It's a problem in hospitals, too. Just take the neonatal intensive care unit at the University of California San Francisco.

On a recent morning, Mardi Thompson was swaddling a baby the size of a burrito with firm assurance. She's been a nurse here for 13 years.

Some of the babies who come through here were born prematurely. Others were born with congenital defects; some part of their internal anatomy didn’t develop the way it’s supposed to.

"Maybe their diaphragm is missing, or part of their intestine is outside of their chest," says Thompson. Some suffer from a condition called esophageal atresia, in which the child's feeding tube isn't properly connected to her stomach. That condition affects roughly one in every 4,000 children.

Working with Tools Too Big for the Job

They are what Sanjeev Dutta refers to as "plumbing problems."

Dutta is a pediatric surgeon at Lucile Packard Children’s Hospital, in Palo Alto, where he operates on children with these and other problems. He says often, the instruments he uses when he does these surgeries weren’t built for tiny babies. They were made for adults.

"We struggle with instruments that were never designed for the type of patient we are working on, and we adapt."

Dutta says the issue here isn’t safety. Most of these surgeries are, by now, pretty routine. But pediatric surgeons have to improvise in ways other surgeons don’t.

Working with tools that are several times too large for his tiny patients, Dutta is sometimes forced to stand a foot and a half away from his patient.

Size isn't the only problem pediatric surgeons face. Many pediatric procedures are specific to infants and children, fixes to problems that, unaddressed, would be fatal. In such cases, often the right tools simply don't exist.

Partly because of problems like these, pediatric surgeons have a reputation as being mavericks, people who are particularly good at improvising the tools they might need to operate successfully. No one fits that mold as well as Michael Harrison, at UCSF.

A History of Improvisation and Innovation

Harrison is known as the father of fetal surgery. He says twenty years ago, when the field was just getting started, his team had to make almost everything from scratch.

"We had to make all the tools and devices that allowed the fetal surgery, [the tools for] the the mom, and opening and closing the uterus. All that stuff we had to make up, because the tools were ten times too big."

Harrison describes this era — the 1970s and early 80s — as a golden age of pediatric surgery, a time when you could rig up a new tool or procedure, run tests on animals, if necessary, and then bring it into the operating room. He says he never felt like they had a choice.

"It’s almost a moral imperative. It’s usually in a circumstance where this kid is going to die. The only way we think we might be able to save him is this new way. We’d have to have this thing. Let’s do it. And that’s what we can’t do now."

In the mid 1970s, the FDA began regulating surgical devices, much the same way it regulates drugs. It can take a decade to get a device through the regulatory process, sometimes longer for pediatrics.

Harrison says this — along with the fact that many pediatric surgical procedures are rare — has had a chilling effect on medical device manufacturers.

"The market is too small to justify the research and development for new devices," he says. "That’s the fundamental problem."

In 2007, Congress passed the Pediatric Medical Device Act, which set aside a small pot of money, administered through the FDA’s Office of Orphan Products, to spur innovation in the field of pediatric surgery.

The program was initially intended to receive $6 million for each two-year cycle, but appropriations have come out much lower: $2 million dollars for 2009-2010 and $3 million for 2011-2012.

The idea is to bring together doctors and engineers to solve problems in pediatric surgery. These are the kinds of partnerships that Mike Harrison has been trying to forge for a decade. He says it can be a culture clash.

"We’re, you know, sort of blood and guts. We're saying, 'hey we've got to have this device, we’re going into the operating room tomorrow.' And they were thinking nanotechnology and PhDs."

Developing Tomorrow's Kid-Sized Tools

But the FDA money is making these partnerships routine at a handful of institutions across the country, including Georgia, Michigan, and here in the Bay Area.

The Magnetic Mini Mover uses two rare earth magnets to slowly reconfigure a sunken chest, similar in concept to orthodontics. Courtesy UCSF.

UCSF has received about a million dollars since 2009. That money has supported the development of tools to treat scoliosis, kidney failure and sunken chest, among other conditions. The pectus, or sunken chest device, is in clinical trials.

In Palo Alto, Sanjeev Dutta has paired up with an engineer named Pablo Garcia, from SRI International, in Menlo Park. In 2009, he and Sanjeev Dutta received 500 thousand dollars to fund their collaboration.

Garcia says there was an adjustment period on both sides, as he and Dutta learned how to collaborate. "When you actually put yourself in shoes of surgeon, things you thought were important actually are not. And things that you overlooked turn out to be the driving factors."

