Go Retire Psychiatrist

Call Carlos for Computer Help

I’ve been getting messages from Microsoft needling me to update my computer to Windows 11. I’m familiar with the tone and wording which is supposed to nudge me to do something which I might regret. I’m also familiar with the awful blue screen of death. Even though Microsoft assures me my computer is Windows 11 ready—I’m not.

And I’ve seen the article about the old computer wizard named Carlos who was able to update his 15-year-old Intel Pentium computer to Windows 11. That should have been impossible. It doesn’t make me more comfortable about updating my modern machine.

I’m also sort of in the market for a new computer. I was all set to order a Dell XPS 8940. Sena is a genius shopper and asked if I’d checked to see if there was a newer model on the launching pad. She reminded me that I had made a similar purchase several years ago and regretted just missing the new model that came out only days after I bought the machine which I thought was the newest model. I’m thinking of an old commercial from many moons ago, showing a happy guy driving down the road in his convertible, his arm draped lovingly around a big box containing what he obviously thought was the latest and greatest computer—which he had just bought. He looks up and sees a billboard showing a picture of a model that is obviously the next generation up from his.

So, I got on line and searched and could find nothing newer than the Dell XPS 8940. I searched the Dell web site and could not find anything on the XPS 8950. She got on line and triumphantly called out she had found a newer model in the wings, the Dell XPS 8950. I rephrased my search term to ask a question, “Is there a Dell XPS model newer than the 8940?”

Bang, there were several hits for the XPS 8950. They were mostly press releases from late October 2021, although one of them was a question from a guy who tapped the Dell Community users web page. He asked “Should I have waited for the 8950?!—I just bought a 8940—Need Advice.” It was dated October 28, 2021. One user suggested looking a web page which pointed to an XPS 8950 press release with 138 comments. Many of them were obviously from experienced computer experts who spoke tech lingo beyond my understanding, but mentioned things like the 3 fans and a liquid cooling system in the much larger tower, and the opportunity to easily overclock the CPU.

I remember reading about overclocking many years ago. It involved soldering, if you can believe that. I think I flunked soldering back in shop class. I guess overclocking is easier now—for guys like Carlos. Incidentally, why does overclocking sound like a perk? Why can’t Dell just make the CPU powerful enough to obviate the need for overclocking? I probably just don’t get the power gamer culture out there.

Anyway, the XPS 8950 is supposed to be out by next month. Needless to say, there are no Black Friday deals for it, especially if it’s not even advertised on the Dell website. Maybe Dell is just trying to sell down the XPS 8940 inventory.

There are more than 7,000 customer reviews out there about the XPS 8940, most of them positive. You can get it loaded with Windows 11, which has not been out there for very long. My impression of the negative reviews is that the machines take a long time to boot up. Could Windows 11 be influencing that?

Maybe Dell should hire Carlos.

Follow the Trail of the Woolly Bear Tale

Sena and I went for a walk on the Clear Creek Trail today. It’s been about a year and a half since we last saw the place. A few things have changed, but one thing has not. You can nearly always find a woolly bear caterpillar somewhere along the trail, especially in the fall. I know I mentioned the insect not that long ago in a post after we thought we might have seen one on the Terry Trueblood Trail.

But we’re talking banded woolly bear, the genuine article. They have a brown band in the middle bounded by black bands at the head and tail ends. They’re fat and always busy looking for cover. There is a folk tale about it foretelling how hard the winter is going to get. The longer the black bands, the worse the winter will be.

However, the folk tale has long been debunked, according to my alma mater, Iowa State University (ISU). The bands are just indicators of the age of the insect, which is the larval stage of the Isabella moth.

But don’t try to tell that to the people of Vermilion, Ohio where they have the annual Woolly bear Festival. Dang, we just missed it in early October. They have a parade, woolly bear races, and an “official” examination of the woolly bears to nail down the winter forecast. I guess that’s sort of like hauling out the groundhog Punxsutawney Phil in Punxsutawney, Pennsylvania each Groundhog Day on February 2 to predict how much longer winter will last.

