Madness #AmericanAutocracy

‘Vaguely Threatening’: #Trump Federal Prosecutor #EdMartin Queries Leading #Medical Journal

The New England Journal of Medicine [#NEJM] received a letter suggesting that it was biased & compromised by external pressure. Other journals have also received the letter.

#law #censorship #FirstAmendment #Constitution #democracy #AbuseOfPower #authoritarianism #tyranny #dictatorship #AntiIntellectualism #science #medicine
https://www.nytimes.com/2025/04/25/health/nejm-prosecutor-letter.html?smid=nytcore-ios-share&referringSource=articleShare&sgrp=p&pvid=68CE025A-703F-4C94-87AA-8D0D7D06D23B

The #Trump administration of lunacy continues its quest to take the #USA back to the Dark Ages -- and again demonstrates zero understanding of #scholarship. Y'know, concepts like 'evidence', 'peer review', 'empiricism' (!?!?).

I guess I'm just astonished that so many US citizens are taking this insidious trolling lying down. I know many aren't. But some are. C'mon compadres, where is the 'Tea Party spirit'?!

https://www.nytimes.com/2025/04/25/health/nejm-prosecutor-letter.html #NEJM #research #universities

Not Surprising: Endovascular treatment (EVT) is beneficial in persons with an acute ischemic stroke caused by a large-vessel occlusion, but its efficacy not evident for treatment of stroke caused by occlusion of medium or distal vessels.

#NEJM #Outbreaks #Update — #H5N1, https://www.nejm.org/doi/full/10.1056/NEJMe2502267?query=TOC&cid=DM2392650_Non_Subscriber&bid=-1425531110

In this NEJM Outbreaks Update, Editor-in-Chief Eric #Rubin and Deputy Editor Lindsey Baden are joined by veterinarian and #virologist Yoshihiro #Kawaoka to discuss avian influenza and its current impact on chickens, cows, cats, and humans.

Gotta give thumbs up to #NEJM Pain Management modules

Gotta give thumbs up to #NEJM Pain Management modules

Details about the kid in Canada hospitalized from bird flu.

Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection | New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/NEJMc2415890

Entering a New Era in #SleepApnea Treatment

TL:DR Tirzepatide resulted in 50% reduction in AHI (apnea-hypoxia index) and a lowering of blood pressure (which may reduce risk of stroke and heart attack!)

#ObstructiveSleepApnea is one of the most common respiratory disorders worldwide. Persons with obstructive sleep apnea can have loud #Snoring that is detrimental to social relationships and have breathing problems that result in recurrent nocturnal awakenings, unrefreshing sleep, and excessive daytime sleepines —effects that together can substantially impair quality of life

#obesity #osa #stroke #heart #nejm
https://www.nejm.org/doi/full/10.1056/NEJMe2407117

““Blessed Be the Fruit”

The Contemporary Rise of Pronatalism

“In interviews, novelist Margaret Atwood explains that her inspiration for her 1985 novel The Handmaid’s Tale arose from the U.S. political climate of the time.

Specifically, changing voter demographics and policy attitudes after the civil rights and second-wave feminist movements prompted some Reagan-era politicians to build alliances with religious traditionalists.”

#NEJM #Pronatalism #trump #jdvance #Christiannationalism #fascism
https://www.nejm.org/doi/full/10.1056/NEJMp2410208

Woman drips with sweat from a bite of food due to rare nerve-wiring mix-up - Enlarge (credit: Getty | MICHAEL KAPPELER)

The human body is f... - https://arstechnica.com/?p=2048913 #gustatoryhyperhidrosis #nerveregeneration #freyssyndrome #salivarygland #sweating #science #health #nerves #nejm

A few belated points about the surprising and slightly troubling #NEJM study (https://www.nejm.org/doi/full/10.1056/NEJMoa2400645) on cognitive motor dissociation in #DisordersOfConsciousness, which I think have been underemphasized in the conversation so far:

The topline finding was that 25% of patients without observable responses to commands had fMRI or EEG evidence of awareness (physiologically meaningful activity modulation to specific commands). This is quite a bit higher than in earlier, smaller studies, many only using either fMRI or EEG.

A very surprising finding to me was in Figure S5. This shows even with the lowest possible bedside CRS-R score of 0, clinically doing nothing at the bedside, someone could have fMRI or EEG evidence of awareness. Some prior literature considers threshold scores in the range of 8 to 10, but the figure suggests that no bedside examination procedure can exclude preserved conscious awareness. This is super-humbling.

Also, 25% is really conservative, and almost certainly an underestimate. The fMRI and EEG tasks and statistical thresholds are demanding; maybe because they're from #cogsci research, they're designed to limit the likelihood of false positives. This comes at the cost of many false negatives, as seen in light blue (merely the known false negatives, there are still more undetected false negatives)--these patients follow commands at the bedside but their fMRI and EEG tests are negative. Also, given behavioral variability over time, serial assessments would have revealed more positives. While in science it's a priority to avoid false positives, arguably in the clinical setting false negative findings about consciousness are a bigger problem.

And: while this study used formal CRS-R scoring procedures from research, we know that informal clinical diagnoses of coma or the vegetative state are even less sensitive to signs of consciousness than the CRS-R. So overall in clinical settings we can presume there are many more patients falsely assessed as unconscious.

I don't do clinical work anymore with patients with disorders of consciousness, but I would take this study as a humbling reminder of how much we still don't know about consciousness and the brain. It reinforces the clinical teaching I received to treat every clinically comatose and vegetative person as if they might be covertly aware. Our bedside examination procedures and these new high-tech tests are highly specific for consciousness but also very insensitive and nonconcordant.

Philosophically and conceptually, there's important work to be done to design more sensitive and less stringent indicators of awareness, and to think more about the balance to strike between false positive and false negative findings in tests for these patients.

Man suffers rare bee sting directly to the eyeball—it didn’t go well - Enlarge / Bees fly to their hive. (credit: Getty | Federico Gambarini) ... - https://arstechnica.com/?p=2034341 #ophthalmology #beesting #science #health #nejm #eye

Die #Vogelgrippe #H5N1 ging in einem einmaligen Event auf Rinder über. Das ist das Ergebnis einer im #NEJM veröffentlichten virologischen Untersuchung. Knapp zuvor war es zu einem Reassortment des Virus gekommen.

Eine zufällige Mutation sorgte also offenbar für eine bessere Anpassung an Rinder (und andere Säugetiere?).
Das Virus breitete sich dann wohl von Rind zu Rind aus.

Das kommt nicht überraschend, ist aber trotzdem keine gute Nachricht. Eine Anpassung des Virus an Säugetiere ist genau das, was wir nicht wollen.

https://www.nejm.org/doi/full/10.1056/NEJMc2405495