Category Archives: Viva!

Microcephaly in Brazil: is it occurring in greater numbers than normal or not?

A paper came out yesterday (AEST) from Morbidity and Mortality Weekly Report (MMWR) with the heading…

Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015


Reads as though some great data may finally show us a hint of an association between Zika virus (ZIKV) infection and microcephaly disease. Right? 

Nope. There are none. At least none that could approach satisfying that title which highlights that it is not just the popular media who can generate misleading titles (headlines in their case).

In fact there are no Zika virus testing results in this study of 35 infants with microcephaly (defined using a useful protocol described detailed within). At all.

The closest we get to identifying a role for ZIKV in this disease are the statements…

  1. Therefore a mother’s report of a rash illness during pregnancy was used as a proxy indicator of potential Zika virus infection.
    ZIKV is not the only agent capable of causing a rash-we’ve seen evidence for concurrent circulation of other rash-causing arboviruses in print from Brazil including dengue virus and chikungunya virus.[2] There is also malaria, filiaris, leishmaniasis and yellow fever to consider in this region.[3]
  2. [cerebrospinal fluid] “CSF samples from all infants enrolled in the cohort were sent to a reference laboratory in Brazil for Zika virus testing; the results are not yet available.
    Why publish these data ahead of these CSF results I wonder? It does not take long to perform RT-PCR for ZIKV. Certainly not long enough to hold up a paper for more than a day or two at most
Oh and there’s this..

because Zika virus infection was not laboratory confirmed in infants or their mothers, the history of a nonspecific rash illness during pregnancy is subject to recall bias and might have resulted in misclassification of potential Zika virus exposure” 

Recall bias being that thing you get when you don’t really remember what happened a while ago; the details get a little hazy. I imagine that might be a factor in at least some instances here. But clearly not all.

The authors also note that the case definition they describe is unlikely to have been used prior to November 2015. For example, head measurement was not being routinely recorded thus milder cases may not have been reported prior to the ZIKV epidemic/pandemic/global epidemic/multi-country outbreak (or whatever it is being called-my choice underlined). Again, this doesn’t negate the rise nor the issue, but it may reduce the total a little. This idea was given more oxygen earlier in the week in an article by Declan Butler in Nature.[4] Although not all agree, some even suggesting the numbers are underestimates.[5]

A little over a week ago I wondered why the United States had a higher averaged number of microcephaly cases than Brazil…
Q: The US averages 20-120 microcephaly births per 100,000 per year. Brazil about 5 pre-#Zika.
Why higher in US?
ping: @who @DrJudyStone
1/2

— Ian M Mackay, PhD (@MackayIM) January 22, 2016

Crof_Zika%2526Microcephaly_Quote_30JAN20

Flu-blog-eyah’s ProfCrof has just penned a very nice analysis of this issue.[6]

He looks more deeply than I did and folks, this is why we should demand and ensure public health infectious disease data are accessible to the public-not all useful ideas come from, or are communicated by, a paid position. 

The wash-up of Crof’s analysis is that perhaps the rise in microcephaly cases is not a rise at all, but simply a more successful effort to collect data, and that the total number of microcephalic babies may not be too far from the norm (also considering those issues above).[6]

The MMWR study did look for, and found no evidence of the following infections of diseases…
  • syphilis
  • toxoplasmosis
  • rubella
  • cytomegalovirus
  • herpes simplex virus
But no mention was made of seeking signs of those other agents listed in above. And what about toxicology?

So the MMWR paper is essentially providing a useful definition of microcephaly and informing us that a cohort has been started/is still recruiting (?) For me, its title would have been better written as 

Case definition of microcephaly epidemic in Brazilor perhaps, 

“>insert name< : a birth cohort study into ZIKV infection and congenital disease“…or something.
Zika-PubMED_30JAN2016.pngThe search for a cause for Brazil’s reported spike in microcephaly cases will go on. If it is a true spike then it must, but even that is not clear right now. As is much at all about ZIKV. This event in the Americas really serves a s reminder that we must keep our eyes open to all possibilities – we can do, and think, about more than one thing at a time. If it is not a true spike, then an awful lot of resources are currently moving towards defeating ZIKV that probably, sadly, would not be moving if microcephaly was not a front page story. Right now it seems we’re not very clear on even the most basic facts.

It is great to see some more papers coming out because there have not been many to date (see graph above). Bravo. It would be greater still if they had more relevant data and came out faster. 

As always, don’t just believe the headline. Read further. And maybe do your own analysis, like the Crof did.

