UCSF Study Probes Long-Term Effects of Head Trauma -- and Not Just in Football
Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK
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Now head injuries among \"the rest of us\" are getting a long look from researchers, too.\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441252/proposed-california-ban-on-kids-football-sacked-early-and-hard\" target=\"_blank\" rel=\"noopener\">California Ban on Kids Football Sacked Early\u003c/a>\u003c/aside>\n\u003cp>\"They're actually very, very common,\" said Geoff Manly, who chairs the Dept. of Neurosurgery at UCSF and is leading the study. He says nearly 3 million people with head injuries turn up at U.S. emergency rooms every year, caused by everything from traffic accidents to falling down stairs to being thrown off a bicycle. Manley says the numbers are increasing yearly \"on a scale that dwarfs\" the problem in sports alone.\u003c/p>\n\u003cp>\"Historically, we've sort of treated this as an event, rather than a process,\" he said. \"And now we see that many people are suffering long-term consequences of these injuries.\"\u003c/p>\n\u003cp>The National Football League is putting up nearly $3.5 million to fund the long-term study of \"community-acquired\" concussions and the long-range effects they have on some patients, such as depression, dementia, Parkinson's and Alzheimer's.\u003c/p>\n\u003cp>The study will track patients from the time they present for emergency care to as long as seven years beyond, to try to determine why some patients are able to shake off head trauma, while others are plagued with long-term and sometimes fatal consequences.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It's probably not just by chance that there's a strong association between prior history of TBI and the development of some of these disorders,\" says Manley. \"We're trying to figure out what those risk factors are and hoping that in identifying these risk factors, we can find a mechanism.\"\u003c/p>\n\u003cp>With funding from the NFL's \u003ca href=\"https://protect-us.mimecast.com/s/h_yFCyPmRxsr24VOiZjhit?domain=email.prnewswire.com\">Play Smart - Play Safe\u003c/a> initiative, Manley says, the study will track about 2,700 patients whose data has \u003ca href=\"https://protect-us.mimecast.com/s/5K4lCzpn0ysMwrVWUXH4uq?domain=email.prnewswire.com\" target=\"_blank\" rel=\"noopener\">already been gathered\u003c/a> by major trauma centers around the country. The research team will collect data on brain imaging, blood-based biomarkers and outcome assessments of psychological health, physical recovery and functional status.\u003c/p>\n\u003cp>The results could also provide insights into a condition known as chronic traumatic encephalopathy, which has turned up in alarming numbers of professional football players and is blamed for the tragic deaths of former stars like Pittsburgh Steelers center \"Iron\" Mike Webster and San Diego Chargers linebacker Junior Seau.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the wake of these high-profile cases and \u003ca href=\"https://www.nytimes.com/2018/10/05/sports/junior-seau-suit-nfl.html\" target=\"_blank\" rel=\"noopener\">associated litigation\u003c/a>, the NFL has set aside $40 million in funding for medical research, primarily dedicated to neuroscience.\u003c/p>\n\n","blocks":[],"excerpt":"Long-term consequences of concussion aren't just a problem for combat veterans and football players. A new study seeks to find the reasons why.","status":"publish","parent":0,"modified":1542403607,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":415},"headData":{"title":"UCSF Study Probes Long-Term Effects of Head Trauma -- and Not Just in Football | KQED","description":"Long-term consequences of concussion aren't just a problem for combat veterans and football players. A new study seeks to find the reasons why.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"UCSF Study Probes Long-Term Effects of Head Trauma -- and Not Just in Football","datePublished":"2018-11-16T21:22:04.000Z","dateModified":"2018-11-16T21:26:47.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"445528 https://ww2.kqed.org/futureofyou/?p=445528","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/11/16/ucsf-study-probes-long-term-effects-of-head-trauma-and-not-just-in-football/","disqusTitle":"UCSF Study Probes Long-Term Effects of Head Trauma -- and Not Just in Football","path":"/futureofyou/445528/ucsf-study-probes-long-term-effects-of-head-trauma-and-not-just-in-football","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Traumatic brain injury has long been associated with combat and, more recently, contact sports like football. Now head injuries among \"the rest of us\" are getting a long look from researchers, too.