At one of their first meetings, says Garcia, Dutta asked whether a certain robotic instrument could be made smaller. "Sure," said Garcia. "But it'll take five to ten years."

One of the projects Garcia has developed in collaboration with Dutta is a catheter used to deliver nerve blocks to kids who have broken, for example, an arm or a leg.

Current catheters, says Garcia, "are placed blindly, based on anatomical landmarks, and they often get dislodged. So the catheter we designed has some features in the tip that allow it to grab onto the tissue, lock onto it, and navigate it in a more effective way than the current catheters."

One of Dutta's favorite tools is a device used to treat esophageal atresia. The surgery is complex and often invasive. Dutta says many surgeons rely on the same techniques they've been using for decades. A newer, less invasive method is becoming more common, but it's technically very difficult. Dutta and Garcia have developed a tool designed to make the less invasive procedure much easier, so that more kids can recover faster, and with less scarring.

A prototype tool used to perform cutting and spreading functions in the treatment of esophageal atresia. Courtesy SRI International.

The tool is just a prototype now, with many stages of trials standing between it and the operating room. With Dutta and Garcia's FDA funding running out, they'll need to find other ways to fund their work on this and other devices. Dutta hopes that private philanthropy can bridge the gap between R&D and commercialization.

Dutta says he knows, from the perspective of a commercial manufacturer, that the market for a tool like this is just too small to be profitable. "Eyes glaze over," he says, "if they hear ten thousand cases a year."

But what people need to realize, he says, is that the market could be a lot bigger. What’s helpful to kids could be useful in adult surgeries, too.

"What we need to do is figure out how we can connect the two markets," he says, "and make them sort of symbiotic."

In other words, Dutta and others are learning how to be not just surgeons, but entrepreneurs. Their business will be nurturing these products to the point where someone else will see the profit in making them.

Changing behavior is no easy task, but Stanford University researcher BJ Fogg is working on a new technique. Fogg runs Stanford’s Persuasive Technology Lab. He says not to worry about New Year’s goals. Instead, he focuses on what he calls “tiny habits.”

What’s a tiny habit? Fogg demonstrates by picking up his ukulele and playing for 30 seconds. "I used to play ukulele a lot. But I stopped practicing for a while so to get back into it I thought I’m going to create a tiny habit of just practicing this cord sequence," he says.

“I set it right by the piano so right after I finish breakfast I go pick the ukulele up. That’s what a tiny habit is. It’s a very little thing that you sequence into your life in a place that makes sense and you work to make it automatic.”

Thirty seconds doesn’t seem like much when you compare it to goals like getting in shape or eating better. But these broad ideas are where Fogg says most people get into trouble.

Resolutions vs. Habits

“What a mistake – the whole idea around New Year’s resolutions. People aren’t picking specific behaviors, they’re picking abstractions,” he says.

Abstract goals don’t work, says Fogg, when they aren’t tied to specific behaviors. And to retain new behavior, he says it needs to be instinctual. The more you have to remember to do something, the better the chances are that you’ll talk yourself out of it.

“The strength of a habit is defined, at least the way I see it, is how much of a decision was that behavior. So if you’re deciding ‘yeah, I’m going to go to the gym today’ it’s a pretty good indication it’s not a habit. Habits are things you do without deciding,” says Fogg.

Classic behavior models focus on decision-making as a key component of behavior. Fogg is trying to get away from that by working on a new model of habit formation that’s built on baby steps.

Forming a Habit

Take something like flossing your teeth. Instead of trying to floss all your teeth every day, Fogg says start with flossing just one tooth.

Next, find a habit you already have and do your new habit immediately after. “For me and for most people, brushing your teeth is a solid habit. So that can serve as a trigger for the new behavior you want.”

Then, reward yourself. “You declare victory. Like I am so awesome, I just flossed one tooth. And I know it sounds ridiculous. But I believe that when you reinforce yourself like that, your brain will say yeah, awesome, let’s do that.”

And once the habit is formed, Fogg says you’ll find yourself flossing all your teeth. That’s a theory he’s testing out, at least, with several hundred volunteers. Fogg put out a call on twitter, asking participants to do three tiny habits for a week.

Testing the Model

One of those people is Charles Wang, a psychiatrist in Palo Alto, who picked flossing as one of his habits. “So right now I’m probably doing on average six or seven teeth, I think,” he says.

He’s also trying to do ten pushups as soon as he wakes up and to answer emails as soon as he opens them. “When I look at the email, then I just say, you know, I’m going to immediately hit reply and then send a response. There are still times where it’s just challenging to do that one so I don’t always do it.”

