What I Don't Know Yet

Archive for 2018|Yearly archive page

The Runs for the Roses? The other race to Derby Day

In Epidemiology, Horse Racing, Kentucky, Kentucky Derby, Louisville, Science and Medical Research on April 25, 2018 at 4:14 pm

catchyWeek 1, Sept. 3-9, 2017:
One case of hepatitis A

Rui Zhao hunkers behind his twin computer monitors. Most visitors to the epidemiologist’s uncomfortably cramped office talk to his brow and the short black hair on the top of his head. They may glimpse his eyes when he looks up from his screens. On the wall to his left are small stuffed toys of irregular shapes, each a cuddly version of some nasty germ. From this third-floor office at the Louisville Metro Department of Public Health and Wellness, Zhao watches other germs work their way across Louisville. In the 90-degree days of early September, it’s a bit too soon to think about influenza, which will sweep through nursing homes in cold weather, taking lives as it does most every year. More of interest now: the chronic liver diseases hepatitis B and C. In fact, cases of hepatitis B are dancing upward in the metro area. Hepatitis C is already considered an epidemic, although the number of new cases is tiny.

Of hepatitis A, there’s a single case. And there’s no case the following week. It’s meaningless noise in the ebb and flow of the 25 or so infectious diseases surveilled by the state. Each year, one or two people in the city — and, rarely, as many as five — will contract the hepatitis A virus. They travel to a country where it’s common, endemic. They bring it home from mission trips or as a souvenir from an exotic vacation. More frequently, travelers never know they have it. About 30 percent of adults with hepatitis A produce no symptoms.

But for the unlucky, it can be brutal, bringing low-grade fever, headache, weakness and exhaustion, diarrhea, sudden nausea and vomiting, and abdominal pain, especially under the ribs on the right side, where the liver sits. Stools turn pale and urine dark. There may be intense itching. The white of the eye and skin often yellow, another sign that the virus is in the liver. And that’s the end of it, usually. Unlike hepatitis B and C, hepatitis A doesn’t settle in for a lifetime, grinding away at the liver. Uncomfortable? Absolutely. Miserable? Often. Life-threatening? Only in people older than 50 and those with other health problems. And it’s self-resolving, with no cure but time. It’s also highly contagious, most likely to spread while its host feels tip-top, before discomfort sets in. Any virus shed during infection lingers on surfaces for months. It is frequently transmitted by food, and while it succumbs to soap and water, or near-boiling temperatures, gel sanitizers can’t touch it.

Hepatitis B and C, on the other hand, infect via body fluids like blood, semen or vaginal secretions — the same pathways taken by the virus that causes AIDS. Since February 2017, a combined hepatitis A-B vaccine has been offered to visitors at the syringe-exchange sites operated by Metro Health and Wellness. There is no vaccine against the relatively new virus hepatitis C, which was discovered in 1989 and originally called non-A, non-B hepatitis. The syringe-exchange clinic is one sure way for the health department to reach a group of people normally driven into the shadows, a population vulnerable to a variety of diseases.

The importance of such contact is about to increase. The question is, will it be enough? By April, few will think so.

 

Weeks 2-5, Sept. 10-Oct. 7:
Three new cases of hepatitis A. Total: 4

The Courier Journal is full of the troubles facing the University of Louisville basketball program as October rolls in with 70- and 80-degree days and enough sunshine to convince anyone that summer will stretch on forever. Zhao notes that hepatitis A cases are now double the number seen in a normal year. But whether those four cases are significant isn’t clear. There’s also an unusual surge in false-positive hep A tests. He always sees a few. Every year, three or four people will test positive, yet their illness makes no sense. Usually, these cases of mistaken viral identity involve women 60 and older who have symptoms that would fit any number of diseases, including hepatitis A. It’s essentially a bad joke played by an aging immune system. Immune defenses lose precision with each passing year; our bodies are more prone to interpret any number of ailments as an attack on the liver and ramp up antibody production to fight a phantom infection.

For the rest of these story, go to Louisville.com

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Audiobook reviews: The Book of Dust; Turtles All the Way Down; The Midnight Line

In audiobook review, Books, Reviews, Uncategorized on April 22, 2018 at 10:43 am
Dust, Turtles, MidnightJenni Laidman
Chicago Tribune
Nov. 20, 2017

“The Midnight Line” by Lee Child, narrated by Dick Hill, Random House Audio, 13 hours, 6 minutes

Dick Hill is Jack Reacher for audiobook fans. Hill narrated the last 18 of the 22 books in this Lee Child series. Although he missed books two through four, he spoke at the genesis with the first Reacher book, “Killing Floor.” So it pains me to say this, but: It’s time for Hill to go. Somewhere around book 19, “Personal,” Hill’s voice developed a warble. With each successive novel, Reacher sounds less like a tough guy and more like someone’s uncertain grandpa. The problem is more of tone than age. There is little in the books to remind us that Reacher, who fights with the ferocity and experience of a 30-something brawler, is actually 57. But Hill’s narration turns him geriatric. While it is delightful to imagine pops taking on seven outlaw bikers — none of whom so much as scuffs his shoes — it strains even my very elastic credulity when it comes to Jack Reacher. (I also miss the days when Reacher still took an occasional punch.)