\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441252/proposed-california-ban-on-kids-football-sacked-early-and-hard\" target=\"_blank\" rel=\"noopener\">California Ban on Kids Football Sacked Early\u003c/a>\u003c/aside>\n\u003cp>\"They're actually very, very common,\" said Geoff Manly, who chairs the Dept. of Neurosurgery at UCSF and is leading the study. He says nearly 3 million people with head injuries turn up at U.S. emergency rooms every year, caused by everything from traffic accidents to falling down stairs to being thrown off a bicycle. Manley says the numbers are increasing yearly \"on a scale that dwarfs\" the problem in sports alone.\u003c/p>\n\u003cp>\"Historically, we've sort of treated this as an event, rather than a process,\" he said. \"And now we see that many people are suffering long-term consequences of these injuries.\"\u003c/p>\n\u003cp>The National Football League is putting up nearly $3.5 million to fund the long-term study of \"community-acquired\" concussions and the long-range effects they have on some patients, such as depression, dementia, Parkinson's and Alzheimer's.\u003c/p>\n\u003cp>The study will track patients from the time they present for emergency care to as long as seven years beyond, to try to determine why some patients are able to shake off head trauma, while others are plagued with long-term and sometimes fatal consequences.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It's probably not just by chance that there's a strong association between prior history of TBI and the development of some of these disorders,\" says Manley. \"We're trying to figure out what those risk factors are and hoping that in identifying these risk factors, we can find a mechanism.\"\u003c/p>\n\u003cp>With funding from the NFL's \u003ca href=\"https://protect-us.mimecast.com/s/h_yFCyPmRxsr24VOiZjhit?domain=email.prnewswire.com\">Play Smart - Play Safe\u003c/a> initiative, Manley says, the study will track about 2,700 patients whose data has \u003ca href=\"https://protect-us.mimecast.com/s/5K4lCzpn0ysMwrVWUXH4uq?domain=email.prnewswire.com\" target=\"_blank\" rel=\"noopener\">already been gathered\u003c/a> by major trauma centers around the country. The research team will collect data on brain imaging, blood-based biomarkers and outcome assessments of psychological health, physical recovery and functional status.\u003c/p>\n\u003cp>The results could also provide insights into a condition known as chronic traumatic encephalopathy, which has turned up in alarming numbers of professional football players and is blamed for the tragic deaths of former stars like Pittsburgh Steelers center \"Iron\" Mike Webster and San Diego Chargers linebacker Junior Seau.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the wake of these high-profile cases and \u003ca href=\"https://www.nytimes.com/2018/10/05/sports/junior-seau-suit-nfl.html\" target=\"_blank\" rel=\"noopener\">associated litigation\u003c/a>, the NFL has set aside $40 million in funding for medical research, primarily dedicated to neuroscience.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/445528/ucsf-study-probes-long-term-effects-of-head-trauma-and-not-just-in-football","authors":["221"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1414","futureofyou_80"],"featImg":"futureofyou_445545","label":"futureofyou"},"futureofyou_437552":{"type":"posts","id":"futureofyou_437552","meta":{"index":"posts_1591205157","site":"futureofyou","id":"437552","score":null,"sort":[1513090813000]},"guestAuthors":[],"slug":"just-because-you-have-a-mild-concussion-doesnt-mean-youre-ok","title":"Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK","publishDate":1513090813,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Last February Baxter Bailey injured himself trying to break into his own home when he couldn’t find his key. Crawling through a window leading to the utility room, he slipped and fell, hitting his head on the concrete floor.\u003c/p>\n\u003cp>He was unconscious for about an hour.\u003c/p>\n\u003cp>“My skull, my forehead was bloody, bruised and banged,” says the 77-year-old architect from Richmond, Virginia. “And I had blood all over my shirt, my pants and underwear.”\u003c/p>\n\u003cp>At the hospital, “Doctors told me that my brain moved inside the skull,” Baxter says. But a small hemorrhage in the brain visible through scans wasn’t bad enough to keep him as an inpatient for more than a day. Baxter was diagnosed with a concussion, or what medical professionals call a mild traumatic brain injury, and released.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion.'\u003ccite>Teena Shetty, neurologist\u003c/cite>\u003c/aside>\n\u003cp>“Within two weeks, the abrasion on my head got healed, and you couldn’t tell that anything ever happened to me if you looked at me,” says Baxter.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But his troubles were just starting. Two months later, Baxter was in the emergency room again. He had started losing control of his left side. He found lifting his leg to get into a car difficult. Walking caused him trouble. This time the scans showed a chronic hematoma — swelling and bruising — on the right side of his skull.