If the ideas of behavioral triggers and rewards sound familiar to pet owners, Fogg says there’s a reason. “If you really took the techniques for training dogs and applied it to yourself, you would have much better success. Now, I’m sure people are upset with me for saying that because people want to think we’re different from other animals. When it comes to behavior, we’re a lot more alike than people want to believe.”

Fogg is eager to see if a person’s habit-making ability improves with every new one they make. And he believes understanding habit formation better is vital to industries like medicine and healthcare.

“The mistakes that are being made are pretty predictable. Don’t create a system that assumes that people are going to make these big huge changes in their lives. The good news is there are a lot of things in the works to help people stay healthy.”

Do you have a unique voice that sets you apart from the crowd? Contribute your stories to QUEST!

KQED QUEST is looking to add new voices to our blog, which already offers commentary from our producers, reporters, and local writers from our partner institutions at Chabot Space & Science Center and The Tech Museum.

We're looking to include folks who are actively involved in the science, environment and nature blogging community – e.g. have a blog, guest post on others' site, and comment / participate in relevant discussions. And we're looking locally. Our blog has a strong SF Bay Area focus, though we do occasionally cover and/or perform analysis on how this stuff elsewhere that affects the Bay Area.

What we cover

QUEST’s geographic coverage is from Mendocino to Monterey and from Sacramento to Santa Clara, and generally covers 9 content areas: astronomy, biology, chemistry, engineering, environment, geology, health, physics and weather.

Requirements

• Original posts, 3-500 words with at least 1 image. Schedule determined on availability, but weekly or bi-monthly is preferred.
• Posts should relate back to at least one of our 9 themes for the program: Astronomy, Chemistry, Engineering, Physics, Weather, Geology, Biology, Environment, Health.
• Topic should be something about which you have some expertise and/or passion.
• A unique voice and ability to follow our QUEST writing guidelines (see below).
• Experience with WordPress or similar blogging platform.
• Willingness to occasionally be assigned a post topic by the editor as current events dictate.
• Respect for copyright and fair use.

Would I get paid?

Yes – we offer a small stipend on a per post basis.

Alrighty, then. How do I apply?

Email us a note and bio to questeditor@kqed.org explaining what you'd like to write for us. Please also include some links to relevant blogs you admire, and/or participate in, and why. Send us a writing sample or two (links are fine), and we'll review it in the next couple weeks. Last day to submit is February 1st. Our hope is to bring aboard a few new bloggers by mid-February.

Some beats we're interested in

Although we want to hear from a wide range of writers, here are a few coverage areas we're keen on in particular:

• Bay ecology background and issues
• Science education
• Silicon Valley / engineering innovations
• Hacks, DIY, and hands-on science activities
• Hiking and outdoors (with a science focus)
• Food science
• Convergence of art & science
• Nature & science photography

Writing Guidelines

(As laid out by our managing editor, Paul Rogers)

Why does my grandmother care? A key requirement of QUEST bloggers will be to explain scientific and environmental issues in a way that the general public can understand. Our audience is mostly made up of people who aren’t scientists or environmental activists. Posts should explain why the topics they are writing about are relevant to Bay Area residents.

Get to the point. Studies have shown that readers spend only a minute or two on most web sites before moving on. The average reader reads about 200 words a minute. Write tight, and lively. Keep it interesting and informative.

Avoid jargon. The purpose of good writing is to communicate clearly. Don’t use complex, esoteric scientific terms. Instead of saying "non-point source pollution," say "polluted runoff." Instead of "extravehicular activity," say “space walk.”

Be personal. Relate personal experiences. Speak in the first person. Tell them where you saw the blue herons or which movie best depicts what a real moon base might look like. Find your own voice and write in a compelling, approachable way.

Be passionate. Write about subjects and topics that you care about. Please don’t feel you have to stick to a script or formula. Express yourself.

Drive traffic to the blog. Place a link in your correspondence and comments to the blog. Mention it on other web forums.

Write for the bigger picture. Don’t view the blog as a place just to promote your institution or pet cause. Keep in mind your audience is made up of a wide diversity of people, with wide interests.

Speak your mind, but check your facts. Or your audience will do it for you with painful results.

Know your fellow bloggers. You'll be part of a vibrant community with fresh ideas and discussions nearly every day. Don't be afraid to comment on their posts, or link to their entries. Have fun with it! Dreary bloggers or insufferable policy wonks need not apply.

