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Major medical incidents [timeline]

Major incidents are defined as any incident ‘that requires the mobilisation and use of extraordinary resources’; with the NHS further expanding the definition of such events as ‘any incident where the location, number, severity, or type of live casualties requires extraordinary resources’. There have been many major incidents throughout history that have required an ‘extraordinary’ response by emergency services, medical personnel, and government bodies. Whilst this definition may seem strict, the variety in such incidents is wide: from health epidemics and natural disasters, to man-made events and accidents, with each requiring a complex and often changing response to help those affected.

Our timeline below explores the variety of major medical incidences that have occurred globally from 16th century and the immediate response to them by emergency services. Although major medical incidents cannot be foreseen, history has revealed that detailed preparation for and rapid response of such occurrences may help mitigate the devastation that follows.

Featured image credit: ‘StateLibQld 1 199599 Ambulance workers practise first aid on a volunteer patient, Brisbane, ca. 1942’, by Queensland Newspapers Pty Ltd. Public domain via Wikimedia Commons.

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How to write a conclusion

Writing essays is complicated work, and writing the ending to an essay is often the hardest part of that work. Endings are tough for several reasons. You may be tired from writing–or tired of what you have written. You may feel that you have made your point sufficiently and that no more needs to be said or can possibly be said. You may feel like just tying a bow around the essay and calling it good, but doing so is a mistake. The ending is your last chance to make an impression.

And even if you try to write a powerful, substantive ending, there are plenty of ways to go wrong: repeating, equivocating, going off on a tangent, introducing a call to action from out of nowhere, marveling at the mysteries of the universe, tacking on an afterthought, and so on. I know because I’ve made all of these mistakes.

With so many ways to go wrong, planning the ending is too important to leave until the end. Consider the analogy of a road trip. If you are on the highway, you want to know where your exit is, slow down, signal and safely leave the highway. If you are driving too fast, or are in the wrong lane, or if the road is hazardous, you may be in for an accident. So think about the ending all through the essay, perhaps even finding ways to drop foreshadowing clues as you go, so the ending seems natural rather than forced.

Your ending should also match the purpose of the piece of writing. An opinion essay might end by reinforcing a particular course of action and its outcomes; a historical essay might connect the material discussed with what happened later or could happen in the future; satire might end with a wink to the reader; and analytic writing might offer readers a chance to test their thinking abilities. Even a listicle has a natural ending: the last item is often the most complex one–the item that the others in the list prepare the reader for.

Besides matching the purpose of the writing, the ending should be in proportion to the rest of the work—probably between ten to fifteen per cent of the content but no more than twenty and no less than five. Finally, an ending should not be over-signaled with transitional phrases like “In conclusion,” or “to summarize” or even “so….” It should emerge naturally, almost inevitably from your points.

Once of the best ways to refine conclusions is to spend notice how some writers you admire handle their endings. Take Sam Anderson’s New York Magazine review of The Anthology of Rap, in which he discusses rap as written poetry. His ending teases us with “And now to the ultimate question…who is the best rap lyricist of all time?” His gives us his shortlist, his reasoning, and his choice and leaves us with the reminder that he is just talking about rap as poetry not rap as performance. The ending reminds us that there are different ways to think about rap.

Or consider Nadja Spiegelman New Yorker essay on two-hundred-year-old Bureau of Found Objects in Paris. She takes us to that quaintly named lost-and-found bureau and shares the experiences of people looking for lost objects. Her ending takes us out the door with them: “As people leave the bureau, the communion of the waiting room fades,” she explains: she–and we–see the relationship between people and objects differently at the end. Our possessions become things waiting to be lost.

One more, from Robin Marantz Henig’s a New York Times magazine piece called Taking Play Seriously, a longer essay with a longer conclusion. Her 7,500-word article on the biology of play begins at a lecture by the president of the National Institute for Play and she asks us to think about what play is good for. The essay goes on to describe the evolutionary and neurobiological bases of play and its benefits. The conclusion, a little over four hundred words (or five percent), returns the reader from the world of science to the every-day, even touching on a new insight from the talk at the National Institute of Play. It re-asks the opening questions as What would be lost if play is a thing of the past?