That reminds me (too late!) that we also missed this year’s ISU Department of Entomology Insect Zoo Film Festival, in Ames, Iowa, which was in late October. It’s an outreach program which travels all over Iowa to educate the public about insects.

I gather this evolved from another annual ISU Department of Entomology project called the Insect Horror Film Festival. It began in the early 1990s and gradually settled down into the Insect Zoo Film Festival in the mid-2000s.

That reminds me of one of my favorite movies, the 1997 film Men in Black, in which a bad-tempered giant cockroach alien crash lands its space ship on earth, eats a guy to use his skin as a disguise, tries to steal the Arquillian (tiny alien) galaxy, the best source of sub-atomic energy in the universe, and gets enraged every time it sees humans so much as swat a fly.

The other movie this makes me think of is the 1988 film Beetlejuice. Beetlejuice was sort of the star of the show, played by Michael Keaton. Beetlejuice was a dead guy who ate bugs and hired himself out to the newly dead, claiming to help ghosts get rid of a different species of pest—the living.

Finally, that makes me think of how long it’s going to take to get our Zombie Cribbage game delivered, given the recent slowdown of the Post Office. The snow may fly before it arrives.

But if the woolly bear analysis is right, at least there won’t be a lot of snow to slow down the mail truck.

Great YouTube Q&A on Covid-19 Vaccine for Children Ages 5-11: It’s better than a stick in the nose!

There was a great live stream YouTube Q&A presentation today on the Covid-19 vaccine for kids ages 5-11 through the University of Iowa Stead Family Children’s Hospital this afternoon at 2:15 and it ran for about 30 minutes (scrub the play button forward to about a minute to start the recorded video). There were excellent questions and informative answers as well as helpful guidance for parents by Chief Medical Officer Dr. Theresa Brennan, MD and Pediatrician Dr. Rami Boutros, MD.

Parents have been eager to bring their kids in to the pediatric clinic to get the vaccine. Dr. Boutros shared a funny anecdote about his interaction with a child who had just got his shot yesterday. It’s about 34 minutes into the video. After the child received the shot, Dr. Boutros asked him, “How was it?” The child replied, “The vaccine is better than a stick in the nose!” Anybody who’s been tested for Covid-19 can relate to that.

How’s that for a meme? Get the vaccine; it’s better than a stick in the nose!

CDC Recommends COVID-19 Vaccine for Children Ages 5-11

Following the Advisory Committee for Immunization Practices (ACIP) vote yesterday recommending the Pfizer Covid-19 vaccine for children ages 5-11, CDC formally announced agreement with the committee’s decision after the meeting.

What You See is Not Always What You Get

A couple of days ago I thought of Gary Larson’s Far Side cartoon, the one with the toggle switch in a passenger airplane cabin seat with the message “Wings Stay On; Wings Fall Off.” I googled it just for fun and found that it spawned a lot of web articles obviously trying to reassure the flying public that airplane wings don’t just fall off.

What brought the “Wings Stay On; Wings Fall Off” cartoon to mind were a few events in the last two days. Day before yesterday, Sena took our lease car to one of the local dealership’s car wash. She does this all the time without incident but this time she noticed that the “soap” didn’t rinse off. She drove it home and still couldn’t get what appeared to be soap film off the car. She finally drove back to the dealership and discovered that the car wash attendant had accidentally pressed the hydraulic oil lubricant button instead of the detergent button. A number of other car wash customers also had been victims of the mishap and were complaining to dealership management.

So, what had looked like soap film actually turned out to be hydraulic lubricant meant for the car wash motors. It turns out that accidents like these can happen. Could the button for the lubricant have been situated so close to the detergent button that the attendant accidentally pressed the wrong one? By itself, that reminded me of the Larson cartoon. If the systems analysist for the car wash design was asleep at the desk on the day of manufacture, I guess all you can do is think before you act. And what you see is not always what you get.