\u003c/p>\n\u003cp>“It was like 3 inches long and an inch thick and I could see that my brain literally was off center and my cerebellum was misaligned,” says Baxter. Doctors told him he needed immediate surgery. The plan was to drill a little hole in his head the size of a dime.\u003c/p>\n\u003cp>“I thought, ‘My lord, is this the end of me?’ ”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Brain Injuries\u003c/strong>\u003c/p>\n\u003cp>Each year, about \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm\" target=\"_blank\" rel=\"noopener\">2.5 million people in the United States\u003c/a> are admitted to emergency rooms with traumatic brain injuries, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned brain injury into a “silent epidemic,” in the words of \u003ca href=\"http://profiles.ucsf.edu/pratik.mukherjee\" target=\"_blank\" rel=\"noopener\">Pratik Mukherjee\u003c/a>, a neuroradiologist at UCSF.\u003c/p>\n\u003cp>\u003ca href=\"https://www.hss.edu/physicians_shetty-teena.asp\" target=\"_blank\" rel=\"noopener\">Teena Shetty\u003c/a>, a neurologist at New York City's Hospital for Special Surgery, agrees. “Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion,” she says.\u003c/p>\n\u003cp>Doctors are not even in agreement about how to treat concussions. Some advise resuming daily activities as soon as possible, others suggest avoiding demanding work and staying away from bright lights and loud sounds.\u003c/p>\n\u003cp>Existing guidelines are not backed by evidence, according to \u003ca href=\"https://www.urmc.rochester.edu/people/20187378-jeffrey-j-bazarian\" target=\"_blank\" rel=\"noopener\">Jeff Bazarian\u003c/a>, professor of emergency medicine at the University of Rochester Medical Center, in New York.\u003c/p>\n\u003cfigure id=\"attachment_437557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg\" alt=\"\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Tom Gal, 37-year old entrepreneur from San Francisco, recovering from a car accident at Zuckerberg San Francisco General Hospital and Trauma Center. \u003ccite>(Courtesy Tom Gal)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A New Approach Tracks Patients in Detail\u003c/strong>\u003c/p>\n\u003cp>Predicting which concussion patients will fully recover and which will be permanently debilitated is more or less a guessing game.\u003c/p>\n\u003cp>Tom Gal, a 37-year old entrepreneur from San Francisco, spent almost two days in a coma after being hit by a car last August. He woke up with no memory of what happened and had to learn the details from his medical report. But eight months after the injury, he says he is doing just fine. In contrast, 29-year-old bread baker Ana Diaz, from Richmond, Virginia, complains about short-term memory lapses and increased anxiety six months after a biking accident that left her with no signs of head trauma on a CT scan.\u003c/p>\n\u003cp>In light of such counter-intuitive outcomes, many researchers feel it is now time to make the diagnosis and prognosis of concussions more precise and evidence-based.\u003c/p>\n\u003cp>According to Mukherjee, \u003ca href=\"https://link.springer.com/article/10.1186/s12245-014-0031-6\" target=\"_blank\" rel=\"noopener\">15 to 30 percent of concussion patients\u003c/a> will experience \u003ca href=\"http://www.neurosymptoms.org/post-concussion-syndrome/4582101276\" target=\"_blank\" rel=\"noopener\">worsening brain function\u003c/a> later on, including problems with thinking, memory, attention and decision-making. Patients can also experience sleep disorders and headaches that persist for weeks, months or years. In the severest cases, people can develop epilepsy and seizures, with increased risk of Alzheimer’s disease.\u003c/p>\n\u003cp>As a result, about 3 to 5 million people live with the long-term physical, cognitive and psychological health disabilities of traumatic brain injury. Estimated annual direct and indirect costs are over $75 billion, \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/severe.html\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>What’s needed, some researchers believe, is a large study focused on improving how doctors measure concussions and predict the long-term effects on patients.\u003c/p>\n\u003cp>Baxter, Gal and Diaz may have found one. While recovering from their injuries, they signed up for a study called \u003ca href=\"https://tracktbi.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">TRACK TBI, \u003c/a>for Transforming Research in Clinical Knowledge in Traumatic Brain Injury.\u003c/p>\n\u003cp>TRACK TBI, spearheaded at UCSF, started in 2014 with just 75 enrolled patients. The cohort has now expanded to include over 2,000, with the goal of enrolling 1,000 more. The study spans 19 research centers across the country, and major funding comes from the National Institutes of Health and the Department of Defense. TRACK TBI is also partnering with CENTER TBI, a European sister-trial, monitoring 10,000 concussion patients.