What the examples from Anderson, Spiegelman, and Henig show me is that a good ending both reinforces and reframes an essay. When we read, we enter into a literary experience with a writer, getting into their thoughts for a time. A good conclusion takes us smoothly out of their thoughts and back to our own with a new perspective and a renewed curiosity.

Featured image credit: The origin and progress of writing, as well hieroglyphic as elementary by Special Collections at Johns Hopkins University. CC-BY-2.0 via Flickr.

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Beethoven in space

Katie Paterson has always wanted to shoot Beethoven to the moon. In Earth-Moon-Earth (2007) the Scottish conceptual artist translated a performance of Beethoven’s Moonlight Sonata into Morse code, sent the radio signals to the moon, and recaptured the reflection. What came back of the transmission, having traveled 230,000 miles and back, was refracted on the irregularities moon’s crooked surface, and re-translated into a fragmentary and partial “score” of Morse code, which was then re-sonified and performed on a modern player piano. The absences and gaps in the resulting performance are remnants of the music’s impossible journey to the moon and back.

Paterson has made a name for herself for creating artworks that give concrete material shape to the unfathomable dimensions of the universe, of geological time and galactic space. The nickname of Beethoven’s piano sonata Quasi una fantasia op. 27 no. 2 – “Moonlight” – which goes back to the music critic Ludwig Rellstab in the nineteenth century, makes this piece an obvious choice, an artistic quip. But there is more to using Beethoven in conceptual art projects than just a clever word association. Paterson’s work is part of a wider trend in conceptual art that has embraced music and its curious ability, despite its evanescent materiality, to make time and space manifest.

Perhaps the most celebrated instance of Beethoven in outer space is on the Golden Record of the Voyager mission that recently celebrated its 40th anniversary and that has left the solar system, on its way to a galaxy far, far away. The Golden Record is not an artwork in the strict sense, but an interstellar mix tape that Carl Sagan and his team curated for the use of extra-terrestrials in 1977. While the Golden Record had nothing to do with the scientific goals of this space mission, it did manage to capture the collective imagination, by humanizing the idea of outer space. While the disc jockeys that put together the Golden Record made an effort at assembling a collection of different musical traditions from across the world, from Japanese gagaku to Louis Armstrong, and from Mexican mariachi to Indian raga, they deviated slightly from their attempts at inclusiveness and balance by allowing a special place for Bach and Beethoven, who represent Western classical music with multiple compositions. The record includes Beethoven’s Fifth Symphony, as one might expect, but also the Cavatina from the String Quartet op. 130, perhaps a less obvious choice. Apparently, this movement was a favorite of Carl Sagan’s—the intense humanity of this piece, underlined in the famous performance indication beklemmt (stifled, inhibited) for the first violin in the contrasting middle section, makes this piece such an intriguing choice. Music critic Alex Ross called it “a wistful farewell” from earth. But second-guessing intentions behind the inclusion of specific pieces matters less than the fact that there is music traveling to the farthest reaches of the universe, as a sign that we humans exist.

“The Voyager Golden Record”, by NASA. Public Domain via Wikimedia Commons.

Over time, the significance of the record has changed: as critics pointed out at the time, the record rests on huge assumptions (for starters: do aliens have ears?); but by now there is a sense that if extra-terrestrials have the technology to explore our spacecraft, they are unlikely to learn much from our technology—but they will probably be interested to find out more about human culture. And we have time: there is every reason to believe that Voyager, and the Golden Record, will continue their voyage for millions of years. As Evander Price has pointed out, the Golden Record traveling away from earth at 35,000mph into the future will likely be the most lasting testimony of human culture, a piece of space trash still flying into the unknown, long after earth itself has disappeared.

