Go Us!

I'm reading a story at the moment. It's pretty good, but I'm having trouble deciding who to root for.

It starts off OK. About 150,000 years ago Homo sapiens evolves in Africa and starts exploring the world. It's easy to support them - they're humans, battling for survival in a world of wild animals (and Neanderthals, in some cases). Woo, go us!

But then it gets confusing. The humans split up into nations, and they start conquering each other. Which side to cheer on? Take the Sumerians, who built the world's first cities over 7000 years ago, in what's now Iraq. They were conquered by the Akkadians, who also lived in what is now Iraq. Who was "us" and who was "them" in that conflict? Neither.

I'm English, so you might expect that it would get easier when the British Isles come into play. But it doesn't. When the Romans start invading Britain in 55BC, I initially rooted for the native Britons, defending their lands against the Roman oppressors. I'm a Briton, right? 2000 years ago, there were Britons living where I'm sitting right now! Go us!

However, I then found out that in the end the Romans won, and took over. The Britons ended up confined to the fringes of the islands, hundreds of miles away. So I'm a Roman, not a Briton, and I should have supported the armies of Rome as they brought the benefits of civilization to the primitive Briton barbarians. But then, a few hundred years later, the Anglo-Saxons successfully invade, and then again with the Normans - leaving me really confused.

Once we get to the Middle Ages, English people are finally on the scene, but things don't get much easier. For example, at first, I was 100% behind the English colonists who settled North America. The French were trying to take over the continent too, but we beat them - go us! (As for the natives, they split off from us about 50,000 BC, the losers.)

But hang on - a few pages later those colonists are declaring, and achieving, independence. They're them, suddenly. Hmm. But doesn't that mean I shouldn't have rooted for the colonists in the first place, since they ended up fighting a war against us? When did they stop being "English" and become "Americans"? Us, them?

Overall, the story is OK, but it needs editing. It's unnecessarily complicated, and it's hard to identify with any of the characters.

*

What I'm saying here (inspired by this book I'm reading, although there are better world histories out there) is that "identity" is not real. I could identify myself with the Normans, or the Romans, or the Britons, or indeed the Native Americans. None of these would be right or wrong. I'm me, and all the other people were themselves, individuals. "Us" and "them" are all in my head.

If you look anyone up on Wikipedia the first three things you get are their name, their dates, and their nationality. Only then do you learn what they did. "Charles Robert Darwin (12 February 1809 – 19 April 1882) was an English naturalist..." But it's only in past few hundred years that nationality has been thought of an important part of identity. In Europe 500 years ago, the King of England had little, if anything, in common with an English peasant. They barely even spoke the same language. He had a lot in common with the King of France or the Queen of Poland, though - in fact, they were probably related.

It's a historical accident that I think of myself as "English", and it's a historical accident that we think of ourselves in terms of nations at all.

Go Us!

I'm reading a story at the moment. It's pretty good, but I'm having trouble deciding who to root for.

It starts off OK. About 150,000 years ago Homo sapiens evolves in Africa and starts exploring the world. It's easy to support them - they're humans, battling for survival in a world of wild animals (and Neanderthals, in some cases). Woo, go us!

But then it gets confusing. The humans split up into nations, and they start conquering each other. Which side to cheer on? Take the Sumerians, who built the world's first cities over 7000 years ago, in what's now Iraq. They were conquered by the Akkadians, who also lived in what is now Iraq. Who was "us" and who was "them" in that conflict? Neither.

I'm English, so you might expect that it would get easier when the British Isles come into play. But it doesn't. When the Romans start invading Britain in 55BC, I initially rooted for the native Britons, defending their lands against the Roman oppressors. I'm a Briton, right? 2000 years ago, there were Britons living where I'm sitting right now! Go us!

However, I then found out that in the end the Romans won, and took over. The Britons ended up confined to the fringes of the islands, hundreds of miles away. So I'm a Roman, not a Briton, and I should have supported the armies of Rome as they brought the benefits of civilization to the primitive Briton barbarians. But then, a few hundred years later, the Anglo-Saxons successfully invade, and then again with the Normans - leaving me really confused.

Once we get to the Middle Ages, English people are finally on the scene, but things don't get much easier. For example, at first, I was 100% behind the English colonists who settled North America. The French were trying to take over the continent too, but we beat them - go us! (As for the natives, they split off from us about 50,000 BC, the losers.)

