & Stucky, 2001). “Sixty-four percent (64%) of soldiers wounded in action in Operation Iraqi Freedom sustained blast injuries, according to the Office of the Surgeon General of the Army.” (http://www.hjf.org/research/feature_DVBIC.html) There is a lack of clear evidence as to whether or not the military proactively screens its injured personnel for TBI in the field. Due to the sheer numbers of traumatically brain injured personnel, the implication is that proactive screening should be conducted in the field to identify military personnel with closed head injuries where no visible signs of injury are present.
Due to the prevalence of undiagnosed traumatic brain injury (TBI) in military personnel, proactive screening utilizing established tests employed in other applications would best identify those suffering from TBI. I suggest three readily available and portable tests (Stroop Task, Virtual Water Maze and Field Sobriety Test) currently employed in other applications that could potentially be most efficient in detecting traumatic brain injury in military personnel in the field.
Traumatic brain injury can lead to a diverse range of neuropsychological deficits, including attention, memory, processing speed, and executive functioning (Axelrod, Fichtenberg, Liethen, Czarnota, & Stucky, 2001). “Sixty-four percent (64%) of soldiers wounded in action in Operation Iraqi Freedom sustained blast injuries, according to the Office of the Surgeon General of the Army.” (http://www.hjf.org/research/feature_DVBIC.html) There is a lack of clear evidence as to whether or not the military proactively screens its injured personnel for TBI in the field. Due to the sheer numbers of traumatically brain injured personnel, the implication is that proactive screening should be conducted in the field to identify military personnel with closed head injuries where no visible signs of injury are present.
Personnel sustaining injuries from blasts, motor vehicle accidents, falls or gun shot wounds to the head, who are medically evacuated to hospitals, are proactively screened. (J Head Trauma Rehabil, Vol. 21, No. 5, pp 398-402, 2006) Unlike visibly obvious wounds, closed head injuries can go undetected for years. “Proactive patient education, ongoing health screening with appropriate medical follow-up, and timely interventions for individuals with TBI are indicated.” (J Head Trauma Rehabil. 1998 Aug;13(4):47-57) Military personnel diagnosed with TBI report subjective symptoms that are unlikely to be measured through conventional means, such as diagnostic imaging.
Therefore, tests need to be devised that can capture and evaluate the subjective complaints expressed by undiagnosed TBI personnel. The nature of brain injury itself is damage to the core of the central nervous system. The brain is the organ we use to create and decipher our experiences and understand who we are as a person and our place in the world. Therefore, the brain itself becomes an unreliable source of detecting and measuring cognitive and motor function and selfhood. TBI military personnel often complain of symptoms of not feeling like themselves and experiencing difficulty navigating without bumping into obstacles and difficulty in completing routine tasks. This subjective reporting is not addressed by traditional measures of objective diagnostic imaging which may detect structural damage to the brain. Objective questioning to determine alert and oriented status (e.g., person, place and time orientation) too may be less than optimal in determining the functioning of the TBI person. One can potentially maintain person, place and time orientation while suffering from a disoriented selfhood, altered spatial orientation and an inability efficiently process information needed to complete routine tasks. Therefore, military personnel suffering from a traumatic brain injury could potentially be assigned where they are driving, utilizing hazardous equipment, handling weapons, making snap judgments and other tasks that require full capacity thinking and reflexes where theirs is lacking. There exists some established testing for the counterparts of TBI patient’s suffering from organic diseases with similar symptomatology. These are the three tests that I recommend:
Stroop Task: Publishing his PhD thesis in 1935, John Ridley Stroop devised a psychological test of mental (attention) vitality and flexibility. “The task takes advantage of our ability to read words more quickly and automatically than we can name colors. If a word is printed or displayed in a color different from the color it actually names; for example, if the word ‘green’ is written in blue ink we will say the word ‘green’ more readily than we can name the color in which it is displayed, which in this case is ‘blue’.” The cognitive mechanism involved in this task is called directed attention, you have to manage your attention, inhibit or stop one response in order to say or do something else. (http://www.snre.umich.edu/eplab/demos/st0/stroopdesc.html)
Virtual Morris Water Maze: Devised by Prof. Richard Morris in 1984, the Morris water maze tested mice introduced into a pool where an unseen platform gave them access out of the pool. Around the pool are several markers as points of reference. When the mice are placed into the pool at the same point of entry they eventually recall the location of the platform. After repeatedly placing the mice into the pool they become familiar with the location of the markers in reference to the platform. Therefore, when placed into the pool at different locations the mice are able to identify the markers as a point of reference to where the platform is located.