The next day, Sena and I were at the dealership sitting in an agent’s office. We noticed a tipped over cup of coffee. I reached over to pick it up, mentioning that he must have had a little accident. Much to my surprise, both cup and mess came up as a spill prank, which I had never seen before, believe it or not. The joke capitalizes on our human tendency to sometimes act before we think.

Finally, a couple of on-line news items caught my eye this morning. They were both about white tail deer in Iowa, discovered by Iowa State University (ISU) researchers to have somehow picked up the Covid-19 virus. One story was much shorter than the other.

The longer story by the Des Moines Register had a lot more ISU research detail in it and didn’t stress certain facts that might reassure readers that there was low likelihood that humans might be vulnerable to catching the virus from deer.

The shorter story by the KCCI news network didn’t present as much of the ISU research details and basically said as long as you used gloves to dress the animal in the field and thoroughly cooked the meat, you were in no danger of infection. Both stories basically carried the same message that there was low likelihood of infection to humans. But there was a slight tendency to overemphasize the risk in one article and maybe a tendency to underemphasize it in the other. These might illustrate the “spin” phenomenon for which readers should just be on the alert.

By the way, the CDC web site carries a message saying the risk of catching Covid-19 from wild animals is generally low.

What you see is not always what you get, especially at first glance. And it pays to think before you act.

CDC Advisory Committee Meeting Today on COVID-19 Vaccine for Children Ages 5-11

Today the Advisory Committee on Immunization Practices (ACIP) had the meeting today to discuss the Pfizer Covid-19 vaccine for children aged 5-11 years of age. Presentation slides are here. The Policy Question to be voted on for today is:

“Should vaccination with Pfizer-BioNTech COVID-19 vaccine (2-doses, 10µg, IM) be recommended for children 5–11 years of age, under an Emergency Use Authorization?”

Dr. Kevin Chatham-Stevens’ presentation on implementation of the vaccination program for children in the age group was informative. Most children will likely be vaccinated in their regional doctors’ office. Dr. Woodworth presented very helpful, practical, and reassuring information about the practical aspects of vaccination, see slides from “Interim Clinical Considerations for COVID-19 Vaccine in Children Ages 5–11 Years.”

Dr. Oliver’s presentation “EtR Framework: Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years” as part of the evidence to framework details.

“§ Children are at least as likely to be infected with SARS-CoV-2 as adults

– Over 1.9 million reported cases; seroprevalence estimated ~38% among 5–11 years in Sept 2021

– Infections in children less likely to be reported as cases than infections in adults

§ Children 5-11 years of age are at risk of severe illness from COVID-19

– >8,300 COVID-19 related hospitalizations as of mid-October

– Cumulative hospitalization rate is similar to pre-pandemic influenza seasons

– Severity comparable among children hospitalized with influenza and COVID-19, with approximately 1/3 of children 5–11 years requiring ICU admission

– MIS-C most frequent among children 5–11 years

– Post-COVID conditions have been reported in children

§ Secondary transmission from young school-aged children occurs in household and school settings”

The negative impact on children is considerable, especially for those of color. Vaccine efficacy was 90.9% in the Pfizer randomized controlled trial. The bottom line was that the balance and risks is favorable for vaccinations of all children. Post authorization safety monitoring will continue. The Work Group proposed to recommend the intervention.

After discussion, the committee voted on the ACIP Interim Recommendation below:

“The Pfizer-BioNTech COVID-19 vaccine (2-doses, 10µg, IM) is recommended for children 5–11 years of age, in the U.S. population under the FDA’s Emergency Use Authorization.”

The vote on the interim recommendation passed unanimously (14 yes votes).

The meeting was adjourned at approximately 5:00 PM, ET.

Rattlesnake Hat vs Hornet’s Nest Snoot Flute

OK, so this should have been in yesterday’s post but I don’t care. You remember I mentioned the guy who wore the live rattlesnake on his head while strolling down State Street in Madison, Wisconsin? Well, in Iowa we have The Sitting Man who wore a hornet’s nest on his nose. It’s all about style points.

Beat that, Wisconsin.