But hang on - a few pages later those colonists are declaring, and achieving, independence. They're them, suddenly. Hmm. But doesn't that mean I shouldn't have rooted for the colonists in the first place, since they ended up fighting a war against us? When did they stop being "English" and become "Americans"? Us, them?

Overall, the story is OK, but it needs editing. It's unnecessarily complicated, and it's hard to identify with any of the characters.

*

What I'm saying here (inspired by this book I'm reading, although there are better world histories out there) is that "identity" is not real. I could identify myself with the Normans, or the Romans, or the Britons, or indeed the Native Americans. None of these would be right or wrong. I'm me, and all the other people were themselves, individuals. "Us" and "them" are all in my head.

If you look anyone up on Wikipedia the first three things you get are their name, their dates, and their nationality. Only then do you learn what they did. "Charles Robert Darwin (12 February 1809 – 19 April 1882) was an English naturalist..." But it's only in past few hundred years that nationality has been thought of an important part of identity. In Europe 500 years ago, the King of England had little, if anything, in common with an English peasant. They barely even spoke the same language. He had a lot in common with the King of France or the Queen of Poland, though - in fact, they were probably related.

It's a historical accident that I think of myself as "English", and it's a historical accident that we think of ourselves in terms of nations at all.

JoAnn's

One of my presents from my Nono was a gift card for JoAnn's. He didn't have to get me one. But it was really nice of him! Today, we're going to JoAnn's to spend it. My Nono is a little worried. He doesn't know anything about crafts. But I think it will be a fun trip!

I want to get some sewing stuff. And maybe some yarn. My abuelita has been showing me a lot of new crochet stuff. It's super exciting! I can't wait to get to Joann's! :) C

"Cortical Stimulation" for Depression

The last decade saw a number of new experimental treatments for depression based around the idea of using electricity to alter brain function - deep brain stimulation (DBS), vagus nerve stimulation (VNS), and transcranial magnetic stimulation (TMS).

The mechanics of these technologies differ, but they're all being promoted as options for "treatment-resistant depression" - depression which hasn't responded to more conventional approaches. They're also alike in that their usefulness is uncertain - either because there have been no randomized-controlled trials (DBS), or because the results of randomized trials are mixed at best (TMS,VNS).

Now there's a new kid on the neurostimulatory block: epidural prefrontal cortical stimulation (EpCS). This involves implanting electrodes beneath the skull, but above the meninges, the "skin" surrounding the brain. So it's unlike deep brain stimulation (DBS), in which the electrodes are placed inside the brain itself.

Late last year, Nahas et al reported on EpCS in a paper, Bilateral Epidural Prefrontal Cortical Stimulation for Treatment-Resistant Depression. They took 5 severely depressed patients, with either major depression or bipolar disorder, who'd all tried many treatments and experienced no benefit:

The mean age was 44.2 years. Four were women, and three were diagnosed with recurrent major depressive disorder; two others had bipolar affective disorder I, depressed type. All were unemployed, and three were receiving disability. The average length of depressive illness was 25.6 years. The average length of the current depressive episode was 3 years, 7 months ... participants had received an average of 9.8 unsuccessful clinical treatments during the current major depressive episode ... They enrolled in the study taking on average 6 psychotropic drugs.

Electrodes were implanted bilaterally over the "anterior and midlateral frontal cortex". This is as sensible a place to stimulate as any, although we really don't know what these parts of the brain do, or how they relate to depression. Nor do we know what "60 Hz, 2–4 V, 30 min on/ 2.5 hours off from 8 AM to 10 PM." stimulation does to these areas.

2 weeks after surgery the electricity was turned on, and the stimulation was then optimized over 2-3 weeks. Did it work? Out of the 5 patients, one didn't get any better, two felt somewhat better, and two were greatly improved at the end of the study 7 months post-op. And there were no major side effects or cognitive changes; one patient got a bacterial infection, but it was treatable. Hurrah!

But hang on. There was no control group, so the improvement could have been due to the placebo effect or, more likely, the passage of time. The guy with the single best response, Subject 2, was as depressed as ever during the first 4 months, but then improved dramatically by month 7. It may not be a coincidence that this subject was bipolar. Bipolar people who are depressed eventually stop being depressed - that's kind of the point.

Indeed, all of the others who improved did so between 2 weeks and 4 months after the stimulation was started, not straight away. So it's not like flicking a switch and turning off the depression... but on the other hand it's exactly that if you listen to what the patients say during the operation itself.