If Paterson’s Earth-Moon-Earth and the Golden Record take Beethoven on journeys exploring unimaginable dimensions in time and space, giving concrete shape to the transcendent, the Norwegian ideas-based artist Leif Inge manipulates musical time in his digital artwork 9 Beet Stretch (2002) without the intervention of distant planets. This piece, which has been performed as sound installations all over the world and also exists online on a permanent loop, takes a recording of the ‘Ninth Symphony’ and decelerates it so as to last exactly twenty-four hours. Thanks to the technology of granular synthesis, the pitches in this rendition remain the same; the music just slows down tremendously. The resulting sounds coalesce in a soundscape that moves past us gradually and granularly, with smooth contours, in continual, barely perceptible transformation. If we choose to, we can be permanently enveloped by the sounds of this endless slowed-down Ninth, every day the earth circles the sun, in perpetuity.

In terms of the space music surrounding ‘9 Beet Stretch’, admittedly, this digital artwork is a mere blip on the radar of the geological (or rather intergalactic) clock. Other musical installations that play with extreme durations last 539 years, 1000 years, or even close to 40 billion years—longer than the lifespan of the universe itself. But there is something very apt about the rate of deceleration (the 74-minute recording is “stretched out” by a factor of 22.15): at the resulting tempo it is just about possible to make out some individual changes in the day-long symphony, to recognize the dotted rhythms of the Scherzo thundered on the timpani, the descending void fourths and fifths that open the symphony, and which are stretched out to last many seconds, but that still (barely) fall within our attention span. In this way, we can hear slowness; we can perceive how time passes through the music persistently and glacially.

Why Beethoven? One part of the fascination with Beethoven is certainly related to the centrality of his music in our culture. Even the Voyager mission made two slots available for him, in the extremely limited space on the grooves of the Golden Record that was supposed to represent all of earth’s musical cultures. For us earthlings, meanwhile, we know Beethoven so well that we can even restore the original sounds under extreme circumstances: we hear the resonances in the gaps of the moon-reflected Moonshine Sonata and the otherworldly slow sublimity of the Ninth, even where the sounds go beyond what our senses are able to perceive.

Featured image: “ Hubble Monitors Supernova In Nearby Galaxy M82” by NASA Goddard Space Flight Center. CC BY 2.0 via Flickr.

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Misattributed quotations: do you know who really said it? [quiz]

The seemingly simple task of asking ‘who said what’ has perhaps never been more difficult. In the digital age, quotations can be moved around, attributed, questioned, re-appropriated, and repeated in the blink of an eye. If someone is ‘widely quoted’ as saying something and it sounds more or less right, many people take this to be sufficient proof of the quotation’s origin. With this tacit approval, misquotations spread even further, in an ever-increasing pattern of misattribution and acceptance. With more data available than ever before (instantly available at the click of a mouse), such issues are ironically a result of more information – not less! Hesketh Pearson, author of Common Misquotations, wryly commented:

“Misquotation is, in fact, the pride and privilege of the learned. A widely-read man never quotes accurately, for the rather obvious reason that he has read too widely.”

Certain figures can also ‘attract’ quotations more than others; Abraham Lincoln, Maya Angelou, Oscar Wilde, and Groucho Marx being just some of the main victims (or victors) of misattribution. As James McNeill Whistler once amusingly wrote:

“Oscar Wilde:  How I wish I had said that.

Whistler:  You will, Oscar, you will.”

With this in mind, we thought it was a good time to test your knowledge of commonly misquoted phrases. Do you know who said what?

Feature image and quiz background image credit: Talk, chat comic cartoonby Prawny. Public domain via Pixabay .

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POTY 2017 nominee Spotlight: the sun [excerpt]

On 21 August 2017, a total eclipse could be seen in the contiguous United States for the first time in nearly four decades. The path of totality stretched from Oregon to South Carolina, and an estimated 1.85 million to 7.4 million people were expected to travel to experience totality.

In the following excerpt from Totality: The Great American Eclipses of 2017 and 2024, Mark Littmann and Fred Espenak explain what causes a solar eclipse—and totality.

How big is the Moon in the sky? What is its angular size? Extend your arm upward and as far from your body as possible. Using your index finger and thumb, imagine that you are trying to pluck the Moon out of the sky ever so carefully, squeezing down until you are just barely touching the top and bottom of the Moon, trapping it between your fingers. How big is it? The size of a grape? A plum? An orange?