More problematic: It’s often difficult to tell who’s talking. Is it Reacher or the private investigator he’s teamed with? Is it Reacher or the general who runs West Point? They are frequently indistinguishable. You can regain a younger Reacher if you speed the playback to 1.25x on your smartphone, but that doesn’t fix the dialogue confusion. Hill is a celebrated narrator, with more than 500 titles to his name and three Audie awards. He’s earned his place among the great voices. But for Jack Reacher, his voice is great no longer.

“The Book of Dust” by Philip Pullman, narrated by Michael Sheen, Listening Library, 13 hours, 7 minutes

“His Dark Materials,” Philip Pullman’s beloved trilogy about the indomitable girl hero, Lyra Belacqua, are full-cast recordings, Technicolor feasts of memorable voices. Lyra’s scrappy breathlessness remains my favorite girl voice, and the rumbling Iorek Byrnison, my favorite bear. So what were they thinking, giving a single actor the “Dark Materials” prequel, “The Book of Dust: La Belle Sauvage”?

For the rest of this review, plus “Turtles All the Way Down,” follow the link.

Audiobook Reviews: The Music Shop; My Absolute Darling; Montpelier Parade

In audiobook review, Books, Reviews on April 22, 2018 at 10:27 am
Music, My Absolute, MontpelierJenni Laidman
Chicago Tribune

“The Music Shop” by Rachel Joyce, narrated by Steven Hartley, Random House Audiobooks, 8 hours, 33 minutes

Rachel Joyce, the author of the delightful and not-quite believable “The Unlikely Pilgrimage of Harold Fry,” has done it again with the often laugh-out-loud funny and similarly unbelievable “The Music Shop.” The shop is owned by Frank, who sells only vinyl records. One day Ilse Brauchmann stops by his shop and collapses, and thus the love story begins. Frank has a special musical gift. He can look at anyone and know what music they need to hear. He’s done it for Father Anthony, who runs the small religious gift shop next door. He’s done it for Maud, who owns the nearby tattoo studio. But his gift fails him in the face of Ilse Brauchmann.

English actor Steven Hartley approaches this narration with the good humor it requires, gamely singing when it’s called for — just don’t expect to be reminded of Aretha Franklin or Handel’s Messiah when he tackles them. Joyce is clearly an author who loves her characters, and Hartley helps make each memorable, from the prickly Maud, not-so-secretly in love with Frank, to Frank’s lovable and clumsy assistant, Kit, who, in one of the book’s most adorable chapters, dances around the record shop to the tune of “Shaft.” Frank is ill-prepared to believe he has the right to love, which leads to the plot twists that just don’t bear scrutiny. But, do you really expect believability from a story built around one man’s magical ability to find the music to save your life? Of course not. So just sit back and enjoy the music.

“Montpelier Parade” by Karl Geary, narrated by Geary, Audible Studios, 5 hours, 51 minutes

Actor and club owner Karl Geary, who left Dublin for the United States as a teenager, adds a mournful shade to every sentence in “Montpelier Parade,” his debut novel shortlisted for the Costa First Novel Award. It’s an appropriate tone for a story so full of longing.

To read the rest of this review, and a review of “My Absolute Darling,” click here.

Audiobook reviews: Munich, Anatomy of a Scandal, This Could Hurt

In audiobook review, Books, Reviews, Uncategorized on April 22, 2018 at 10:15 am
Anatomy, This, MunichJenni Laidman
Chicago Tribune
April 10, 2018

“Munich” by Robert Harris, narrated by David Rintoul, Random House Audio, 9 hours, 38 minutes

Actor David Rintoul, the narrator of Robert Harris’ thriller, “Munich,” summons a grumbling chorus of voices as the diplomatic maneuvers to prevent World War II unfurl. Not only must Rintoul manage the dry-leaves delivery of British Prime Minister Neville Chamberlain and the beer-hall harshness of Adolf Hitler, he has all the politicians and civil servants at the hearts of the British and German governments to enliven. Rintoul keeps a taut rein on the growing tension as a pair of young men — one German, one English — try to change the course of history.

The story of Chamberlain’s effort to forestall war is so well-worn, it’s lost its edges for many, but Harris’ story snaps the prime minister’s motivations into place. Chamberlain is a wily negotiator, working hard to outflank Hitler. If words could bind a criminal, Chamberlain’s desperate machinations would have changed history. But the prime minister disregarded Hitler’s essence; Paul von Hartmann, temporarily assigned to Hitler’s staff, has information he hopes will change Chamberlain’s course. His only hope of passing it along is a former Oxford friend, Hugh Legat, a low-ranking member of Chamberlain’s staff. Harris, who wrote “Fatherland” and the Cicero Trilogy, is a master of layering detail for tightly plotted, immersive fiction. His two young schemers are positioned to provide an intimate view of the political and defense calculations on both sides of the channel, while on the streets of London, workers scurry with sandbags and shovels to prepare for the worst — the only efforts that, in the end, really mattered.

To read the other reviews, follow the link here.

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