\u003c/p>\n\u003cp>Study researchers want to analyze the results of blood analysis, MRI scans and cognitive tests to find which patients are at higher risk of developing long-term cognitive problems after suffering concussions.\u003c/p>\n\u003cfigure id=\"attachment_437556\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-437556 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-520x293.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Pratik Mukherjee, neuroradiologist at UCSF, looking at a brain image. \u003ccite>(Julia Vassey/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Getting a Closer Look\u003c/strong>\u003c/p>\n\u003cp>The problem with diagnosing concussions starts in the emergency room. The majority of patients with mild, non-life-threatening traumatic brain injuries get released from ER without any follow-up evaluation.\u003c/p>\n\u003cp>“And that is a mistake,” says Mukherjee, who is also one of TRACK TBI’s principal investigators.\u003c/p>\n\u003cp>CT scans in the ERs across the country can miss subtle brain damage, as occurred in Baxter’s first CT scan. These diagnostics can only detect structural changes or internal bleeding in the brain, like the hemorrhage Baxter eventually developed.\u003c/p>\n\u003cp>Even following severe traumatic brain injuries, as Gal suffered, neither CT nor standard MRI can detect microstructural changes and alterations in brain functioning.\u003c/p>\n\u003cp>But it is these subtle changes that may predict the likelihood of lasting problems, including impaired focus, attention, memory and decision-making.\u003c/p>\n\u003cp>TRACK TBI researchers are looking for biochemical signals that could ensure reliable, speedy diagnoses and good predictions of whether patients will suffer long-term effects.\u003c/p>\n\u003cp>Mapping is another focus of TRACK TBI. Powerful MRI scanners with software that allows precise reconstruction of high resolution MRI images could help scientists create brain maps.\u003c/p>\n\u003cp>The study is using the latest MRI scanners, at least twice as powerful as the ones installed in many of the country’s hospitals and imaging centers, to peer deeper into the brain and search for abnormalities in the fine-grain structure of the brain’s “white matter.” If this is damaged, it can disrupt brain functions like imprinting memories, maintaining focus and making decisions.\u003c/p>\n\u003cp>Patients enrolled in the TRACK TBI study get scanned two weeks after their head injury and then again six months later to reveal the presence of any chronic effects.\u003c/p>\n\u003cp>Researchers are also scanning for the presence of specific types of proteins in the blood that can be detected in brain-injury patients. TRACK TBI is particularly focusing on GFAP (glial fibrillary acidic protein) and Tau protein.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>“This is similar to how they diagnose heart attacks,” says Mukherjee. “If you are having a heart attack, the heart will spill particular proteins that can be detected, and provide a good objective test.”\u003c/p>\n\u003cp>In the 1950s and 1960s an electrocardiogram was the only way to measure a patient’s heart for signs of heart disease. But a patient could show a normal-looking EKG even while suffering a heart attack. With time, blood tests measuring proteins have proven to be more reliable. Using a similar approach could transform concussion diagnoses as well.\u003c/p>\n\u003cp>Shetty, who is not involved in the study, believes it has “a tremendous potential to understand relationships between biomarkers, neuroimaging and cognitive data.”\u003c/p>\n\u003cp>\u003ca href=\"https://www2.eecs.berkeley.edu/Faculty/Homepages/chunleiliu.html\" target=\"_blank\" rel=\"noopener\">Chunlei Liu\u003c/a>, an associate professor of the Helen Wills Neuroscience Institute at UC Berkeley, who also has no relationship to the study, is glad to see TRACK TBI’s multipronged approach.\u003c/p>\n\u003cp>Because brain trauma involves systemic changes in different parts of the brain, Liu says, “A single biomarker won't make a definitive answer.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"fpfN1gUvcMM6xziiLMO3LOmy1Q3hTGxh\"]This approach is part of a trend. The \u003ca href=\"http://www.careconsortium.net/\" target=\"_blank\" rel=\"noopener\">CARE Consortium\u003c/a>, funded by the NCAA and the U.S. Department of Defense, is similar in many ways to TRACK TBI, but focuses on student-athletes and military service members. At the University of Pittsburgh. the \u003ca href=\"http://www.adapttrial.org/\" target=\"_blank\" rel=\"noopener\">ADAPT Trial\u003c/a> is focusing on children with severe traumatic brain injury, hoping to determine the best care procedures.