The new Mercury and Air Toxic Standards announced by EPA administrator Lisa Jackson on December 21st require the electrical industry to limit stack emissions of mercury, arsenic and other toxic pollutants that originate from coal and oil-fired power plants and end up in America's air, water and food. Power plants are the largest source of mercury emissions at around 50 tons of mercury pollution annually. Because the particles are heavier than air, the mercury eventually falls back down and is deposited in rivers, lakes and oceans where it is converted into a more toxic form called methylmercury. This builds up in the food chain, meaning that fish at the top, such as striped bass, blue fin tuna and shark, carry the highest levels of the toxin.

The EPA estimates that 11,000 premature deaths and 130,000 cases of aggravated asthma among children annually by 2016 will be prevented, as well as other health benefits. Women, children and the developing fetus are most at risk for serious health problems resulting from mercury exposure. Between 300,000 and 600,000 of the 4 million babies born in the U.S. each year are exposed to significant amounts of the neurotoxin while in the womb.

Using scrubbers and other well-demonstrated technology, the rule requires power companies install equipment or shut down old plants by 2014 with the possibility of an extension into a fourth year. Seventeen states have already required the industry to apply the clean technology. These older US plants, operating mostly in the Midwest and East, can affect our Bay Area waterways and we will benefit from the new rule. However, most of the mercury in the San Francisco Bay enters from spills, the air, or water runoff from land from natural sources and historical mining.

Mercury levels will remain high in many species of San Francisco Bay and some ocean fish as well as other toxins like PCBs. The California Office of Environmental Health and Hazard Assessment (OEHHA) monitored contaminants in chemical contaminants in fish from the San Francisco Bay.

While the EPA rule is good news for Americans, we must be cautious about what fish and how much fish we consume. Some fish from San Francisco Bay like rockfish and smelt are low in mercury and can be safely eaten. Others like wild king salmon are high in Omega-3s that have been demonstrated to be beneficial to human health. Others like sharks, striped bass and other top predators like swordfish and tuna bio-concentrate mercury and should be avoided, especially by women 18-45 and children under 7 years. The point is to ask where your fish is coming from, how was it caught and how much can you eat. A mercury calculator on the "Got Mercury?" website allows one to calculate how much mercury they are consuming and if it exceeds advisory guidelines produced by the EPA.

The "Got Mercury" Campaign, a project of the Turtle Island Restoration network based in Marin County, is building awareness about toxic mercury in commonly eaten seafood. To reduce risk from mercury exposure, "Got Mercury" is asking the government to increase health advisories and reduce action levels for mercury in fish. The program is also petitioning the FDA to lower the legal mercury action level from 1 part per million (ppm) to 0.5 ppm to be in line with the Environmental Protection Agency’s mercury standards for recreationally caught fish and to require seafood sellers to post mercury in fish warning signs.

From hackerspaces to banana slugs, flying telescopes to cheese — it's been a quite a diverse year of storytelling here at QUEST. Here's a round-up of the top 10 video and audio stories and blog posts (based on page views) that you've enjoyed from the past year. Please let us know what other stories you've enjoyed in the comments section below, and if there's anything you'd like to see in the coming season!



VIDEO:

Nanotechnology Takes Off

Stem Cell Gold Rush
Science on the SPOT: Banana Slugs Unpeeled
Berkeley Lab Physicist Shares Nobel
Science on the SPOT: Open Source Creativity – Hackerspaces
Super Laser at the National Ignition Facility
The World's Most Powerful Microscope
The Science & Art of Cheese
Mt. Umunhum: Return to the Summit
The Fierce Humboldt Squid

AUDIO:

Up All Night on NASA's Flying Telescope</a>

The Lost Lagoon
Energy-Saving Windows Get Smarter
The Amazing Transformation of San Francisco's "Sludge Puddle"
Supercomputers Hit an Energy Wall
From Tunnel to Tap: Quake-Proofing Our Water Supply
"A Big, Captivating Idea": The Bay Area Ridge Trail
Architecture for the Birds
Gulls Threaten South Bay Salt Pond Restoration Work
In a Sea of Energy Data, Utilities Try to Inspire Conservation

BLOG:

Explosive hypothesis about humans' lack of genetic diversity
Diet Sodas May Not Be As Harmless As You Think
Health Officials to Consider Tightening Vaccine Exemptions
Scientists Understand Heart Disease Better, Still Give Bad Advice
The Megalodon's Descendants
Famous African American Scientists & Innovators: Part II
Swine Flu – A Virus or a Bacteria?
Cyber Wolves in (Fire)Sheep Clothing
Why Do Mosquitoes Buzz in People's Ears?
15 Months Later, Rediscovered San Francisco Plant Thrives

Dr. Kevin Guskiewicz and his team use helmet accelerometers, known as the Head Impact Telemetry (HIT) systems, to identify at-risk behavior on the football field.

In September 2011, UNC-Chapel Hill sports medicine researcher Kevin Guskiewicz was awarded a MacArthur “Genius Grant” for his work on what he calls a hidden epidemic: sports-related concussions.

The award comes with a head-spinning a $500,000 grant, a major portion of which Guskiewicz says will go towards his work:

“We have an amazing interdisciplinary research team at UNC, and the MacArthur Fellowship will help us to expand our work into developing injury prevention strategies and rehabilitation protocols for concussion that can help to preserve sports as we know it today.”

That’s right: a world-renowned concussion expert wants to save, not eliminate, contact sports.

You might assume that Guskiewicz prefers to keep his four children off the field and on the sideline, but that’s not the case at all.  It’s been reported that  “three of his four children have played football, and Guskiewicz has coached Pop Warner teams for five of the last six years.”

These days, barely a week goes by without another news report linking sports related concussions to brain trauma. Even PBS NewsHour is jumping into the rink. Guskiewicz applauds the media for bringing attention to the issue but he stops short of calling a TKO on all contact sports.

Below is an edited version of an UNC-TV interview with with Kevin Guskiewicz after he was awarded the MacArthur Fellowship:

UNC-TV: Let's break this down into very simple terms. What is a concussion?

Guskiewicz:  The word “concuss” means to shake violently. It's a shaking of the head. The brain rebounds off of the undersurface of the skull and can be damaged.  Most often, fortunately, it's considered a mild traumatic brain injury because it's temporary in nature in terms of the signs and symptoms that [athletes] experience.

Kevin Guskiewicz utilizes balance and orientation tests to determine the severity of sports-related head injuries.

UNC-TV: What does the public think of a concussion? Do we under or overplay it?

Guskiewicz: I think there certainly has been a culture shift in the right direction, meaning we're taking it more seriously.  The media has done a great job of creating awareness about the dangers of playing while still experiencing symptoms from a concussion, and we're trying to educate athletes, coaches, parents about those signs and symptoms and to take the right precautions in terms of staying out of play and not returning to play until the symptoms have resolved and being cleared by a physician or a clinician with training in concussion management.

UNC-TV: In which sports are athletes most prone to suffering a concussion?

Guskiewicz:  [With] any collision sport there's a higher incidence of concussion. So football, lacrosse, hockey, wrestling, gymnastics.  Those tend to sit at the higher end of the incidence rates in terms of concussion.

UNC-TV: How do you know you’ve suffered a concussion?

Guskiewicz: Common signs and symptoms are headache, dizziness, blurred vision, feeling as though you're in a fog or having concentration problems.

Later that day or that evening could be difficulty sleeping or loss of appetite, things of that nature.  Memory impairment, loss of consciousness.  Those are two parameters we used to weigh very heavily when diagnosing a concussion and saying this truly is a “concussion.”

If you go back 15, 20 years ago, it used to be, “Johnny hasn't lost consciousness, so he hasn't sustained a concussion.”  Less than 10% of concussions involve loss of consciousness.  So it's admitting you don't feel quite right.

It's been described as a hidden epidemic. Unlike an ankle sprain, we can't see this injury.  X-rays can't be used to identify the injury.

UNC-TV: In the everyday world, are concussions a big deal?  If you get a couple in high school playing football, should you worry about it when you grow up and go about your daily life?

Guskiewicz: At UNC, we house the Center for the Study of Retired Athletes. We've been studying retired NFL football players for the last 11 ½ years. Those with a history of three or more concussions are at an increased risk for depression or a precursor to Alzheimer's. We do need to be concerned that once a young child or a high-schooler has had two or three concussions, we begin to ask the question, what does that mean for that individual at age 35, 45, 55?  And so the late in life consequences must be considered in managing these acute injuries.

Kevin Guskiewicz, Ph.D., ATC  is the Kenan Distinguished Professor and chair of the department of exercise and sport science in UNC’s College of Arts and Sciences.

To see a recent QUEST Northern California video about concussions, watch our Sidelined: Sports Concussions video story.

Archivist Stacey Peeples displays a hand-written text with a recipe for 'stomach pills.' (Photo: Todd Vachon/WHYY)

The nation's first hospital culled its archives to create a collection of medical and botanical texts from the 18th and early 19th century.

The exhibit, “Flower to Pharmacy,” is housed at the Pennsylvania Hospital Historic Collections in Philadelphia. The illustrations are beautiful, the hand-written lecture notes from medical students are fun to decipher, but maybe most striking is the physicians' focus on body fluids.

Phlegm was a big deal in Colonial times.

“They really believed that these systems were out of whack and you had to do something to bring it back into order,” said curator and archivist Stacey Peeples.

Doctors practiced “humoral medicine,” an ancient idea that health comes from a balance of the body's four humors–phlegm, blood, yellow bile and black bile. In addition to bloodletting, physicians relied on sweating and purging and needed the right mix of flowers, roots and herbs to make that happen.

A view of the library inside the historic Pennsylvania Hospital (Photo: Todd Vachon/WHYY)

The exhibit is a compendium of plants used for medicine as well as prescriptions for pills and poultices. Long lists detail the healing properties of blue flag and yellow-button tansy as well as familiar kitchen herbs such as ginger, rosemary and thyme.

In “The American Practice of Medicine,” Connecticut-born Wooster Beach writes that peppermint is “agreeable and penetrating, slightly bitter, followed by a sensation of cold in the mouth” and good for settling the stomach.

You can also look up ways to fight flatulence, hysteria, dropsy (inflammation), piles (hemorrhoids) and cardialgia (heartburn).

One of the oldest texts is a 1633 edition of John Gerard's “Herball, or Generall Historie of Plantes.” The English herbalist includes detailed line drawings and warnings against the most poisonous plants.

“For them to say something will kill you immediately, probably means it was pretty harsh,” Peeples said. “Given the amount of enemas and purgatives these people were taking. It had to be really bad. We like to call it “heroic medicine,” that idea that the physician will go to any means to cure you, even if meant killing you.”

Most of the books were part of the hospital's active lending library and are amazingly preserved, especially Mark Catesby's “Natural History of Carolina, Florida and the Bahama Islands.” It's a picture book of plants and insects illustrated on deeply saturated color plates – and lovely for art’s sake alone.

Wendy Grube is a nurse practitioner and registered herbalist who teaches a course on alternative therapies at the University of Pennsylvania. She collects her own historical volumes on plant medicine and has done research in the Pennsylvania Hospital archives.

“Flower to Pharmacy” includes some of the first “materia medica” produced for an American audience, and Grube says the meticulous anthologies are fascinating for modern day herbalists.

Early colonial doctors had a very different conception of disease and hadn’t discovered viruses or bacteria, but Grube says that didn’t keep them from hitting on the true medicinal value of plants.

Sage, for instance, is antimicrobial and thyme has anti-viral properties.

Physicians made connections from careful observation over time, Grube says. Doctors likely didn’t understand that an herb was killing off microbes, but it was clear that certain plants helped for cold and cough, she said.

“Flower to Pharmacy” collects the texts used by white, male physicians at Pennsylvania Hospital in the 1700s, but Grube says their records include knowledge learned from Native Americans and traced back to ancient Egypt and Greece.

Curator Stacey Peeples said some of the information in the library collection was surely common knowledge among Colonial women who kept their own recipe books.

“Today if you have a headache, you don't run to the hospital,” Peeples said. “The first thing do, is you take an aspirin. It was similar at that time. The woman was entrusted with the care of the family.”

“Why did these traditions happen? They happened because they were effective. I don't think people really waste their time on things that aren't effective,” Grube said.

In many PTSD patients, sleep problems such as insomnia and nightmares are the most common complaint. (Photo courtesy of Flickr user <a href="http://www.flickr.com/photos/kreep" target="_blank">Kreep</a>.)

Sam Brace doesn’t want to talk about what he saw when he was a soldier in Iraq eight years ago. Brace is an inpatient at a PTSD treatment center run by the Department of Veterans Affairs in Menlo Park, and that trauma is something he’s actively trying not to dwell on. But what he can’t control are his dreams.

"When I was overseas we hit an IED, um…" he says, trailing off. "When I have a nightmare normally it’s something related to that. "

In the past, scientists who study PTSD thought of nightmares and insomnia as byproducts of the disorder, side effects that could only be targeted through daytime interventions, such as cognitive behavioral therapy. But that view is changing.

In Sam Brace and others afflicted with PTSD, nightmares and insomnia lead to alcoholism and drug abuse, and the inability to function well during the day. Doctors who treat PTSD say that sleep is central to the disorder, and that restoring it may go a long way toward helping patients return to normal lives.

"Wacky" dreams are healthy dreams

Steve Woodward, a psychiatrist with the National Center for PTSD in Menlo Park says the hallmark of a healthy dream is that it seems kind of random.

"They’re wacky," says Woodward. "They associate things that are not normally associated."

PTSD dreams, in contrast, are like a broken record: the same, real-life event, played over and over again. Woodward says he's seen patients haunted by the same true-to-life nightmare for twenty years.

The question scientists had was: why? Why can't people with PTSD sleep normally?

Healthy sleep as therapy

Matthew Walker is a sleep researcher at the University of California, Berkeley. One of his particular interests is in rapid eye movement, or REM. It’s the stage of sleep where a lot of dreaming occurs.

REM sleep is also the only time of the day that the brain stops producing a kind of adrenaline called norepinephrine. That fact struck Walker as an intriguing mystery. Why would rapid eye movement sleep suppress this neurochemical, he wondered. Is there any function to that?

What Walker and his colleagues found is that in healthy people, REM sleep is kind of like therapy. It's an adrenaline-free environment where the brain can process its memories while stripping away their sharp, emotional edges.

"When you come back the next day," says Walker, "yes, you can better recollect [the memory]. But also, it doesn’t trigger that same visceral reaction that you had at the time of learning."

Emotions are useful, says Walker, because they show us what really matters to us. But it's not useful to hold onto what he calls the "emotional blanket," that accompanied the original event. The emotions, he says, "have done their job. Now it’s time to hold on to the information of that memory, but let go of the emotion."

"Broken" REM sleep

Walker believes that in many people who have PTSD, REM sleep is broken. Something about PTSD either causes the brain to be overly sensitive to norepinephrine, or forces the brain to create too much of it. The brain's adrenaline system is effectively out of whack.

As a result, REM sleep is no longer theraputic. The PTSD brain can't process tough memories, so it just cycles through them, again and again.

Which begs a question: What if you could change that? What if you could make the adrenaline go away?

An old drug finds a new role

Murray Raskind directs Mental Health Services for the Department of Veterans Affairs Puget Sound Health Care System. About a decade ago, he became interested in a drug called Prazosin, which was traditionally used to treat high blood pressure.

Prazosin can be bought generically for about ten cents a pill. It can have the side effect of making people dizzy. For the most part, it's been supplanted by other, more recent hypertension drugs, whose effects last longer. But Prazosin turned out to have another use: It makes the PTSD brain less receptive to adrenaline.

As a result, as Raskind discovered, prazosin can change the way those patients dream.

Raskind tells the story of one of the first vets he ever treated with prazosin, a veteran Raskind calls Charles, who spent 13 months in a combat infantry unit in Vietnam.

What haunted Charles was one specific event from his service: Under an ambush by Vietcong forces, Charles and a fellow soldier, his closest friend, found themselves trapped in a landing zone in the jungle. Charles watched as his friend was killed by a mortar round. Fragments of the round pierced Charles' right knee, leaving him unable to run. Charles was saved at the last minute by troops in a Huey helicopter, just as Vietcong forces climbed through the wire to reach him.

"This near-death experience," says Raskind, "and even more distressing, the death of his best friend, whose death he felt he was unable to prevent, haunted him most nights, every week, year in and year out."

After a few weeks of Prazosin, Charles came in for a follow-up appointment. He told Raskind that he didn't think the drug was working. He was still dreaming, just about something else.

According to Raskind, the dream went like this: "I'm in my fifth-grade classroom. And there’s a test, and if I don’t pass the test, I’m not gonna be promoted to the next grade. And I never even got the assignment!”

It was the stress dream, says Raskind, of a healthy brain, trying to work things out. "I said 'Charles, that’s MY nightmare!'" Raskind recalls.

So far the studies on prazosin have been small (abstracts can be found online, here and here and here – as well as of a 2008 round-up of data, here) but promising in decreasing nightmares and helping people sleep longer.

Other small studies involving non-combat PTSD – people who had been victims of crime and sexual assault, as well as refugees – found an improvement in the quality of their dreams, and overall sleep, as well.

The Department of Veterans Affairs is undergoing its own study on prazosin in PTSD, which is taking part in 13 medical centers across the country. But is already prescribing the drug to about 15 percent of its PTSD patients — about 70,000 people.

Murray Raskind, for one, would like to see that number rise.

"For us," he says, "it's a simple thing that works."

Photo Credit: Kimberli Miller, USGS National Wildlife Health Center.

Standing in the entrance of a Vermont cave in March 2008, it was clear from the dead bats in the snow, another flying in the frigid cold and one clinging to an icicle that something was wrong.

I’m a Wildlife Disease Specialist for the USGS National Wildlife Health Center in Madison, Wisconsin.  The Center’s mission is to safeguard wildlife and ecosystem health through dynamic partnerships and exceptional science.  I was at the cave with two Vermont Fish and Wildlife Department biologists to learn more about white-nose syndrome (WNS), a new disease that was killing bats in New York, Vermont, Massachusetts, and Connecticut by the thousands.

Bats are fascinating creatures that have evolved very specialized survival skills.  One of these is their ability to hibernate to conserve energy by reducing their heart rate, temperature and other body functions to very low levels for extended periods.  This allows bats to survive long winters using their stored body fat when their insect food source is unavailable.  Although bats may briefly rouse out of hibernation to drink water or move to a different part of the cave, they typically stay deep in their hibernaculum or winter “roost site” until spring.

So it was odd in winter 2007 when New York residents reported seeing bats flying during the day and finding them dead in the snow in their yards.  Biologists following up on the reports were surprised to find a nearby cave littered with dead bats and a fuzzy white growth on the nose and wings of some of the live bats.  The following winter, sick and dead bats were reported in multiple locations in New York as well as Vermont, Massachusetts, and Connecticut.  The disease has now spread as far west as Kentucky, as far south as North Carolina, and to four Canadian provinces.  It is estimated that over a million bats have died since 2007, making this the largest disease outbreak among mammals in modern times.  WNS has spread very rapidly, by bats themselves, and likely also by people moving between affected and unaffected sites.

WNS Occurrence by County. Map courtesy of Cal Butchkoski, Pennsylvania Game Commission.

Navigating the icy rocks into the Vermont cave, dead bats were so numerous; stepping on them was sometimes unavoidable.  A live little brown bat clinging to the rocks overhead didn’t have white nose fuzz but did have wing damage, which we now know, is one of the components of WNS.

Photo Credit: Kimberli Miller, USGS Nation Wildlife Health Center

Nationwide, scientists are collaborating to quickly learn as much as possible about this disease.  One of my Center’s laboratories first isolated a cold-loving fungus from sick bats that they later named Geomyces destructans.  Additional studies determined that it is the cause of WNS.  Other scientists studied the wing damage caused by the fungus and how the injury affects body temperature and hydration during hibernation.  The caving community has helped efforts to prevent the accidental spread of the fungus to new areas on equipment and supplies.  All involved hope to one-day find ways to slow or halt the spread of the disease and reduce bat deaths before WNS causes some bat species to become extinct.

More than 60-million people are infected with HIV, worldwide, and more than 25 million have died of the virus according to Greene. While HIV has become more of a chronic disease in the U.S., thanks to progress in antiretrovirals, it still continues to expand across the globe. In Sub-Saharan Africa, approximately 25 million people are living with the disease. In fact, for every person put on antiretrovirals, two more become infected. Says Greene, “We do not yet have a winning strategy in Africa.”

Greene views HIV research now as three big unanswered questions:

1) We need a vaccine for those that are not infected

2) We need a cure for those that are infected

3) We need to understand why individuals who are on antiretrovirals, and doing well, are dying ten to fifteen years before their time.

Greene says scientists at Gladstone, and around the world, are looking at promising research that could one day lead to a cure. “Right now people have to take the antiretroviral medicines for their entire life because there is a small set of cells that are harboring a latent or sleeping form of the virus which is not affected by antiretrovirals but once in a while it wakes up and spits out new virus. But if you remove antiretroviral therapy, after years of successful treatment, the slumbering virus can rekindle the entire fire and lead to a full blown infection within weeks. There are programs being funded by the federal government to attack these latent reservoirs,” says Greene who is working on the latency challenge at Gladstone.

The biggest breaks in HIV research, according to Greene, include identifying the HIV virus, the advancement of antiretroviral therapy and the discovery that circumcision could drastically reduce the spread of the virus.

Says Greene, “HIV is like no other virus. On the one hand it acts like a guided missile that attacks the immune system and on the other it has this amazing ability to change its form. It is like the virus is always a step ahead.”