It is the size of a pea. (You can win bets at cocktail parties with this question.) The Moon has an angular size of only half a degree.

Now, how large is the Sun in the sky? Your friends will almost all immediately guess that it is bigger. Before they damage their eyes by trying the Moon pinch on the Sun, just remind them that a total eclipse is caused by the Moon completely covering the Sun, so the Sun must appear no bigger than a pea in the sky as well. It is the brightness of the Moon and especially the Sun that deceives people into overestimating their angular size.

Poster promoting the 2017 total eclipse, designed for NASA Goddard Space Flight Center. Credit: “Eclipse Across America Red-White-and-Blue Poster” by NASA Goddard Space Flight Center. CC BY 2.0 via Wikimedia Commons.

Now that you have collected on your bets and can lead a life of leisure, think about the remarkable coincidence that allows us to have total eclipses of the Sun. The Sun is 400 times the diameter of the Moon, yet it is about 400 times farther from the Earth, so the two appear almost exactly the same size in the sky. It is this geometry that provides us with the unique total eclipses seen on Earth when our Moon just barely covers the face of the Sun. If the Moon, 2,160 miles (3,476 km) in diameter, were 169 miles (273 km) smaller than it is, or if it were farther away so that it appeared smaller, people on Earth would never see a total eclipse.

It is amazing that there are total eclipses of the Sun at all. As it is, total eclipses can just barely happen. The Sun is not always exactly the same angular size in the sky. The reason is that the Earth’s orbit is not circular but elliptical, so the Earth’s distance from the Sun varies. When the Earth is closest to the Sun (early January), the Sun’s disk is slightly larger in angular diameter, and it is harder for the Moon to cover the Sun to create a total eclipse.

An even more powerful factor is the Moon’s elliptical orbit around the Earth. When the Moon is its average distance from the Earth or farther, its disk is too small to occult the Sun completely. In the midst of such an eclipse, a circle of brilliant sunlight surrounds the Moon, giving the event a ring-like appearance—hence the name annular eclipse.

Because the angular diameter of the Moon is smaller than the angular diameter of the Sun on the average, annular eclipses are more frequent than total eclipses.

But the Moon does not just dangle motionless in front of the Sun. It is in orbit around the Earth. It catches up with and passes the Sun’s position in the sky about once a month.

The Moon gives off no light of its own. It shines only by reflected sunlight. So half the Moon is always lighted by the Sun. But as the Moon orbits the Earth, sometimes we see the Earth-facing side fully illuminated and sometimes we see only a thin crescent. As the days pass, the Moon changes phase—crescent, gibbous, full. . .

In 29.53 days, the Moon goes from new moon through full moon and back to new moon again. Solar eclipses can take place only at new moon, and lunar eclipses may occur only at full moon.

So why don’t we have an eclipse of the Sun every 29.53 days—every time the Moon passes the Sun’s position? The reason is that the Moon’s orbit around the Earth is tilted to the Earth’s orbit around the Sun by about 5°, so that the Moon usually passes above or below the Sun’s position in the sky and cannot block the Sun from our view.

The Moon’s tilted orbit crosses the plane of the Earth’s orbit at two places. Those intersections are called nodes. The point at which the Moon crosses the plane of the Earth’s orbit going northward is the ascending node. Going south, the Moon crosses the plane of the Earth’s orbit at the descending node.

A solar eclipse can occur only when the Sun is near one of the nodes as the Moon passes. If the Sun stood motionless in a part of the sky away from the nodes, there would be no eclipses, and you would not be agonizing over this. But the Earth is moving around the Sun, and, as it does so, the Sun appears to shift slowly eastward around the sky, through all the constellations of the zodiac, completing that journey in one year. In that yearly circuit, the Sun must cross the two nodes of the Moon. Think of it as a street intersection at which the Sun does not pause and runs the stop sign every time. It is an accident waiting to happen. When the Sun nears a node, there is the “danger” that the Moon will be coming and—crash!