Random Thoughts on the Iowa vs Wisconsin Football Game Today

OK, I know it’s in the books. Wisconsin won the football game with Iowa today, 27 to 7. Anybody can have a bad day. Iowa quarterback, Spencer Petras scored the only touchdown for Iowa. We hope the best for Wisconsin player Clay Cundiff, who had to be taken off the field in an ambulance after a leg injury. You know the game is over when the announcers start chatting about things like Wisconsin player, Braelon Allen, who can squat 610 pounds, and Halloween candy. I’m not going to tell you how early that chatter started.

Actually, I learned something new about the Iowa head football coach staff. It was from a trivia question during the game. Kirk Ferentz and Hayden Fry have been the only head coaches for the Iowa football team since 1979. How many head coaches have the other 13 teams in the Big Ten conference run through in the same time period? The answer is 94 (about 7 per school). Are there 13 or 14? I don’t know but 13 is how many the trivia question mentioned. Details.

How’s that for continuity of leadership? I’d say that’s a win.

Anyway, we tend to have a soft spot for Wisconsin. We visited a couple of times a dozen years ago before moving there briefly so I could try private practice psychiatry. My first vivid memory is of some guy walking down the middle of State Street in Madison wearing a live rattlesnake on his head. I can think of safer hats. But a rattlesnake says something more about you than your fashion sense. I’m just not sure what.

We also visited the Henry Vilas Zoo, where we saw, among other things, a real live badger. It doesn’t look like much. I guess the reason why the Wisconsin football team adopted the name of that animal is that it’s said to be totally fearless.

Madison is a not a huge metropolis but there’s a lot of interesting to see and do. I put on a little weight there from all the great food.

Iowa is a great place to live, too. Where else can you see a huge sculpture of a sitting man on the side of a road?

CDC Advisory Committee Meeting November 2nd on Pfizer Covid-19 Vaccine for Children Ages 5-11

The Advisory Committee on Immunization Practices (ACIP) have scheduled a meeting for November 2, 2021 from 10 AM-5 PM, ET to discuss the Covid-19 vaccine for children ages 5-11.

This follows the FDA authorization for the vaccine in this age group, which was announced today on their web site.

Two Way Street Between Medicine and Psychiatry in Covid-19

I just found out that, as of the middle of this month, a new category, mental health disorders, has been added to the CDC list of medical conditions associated with higher risk for severe Covid-19 disease and thus, qualifies those in the category for receiving the COVID-19 vaccines . It makes sense. Mood, anxiety, and other neuropsychiatric disorders are known to be connected to a variety of medical conditions, such as diabetes mellitus, thyroid disease, and heart disease. Substance use disorders was already on the list previously. There are medical literature references supporting this:

Fond G, Nemani K, Etchecopar-Etchart D, Loundou A, Goff DC, Lee SW, Lancon C, Auquier P, Baumstarck K, Llorca PM, Yon DK, Boyer L. Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021 Jul 27:e212274. doi: 10.1001/jamapsychiatry.2021.2274. Epub ahead of print. PMID: 34313711; PMCID: PMC8317055. https://pubmed.ncbi.nlm.nih.gov/34313711/

Ceban F, Nogo D, Carvalho IP, Lee Y, Nasri F, Xiong J, Lui LMW, Subramaniapillai M, Gill H, Liu RN, Joseph P, Teopiz KM, Cao B, Mansur RB, Lin K, Rosenblat JD, Ho RC, McIntyre RS. Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021 Oct 1;78(10):1079-1091. doi: 10.1001/jamapsychiatry.2021.1818. PMID: 34319365; PMCID: PMC8319830. https://pubmed.ncbi.nlm.nih.gov/34319365/

It’s also interesting that a large randomized controlled trial of the antidepressant fluvoxamine showed that the agent reduced the need for hospitalization in high-risk outpatients diagnosed with early Covid-19:

Gilmar Reis, Eduardo Augusto dos Santos Moreira-Silva, Daniela Carla Medeiros Silva, Lehana Thabane, Aline Cruz Milagres, Thiago Santiago Ferreira, Castilho Vitor Quirino dos Santos, Vitoria Helena de Souza Campos, Ana Maria Ribeiro Nogueira, Ana Paula Figueiredo Guimaraes de Almeida, Eduardo Diniz Callegari, Adhemar Dias de Figueiredo Neto, Leonardo Cançado Monteiro Savassi, Maria Izabel Campos Simplicio, Luciene Barra Ribeiro, Rosemary Oliveira, Ofir Harari, Jamie I Forrest, Hinda Ruton, Sheila Sprague, Paula McKay, Alla V Glushchenko, Craig R Rayner, Eric J Lenze, Angela M Reiersen, Gordon H Guyatt, Edward J Mills,

Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial,

The Lancet Global Health, 202, ISSN 2214-109X, https://doi.org/10.1016/S2214-109X(21)00448-4.

(https://www.sciencedirect.com/science/article/pii/S2214109X21004484)

Abstract: Summary

Background

Recent evidence indicates a potential therapeutic role of fluvoxamine for COVID-19. In the TOGETHER trial for acutely symptomatic patients with COVID-19, we aimed to assess the efficacy of fluvoxamine versus placebo in preventing hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to a tertiary hospital due to COVID-19.

Methods

This placebo-controlled, randomised, adaptive platform trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 included eligible patients from 11 clinical sites in Brazil with a known risk factor for progression to severe disease. Patients were randomly assigned (1:1) to either fluvoxamine (100 mg twice daily for 10 days) or placebo (or other treatment groups not reported here). The trial team, site staff, and patients were masked to treatment allocation. Our primary outcome was a composite endpoint of hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to tertiary hospital due to COVID-19 up to 28 days post-random assignment on the basis of intention to treat. Modified intention to treat explored patients receiving at least 24 h of treatment before a primary outcome event and per-protocol analysis explored patients with a high level adherence (>80%). We used a Bayesian analytic framework to establish the effects along with probability of success of intervention compared with placebo. The trial is registered at ClinicalTrials.gov (NCT04727424) and is ongoing.

Findings

The study team screened 9803 potential participants for this trial. The trial was initiated on June 2, 2020, with the current protocol reporting randomisation to fluvoxamine from Jan 20 to Aug 5, 2021, when the trial arms were stopped for superiority. 741 patients were allocated to fluvoxamine and 756 to placebo. The average age of participants was 50 years (range 18–102 years); 58% were female. The proportion of patients observed in a COVID-19 emergency setting for more than 6 h or transferred to a teritary hospital due to COVID-19 was lower for the fluvoxamine group compared with placebo (79 [11%] of 741 vs 119 [16%] of 756); relative risk [RR] 0·68; 95% Bayesian credible interval [95% BCI]: 0·52–0·88), with a probability of superiority of 99·8% surpassing the prespecified superiority threshold of 97·6% (risk difference 5·0%). Of the composite primary outcome events, 87% were hospitalisations. Findings for the primary outcome were similar for the modified intention-to-treat analysis (RR 0·69, 95% BCI 0·53–0·90) and larger in the per-protocol analysis (RR 0·34, 95% BCI, 0·21–0·54). There were 17 deaths in the fluvoxamine group and 25 deaths in the placebo group in the primary intention-to-treat analysis (odds ratio [OR] 0·68, 95% CI: 0·36–1·27). There was one death in the fluvoxamine group and 12 in the placebo group for the per-protocol population (OR 0·09; 95% CI 0·01–0·47). We found no significant differences in number of treatment emergent adverse events among patients in the fluvoxamine and placebo groups.

Interpretation

Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital.

Funding

FastGrants and The Rainwater Charitable Foundation.

Translation

For the Portuguese translation of the abstract see Supplementary Materials section.

Covid-19 pneumonia affects the brain by causing hypoxia and inflammatory reactions, leading to neurologic dysfunction. Mental health disorders may be partly caused by inflammation. Depressed persons may not protect themselves from Covid-19 because they’re apathetic and hopeless. It’s a two-way street. It’s like Dr. Wes Ely, MD, MPH says: