Newfangled device

     A cell phone today is as necessary as shoes, and most of us would feel as naked leaving the house without a phone as we would going outside barefoot.  But 15 years ago a cell phone—a little blue Nokia—was more of an option, a luxury item that an indulgent wife would give her husband, particularly if he sometimes nodded off and missed his train stop. As today is my birthday, I thought I'd dig into the past for a previous birthday column. The day this column ran, the city editor saw me, smiled, and shouted across the newsroom, "Throw it! Throw it!"  

     When I was 17, I bought a switchblade. I was spending the summer in Switzerland, where such knives were legal. Passing the window of a cutlery shop in Zurich, I noticed an impressive array of switchblades. Entranced, I went in and bought one. The first few minutes were pure thrill--to press the round button and have the knife snap open with a hard metallic click. To fold the long pointed blade back inside the black handle again with a smooth motion. I felt cool, dangerous.
     But very soon I began thinking, and qualms set in. As I walked home, I questioned buying the knife. "Why," I wondered, "did I buy this thing? What am I going to do with it?" I tried telling myself that it was for self-defense. That, confronted by bullies, I would pull out my switchblade and they would back off, terrified. Stupid of me.
     OK, I reasoned, maybe I won't use it against bullies. I'll show it off, to impress people. It will make me seem tough. Girls will be impressed.
     Double stupid.
     I was walking on a causeway, across a lake, having these thoughts when, acting impulsively, I took the switchblade out of my pocket and flung it into the water. It made a small blooping splash.
     Over the years, from time to time I've regretted not having the switchblade, just as a relic. But in the main I am proud that, at 17, I realized that toting a switchblade around was a bad idea, and believe that my life has gone more smoothly without it.
     The memory of the switchblade's final dive slumbered in my mind for 25 years, to be triggered afresh this morning as I crossed the Madison Street bridge over the Chicago River on my way from the train station to work. I turned 42 earlier in the week and my wife gave me a cell phone as a present. Thanks, honey. I let it sit on the coffee table for a few days, but I knew I'd have to come to terms with the thing, eventually. This morning I noticed it, sighed, and slipped the phone into my shirt pocket as I left for the train.
     Hurtling downtown, I plunged into the 148-page instruction book. It began with a raft of unexpected warnings: Don't use the phone at a gas station! Don't use it near chemicals, or at a blasting site! Don't point the infrared beam (the infrared beam?) at anyone's eyes! The thing made a switchblade seem as benign as a soup spoon.
     Calling people, it turns out, is the least of the phone's abilities. It is a calculator and an alarm clock. You can store phone numbers, send text messages. My phone plays games. (Such as Snake 2: "Feed the snake with as many goodies as possible and watch it grow ...")
     Not that these tricks came easy. Getting the phone to work was like studying for a math test. There were mysterious glyphs to decipher, buttons to find, tasks to master. I did manage to place a call, to my wife, whom I had just spoken to 20 minutes earlier.
    "Hello," I bellowed, as if shouting down a well. "I'm on the train. The TRAIN! That's right." I had to yell that phrase--it's what everyone with a cell phone seems compelled to say. If I was now a cell phone guy, I should play the part.
     I suppose a cell phone does not seem the most romantic birthday gift, but we are practical people. My wife got me the phone because she knew I would never buy one myself. In fact, I had never even thought of buying one, and my face must have reflected puzzlement, opening the gift, because she felt the need to point out its utility.
     "If you think you're going to fall asleep on the train, you can tell me to call you before your stop and wake you up," said my wife, cheerily.
     I paused on the bridge, took out the phone, and looked at it. An amazing bit of technology. The size of a squashed Milky Way bar, a cool industrial blue, with a dozen little oval keys set in four discretely arcing rows under a screen the size of a big postage stamp.
     A modern miracle, really. Half the people in the country have them, and they seem to use them all the time, yammering happily away as they march down the street. Why not me?
     Because it made me uneasy. I bounced it in my palm, remembering the knife, smiling just at the thought of pitching it off the bridge. We are defined by our tools. A guy carrying a switchblade is itching to cut somebody; a guy carrying a phone must be eager to talk.
     Which is not me. I'm trying to talk less, not more. I've gotten three phone calls in the past 10 minutes, while writing this, each more bothersome than the next. Frankly, rather than get a new phone, I'd be happier losing the ones I've got. Communication could use a few hurdles.
     Yes, a cell phone is handy if the train is late. But the train isn't usually late, and when it's on time the phone is just another thing to carry, to keep in my drawer and load in my pockets every morning--wallet, keys, money clip, handkerchief and, now, telephone. You have to worry about losing it, worry is it on, or off, worry does it have enough juice? It's practically like carrying around a tiny electronic baby.
     Yet I didn't throw the phone into the river. I put it back in my pocket and plodded on. Dramatic displays are for teenagers. And the phone was, after all, a gift from my wife. But even as I kept the phone, I felt a pang for my former, unconnected self, now gone forever. I have become hooked to the big grid, like everybody else. Well, I comforted myself, the good thing is, knowing me, it won't be long before I lose it.
                 — Originally published in the Sun-Times, June 14, 2002

Will Russia really conquer the U.S. this easily?

   In 1855, an Illinois railroad lawyer named Abraham Lincoln wrote to his longtime friend, Joshua Speed, who had moved back to their native Kentucky. Lincoln focused on the slavery question, already tearing the country apart.
     “As a nation, we began by declaring that 'all men are created equal.'" the future president wrote. "We now practically read it 'all men are created equal, except negroes.' When the Know-Nothings get control, it will read 'all men are created equal, except negroes, and foreigners, and Catholics.' When it comes to this I should prefer emigrating to some country where they make no pretense of loving liberty – to Russia, for instance, where despotism can be taken pure, and without the base alloy of hypocrisy.”
     Russia, "where despotism can be taken pure." Long before the Communist revolution roiled Russia, that nation was notorious for its repression, its medieval cruelty, the misery of its serfs, and its backward ways. In Lincoln's time, the thinking was: Americans might hold slaves, but Russians are slaves.
     That scorn hardened over the 20th century into fear of deep intensity, as Russia's repressive nature became married to the philosophy of communism. Yes, there were periods of reduced tension. While supporting the Russian Revolution was enough to get an American deported in 1919, by the 1930s romanticizing Stalin was a common fault of the liberal left — turning a blind eye to Russian menace certainly wasn't invented by Donald Trump. We were allies for a few awkward years, after Stalin's pal Adolf Hitler turned against him.
     But by 1947 the Iron Curtain was drawn across Europe and half a century of Cold War had set in. Kind words for Russia would cost you your career in the 1950s, and by the 1960s, we feared the Commies would kill us all. The notion of our government being in collusion with them was the stuff of John Birch paranoid delusions and Hollywood thrillers.
     Since communism collapsed, what Ronald Reagan dubbed an "evil empire" has contracted, losing its Eastern Europeans vassals and large swaths of territory. It flirted with democracy, then became a vast criminal enterprise headed by a dictator, the former KGB colonel Vladimir Putin.
     As historians pick through the train wreck of the Trump years, their admiration for and compliance with Russia will fascinate and boggle them beyond all else, and rightly so. It fascinates and boggles now.
     James Comey, the former FBI director, testified Thursday that he is certain the Russians meddled in the 2016 election, by trying to undermine Hillary Clinton and boost their preferred candidate, Donald Trump. Various members of the Trump administration met with Russian officers. And the president, whose financial ties to Russia are unknown since he is refusing to release his tax returns, himself put pressure on Comey to abandon the investigation.
     This would be unacceptable if the country in question were Belgium. That it is Russia is off-the-charts, or should be. Yet Republican leaders like Paul Ryan and Mitch McConnell defend behavior that veers between treachery and treason.
     That isn't a rhetorical question. There is an answer, one that came to me when I was reading about former Minnesota Gov. Jesse Ventura—sort of the Alpha version of Donald Trump, right-wingnut-TV-personality-turned-politician—now appearing in a show on Russian TV. Asked to rationalize producing anti-American propaganda, Ventura said, "I am working for the enemies of the mainstream media now."
     To Republicans, the media—the newspapers, TV, though not Fox News—is a greater threat to the well-being of the United States than its traditional enemy. That belief did not develop in a vacuum. Newt Gingrich taught the GOP to view Democrats as traitors. Now, just as an activist judge is a judge who makes a ruling you don't like, so the media is "fake news" when it reports a fact you find uncomfortable. Trump is the scab that formed over America's self-inflicted wound.
     In that light, the Russians have already taken us over, partially. Our government is already led by the same fact-averse, power-addled, cult of personality that Putin built around himself. The only difference is that Americans still have a chance to do something about it. Russians do not.

How to fall to your death and live to tell the tale.

©Dave Imms

     This is my third article for Mosaic, the web site of science and medicine once run by the Wellcome Trust, the largest medical charity in the world. Now, sadly shuttered. Mosaic published this piece under a creative commons license, meaning it can be reprinted by anybody, provided they credit Mosaic, as well as me, as the author. 

Slipping in the shower, tripping down the stairs, taking a tumble in the supermarket – falls kill over 420,000 people per year and hospitalise millions more. We can’t eliminate all falls, says Neil Steinberg. So we must to learn to fall better.

June 2017

     Alcides Moreno and his brother Edgar were window washers in New York City. The two Ecuadorian immigrants worked for City Wide Window Cleaning, suspended high above the congested streets, dragging wet squeegees across the acres of glass that make up the skyline of Manhattan.
     On December 7, 2007, the brothers took an elevator to the roof of Solow Tower, a 47-storey apartment building on the Upper East Side. They stepped onto the 16-foot-long, three-foot-wide aluminium scaffolding designed to slowly lower them down the black glass of the building.
      But the anchors holding the 1,250-pound platform instead gave way, plunging it and them 472 feet to the alley below. The fall lasted six seconds.
      Edgar, at 30 the younger brother, tumbled off the scaffolding, hit the top of a wooden fence and was killed instantly. Part of his body was later discovered under the tangle of crushed aluminium in the alley next to the building.
     But rescuers found Alcides alive, sitting up amid the wreckage, breathing and conscious when paramedics performed a “scoop and run” – a tactic used when a hospital is near and injuries so severe that any field treatment isn’t worth the time required to do it. Alcides was rushed to NewYork-Presbyterian Hospital/Weill Cornell Medical Center, four blocks away.

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      Falls are one of life’s great overlooked perils. We fear terror attacks, shark bites, Ebola outbreaks and other minutely remote dangers, yet over 420,000 people die worldwide each year after falling. Falls are the second leading cause of death by injury, after car accidents. In the United States, falls cause 32,000 fatalities a year (more than four times the number caused by drowning or fires combined). Nearly three times as many people die in the US after falling as are murdered by firearms.
      Falls are even more significant as a cause of injury. More patients go to emergency rooms in the US after falling than from any other form of mishap, according to the Centers for Disease Control and Prevention (CDC), nearly triple the number injured by car accidents. The cost is enormous. As well as taking up more than a third of ER budgets, fall-related injuries often lead to expensive personal injury claims. In one case in an Irish supermarket, a woman was awarded 1.4 million euros compensation when she slipped on grapes inside the store.
      It makes sense that falls dwarf most other hazards. To be shot or get in a car accident, you first need to be in the vicinity of a gun or a car. But falls can happen anywhere at any time to anyone.
      Spectacular falls from great heights outdoors like the plunge of the Moreno brothers are extremely rare. The most dangerous spots for falls are not rooftops or cliffs, but the low-level, interior settings of everyday life: shower stalls, supermarket aisles and stairways. Despite illusions otherwise, we have become an overwhelmingly indoor species: Americans spend less than 7 per cent of the day outside but 87 per cent inside buildings (the other 6 per cent is spent sitting in cars and other vehicles). Any fall, even a tumble out of bed, can change life profoundly, taking someone from robust health to grave disability in less than one second.
Falling can cause bone fractures and, occasionally, injuries to internal organs, the brain and spinal cord. “Anybody can fall,” says Elliot J Roth, medical director of the patient recovery unit at the Shirley Ryan AbilityLab in Chicago. “And most of the traumatic brain injury patients and spinal cord injury patients we see had no previous disability."
      There is no Journal of Falls, though research into falling, gait and balance has increased tremendously over the past two decades. Advances in technology improve our understanding of how and why people fall, offer possibilities to mitigate the severity of falls, and improve medicine’s ability to treat those who have hurt themselves falling.
      Scientists are now encouraging people to learn how to fall to minimise injury – to view falling not so much as an unexpected hazard to be avoided as an inevitability to be prepared for. Training may even have been a factor determining the outcome of the Moreno brothers’ fall to earth nearly ten years ago.

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     Doctors at NewYork-Presbyterian did not want to risk moving Alcides Moreno from the emergency room into a surgical theatre for fear that the slightest additional bump might kill him. They started surgery in the ER. He had two broken legs, a broken arm, a broken foot, several broken ribs, and a crushed vertebra that could have paralysed him, as well as two collapsed lungs, a swollen brain, plus several other ruptured organs. Alcides was given 24 pints of blood and 19 pints of plasma before the bleeding could be stopped.
     Doctors marvelled that he was alive at all, reaching for an explanation not often used in medical literature: “miracle”.
     By 100 feet or more, falls are almost always fatal, apart from freak accidents. People have fallen miles from planes and lived, due to tumbling down snowy hillsides, the way extreme skier Devin Stratton did when he accidentally skied off a 150-foot Utah mountain cliff in January 2017 and escaped unharmed, his fall arrested by branches and cushioned by deep snow. He was wearing a helmet, which cracked even as its camera recorded his plunge.
     “It’s not the fall that gets you,” the skydiving joke goes. “It’s the sudden stop at the bottom.”       

     Deceleration is the key to surviving falls and reducing injuries − it isn’t the length of fall that’s relevant, but what happens as you reach the ground. This was dramatically demonstrated in the summer of 2016 by professional skydiver and safety expert Luke Aikens.      He jumped from a plane without a parachute at an altitude of 25,000 feet, or 4.7 miles, hitting a 100-by-100-foot net positioned in the southern California desert and emerging without a scratch.
     One theory was that Alcides lived because, when the scaffolding gave way, he lay flat and clung to the platform, as professional window washers are trained to do. The scaffold fell not in the open street but in a narrow alley – air resistance may have built up against the platform, slowing it. The platform also may have scraped against the building and its neighbour, reducing its rate of fall. The aluminium crushed on impact, and landed on a pile of cables, both of which absorbed some of the impact, forming a cushioned barrier.
     Survival from heights prompted the first medical writing about falls. Hippocrates, in his treatise on head injuries, observes, sensibly, that “he who falls from a very high place upon a very hard and blunt object is in most danger of sustaining a fracture… whereas he that falls upon more level ground, and upon a softer object, is likely to suffer less injury”. The first modern medical paper on a fall was Philip Turner’s ‘A fall from a cliff 320 feet high without fatal injuries’, published in the Guy’s Hospital Gazettein 1919. It examined the case of a  Canadian Army private who stumbled over a chalk cliff on the coast of France in 1916 and lived.
     In 1917, an American air cadet named Hugh DeHaven was flying in a Curtiss JN-4 “Jenny” when it collided with another biplane 700 feet above an airfield in Texas. Among the four men aboard the two planes, DeHaven alone survived the plunge. He spent the rest of his career trying to figure out why, culminating in his pioneering 1942 paper, ‘Mechanical analysis of survival in falls from heights of fifty to one hundred and fifty feet’.
     In it, he examined eight cases of people surviving long falls – ignoring his own, but including the lucky Canadian private from 1916 – and found that those who landed on newly tilled gardens could walk away surprisingly intact, noting: “It is, of course, obvious that speed or height of fall, is not in itself injurious.” That might sound like the first half of the skydiving joke, but his research led him to design and patent the combined seatbelt and shoulder harness worn in every car today.
     Up to the 1960s and 1970s, scientific papers on falls focused on forensics – their subjects tended to be dead, the medical questions centring on what had happened to them. This was important, for instance, when assessing trauma to children – could this child have fallen and suffered these injuries, as the caregiver claimed, or is it abuse? Falls as a separate, chronic, survivable medical problem began to get attention only in the past quarter-century. The journal Movement Disorders was begun in 1986, but the bulk of papers examining the interplay of balance, gait and falls at ground level appear after 2000.

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     You can trip or slip when walking, but someone standing stock still can fall too – because of a loss of consciousness, vertigo or, as the Moreno brothers remind us, something supposedly solid giving way. However it happens, gravity takes hold and a brief, violent drama begins. And like any drama, every fall has a beginning, middle and end.
     “We can think of falls as having three stages: initiation, descent and impact,” says Stephen Robinovitch, a professor in the School of Engineering Science and the Department of Biomedical Physiology and Kinesiology at Simon Fraser University in British Columbia, Canada. “Most research in the area of falls relates to ‘balance maintenance’ – how we perform activities such as standing, walking and transferring without losing balance.”
      By “transferring”, he means changing from one state to another: from walking to stopping, from lying in a bed to standing, or from standing to sitting in a chair. “We have found that falls among older adults in long-term care are just as likely to occur during standing and transferring as during walking,” says Robinovitch, who installed cameras in a pair of Canadian nursing homes and closely analysed 227 falls over three years.
     Only 3 per cent were due to slips and 21 per cent due to trips, compared to 41 per cent caused by incorrect weight shifting – excessive sway during standing, or missteps during walking. For instance, an elderly woman with a walker turns her upper body and it moves forward while her feet remain planted. She topples over, due to “freezing”, a common symptom of Parkinson’s, experienced regularly by about half of those with the disease.
In general, elderly people are particularly prone to falls because they are more likely to have illnesses that affect their cognition, coordination, agility and strength. “Almost anything that goes wrong with your brain or your muscles or joints is going to affect your balance,” says Fay Horak, professor of neurology at Oregon Health & Science University.
     Fall injuries are the leading cause of death in people over 60, says Horak. Every year, about 30 per cent of those 65 and older living in senior residences have a fall, and when they get older than 80, that number rises to 50 per cent. A third of those falls lead to injury, according to the CDC, with 5 per cent resulting in serious injury. It gets expensive. In 2012, the average hospitalisation cost after a fall was $34,000.
     How you prepare for the possibility of falling, what you do when falling, what you hit after falling – all determine whether and how severely you are hurt. And what condition you are in is key. A Yale School of Medicine study of 754 over-70s, published in theJournal of the American Medical Association in 2013, found that the more serious a disability you have beforehand, the more likely you will be severely hurt by a fall. Even what you eat is a factor: a study of 6,000 elderly French people in 2015 found a connection between poor nutrition, falling and being hurt in falls.

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     Alcides Moreno underwent 15 more surgeries and was in a coma for weeks. He was visited by his three children: Michael, 14, Moriah, 8, and Andrew, 6. His wife, Rosario, stayed at his bedside, talking to him. She repeatedly took his hand and guided it to stroke her face and hair, hoping that the touch of her skin would help bring him around. Then, on Christmas Day, Alcides reached out and stroked not his wife’s face but the face of one of his nurses.
“You’re not supposed to do that,” Rosario chided him. “I’m your wife. You touch your wife.”
“What did I do?” he asked. It was the first time he had spoken since the accident, 18 days earlier. His doctors predicted he might walk again, after lengthy rehabilitation, though the challenges proved to be not only physical but also mental. People who fall suffer the expected physical injuries, but accidental falling also carries a heavy psychological burden that can make recovery more difficult and can, counter-intuitively, set the stage for future falls.

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     Children begin to walk, with help, at about a year old. By 14 months they are typically walking unaided. Those first baby steps are guided by three key bodily systems. First, proprioception – input from the nerves in the muscles, a sense of where limbs are relative to each other and what they’re doing. People whose limbs are numb have difficulty walking even if their musculature is completely functional.
     The second sense is vision, not just to see where you are going, but to help process information from your other senses. “Most people who walk into a dark room will sway more than if they can see – about 20 per cent more,” says Horak, an expert in how neurological disorders affect balance and gait.
     And third is your vestibular system, canals of fluid in the inner ear that work in a way not very different from a carpenter’s spirit level. The system takes measurements in three dimensions, and your body uses the data to orient itself.
      With these various systems doing their jobs, you can step forward and begin to walk, a feat that performance artist Laurie Anderson once described in a song with succinct scientific accuracy: “You’re walking, and you don’t always realise it/But you’re always falling/With each step, you fall forward slightly/And then catch yourself from falling/Over and over.”
Or don’t catch yourself. We fall when the smooth, almost automatic process of walking goes awry. Perhaps it is something as crude as your step being blocked by an obstacle: you trip, over a prankster’s outstretched foot perhaps. Or the traction of your foot against the floor is lost because of a slippery substance – the classic banana peel of silent movie fame, what researchers call “perturbation”.
     Christine Bowers is 18. She hails from upstate New York, and is a student at the Moody Bible Institute in Chicago. One day she hopes to teach English abroad. In January 2016 she had a cavernous malformation – a tangle of blood vessels deep within her brain – removed.
“It paralysed my left side,” she says, as her physical therapist straps her into a complex harness in a large room filled with equipment at the Shirley Ryan AbilityLab. “I’m working on preventing a fall.”
     Under the supervision of Ashley Bobich, the therapist, Bowers is walking on the KineAssist MX, a computerised treadmill with a robotic arm and harness device at the back. The metal arm allows patients freedom of motion but catches them if they fall. This version of the device is quite new – the AbilityLab only got it at the end of 2016 and Bowers is the second patient of Bobich’s to try it. Previously, those in danger of falling would be tethered to overhead gate tracks, a far cruder system, which still can be seen in the ceilings above.
Being a student, Bowers often finds herself in crowded academic hallways, and says she values her cane as much to alert those around her that she has mobility problems as for support. Seeing the cane, she says, her classmates tend to give her a bit of room as they hurry through the corridors.
     Still, she has fallen several times, and those falls made her very skittish about walking, a serious problem in the rehabilitation of those who have fallen. “It’s huge,” says Bobich. “Fear of falling puts you at risk for falling.”
     Elliot Roth agrees. “Falls often cause fear of falling, and fear of falling often causes fear of walking, and fear of walking often causes abnormal or inadequate walking,” he says. A challenge of rehabilitation is to not only increase physical capacity, but also build patient confidence.
     "We've been doing what’s called ‘perturbation training’, where I pick a change in the treadmill speed,” says Bobich. “She’s walking along, I hit the button, and the treadmill speeds up on her and she has to react… Her biggest fear was slipping on ice, so I said, ‘You know what? I have a really great way for us to train that.’”
     The treadmill hums while Bobich speeds it up and slows it down, and Bowers, her right hand clasping her paralyzed left, struggles to maintain her balance.
“You’re getting better at this,” says Bobich. “You’re getting way better.”

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     The KineAssist is an example of how technology that was once used to study ailments is now used to help patients. Advanced brain scanning, having identified the regions responsible for balance, now diagnoses damage that affects them. Accelerometers attached to people’s ankles and wrists have been used in experiments, plotting induced falls directly into a computer for study, and are now being used to diagnose balance problems – or to detect when someone living alone has fallen and summon help.
      “Over one-half of older adults who fall are unable to rise independently, and are at risk for a ‘long lie’ after a fall, especially if they live alone, which can greatly increase the clinical consequences of the falls,” says Stephen Robinovitch. He and his colleagues are working to develop wearable sensor systems that detect falls with high accuracy, as well as providing information on their causes, and on near-falls.
      Researchers at the Massachusetts Institute of Technology took the “wearable” out of the equation by developing a radio wave system that detects when someone has fallen and automatically summons help. The Emerald system was shown off at the White House in 2015 but is still finding its way to a market chock-full of devices that detect falls, invariably pendants.
      Not that a device needs to be high-tech to mitigate falls. Wrestlers use mats because they expect to fall; American football running backs wear pads. Given that a person over 70 is three times as likely to fall as someone younger, why don’t elderly people generally use either?
The potential benefit of cushioning is certainly there. The CDC estimates that $31 billion a year is spent on medical care for over-65s injured in falls – $10 billion for hip fractures alone (90 per cent of which are due to falls). Studies show that such pads reduce the harmful effects of falling.
     But older people have all the vanity, inhibition, forgetfulness, wishful thinking and lack of caution that younger people have, and won’t wear pads. More are carrying canes and using walkers than before, but many more who could benefit shun them because, to them, canes and walkers imply infirmity, a fate worse than death (80 per cent of elderly women told researchers in one study that they would rather die than have to live with a debilitating hip fracture). This sets up another vicious cycle related to falling: fearing the appearance of disability, some elderly people refuse to use canes, thereby increasing their chances of falling and becoming disabled.
     Padded floors would seem ideal, since they require none of the diligence of body pads or canes. But padding environments is both expensive and a technical challenge. If a flooring material has too much give, wheelchairs can’t roll and footing is compromised. That’s why nursing homes tend not to be thickly carpeted. People pick up their feet less high as they age, and so have a tendency to trip on carpets.
     There are materials designed to reduce injuries from falls. Kradal is a thin honeycombed flooring from New Zealand that transmits the energy of a fall away from whatever strikes it, reducing the force. A study of the flooring in Swedish nursing homes found that while it did reduce the number of injuries when residents fell on it, they fell more frequently when walking on it, leading to a dilemma: the flooring might be causing some falls even as it reduced the severity of resulting injuries.
      One unexpected piece of anti-fall technology is the hearing aid. While the inner ear’s vestibular system is maintaining balance, sound itself also seems to have a role.
      “We definitely found that individuals with hearing loss had more difficulty with balance and gait, and showed significant improvement when they had a hearing aid,” says Linda Thibodeau, a professor at the University of Texas at Dallas’s Advanced Hearing Research Center, summarising a recent pilot study. “Most people don’t know about this.”
      Horak agrees, saying that people who have cochlear implants to give them hearing also find their balance improves. Hearing is not as critical for balance as proprioception, vision and the vestibular system, she says, “But hearing may also contribute and we don’t understand how. We think you can use your hearing to orient yourself.”
     Thibodeau says one reason it’s important to establish this link is that insurance companies don’t typically cover hearing aids, because they are seen as improving lifestyle more than sustaining basic health. Hearing aids can be expensive – up to $6,000 – but a broken hip, which insurance companies do cover, can cost five or ten times that figure, or more, and lead to profound disability or death.
     More than half of people in their 70s have hearing loss, but typically wait ten to 20 years beyond the time when they could first benefit before they seek treatment. If the connection to balance and falls were better known, that delay might be reduced.
     The role of hearing reminds us that, while walking is considered almost automatic, balance is at some level a cognitive act, achieved by processing a cloud of information. Pile demands on our attention and that itself can cause falls, particularly among people who are already compromised physically or cognitively.
      Thibodeau once led a group of people with hearing impairments to the Dallas World Aquarium to test out wireless microphone technology in the real world. “There’s a stairway going by an enormous fish tank,” she says. “I had a participant fall on the stairs, and someone at the aquarium told me, ‘A lot of people fall going down those stairs, looking at the aquarium.’” (Asked to comment whether this indeed is a common problem there, the Dallas World Aquarium director did not reply, a reminder perhaps that the legal aspects of falls can inhibit dissemination of information about them).

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      Given the tremendous cost of falls to individuals and society, and the increasing knowledge of how and why falls occur, what can you do to prevent them? And can you do anything to lessen harm in the split second after you start to fall?
1. Prepare your environment
     Secure loose rugs or get rid of them. Make sure the tops and bottoms of stairs are lit. Clean up spills immediately. Install safety bars in showers and put down traction strips, and treat slick surfaces such as smooth marble floors with anti-slip coatings. If there’s ice outside your home, clear it and put down salt.
2. Fall-proof your routine
     Watch where you are going. Don’t walk while reading or using your phone. Always hold handrails − most people using stairways do not. Don’t have your hands in your pockets, as this reduces your ability to regain your balance when you stumble. Remember that your balance can be thrown off by a heavy suitcase, backpack or bag.
     Roth asks most of his patients who have fallen to describe in detail what happened: 

     “Sometimes people are not paying attention. Multi-tasking is a myth, and people should try very hard to avoid multi-tasking. No texting while walking.”

     The more problems you have controlling your balance, the more attention is required, says Horak. “If you’re carrying a big backpack on a slippery log, you don’t want somebody to ask you what’s for dinner.”
3. Improve your gear
Wear good shoes with treads. On ice, wear cleats – you can buy inexpensive soles with metal studs that slip over your shoes. Do not wear high heels, or at least have a second pair of flat shoes for walking between locations. Get a hearing aid if you need one. Wear a helmet when bicycling, skiing and skateboarding. Use a cane or walker if required. Hike with a walking stick.
4. Prepare your body
      Lower body strength is important for recovering from slips, upper body strength for surviving falls. Martial arts training can help you learn how to fall. Drugs and alcohol are obviously a factor in falls – more than half of adult falls are associated with alcohol use – as is sleep apnea. Get a balanced diet to support bone density and muscle strength. If you feel lightheaded or faint, sit down immediately. Don’t worry about the social graces, you can get back up once you’ve established you are not going to lose consciousness.
Understandably, some elderly people fear falling so much that they don’t even want to contemplate it. “People should know they could improve their balance with practice, even if they have a neurological problem,” says Horak.
5. Fall the right way
     What happens once you are falling? Scientists studying falling are developing “safe landing responses” to help limit the damage from falls. If you are falling, first protect your head – 37 per cent of falls by elderly people in a study by Robinovitch and colleagues involved hitting their heads, particularly during falls forward. Fight trainers and parachute jump coaches encourage people to try not to fall straight forward or backward. The key is to roll, and try to let the fleshy side parts of your body absorb the impact.
     “You want to reach back for the floor with your hands,” says Chuck Coyle, fight director at the Lyric Opera of Chicago, describing how he tells actors to fall on stage. “Distribute the weight on the calf, thigh, into the glutes, rolling on the outside of your leg as opposed to falling straight back.”
     Young people break their wrists because they shoot their hands out quickly when falling. Older people break their hips because they don’t get their hands out quickly enough. You’d much rather break a wrist than a hip.

                                                                                    §

     Alcides Moreno underwent a long regimen of physical and occupational therapy at the Kessler Institute for Rehabilitation in New Jersey, working to strengthen his legs, restore his balance, and walk. Occupational therapy was necessary, as well as counselling, as he had grown depressed over the loss of his brother, Edgar.
     He is unable to return to work but received a multimillion-dollar settlement in his lawsuit against the scaffolding company, Tractel, after a Manhattan court found that it had installed the platform negligently. The sum wasn’t revealed, but a source said it was more than the $2.5 million that Edgar’s family received.
     Alcides and his family moved to Arizona, and live outside Phoenix. “This weather is good for my bones,” he told the New York Post. He keeps busy, driving his kids to school and to sporting events, and likes to work out in the gym.
     Last year he and his wife had a fourth child, a son.
     “I keep asking myself why I lived,” he told the BBC this year. “I have a new baby – he must be the reason, to raise this kid and tell him my history.”

Some acts of terror terrify us more than others

     You are going to be killed this afternoon.  
     In one of two ways — hypothetically, I rush to point out. This is a thought experiment, not a warning.
     The first potential manner of your death: You are walking along Wacker Drive, smiling at the sky, when a truck driven by a religious fanatic veers onto the sidewalk and kills you.
     The second: You are at work, calling up a spreadsheet, when a disgruntled former employee bursts in and shoots you.
     Both deaths are instantaneous. Which do you prefer?
     As the victim, it hardly matters. Either way, you're just as dead. Your family misses you just as much.
     Had you foreknowledge, you would try to spare yourself from either attack with equal vigor. In both cases, you would no doubt avoid the fatal spot — Wacker Drive or the office. You would notify authorities of the peril.
     Yet that is not how society approaches such killings. We do not view them with equal attention, equal seriousness. Nor do we try to avoid both situations equally. Attacks such as the one Saturday on the London Bridge that killed seven are acts of terrorism that demand international attention, global grief and brisk action. We demand something be done.
     While the shooting Monday at an awning factory in Florida is generally ignored. Five dead, but nothing to be done, or even contemplated. We hardly care what the motive was. Something work-related.

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Not every 50th anniversary is golden

"One of these things is not like the other...
one of these things just doesn't belong..."

     Today marks the 50th anniversary of the start of the Six-Day War, and it is telling that the media, in general, seems to be marking the half century point of Palestinian occupation, as opposed to the daring victory that allowed Israel to survive for another five decades of international condemnation for the sin of existing.
     You'll forgive me for not parsing once again, on demand from the pitiless calendar, a matter I have dissected endlessly already and that, alas, does not change much as the years slip by, only becoming more hopeless and tragic. I think I pretty much summed it up in last year's post. 
     But I can't just say, "Been there, done that," so I offer up this, which ran immediately after Israel had a bloody encounter with a flotilla of activists who wanted to run their blockade of Gaza. It appeared at a time when my column ran a full page, and I have left in the subheadings.
     At least now I am off the hook for another 25 years. Squinting toward the 75th anniversary, I will be 81. I don't know which is more likely, that the problem will be lingering still, roughly as it is now, or that I'll still be applying myself to this odd business. 

     Those growing up in the 1960s and 1970s, as I did, came to expect a certain genius from Israel, an ability to accomplish tough, nearly miraculous tasks, between the strategic brilliance of the Six-Day War and the daring raid at Entebbe.
     Since the Intifada, though, Israel's record has been spottier, and the latest fiasco—seen coming a mile away, like the Syrians advancing on the Golan Heights in 1973—is Monday's deadly response to the protest flotilla bringing supplies to Gaza.
     It was a lose-lose proposition: let the ships pass, and anybody who wants to is now free to land a boatload of rockets on the beach at Gaza—which, remember, has the habit of firing them at Israel. Stop the ships and you risk a slaughter at sea, which is what happened. Israel took a long look at the trap, then carefully stepped in.
     Israel has justifications for this, but so what? Second-guessing Israel has become an international sport, like soccer, and explanations mean nothing in the capitals of Europe and on college campuses in America, where Israel has long been regarded as a synthesis of apartheid South Africa and the evil Empire from "Star Wars."

TRYING TO BOO THEM OFF THE PLANET

     Does world opinion matter? In the short term, no. Existence as a nation is not a global popularity contest, thankfully, because if it were the U.S. would be voted off the planet along with Israel, which suffers in part because it is so similar to us—a prosperous liberal democracy in the midst of repressive Islamic monarchies and impoverished police states, all too happy to condemn Israel for occasionally doing what they themselves do every day.
     Nothing changed Monday. Those who despised Israel last week continue to do so today, with a fresh outrage to add to their litany. The same people who didn't believe Israel had a right to exist in 1948 and 1956 and 1967 and 1973 and on May 30 continue to do so. And those who support Israel also continue doing so, with the same gathering uneasiness they've felt for years.
     In a way, this unease is misplaced. Israel's supporters tend to forget that the present crisis is actually an improvement over past crises. Forty years ago, the problem was a ring of hostile neighbors keen to destroy the nation, not with global finger-wagging, but with tanks and armies. The current mess is a better problem to have.
     Though not, of course, from the perspective of the Palestinians in two occupied territories, a pair of poison pills that Israel has been unable to either swallow or spit out. I don't think that supporting Israel requires denying the anguish of the Palestinians—betrayed by their corrupt and bellicose leaders, sure, bypassing chance after chance for peace, definitely, but suffering all the same.
     Can the status quo continue? Absolutely. We live in a country routinely condemned by most of the world for whatever we do; in their eyes we are waging not one but two needless wars of aggression in Afghanistan and Iraq. Still, we manage to sleep at night, and the Israelis are used to being scorned for doing what other countries do without notice. Few care that Gaza also borders Egypt, which quickly loosened its own blockade Tuesday, or that Jordan borders the West Bank. If six trucks had rushed an Egyptian checkpoint in Gaza, their occupants would be just as dead as the ship activists, though the world wouldn't notice. And Jordan, which once controlled the West Bank, certainly doesn't want it back. Few bother to wonder why. If "Free Gaza" were the issue, it would be free tomorrow—alas, Gaza doesn't want to be free; it wants to be the outer suburb of a Palestinian Palestine, and prefers to grind through the years in misery rather than function normally and give up the dream.
     Here's where Israel's past successes led it astray—having handled so much, it assumed it could handle an endless occupation, and it can't. Rather, Israel needs to conjure up its past genius and figure out how to end this and get on to the next problem. (Anyone who thinks that solving the Palestinian crisis brings peace is forgetting what the situation was like before).
     Two reasons why this must be done: First, it's a humanitarian nightmare. History has jammed 1.5 million Palestinians into a bad place, and fate's designation of the Israelis as their jailers is one of the cruel ironies that history seems to savor. Just as you can love America and not take pride in its slaughter of the Indians, so you can support Israel and wonder: If they're so smart, why are they still in the bloody occupation business after 43 years? (Of course, nobody flips that question and asks: If the occupation is so cruel, then why don't the Palestinians make peace?)
     Second, the occupation erodes Israel's standing in the world, and while that might not matter now, it will eventually, particularly as the Muslim populations of the United States and Europe grow in numbers and sophistication—adopting the PR techniques that Jews once used to rally the world to Israel. How will Israel fare as a completely ostracized pariah?
     I realize, with miracles confined to biblical times, this might be expecting Israel to do the impossible—but Israel used to be known for achieving the impossible. Maybe it can do so again. If not, the Palestinians are waiting for their own miracle, and lack neither patience nor support.
                    —Originally published in the Sun-Times June 2, 2010.

We might not want to go where Uber is taking us

    I'm old enough to remember when authors of a certain vintage fetishized their manual typewriters. During their smug, how-I-create interviews, they would emphasize the physical process of setting down words on paper, as if the devices themselves somehow conveyed authenticity.
     Let amateurs surrender to the siren call of newfangled electric typewriters or, God forbid, the soulless word processor. They were artists, and artists made a whap-whap-whap sound on their beloved Royals and Olympias.
     That went away, eventually. Because manual typewriters are a pain. Computers are far easier, and they won. Technology always wins.
       Still, before that inevitable victory, the two technologies existed side by side for a spell, the old and new, until the inferior one dies utterly clutching the curtains, decrying its doom.
     We've entered that fatal last act with taxis. I never realized it until last week when I had one of those moments where the two technologies go head to head.
     Something called the UI Labs invited me to visit, which required showing up at 1415 N. Cherry.
     Had I been less busy, I'd have figured out where the nearest Divvy station was and biked over, it was only two miles from the newspaper.

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Repurposed

    
     Sobriety starts out being conceptual. That might be the trickiest part. You have to realize it is possible. People do it. You can do it. It is allowed. You don't have to drink. Life still works. You do other things instead. 
     Thus I was intrigued and delighted to notice, while researching a column a few weeks back, this decanter full of M&Ms in the chambers of Ruben Castillo, the chief judge of the United States District Court for the Northern District of Illinois. Clever. 
     I never quite understood decanters. I have a pair -- wedding gifts—but never used them. The decanters seemed props in search of a soap opera, something Susan Lucci could pause in front of, her hand on the stopper, before making some startling confession. 
     When I gave up drinking, a dozen years ago, I remember thinking, among the swirl of confused regrets, "And now I'll never use those decanters."
     Boo hoo. The decanters had never been used anyway. Because it seemed an unnecessary step to pour the booze out into these heavy cut glass bottles. Toward what end? 
     This colorful repurposing seems ideal—a notion that had literally never crossed my mind -- and worth passing along, under the assumption it would be a revelation to others as well. I asked Castillo about it concerned that he might feel ill-used if I seized this personal detail from a corner of his desk and publicized it. 
     Castillo didn't mind. He said that sometimes his job requires him to interview children in his vast chambers, and a fancy bottle of candy comes in handy.
     The only problem now is this: I don't like M&Ms. I suppose any small bore candy would work. Although, upon second thought, not liking M&Ms makes them ideal, as it would encourage moderation. I would have the repurposed decanter finally on display. And the candy would be safe from its owner, in the main, and thus available for any visitors who might want a treat.