No. The Moon is 400 times closer to the Earth than the Sun, so the worst—the best—that can happen is that the Moon will pass harmlessly but stunningly right in front of the Sun. The Sun’s apparent pathway in the sky is called the ecliptic because it is only when the Moon is crossing the ecliptic that eclipses can happen. Thus, twice a year roughly, there is a “danger period,” called an eclipse season, when the Sun is crossing the region of the nodes and an eclipse is possible.

Featured image credit: “sunset-evening-romantic-sun” by Alexas_Fotos. CC0 via Pixabay.

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A neurocognitive view on the dimensions of Schadenfreude and envy

We usually think highly about ourselves, tending to believe that our prosocial nature prioritizes positive emotions about others. Yet, as highlighted by Hardin’s Tragedy of the Commons, this is not always true. Empathy (that is, the ability to become attuned with others’ feelings) is the basis of cooperation and one of the core links holding human groups together. However, the vast spectrum of human affect includes counter-empathic emotions, complex physiological and neurocognitive states that contradict the naïve view of human empathy. These particular emotions emerge in scenarios that prompt social comparisons, constrained by implicit conceptions of the social order and shaped by contextual requirements. All of us are well acquainted with at least two of these counter-empathic emotions, namely, Schadenfreude and envy. On the one hand, Schadenfreude (a German word referring to gloating) is an emotional state characterized by pleasure at someone else’s misfortune. For instance, a subject might experience Schadenfreude when his rude, abusive boss suddenly stumbles and falls in front of a crowd (so that satisfaction supersedes empathic concern and a caring reaction to his pain). On the other hand, envy is an emotional state marked by displeasure in the presence of another person’s success. For instance, envy might be experienced when a colleague finds a solution to a long-standing problem in your department and earns a promotion.

Counter-empathy emotions have been the subject of study in the social sciences, including classical works in sociology or philosophy. Despite differences in definition and scope, all these inquiries acknowledge their multidimensional and complex nature. Schopenhauer (1788-1860) described Schadenfreude as a most obscure expression of human emotionality. Alternatively, Nietzsche (1844-1900) referred to it as a good-natured emotion expressed in response to principles of fairness. Nowadays, the study of counter-empathy emotions has attracted the interest of researchers in several other fields seeking to illuminate the complexity of social-emotional states in daily human activity. However, several key issues remain poorly understood. For instance, there is no consensus on which situations can modulate Schadenfreude and envy, let alone which neurocognitive factors lie at the core of these emotions. Moreover, most studies to date have considered those emotions as unified or monolithic experiences. Yet, as is the case with other emotional experiences, Schadenfreude and envy can manifest in clearly different ways depending on the situations that elicit them. In other words, little is known about the various dimensions of these counter-empathy emotions.

“Schadenfreude and envy can manifest in clearly different ways depending on the situations that elicit them. In other words, little is known about the various dimensions of these counter-empathy emotions”

Let’s imagine three scenarios in which a subject could experience Schadenfreude:

when seeing that someone smeared his suit with wine while mocking a man for being fat;
when seeing that someone hits a dog with a stick and the dog bites him back; or
when seeing that someone is discovered as denounced for being corrupt.

Now, let’s consider three situations that could evoke envy:

seeing that someone earned recognition as a sportsman although he did not train;
seeing that someone claimed authorship for the work of a subordinate and received a promotion; or
seeing that someone avoids a fine by bribing a police officer.

Evidently, the source of these situations is diverse, considering that the first examples proposed each emotion involve notions of deservingness, whereas the other situations imply notions of fairness and justice.

Building on this field of research, we created a novel task to explore three different dimensions of Schadenfreude and envy, including dimensions of deservingness, morality, and legality. In particular, we studied the neurocognitive correlates of such dimensions in both emotions, relying on a well-documented neurodegenerative lesion model comprised by patients with behavioral variant frontotemporal degeneration (bvFTD).