They reported feeling happier and less anxious as soon as the current was turned on (they weren't told when this was, so this is unlikely to have been a placebo effect). Some said things like

“I feel attentive,” “feel better and I can talk now,” “I can think clearer.” A patient noted during anterior frontal pole stimulation feeling as if a “weight [was] lifting off my shoulder,” “I feel calm”; another stated, “and although I am worried, I feel
dissociated from it. I can think back at my worry.”

Subject 2, the guy who got much better a long time after the operation, was the only patient who didn't enjoy any nice effects during the operation itself, which only adds to my suspicions that he would have got better anyway.

What does all this mean? It's hard to say. The results are very similar to those seen with DBS for depression - patients report suddenly feeling happier as soon as the current is turned on during the operation (the only placebo-controlled aspect of the trials), but afterwards the improvement seems gradual, taking weeks or months.

There's two main ways of interpreting this. The optimistic view is that stimulating the right bits of the brain instantly treats depression, and the apparent "time lag" in improvement after the operation is a product of the fact that when someone's been depressed for so long, as these patients have, it takes time for them to readjust to normal life even once they start feeling much better.

The pessimistic view is that stimulating the brain doesn't treat depression, it just causes a "high" which doesn't last very long, and the subsequent slow, gradual improvement would have happened anyway.

This is why we need randomized controlled trials. Nahas et al note that there has been one randomized controlled trial of EpCS for depression, comparing active EpCS to placebo EpCS with the electrodes switched off. It hasn't been published yet, but a preliminary analysis found no difference between the two conditions - it didn't work. And that trial was more than twice as big as this one (12 patients vs. 5). But, they point out, in that trial only the left side of the brain was stimulated, whereas they stimulated both sides.

Overall, just like DBS, EpCS could be either a great leap forward or a waste of time, money and neurosurgery. Hopefully, by the end of this decade, we'll know. Watch this space.

Links: Dr Shock covered this paper when it came out.

Nahas, Z., Anderson, B., Borckardt, J., Arana, A., George, M., Reeves, S., & Takacs, I. (2010). Bilateral Epidural Prefrontal Cortical Stimulation for Treatment-Resistant Depression Biological Psychiatry, 67 (2), 101-109 DOI: 10.1016/j.biopsych.2009.08.021

"Cortical Stimulation" for Depression

The last decade saw a number of new experimental treatments for depression based around the idea of using electricity to alter brain function - deep brain stimulation (DBS), vagus nerve stimulation (VNS), and transcranial magnetic stimulation (TMS).

The mechanics of these technologies differ, but they're all being promoted as options for "treatment-resistant depression" - depression which hasn't responded to more conventional approaches. They're also alike in that their usefulness is uncertain - either because there have been no randomized-controlled trials (DBS), or because the results of randomized trials are mixed at best (TMS,VNS).

Now there's a new kid on the neurostimulatory block: epidural prefrontal cortical stimulation (EpCS). This involves implanting electrodes beneath the skull, but above the meninges, the "skin" surrounding the brain. So it's unlike deep brain stimulation (DBS), in which the electrodes are placed inside the brain itself.

Late last year, Nahas et al reported on EpCS in a paper, Bilateral Epidural Prefrontal Cortical Stimulation for Treatment-Resistant Depression. They took 5 severely depressed patients, with either major depression or bipolar disorder, who'd all tried many treatments and experienced no benefit:

The mean age was 44.2 years. Four were women, and three were diagnosed with recurrent major depressive disorder; two others had bipolar affective disorder I, depressed type. All were unemployed, and three were receiving disability. The average length of depressive illness was 25.6 years. The average length of the current depressive episode was 3 years, 7 months ... participants had received an average of 9.8 unsuccessful clinical treatments during the current major depressive episode ... They enrolled in the study taking on average 6 psychotropic drugs.

Electrodes were implanted bilaterally over the "anterior and midlateral frontal cortex". This is as sensible a place to stimulate as any, although we really don't know what these parts of the brain do, or how they relate to depression. Nor do we know what "60 Hz, 2–4 V, 30 min on/ 2.5 hours off from 8 AM to 10 PM." stimulation does to these areas.

2 weeks after surgery the electricity was turned on, and the stimulation was then optimized over 2-3 weeks. Did it work? Out of the 5 patients, one didn't get any better, two felt somewhat better, and two were greatly improved at the end of the study 7 months post-op. And there were no major side effects or cognitive changes; one patient got a bacterial infection, but it was treatable. Hurrah!