References…

  1. Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015
    http://1.usa.gov/200iZXv
  2. Dengue, chikungunya and Zika co-infection in a patient from Colombia
    http://bitly.com/1RT34eb
  3. http://bitly.com/200iXyQ
  4. http://bitly.com/1RT365I
  5. http://on.wsj.com/200iZXx
  6. http://bitly.com/1RT365J
© 2013-2015 Ian M. Mackay. PhD.
This content was originally published at http://bitly.com/1Kas2vY
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AMERICA/VENEZUELA – Zika virus throughout Latin America

Caracas – The World Health Organization has launched a global alert on the spread of the zika virus. Currently, America is the most affected continent . In Venezuela, there are between 6 and 10 thousand symptomatic cases of the disease, to which are added 30 to 40% of asymptomatic cases. The Minister of Health has confirmed the state of alert and the monitoring of 4700 suspected cases.

STUDIES: Ohio Executions Reveal Vast Racial, Gender, and Geographic Inequities

“Ohio’s death penalty is plagued by vast inequities” grounded in race, gender, and geography, according to a new University of North Carolina study. UNC-Chapel Hill political science professor Frank Baumgartner examined the 53 executions Ohio has conducted since resuming capital punishment in the 1970s. His study found “quite significant” racial, gender, and geographic disparities in Ohio’s executions that, Baumgartner said, “undermine public confidence in the state’s ability to carry out the death penalty in a fair and impartial manner.” The data showed that Ohio was 6 times more likely to execute a prisoner convicted of killing a white female victim than if the victim was a black male. Although 43% of Ohio murder victims are white, 65% of Ohio executions involved the murder of white victims. Similarly, while only 27% of Ohio murder victims are female, 52% of all executions involved cases with female victims. The study also discovered significant geographic disparities in Ohio executions. More that half of the state’s executions were concentrated in just 4 counties, while more than 3/4 of Ohio counties have not produced any executions. Lake County had an execution rate that was 11 times the statewide average. Although the state’s three most populous counties (Cuyahoga, Franklin, and Hamilton) have similar murder rates, Hamilton’s .60 executions per 100 homicides was more than double the rate in Cuyahoga and nearly 9 times that in Franklin. Sharon L. Davies, Executive Director of the Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University, said that the “race or gender of a victim, and the county of the crime, should not influence who is sentenced to die” and urged “Ohio citizens and lawmakers[to] review the findings of this important research.” (Click image to enlarge.)

(F. Baumgartner, “The Impact of Race, Gender, and Geography on Ohio Executions,” University of North Carolina at Chapel Hill, January 28, 2016; A. Johnson, “Study finds racial, gender bias in Ohio executions,” The Columbus Dispatch, January 28, 2016.) See Studies and Arbitrariness.

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Standoff Continues at Wildlife Refuge in Oregon: Four Domestic Terriorists Refuse to Leave

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Published January 29, 2016

BURNS, OREGON— The takeover of the Malheur National Wildlife Refuge continued into its 28th day today as four domestic terrorists still remain.

The four remain three days after a group of fellow domestic terrorists were arrested and one shot dead.

“The negotiators continue to work around the clock to talk to those four people in an effort to get them to come out peacefully,” said FBI Special Agent in Charge Greg Bretzing.

On Thursday, the FBI released a video that dispels the notion that domestic terrorist LaVoy Fincium was attempting to surrender when he was shot dead by law enforcement.

Below is part of the FBI statement that deals with the moments leading to Finicum being shot:

When we come back to the video, the white truck leaves the scene at a high rate of speed. It travels some distance, quickly approaching a vehicle roadblock in the roadway.

As the white truck approaches the roadblock, there is a spike strip across the road but it appears Finicum missed it as he attempted to drive around the roadblock. He nearly hits an FBI agent as he maneuvers to the left. The truck gets stuck in the snowbank.

Finicum leaves the truck and steps through the snow. Agents and troopers on scene had information that Finicum and others would be armed. On at least two occasions, Finicum reaches his right hand toward a pocket on the left inside portion of his jacket. He did have a loaded 9 mm semi-automatic handgun in that pocket.

At this time, OSP troopers shot Finicum.

Approximately 30 seconds after the shooting, law enforcement officers at the scene deployed flash bangs to disorient any other armed occupants. Shortly after that, they deployed less-lethal sponge projectiles with OC capsules. Those OC capsules would be similar to pepper spray.

The post Standoff Continues at Wildlife Refuge in Oregon: Four Domestic Terriorists Refuse to Leave appeared first on Native News Online.

The productivity and equality nexus: is there a benefit in addressing them together?

NAECGabriela Ramos, Special Counsellor to the OECD Secretary-General, Chief of Staff and G20 Sherpa

Productivity growth has slowed since the crisis and inequality has been getting worse. Could they be influencing each other?

The linkages between the productivity and inequality challenges are still to be fully explored. Each may have its own solution, but there is also good reason to think that there is a nexus between them. For instance, OECD evidence suggests that wage dispersion between firms, which reflects diverging rates of productivity growth, has contributed to rising inequality of incomes between workers. At the same time, the increased prevalence of knowledge-based capital and digitalisation may have unleashed winner-take-all dynamics in key network markets, which in turn may have led, in some instances, to an increase in rent-seeking behaviour.

OECD research has highlighted how the rise in inequality over the last three decades has slowed long-term growth through its negative impact on human capital accumulation by low income families.

Since the crisis, stalled business dynamics have seen resources, including workers, being trapped in firms where they are not using their full potential. In particular, individuals with fewer skills and poorer access to opportunities are often confined to precarious and low productivity jobs or – in many emerging countries – informal ones.

In the spirit of our integrated framework on inclusive growth and our New Approaches to Economic Challenges (NAEC) initiative, at the OECD we believe that our efforts to address productivity and inequality challenges could have a better chance of succeeding if we looked at the synergies and trade-offs emerging from policies to address them. This means designing policies for each of these two core issues bearing in mind how they might impact one another and avoiding the “silo” approach through more effective and comprehensive policy packages.

We must also learn from previous policies. Traditional measures to boost productivity in competition, labour market, or regulatory frameworks would allow for the reallocation of resources to more productive activities, or for increasing productivity in specific sectors. But this may have an adverse impact on inequalities of income and opportunities, as workers better equipped to cope with change are usually those with higher skill sets. For instance, in the past, the drive towards flexible labour markets has benefited many employers, and particularly the most productive firms that have gained from an improved allocation of labour resources. But increased flexibility has also brought a greater prevalence of non-standard work. Recent OECD work on job quality highlights how low skilled individuals can be trapped in precarious low wage jobs, and receive less training.

Our approach to designing policies to ensure that individuals, firms and regions that are left behind can fulfil their full potential and contribute to a more dynamic economy, draws on OECD work from diverse policy areas. It starts from the Inclusive Growth agenda, by focusing on well-being as an ultimate objective of policy. It builds on OECD productivity work via The Future of Productivity report and efforts Towards an OECD Productivity Network. It also synchronises with the Organisation’s efforts to measure productivity more accurately at a time when traditional measures are ill-adapted to account for the full effects of rapid technological change and innovation centred on knowledge based capital, the increasing prominence of the services sector, and productivity in the public sector.

The ultimate outcome is for governments to focus on the extensive range of win-win policies that can reduce inequalities while supporting productivity growth, thereby creating a virtuous cycle for inclusive and sustainable growth. This calls for distinct but complementary policy interventions at the individual, firm, regional and country levels. What this entails in practice will vary for each country depending on its circumstances. But broadly speaking, a number of policy areas are worth considering:

First, a new approach is needed to boost productivity at the individual level so that everyone has the opportunity to realise their full productive potential. Expanding the supply of skills in the population through more equal access to basic quality education is crucial, but not enough. With rapid technological change, skills need to keep up with the demands of the market to avoid the skills mismatches which have contributed to the productivity slowdown. A broad strategy is also needed to ensure a better functioning of the labour market, promote job quality, reduce informality, allow for the mobility of workers and inclusion of underrepresented groups such as women and youth, and promote better health outcomes for everyone.

Second, for people to realise their full productivity potential, businesses have to realise theirs. While heterogeneity among firms is normal, the widening dispersion in productivity levels and its implications for aggregate productivity and workers is a cause for concern. According to our productivity report, the early 2000s saw labour productivity at the global technological frontier increase at an average annual rate of 3.5% in the manufacturing sector, compared to just 0.5% for non-frontier firms. The gap was even more pronounced in the services sector. The larger the share of business that can thrive, the more productive and inclusive our economies will be. Achieving this requires a reassessment of competition, regulatory and financial policies to ensure a level playing field for new firms relative to incumbents. It also requires policies to facilitate the diffusion of frontier innovations from leading to lagging firms.

Third, policy prescriptions will be ineffective unless they take regional and local circumstances into account. Inequalities that play out in regions, like housing segregation by income or social background, poor public transport, and poor infrastructure, can lock individuals and firms in low-productivity traps. This means that some policies to promote both productivity and inclusiveness are best undertaken at the regional level.

Finally, adopting a more holistic approach to policy requires fundamental changes to public governance and institutional structure to strengthen the ability of national governments to design policy that promotes synergies and deals with trade-offs. In highly unequal societies, governments also need to address political economy issues including the capture of the regulatory and political processes by elites that benefit from the status quo, and policies that favour the incumbents.

None of this will be easy, but it is nevertheless essential. At the OECD we believe it is time to develop a better understanding of the dynamics between two of the key issues of our time – productivity and inequality – in order to build a more resilient, inclusive and sustainable future.

Useful links

OECD Inclusive Growth Initiative

OECD Centre for Equality and Opportunity

OECD Inequality webpage

OECD Future of Productivity

OECD Productivity Statistics