Patients with bvFTD usually exhibit impairments in empathy and emotion processing, as well as alterations in social behavior and a proclivity towards illegal and immoral conduct. Those alterations have been associated to atrophy of frontal, temporal, and insular brain areas, all of which are implicated in processing of counter-empathy emotions.

We assessed these patients’ emotional responses to situations dominated by different dimensions of Schadenfreude and envy, and compared them to those elicited in a group of healthy subjects and a group of patients with early-stage Alzheimer’s disease (AD) – another form of dementia which offered a contrastive neurodegenerative model.

Results of our study showed different emotional responses for both types of emotion depending on their governing dimension (deservingness, morality, or legality). Specifically, situations with prominent amoral and illegal components yielded higher emotional engagement than those dominated by notions of deservingness.

In addition, relative to healthy subjects and AD patients, bvFTD patients presented exacerbated feelings of Schadenfreude and envy in all emotional scenarios. This pattern aligned with our predictions, given that those patients present more anti-emphatic behaviors and they tend to be more engaged in moral and legal violations. Also, the increase of these emotions was associated with alterations in tests that measure empathy and other cognitive functions, such as cognitive control and inhibition. In addition, emotional responses in bvFTD were also associated to atrophy of frontal, temporal, and subcortical brain regions, which are part of a network implicated in cognitive processes that integrate social information.

Taken together, our findings reinforce the multidimensional nature of Schadenfreude and envy, highlighting the importance of analyzing subtle variations of ecological emotional experiences for a better comprehension of human affectivity. The study of counter-empathy emotions appears to be a new pathway for examining relevant interactions between cognitive, moral, and emotional processes in healthy subjects and in neuropsychiatric disorders. In addition, our study provides unprecedented evidence of an exacerbated experience of counter-empathy emotions in bvFTD patients, which could be considered as a new behavioral hallmark in this population. In particular, performance in counter-empathic emotions may help clinicians identify patients with neurocognitive disorders with mixed cognitive and early behavioral alterations. Finally, our study invites new research on the multidimensional nature of socially relevant emotions. Furthermore, it opens new avenues to assess the interplay of cognitive processes and social behaviors during complex emotional processes in healthy populations, and to develop novel markers for characterizing and predicting clinical outcomes in patients with neuropsychiatric disorders.

Featured image credit: Neurons by geralt. CC0 public domain via Pixabay.

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The Great Terror in Soviet Ukraine: a timeline

Between the summer of 1937 and November 1938, the Stalinist regime arrested over 1.5 million people for “counterrevolutionary” and “anti-soviet” activity and either summarily executed or exiled them to the Gulag. This was Stalin’s “Great Terror” and, contrary to popular belief, the largest number of victims were not elites or “Old Bolsheviks,” but common people, mainly peasants and a range of non-Russian suspect ethnicities, many of them also peasants. The following timeline captures the key events of the Great Terror in Soviet Ukraine.

Featured image credit: ВВЦ Павильон № 58 9 by Надежда Пивоварова. CC-BY-SA-30 via Wikimedia Commons.

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Philosophers of the year, 2017: Beauvoir, Nietzsche, & Socrates [quiz]

This December, the OUP Philosophy team marks the end of a great year by honouring three of 2017’s most popular Philosophers of the Month. The immeasurable contributions of Simone de Beauvoir, Friedrich Nietzsche, and Socrates to the field of philosophy ensure their place among history’s greatest thinkers. To celebrate, we’ve compiled a quiz highlighting the lives and works of each.

Test your knowledge of these legendary philosophers.

Quiz image: Books by Negative Space. Public Domain via Pexels. 

Featured image: Duke Humfrey’s Library Interior in the Bodleian Library, Oxford by David Iliff. CC-BY-SA-3.0 via Wikimedia Commons.

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A brief history of HIV [excerpt]

The first of December is World AIDS Day: a day to show support for those living with HIV, to commemorate those we have lost, and ultimately unite in the fight against HIV. To combat this pandemic though, we need to understand how the virus – and the wider virus group – reacts with the human body. In the following excerpt from Virus Hunt, Dorothy H. Crawford discusses the discovery and history of HIV and the retrovirus family.

