The repeat concussions suffered by Miami Dolphins quarterback Tua Tagovailoa less than a week apart in September 2022 have brought the seriousness of traumatic brain injury back into the public eye and triggered scrutiny of the NFL’s concussion protocols. And the upcoming World Cup soccer competition, which begins Nov. 20, 2022, will likely include highly visible head injuries.

The Conversation asked David Howell, director of the Colorado Concussion Research Laboratory at the University of Colorado School of Medicine, to explain the latest science behind concussions and why a recently injured brain is more vulnerable to repeat injury. Howell’s work focuses on the many different areas of concussion-related dysfunction and recovery, including movement deficits, sleep problems and rehabilitation.

How widespread are concussions?

The word concussion can evoke a variety of different images for different people. While concussions are most visible during high-profile sporting events, they can also occur on the playground, during the junior varsity football team practice or on the ski slope. The effects can be just as severe for children and teens as for high-profile athletes.

Concussion effects range from mild to severe, from short term to long term, and can affect many different facets of life. A concussion is defined as a traumatic brain injury caused by an impact to the head, resulting in an alteration of brain function.
A concussion often leads to disruptions to everyday life – whether it be a job, academics, sports, physical activity or sleep. Given how unique people’s brains are and how differently they may respond to the injury, concussion recognition, diagnosis and treatment remain challenging for patients and clinicians alike.

What happens to the brain during a concussion?

There is a complex set of events that occur within the brain during and after a concussion occurs.

As a result of the trauma to the brain, brain cells – or neurons – stop functioning as they typically do when healthy. Generally there is not one specific area of the brain that is affected by a concussion. Instead, the injury can affect a widespread set of brain regions, not necessarily at the impact point. Thus, each person may experience a unique set of symptoms or functional problems following the injury.

One main problem that arises following a concussion is an energy crisis of sorts. This occurs when the brain requires a large volume of energy, in the form of glucose delivered by blood flow to the brain, to restore the injured processes. The body also may have trouble delivering blood to the brain because of a brain blood flow disruption caused by the injury, at the very time the brain needs extra energy to restore the injured areas. This mismatch can produce a variety of different symptoms people experience following a concussion.

What signs should you look for if you suspect a concussion?

Concussions produce a wide range of signs and symptoms, such as problems with walking and balance, dizziness, mood changes, disruptions to sleep and more.

Some of the main signs that health care providers look for following an impact to the head or body include unsteadiness of gait, loss of consciousness, seizures or other concussion symptoms like headache, cognitive impairment or problems with vision or balance.

It is critical that if a concussion is suspected, individuals cease playing their sport or activity. A simple mantra of “If in doubt, sit them out” should always be applied, regardless of the setting.

Why is the injured brain more vulnerable to repeat injury?

Miami Dolphins quarterback Tua Tagovailoa, who was carted off the field in late September 2022 after his second head injury in less than a week, serves as an example of how vulnerable the brain can be to additional trauma following an initial concussion.

Research shows that the rate of second concussions is highest in the immediate days following an initial concussion. In addition, recent studies have found that athletes who continue to play following a concussion experience longer recovery times and more severe symptoms.

While athletes of all ages may want to continue competing after a concussion, relying on a person with an injured brain to determine whether their brain is healthy enough to continue playing is flawed logic. Qualified health care professionals should always make these sorts of decisions for an athlete, rather than someone with a vested interest such as the athletes themselves or their coaches.

Given the energy crisis described above that occurs following a head injury, the brain simply cannot handle the added and cumulative stress of two injuries occurring in short succession. A second insult to the brain is often simply too much for the brain to handle, and the brain will preserve its most basic functions, such as breathing, above all else.

This is why it is imperative that athletes who experience a concussion be removed from the field of play and allowed to recover fully before returning to unrestricted sport participation. This often involves a stepwise reintegration approach, which allows for a gradual and safe reintroduction into physical activity at first, and an appropriately safe return to play under medical care.

You’ve had a concussion – now what?