In its virtual application, the Morris water maze was used to test humans by simulating the same pool scenario. In their research, Human spatial navigating deficits after traumatic brain injury shown in the arena maze, a virtual Morris water maze, Skelton, Ross, Nerad and Livingston found that TBI survivors were unable to remember the location of the hidden platform that was always located in the same place. (Brain Injury 20 (2): 189-203 Feb 2006) This test in particular is important in identifying TBI military personnel during wartime because of the significant implications in their ability to identify targets and their locations in reference to the positions of comrades and allies.
Field Sobriety Test: The Standardized Field Sobriety Test (SFST) is a battery of three tests administered and evaluated by trained examiners to obtain validated indicators of alcohol impairment. These tests were developed as a result of research sponsored by the National Highway Traffic Safety Administration and conducted by the Southern California Research Institute. As previously stated, TBI personnel often complain of difficulty navigating around objects. This battery of tests may aid in identifying TBI personnel experiencing balance and navigation difficulties, along with difficulty in following simple instructions. The test consists of three parts: the horizontal gaze nystagmus, the walk-and-turn, and the one-leg stand. (http://www.nhtsa.dot.gov/people/injury/enforce/deskbk.html#SFST)
Stroop Task: Publishing his PhD thesis in 1935, John Ridley Stroop devised a psychological test of mental (attention) vitality and flexibility. “The task takes advantage of our ability to read words more quickly and automatically than we can name colors. If a word is printed or displayed in a color different from the color it actually names; for example, if the word ‘green’ is written in blue ink we will say the word ‘green’ more readily than we can name the color in which it is displayed, which in this case is ‘blue’.” The cognitive mechanism involved in this task is called directed attention, you have to manage your attention, inhibit or stop one response in order to say or do something else. (http://www.snre.umich.edu/eplab/demos/st0/stroopdesc.html)
Virtual Morris Water Maze: Devised by Prof. Richard Morris in 1984, the Morris water maze tested mice introduced into a pool where an unseen platform gave them access out of the pool. Around the pool are several markers as points of reference. When the mice are placed into the pool at the same point of entry they eventually recall the location of the platform. After repeatedly placing the mice into the pool they become familiar with the location of the markers in reference to the platform. Therefore, when placed into the pool at different locations the mice are able to identify the markers as a point of reference to where the platform is located.
In its virtual application, the Morris water maze was used to test humans by simulating the same pool scenario. In their research, Human spatial navigating deficits after traumatic brain injury shown in the arena maze, a virtual Morris water maze, Skelton, Ross, Nerad and Livingston found that TBI survivors were unable to remember the location of the hidden platform that was always located in the same place. (Brain Injury 20 (2): 189-203 Feb 2006) This test in particular is important in identifying TBI military personnel during wartime because of the significant implications in their ability to identify targets and their locations in reference to the positions of comrades and allies.
Field Sobriety Test: The Standardized Field Sobriety Test (SFST) is a battery of three tests administered and evaluated by trained examiners to obtain validated indicators of alcohol impairment. These tests were developed as a result of research sponsored by the National Highway Traffic Safety Administration and conducted by the Southern California Research Institute. As previously stated, TBI personnel often complain of difficulty navigating around objects. This battery of tests may aid in identifying TBI personnel experiencing balance and navigation difficulties, along with difficulty in following simple instructions. The test consists of three parts: the horizontal gaze nystagmus, the walk-and-turn, and the one-leg stand. (http://www.nhtsa.dot.gov/people/injury/enforce/deskbk.html#SFST)
Thursday, April 24, 2008
Hillary Smack Down
This humorous article from the New York Times emphasizes how silly the presidential campaign has become.
Wednesday, April 23, 2008
Making Important Decisions
In a few short weeks, I will be teaching an undergraduate Critical Thinking class. The Pennsylvania primary will most likely be one topic we will cover. When people make important decisions like choosing a presidential candidate few people actually think critically. In particular many Americans seem to find intelligence, introspection (examination or observation of one's own mental and emotional processes), and global thinking elitist and strange.
This was made evident in Pennsylvania by the level of importance placed on Hillary Clinton's photo op in Scranton, Pennsylvania where she downed a shot and a beer and reminisced about her childhood summers visiting the area, where she practiced shooting with her father. Other than making a personal connection with the locals her life experience as a child was limited.
On the other hand, Barack Obama grew up as a child of many cultures and as the product of parents from America (mother) and Kenya (father) and Indonesia (step-father), living in both Indonesia and the United States. Is this life experience not impressive? In today's world where the internet, cell phones and air travel have lifted the boundaries of physical distance, global life experience would seem to be more relevant than that of an experience only relevant to a small few.
I'm sure that neither candidate's childhood can answer my questions about health care, education, the economy or the environment in America, or the war in which the United States is engaged in in Iraq and Afghanistan. Kissing babies and waving flags does nothing to quell the violence gripping the United States from within. U.S. relationships around the world have deteriorated and important issues elsewhere have gone relatively unnoticed. People around the world (e.g., Burma, Ethiopia, and Sudan, etc.) continue to suffer from malnutrition, displacement, poor health, poor education, and violence. Focusing on a candidate's lack of a flag pin on his lapel seems laughable in comparison. Cuba and Russia have experienced political change. China has ignored the cries of those around the world seeking humane treatment of the Tibetans. The list of issues that SHOULD grab the attention of the American public and media are infinite, yet ignored. However, Americans... who have great difficulty even locating other countries on a map... cling to their xenophobia (deep dislike for foreigners) as though the rest of the world has no importance. Why has the political process for selection of an American president, who will surely have influence around the world, been so trivialized?
Whether discussing issues within the United States or issues outside of the United States the focus needs to change. You can either emphasize trivial and meaningless background noise or you can familiarize yourself with the issues and their impact on yourself and the rest of the world and decide by thinking critically.
P.S. I did not have the ability to choose which YouTube videos would be selected. I chose the names of the candidates only. The videos that automatically come up are indicative of what I have said above.
This was made evident in Pennsylvania by the level of importance placed on Hillary Clinton's photo op in Scranton, Pennsylvania where she downed a shot and a beer and reminisced about her childhood summers visiting the area, where she practiced shooting with her father. Other than making a personal connection with the locals her life experience as a child was limited.
On the other hand, Barack Obama grew up as a child of many cultures and as the product of parents from America (mother) and Kenya (father) and Indonesia (step-father), living in both Indonesia and the United States. Is this life experience not impressive? In today's world where the internet, cell phones and air travel have lifted the boundaries of physical distance, global life experience would seem to be more relevant than that of an experience only relevant to a small few.
I'm sure that neither candidate's childhood can answer my questions about health care, education, the economy or the environment in America, or the war in which the United States is engaged in in Iraq and Afghanistan. Kissing babies and waving flags does nothing to quell the violence gripping the United States from within. U.S. relationships around the world have deteriorated and important issues elsewhere have gone relatively unnoticed. People around the world (e.g., Burma, Ethiopia, and Sudan, etc.) continue to suffer from malnutrition, displacement, poor health, poor education, and violence. Focusing on a candidate's lack of a flag pin on his lapel seems laughable in comparison. Cuba and Russia have experienced political change. China has ignored the cries of those around the world seeking humane treatment of the Tibetans. The list of issues that SHOULD grab the attention of the American public and media are infinite, yet ignored. However, Americans... who have great difficulty even locating other countries on a map... cling to their xenophobia (deep dislike for foreigners) as though the rest of the world has no importance. Why has the political process for selection of an American president, who will surely have influence around the world, been so trivialized?
Whether discussing issues within the United States or issues outside of the United States the focus needs to change. You can either emphasize trivial and meaningless background noise or you can familiarize yourself with the issues and their impact on yourself and the rest of the world and decide by thinking critically.
P.S. I did not have the ability to choose which YouTube videos would be selected. I chose the names of the candidates only. The videos that automatically come up are indicative of what I have said above.
Tuesday, April 22, 2008
Health Literacy
What would you do if you didn't understand what your doctor or hospital was telling you about your health? Health literacy extends beyond the ability to read the materials you may be given. The U.S. Department of Health and Human Services (HHS) and Institute of Medicine (IOM) define health literacy as "The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions." Take a look at the videos to your left.
Monday, April 21, 2008
The Power of Suggestion
I find it quite sad how little progress humanity has made in terms of perpetuating the same old problems. Ignorance, prejudice, violence and a host of other unnecessary and suggestive behaviors abound. Why? Okay... maybe that question is a bit daunting. Here's one maybe we can tackle. Why do people, in particular some parents, perpetuate negativity. Again, I don't mean the blatant kind that the majority of us find repugnant. I mean the subtle negativity that comes with a peck on the cheek and a pat on the head.Years ago, I dropped my young daughter off at day care. The day promised rain and had begun to cloud over. I kissed my daughter good-bye at the door of the day care and wished her a great day. As I was leaving another mother, who was mirroring the same routine, kissed her daughter on the cheek and looked skyward with a scowl. She then proceeded to tell her daughter what a gloomy day it was and how miserable it was going to be. I cringed at the thought of her suggestion to her 4 or 5 year old daughter that the day was predestined to be horrible. This type of negativity may appear harmless or said in passing with no intent of malice. However, this is the subtle type of negativity that leaves its indelible mark on impressionable minds. What purpose does it serve to suggest negativity... particularly to a child?