HIV is a virus unlike any other. It works by stealth, silently entering the body and wiping out the very immune defences that have specifically evolved to fight such invaders. Without modern drug treatments it eventually kills virtually everyone it infects, but only after a period of ten years or so. At first it shows no outward signs of its presence and this is the key to its success. Those living with HIV, unaware of the virus within, get on with their daily lives and in so doing unwittingly spread the virus to others. The end game only begins when the immune system is so weakened that all manner of microbes can invade and flourish, thus causing the terrible symptoms of AIDS. So what is this virus and how does it work?

HIV belongs to the retrovirus family, a large and ancient group of viruses that infect many vertebrate species. These viruses are generally harmless in their natural hosts but if transferred to another species they may cause a variety of diseases ranging from cancer to anaemia and immune deficiency. When HIV was first identified in 1983 only two other human retroviruses had already been discovered. Both of these were identified by Robert Gallo and co-workers at the National Institute of Cancer, Bethesda, US, while hunting for viruses that cause human cancers. He concentrated on leukaemia, developing methods for propagating the malignant blood cells in culture with the help of growth factors and for detecting reverse transcriptase, an enzyme uniquely produced by growing retroviruses. In 1981 all his hard work paid off when he detected reverse transcriptase in a single culture of cells from a leukaemic patient. Gallo isolated human T lymphotropic virus (HTLV) I from the patient’s malignant cells and showed that this retrovirus causes the rare blood disorder, adult T cell leukaemia. This discovery was followed by the isolation of a second human retrovirus, HTLV II, but so far this has no disease associations. Gallo’s discoveries, and the technical advances that made them possible, set the scene for the isolation of HIV by Barré- Sinoussi and Montagnier shortly afterwards and for the identification of several related viruses that followed.

Main symptoms of acute HIV infection. Credit: “Symptoms of acute HIV infection” by Mikael Häggström. Public domain via Wikimedia Commons.

The history of retroviruses began over 100 years ago. In 1908 two Danish scientists, Wilhelm Ellermann and Oluf Bang, transmitted leukaemia from one chicken to another with a tumour cell extract that had been filtered to exclude whole cells and bacteria. This experiment did not cause much interest until 1911 when Peyton Rous, working in the US, reported similar tumour transfer using a cell-free extract of a solid tumour from a chicken. The reports predated the characterization of viruses and so, although work continued on these ‘filterable agents’, other scientists were skeptical of their very existence. Rous was only awarded the Nobel Prize for his seminal discovery in 1966, some fifty years after the event. In the meantime a ‘milk agent’ (now known to be mouse mammary tumour virus) that increased the incidence of cancer in pups from mothers with breast cancer was discovered by fellow American, John Bittner. Then in 1936 and in 1951 Ludwig Gross from New York published evidence of a mouse leukaemia virus. All these animal tumour viruses, at the time called oncoviruses, later turned out to belong to the retrovirus family, but this only became apparent after their remarkable method of replication was elucidated in the 1970s.

Retroviruses, in common with several other virus families, including those to which flu and measles viruses belong, carry their genetic material as RNA rather than DNA. But the retrovirus life cycle has a unique step that allows these viruses to colonize their respective hosts for life. Each virus particle contains two copies of the RNA genome along with the reverse transcriptase enzyme, which enables retroviruses to convert their RNA genome into DNA. During the unravelling of this replication cycle reverse transcriptase was discovered independently by American scientists Howard Temin and David Baltimore. The implications of this discovery appeared to belie the central dogma of molecular biology in which genetic information flowed exclusively from DNA to RNA to protein, and so it was initially met with disbelief. However, the evidence was overwhelming, and in recognition of this scientific breakthrough, Temin and Baltimore shared the Nobel Prize for Medicine in 1975.

When a retrovirus infects a cell, its reverse transcriptase converts the viral RNA genome into double-stranded DNA, and another enzyme carried in the virus particle called integrase then catalyses the joining, or integration, of the viral DNA copy into that host cell’s DNA chain. Now part of the cellular genome, the virus is protected from immune attack and remains there for the life of the cell, being replicated along with cellular DNA and passed on to daughter cells.