The first step following a concussion is to stop playing sports and to rest for a day or two. Sleep is critically important in the days following a concussion.

A myth that continues to persist is that a person should be woken up every hour following a concussion. This is simply not supported by science. In fact, poor sleep after a concussion has been widely documented as being a predictor of poor outcomes, including longer recovery times and more severe anxiety, depression or cognitive symptoms. Waking someone up every hour applies to more severe brain injuries that would be ruled out by a health care provider during diagnosis.

In addition, recent guidelines and past research suggest that complete physical and cognitive rest, which is sometimes called cocoon therapy, can actually be harmful to recovery.

Therefore, it is important to keep a balanced approach in mind. Following a day or two of physical rest, people with a concussion should begin resuming light physical and cognitive activity that does not provoke or exacerbate ongoing symptoms.

When a person begins to feel better following a concussion, they should gradually add in higher intensity and greater amounts and duration of exercise, dictated by whether their symptoms are not significantly provoked. Recent studies have focused on the value of an individualized aerobic exercise program in the week following a concussion. Past work suggests that performing aerobic exercise at a heart rate just below the level at which symptoms are exacerbated is safe and effective for recovery.

It is important to note that the effects of a concussion may also result in secondary conditions, such as anxiety or depression due to the biological, social or psychological effects of the injury. A recent study showed that adolescents who sustained a concussion have a higher risk of mental health issues compared to those with an orthopedic injury.

David Howell, Assistant Professor of Orthopedics,, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Herman Daly had a flair for stating the obvious. When an economy creates more costs than benefits, he called it “uneconomic growth.” But you won’t find that conclusion in economics textbooks. Even suggesting that economic growth could cost more than it’s worth can be seen as economic heresy.

The renegade economist, known as the father of ecological economics and a leading architect of sustainable development, died on Oct. 28, 2022, at the age of 84. He spent his career questioning an economics disconnected from an environmental footing and moral compass.

In an age of climate chaos and economic crisis, his ideas that inspired a movement to live within our means are increasingly essential.

The seeds of an ecological economist

Herman Daly grew up in Beaumont, Texas, ground zero of the early 20th century oil boom. He witnessed the unprecedented growth and prosperity of the “gusher age” set against the poverty and deprivation that lingered after the Great Depression.

To Daly, as many young men then and since believed, economic growth was the solution to the world’s problems, especially in developing countries. To study economics in college and export the northern model to the global south was seen as a righteous path.

But Daly was a voracious reader, a side effect of having polio as a boy and missing out on the Texas football craze. Outside the confines of assigned textbooks, he found a history of economic thought steeped in rich philosophical debates on the function and purpose of the economy.

Unlike the precision of a market equilibrium sketched on the classroom blackboard, the real-world economy was messy and political, designed by those in power to choose winners and losers. He believed that economists should at least ask: Growth for whom, for what purpose and for how long?

Daly’s biggest realization came through reading marine biologist Rachel Carson’s 1962 book “Silent Spring,” and seeing her call to “come to terms with nature … to prove our maturity and our mastery, not of nature but of ourselves.” By then, he was working on a Ph.D. in Latin American development at Vanderbilt University and was already quite skeptical of the hyperindividualism baked into economic models. In Carson’s writing, the conflict between a growing economy and a fragile environment was blindingly clear.

After a fateful class with Nicholas Georgescu-Roegen, Daly’s conversion was complete. Georgescu-Roegen, a Romanian-born economist, dismissed the free market fairy tale of a pendulum swinging back and forth, effortlessly seeking a natural state of equilibrium. He argued that the economy was more like an hourglass, a one-way process converting valuable resources into useless waste.

Daly became convinced that economics should no longer prioritize the efficiency of this one-way process but instead focus on the “optimal” scale of an economy that the Earth can sustain. Just shy of his 30th birthday in 1968, while working as a visiting professor in the poverty-stricken Ceará region of northeastern Brazil, Daly published “On Economics as a Life Science.”

His sketches and tables of the economy as a metabolic process, entirely dependent on the biosphere as source for sustenance and sink for waste, were the road map for a revolution in economics.

Economics of a full world

Daly spent the rest of his career drawing boxes in circles. In what he called the “pre-analytical vision,” the economy – the box – was viewed as the “wholly owned subsidiary” of the environment, the circle.

When the economy is small relative to the containing environment, a focus on the efficiency of a growing system has merit. But Daly argued that in a “full world,” with an economy that outgrows its sustaining environment, the system is in danger of collapse.

While a professor at Louisiana State University in the 1970s, at the height of the U.S. environmental movement, Daly brought the box-in-circle framing to its logical conclusion in “Steady-State Economics.” Daly reasoned that growth and exploitation are prioritized in the competitive, pioneer stage of a young ecosystem. But with age comes a new focus on durability and cooperation. His steady-state model shifted the goal away from blind expansion of the economy and toward purposeful improvement of the human condition.

The international development community took notice. Following the United Nations’ 1987 publication of “Our Common Future,” which framed the goals of a “sustainable” development, Daly saw a window for development policy reform. He left the safety of tenure at LSU to join a rogue group of environmental scientists at the World Bank.

For the better part of six years, they worked to upend the reigning economic logic that treated “the Earth as if it were a business in liquidation.” He often butted heads with senior leadership, most famously with Larry Summers, the bank’s chief economist at the time, who publicly waved off Daly’s question of whether the size of a growing economy relative to a fixed ecosystem was of any importance. The future U.S. treasury secretary’s reply was short and dismissive: “That’s not the right way to look at it.”

But by the end of his tenure there, Daly and colleagues had successfully incorporated new environmental impact standards into all development loans and projects. And the international sustainability agenda they helped shape is now baked into the U.N. Sustainable Development Goals of 193 countries, “a plan of action for people, planet and prosperity.”

In 1994, Daly returned to academia at the University of Maryland, and his life’s work was recognized the world over in the years to follow, including by Sweden’s Right Livelihood Award, the Netherlands’ Heineken Prize for Environmental Science, Norway’s Sophie Prize, Italy’s Medal of the Presidency, Japan’s Blue Planet Prize and even Adbuster’s person of the year.

Today, the imprint of his career can be found far and wide, including measures of the Genuine Progress Indicator of an economy, new Doughnut Economics framing of social floors within environmental ceilings, worldwide degree programs in ecological economics and a vibrant degrowth movement focused on a just transition to a right-sized economy.

I knew Herman Daly for two decades as a co-author, mentor and teacher. He always made time for me and my students, most recently writing the foreword to my upcoming book, “The Progress Illusion: Reclaiming Our Future from the Fairytale of Economics.” I will be forever grateful for his inspiration and courage to, as he put it, “ask the naive, honest questions” and then not be “satisfied until I get the answers.”

Jon D. Erickson, Professor of Sustainability Science and Policy, University of Vermont

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Russia’s war on Ukraine has cast a shadow over this year’s United Nations climate summit in Sharm el-Sheikh, Egypt, where officials from around the world are discussing the costs of climate change and how to cut emissions that remain near record highs.

The war has dramatically disrupted energy markets the world over, leaving many countries vulnerable to price spikes amid supply shortages.

Europe, worried about keeping the heat on through winter, is outbidding poor countries for natural gas, even paying premiums to reroute tanker ships after Russia cut off most of its usual natural gas supply. Some countries are restarting coal-fired power plants. Others are looking for ways to expand fossil fuel production, including new projects in Africa.

These actions are a long way from the countries’ pledges just a year ago to rein in fossil fuels, and they’re likely to further increase greenhouse gas emissions, at least temporarily.

But will the war and the economic turmoil prevent the world from meeting the Paris climate agreement’s long-term goals?

There are reasons to believe that this may not be the case.

The answer depends in part on how wealthy countries respond to a focus of this year’s climate conference: fulfilling their pledges in the Paris Agreement to provide support for low- and middle-income countries to build clean energy systems.