But hang on. There was no control group, so the improvement could have been due to the placebo effect or, more likely, the passage of time. The guy with the single best response, Subject 2, was as depressed as ever during the first 4 months, but then improved dramatically by month 7. It may not be a coincidence that this subject was bipolar. Bipolar people who are depressed eventually stop being depressed - that's kind of the point.

Indeed, all of the others who improved did so between 2 weeks and 4 months after the stimulation was started, not straight away. So it's not like flicking a switch and turning off the depression... but on the other hand it's exactly that if you listen to what the patients say during the operation itself.

They reported feeling happier and less anxious as soon as the current was turned on (they weren't told when this was, so this is unlikely to have been a placebo effect). Some said things like

“I feel attentive,” “feel better and I can talk now,” “I can think clearer.” A patient noted during anterior frontal pole stimulation feeling as if a “weight [was] lifting off my shoulder,” “I feel calm”; another stated, “and although I am worried, I feel
dissociated from it. I can think back at my worry.”

Subject 2, the guy who got much better a long time after the operation, was the only patient who didn't enjoy any nice effects during the operation itself, which only adds to my suspicions that he would have got better anyway.

What does all this mean? It's hard to say. The results are very similar to those seen with DBS for depression - patients report suddenly feeling happier as soon as the current is turned on during the operation (the only placebo-controlled aspect of the trials), but afterwards the improvement seems gradual, taking weeks or months.

There's two main ways of interpreting this. The optimistic view is that stimulating the right bits of the brain instantly treats depression, and the apparent "time lag" in improvement after the operation is a product of the fact that when someone's been depressed for so long, as these patients have, it takes time for them to readjust to normal life even once they start feeling much better.

The pessimistic view is that stimulating the brain doesn't treat depression, it just causes a "high" which doesn't last very long, and the subsequent slow, gradual improvement would have happened anyway.

This is why we need randomized controlled trials. Nahas et al note that there has been one randomized controlled trial of EpCS for depression, comparing active EpCS to placebo EpCS with the electrodes switched off. It hasn't been published yet, but a preliminary analysis found no difference between the two conditions - it didn't work. And that trial was more than twice as big as this one (12 patients vs. 5). But, they point out, in that trial only the left side of the brain was stimulated, whereas they stimulated both sides.

Overall, just like DBS, EpCS could be either a great leap forward or a waste of time, money and neurosurgery. Hopefully, by the end of this decade, we'll know. Watch this space.

Links: Dr Shock covered this paper when it came out.

Nahas, Z., Anderson, B., Borckardt, J., Arana, A., George, M., Reeves, S., & Takacs, I. (2010). Bilateral Epidural Prefrontal Cortical Stimulation for Treatment-Resistant Depression Biological Psychiatry, 67 (2), 101-109 DOI: 10.1016/j.biopsych.2009.08.021

FELIZ ANO NOVO A TODOS!!!

ESTOU COM MUITA SAUDADES DE TODOS.
LOGO VOLTAREI!!!!
NA PRÓXIMA SEMANA ESTAREI EM CASA DE NOVO.
ESTOU MUITO FELIZ COM A SUA COMPANHIA.
POR ISSO, QUERO BRINDAR COM VOCÊ ESTE NO ANO ANO QUE SE INICIOU.

SENTI MUITA EMOÇÃO, AO ABRIR ESTE BLOG E VER O GRANDE CARINHO DE TODOS.
COMO É BOM TER VOCÊ, BEM JUNTINHO DE MIM.
ASSIM QUE PUDER VOU RETRIBUIR TODOS OS SEUS CARINHOS.
AMO CADA UM QUE PASSA POR AQUI.
DEIXO UM GRANDE ABRAÇO A TODOS.
FELIZ ANO NOVO A TODOS.
QUE DEUS ABENÇOE CADA UM.
COM MUITO CARINHO
SANDRA

Happy New Year!

We got to go to Disney last night. We went with my Nono. It was so much fun! They had lots of beautiful fireworks. I'm so glad that we got to come. :)

This morning, my Dad and my Nono are making us breakfast. It smells really yummy! Then we're all going to Disney World today! I'm really excited. My Nono and I already have our plans for all the rides we are going to ride!

But I wanted to wish everyone a Happy New Year! :) C