The integration process effectively archives retroviral genomes for the life of the infected cell, and if the virus gains access to germ cells then it will pass from one generation to the next ad infinitum. This latter scenario may seem rather far-fetched but when the human genome was sequenced it revealed a remarkable 96,000 retrovirus-like elements occupying around eight per cent of the entire genome. Nobody really knows what they are doing there but scientists speculate that they are fossils—the remains of ancient virus infections. Maybe some of them caused plagues like HIV/AIDS, and if so then perhaps in several thousand years’ time a fossilized HIV will be found fixed in the human genome.

Featured image credit: “balloons-sky-blue-balloon” by Mark-Krister. CC0 via Pixabay.

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Holding a duality: ambiguity and parenting a child with special needs

In a 2013 interview on NPR celebrating the publication of her memoir, The Still Point of the Turning World, author Emily Rapp made two surprisingly different statements. In her book and on-the-air, Rapp said that she treasured every moment she’d had with her son Ronin, whose short life with Tay-Sachs Disease was the subject of her memoir. Indeed, her telling of Ronin’s story is vibrant, and her joy in sharing that story shines through her work. But she also stated that, while pregnant, she had been tested for Tay-Sachs with the full intention of aborting an affected fetus. Ronin had a rare form of Tay-Sachs that is not detected by the test Rapp was given, but if she had known, she said, Ronin would never have been born. When questioned on the contradiction between these statements, Rapp acknowledged that there was ambiguity in her feelings, but insisted that she could indeed treasure the memory of her time with her son and wish he had never been born. She said that she could, in fact, hold these two opposing thoughts simultaneously, and that this was “a duality that could be held”.

In the past, parents of children with special needs have been suspected of holding ambiguous feelings toward their children. Berit Brinchmann, a researcher in Sweden who interviewed parents of children with profound disabilities, stated that parents both love and hate their children. In addition, Franco Carnevale, a Canadian nursing ethicist, entitled his ethical analysis of children on home ventilator support “Daily Living with Distress and Enrichment”. But neither of them quite captured the essential nature of simultaneously holding two opposing truths. For these families, who must live each day in love with a child who has a potentially life-limiting disability, this is not only a duality that can be held; it is a duality that must be held.

As clinicians we like things to be clear cut, belonging in one box or another. We see families as either failing to cope or coping well. Those who are coping well clearly adore their children and will do anything to insure their health and success. They attend all their appointments, and eagerly embrace all new medical instructions. They champion their child in all things, though they must be careful not to expect too much lest they be labelled “in denial”. But every now and then something goes wrong. Parents might miss appointments, or decide for themselves that a medication is not working. Or they might be in need of help, and so admit to being overwhelmed by the amount of work their child requires in order to qualify for services. Consequently, these families are seen as failing to cope.

We must recognise that it is possible for a child to require too much care work for a single family to perform, and yet still be loved and valued.

The moral value assigned to each category is clear. Parents understand the advantages of coping well and make the sacrifices needed in order to remain “good parents”. They do not admit to becoming overwhelmed or exhausted or grieving, even if they are, as they might be seen as failing to cope and, by extension, be deemed inadequate parents. Admitting to feeling anger or helplessness can be signs of incompetence. In some circles, expressing frustration with a child’s disability is equated with devaluing their child. They dare not complain, lest their very love for the child become suspect.

I believe that placing parents wholly on one side or another of this duality does them a disservice. We must recognise that it is possible for a child to require too much care work for a single family to perform, and yet still be loved and valued. We must acknowledge that joy and sorrow exist side-by-side, as a child learns something new and yet remains achingly behind their peers. We must see, as Emily Rapp did, that it is possible to treasure a child’s existence while simultaneously wishing that things could have been different. These are dualities that can and must be held. It is wrong to force parents to live out one truth or the other for our sense of clarity.

Featured image credit: Palace of Versailles by Peignault Laurent. CC0 Public Domain via Unsplash .  

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