Europe speeds up clean energy plans

A key lesson many countries are taking away from the ongoing energy crisis is that, if anything, the transition to renewable energy must be pushed forward faster.

I work with countries as they update national climate pledges and have been involved in evaluating the compatibility of global emissions reduction scenarios with the Paris Agreement. I see the energy crisis affecting countries’ plans in different ways.

About 80% of the world’s energy is still from fossil sources. Global trade in coal, oil and natural gas has meant that even countries with their own energy supplies have felt some of the pain of exorbitant prices. In the U.S., for example, natural gas and electricity prices are higher than normal because they are increasingly tied to international markets, and the U.S. is the world’s largest exporter of liquefied natural gas.

The shortage has led to a scramble to find fossil fuel suppliers in the short term. European countries have offered to help African countries produce more natural gas and have courted authoritarian regimes. The Biden administration is urging companies to extract more oil and gas, has tried to pressure Saudi Arabia to produce more oil, and considered lifting sanctions against Venezuela.

However, Europe also has a growing renewable energy supply that has helped cushion some of the impact. A quarter of the European Union’s electricity comes from solar and wind, avoiding billions of euros in fossil fuel costs. Globally, investments in the clean energy transition increased by about 16% in 2022, the International Energy Agency estimates.

Developing countries face complex challenges

If Russia’s invasion of Ukraine is a wake-up call to accelerate the clean energy transition in wealthier countries, the situation is much more complex in developing countries.

Low-income countries are being hit hard by the impact of Russia’s war, not only by high energy costs, but also by decreases in grain and cooking oil exports. The more these countries are dependent on foreign oil and gas imports for their energy supply, the more they will be exposed to global market gyrations.

Renewable energy can reduce some of that exposure.

The costs of solar and wind energy have dropped dramatically in the last decade and now represent the cheapest sources of energy in most regions. But advances in expanding access to clean electricity have been set back by the war. Borrowing costs can also be a barrier for low-income countries, and those costs will increase as countries raise interest rates to fight inflation.

As part of the Paris Agreement, wealthy countries were supposed to make good on promises to make US$100 billion per year available for climate finance, but the actual amounts provided have fallen short.

To achieve the Paris Agreement targets, coal, oil and natural gas consumption must decrease dramatically in the next decade or two. International cooperation will be necessary to help poorer countries expand energy access and transition to low-emissions development pathways.

Africa’s fossil fuels and stranded asset risks

A number of developing countries have their own fossil fuel resources, and some in Africa have been calling for increasing production, although not without pushback.

Without a strong alternative within local contexts for sustainable energy resources, and with wealthy countries scrambling for fossil fuels, developing countries will exploit fossil resources – just as the wealthiest countries have done for over a century. For example, Tanzania’s energy minister, January Makamba, told Bloomberg during the U.N. climate conference that his country expects to sign agreements with Shell and other oil majors for a $40 billion liquefied natural gas export project.

While this intersection of interests could boost some developing countries, it can also set up future challenges.

Encouraging the construction of new fossil-fuel infrastructure in Africa – presumably to be earmarked for Europe in the short to medium term – may help ameliorate some near-term supply shortages, but how long will those customers need the fuel? And how much of that income will benefit the people of those countries?

The IEA sees natural gas demand plateauing by 2030 and oil and coal demand falling, even without more ambitious climate policies. Any infrastructure built today for short-term supplies risks becoming a stranded asset, worthless in a low-emissions world.

Encouraging developing countries to take on debt risk to invest in fossil fuel extraction for which the world will have no use would potentially do these countries a great disservice, taking advantage of them for short-term gain.

The world has made progress on emissions in recent years, and the worst warming projections from a decade ago seem to be highly unlikely now. But every tenth of a degree has an impact, and the current “business-as-usual” path still leads the planet toward warming levels with climate change costs that are hard to contemplate, especially for the most vulnerable countries. The outcomes from the climate conference will give an indication of whether the global community is willing to accelerate the transition.

Robert Brecha, Professor of Sustainability, University of Dayton

This article is republished from The Conversation under a Creative Commons license. Read the original article.