Think about all of the opinions and feelings you have about the world around you. What in your opinions and views wasn't formed at the suggestion of someone else? I hate broccoli! Those people aren't like us! He has a problem sitting still. If you're lucky, you've had a predominance of positive statements made by the people who have had a tremendous part in shaping who you are. Wow! You did great! You're so beautiful. I hope you have a wonderful day. However, keep in mind... those are suggestive opinions too. Just think, your perception of beauty was most likely shaped by other people's opinion of what is beautiful. The power of suggestion is strong and needs to be recognized for what it is. Just someone else's opinion. For what it's worth, I like rainy days!
Sunday, April 20, 2008
Blogging 101
I am trying to get the hang of this blogging thing. There are a lot of really interesting and thought provoking blogs. I just have to learn how to link to them. Once I get that, the formatting and advertising down... watch out world.
Friday, April 18, 2008
Racial Disparities in Health Care
There has been a lot of speculation as to why "minorities" suffer at a much higher rate than their white counterparts with poor health and health care outcomes. Consideration has been given to educational level, socio-economic status, insurance coverage, cultural issues, etc.
Here's my thought... People of color (because I despise the term "minority") tend to be people of faith. This might have a little to do with the fact that for many a personal connection to God is their only source of power. Historically, people of color have experienced and continue experience many hardships often not of their own doing. Prayer and faith provide strength. When pain and struggles continue over an extended period of time or even a lifetime people become desensitized to their pain and struggles. There is a tendency to muddle through and make the best of the situation.
When a person who experiences pain and struggles on a regular basis becomes ill or injured that illness or injury becomes just one more issue or struggle to cope with. A prioritization occurs. For example, if someone is diagnosed with diabetes he/she will be expected by the health care system to conform to strict regimens of testing and monitoring, eating well, exercising, not smoking and all that goes with stabilizing the blood sugar. However, when meeting one's basic needs (food, shelter and clothing), along with other priorities (raising children, caring for elderly family members, working, maintaining utilities, etc.) arise a conflict develops. People of color know that their health is important. There is an understanding that if I don't take my medicine I may eventually experience greater illness, but for now... I have to get to work, I can't afford the testing device, the only grocery store available to me sells a poor selection of foods. As long as one can continue to function, even if ill, there is a need to keep going.
Address the issues of the struggles (education, socio-economic, insurance). Yes. But, also address the fatigue and desensitization that accompanies the struggles. For many, God is the only source of strength to keep going. Unfortunately, for many there is a belief that God expects one to suffer for salvation, which also facilitates a mind-set that struggling is necessary. Struggling equals desensitization, which equals poor outcomes.
Here's my thought... People of color (because I despise the term "minority") tend to be people of faith. This might have a little to do with the fact that for many a personal connection to God is their only source of power. Historically, people of color have experienced and continue experience many hardships often not of their own doing. Prayer and faith provide strength. When pain and struggles continue over an extended period of time or even a lifetime people become desensitized to their pain and struggles. There is a tendency to muddle through and make the best of the situation.
When a person who experiences pain and struggles on a regular basis becomes ill or injured that illness or injury becomes just one more issue or struggle to cope with. A prioritization occurs. For example, if someone is diagnosed with diabetes he/she will be expected by the health care system to conform to strict regimens of testing and monitoring, eating well, exercising, not smoking and all that goes with stabilizing the blood sugar. However, when meeting one's basic needs (food, shelter and clothing), along with other priorities (raising children, caring for elderly family members, working, maintaining utilities, etc.) arise a conflict develops. People of color know that their health is important. There is an understanding that if I don't take my medicine I may eventually experience greater illness, but for now... I have to get to work, I can't afford the testing device, the only grocery store available to me sells a poor selection of foods. As long as one can continue to function, even if ill, there is a need to keep going.
Address the issues of the struggles (education, socio-economic, insurance). Yes. But, also address the fatigue and desensitization that accompanies the struggles. For many, God is the only source of strength to keep going. Unfortunately, for many there is a belief that God expects one to suffer for salvation, which also facilitates a mind-set that struggling is necessary. Struggling equals desensitization, which equals poor outcomes.
My Photographs
Just a note to let you know that all of the pictures you will see on my blog are my creations. Enjoy!
Thursday, April 17, 2008
Welcome
Welcome to my blog.
I often think about how much better life, the world, relationships, family, work, play... whatever... would be, if we all would just take a few minutes on a regular basis and just think. Think in silence. When you actually stop and think what seems opaque gently fades to transparent.
I would like to use this blog as a forum to think out loud. I hope you will spend a little time thinking with me and sharing your thoughts. Maybe together we can change the world.
OK. Think about this...
Why doesn't the health care system in the United States reward physicians, hospitals, clinics and other providers for preventive care? In the current system health care providers make money from sick patients. The sicker the better. Shouldn't the system pay for keeping patients healthy? The healthier the better. With all of the squawking about the over burdened system and limited resources... keeping things the way they are doesn't make sense. What do you think?
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