\u003c/p>\n\u003cp>If prognostic biomarkers can be identified by TRACK and other studies, it could help scientists resurrect once-promising treatments that were abandoned after failed clinical trials. One of the most disappointing failures was the PROTECT trial, which in 2015 experimented with treating acute traumatic brain injury with progesterone, a steroid found to sometimes have powerful neuroprotective properties.The study showed promising results on lab animals, but it collapsed after moving to phase III human trials.\u003c/p>\n\u003cp>“Currently with the clinical trials, it has been one-size-fits-all for every patient,” says Mukherjee. He says researchers often enroll participants without knowing if they are prone to developing complications. “But this is a mistake, because patients are affected in many different ways, and types of pathologies are different.”\u003c/p>\n\u003cp>If biomarkers can be discovered, researchers can determine exactly which patients will or will not benefit from treatment.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And patients recovering from brain injuries may be able to face their future with a clearer idea of the path ahead.\u003c/p>\n\n","blocks":[],"excerpt":"The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned diagnosing brain injuries into a guessing game. Researchers are now looking into making it more precise.","status":"publish","parent":0,"modified":1513354898,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":47,"wordCount":1679},"headData":{"title":"Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK | KQED","description":"The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned diagnosing brain injuries into a guessing game. Researchers are now looking into making it more precise.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK","datePublished":"2017-12-12T15:00:13.000Z","dateModified":"2017-12-15T16:21:38.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"437552 https://ww2.kqed.org/futureofyou/?p=437552","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/12/12/just-because-you-have-a-mild-concussion-doesnt-mean-youre-ok/","disqusTitle":"Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK","source":"KQED Future of You","nprByline":"Julia Vassey\u003cbr />KQED Future of You","path":"/futureofyou/437552/just-because-you-have-a-mild-concussion-doesnt-mean-youre-ok","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last February Baxter Bailey injured himself trying to break into his own home when he couldn’t find his key. Crawling through a window leading to the utility room, he slipped and fell, hitting his head on the concrete floor.\u003c/p>\n\u003cp>He was unconscious for about an hour.\u003c/p>\n\u003cp>“My skull, my forehead was bloody, bruised and banged,” says the 77-year-old architect from Richmond, Virginia. “And I had blood all over my shirt, my pants and underwear.”\u003c/p>\n\u003cp>At the hospital, “Doctors told me that my brain moved inside the skull,” Baxter says. But a small hemorrhage in the brain visible through scans wasn’t bad enough to keep him as an inpatient for more than a day. Baxter was diagnosed with a concussion, or what medical professionals call a mild traumatic brain injury, and released.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion.'\u003ccite>Teena Shetty, neurologist\u003c/cite>\u003c/aside>\n\u003cp>“Within two weeks, the abrasion on my head got healed, and you couldn’t tell that anything ever happened to me if you looked at me,” says Baxter.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But his troubles were just starting. Two months later, Baxter was in the emergency room again. He had started losing control of his left side. He found lifting his leg to get into a car difficult. Walking caused him trouble. This time the scans showed a chronic hematoma — swelling and bruising — on the right side of his skull.\u003c/p>\n\u003cp>“It was like 3 inches long and an inch thick and I could see that my brain literally was off center and my cerebellum was misaligned,” says Baxter. Doctors told him he needed immediate surgery. The plan was to drill a little hole in his head the size of a dime.\u003c/p>\n\u003cp>“I thought, ‘My lord, is this the end of me?’ ”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Brain Injuries\u003c/strong>\u003c/p>\n\u003cp>Each year, about \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm\" target=\"_blank\" rel=\"noopener\">2.5 million people in the United States\u003c/a> are admitted to emergency rooms with traumatic brain injuries, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned brain injury into a “silent epidemic,” in the words of \u003ca href=\"http://profiles.ucsf.edu/pratik.mukherjee\" target=\"_blank\" rel=\"noopener\">Pratik Mukherjee\u003c/a>, a neuroradiologist at UCSF.\u003c/p>\n\u003cp>\u003ca href=\"https://www.hss.edu/physicians_shetty-teena.asp\" target=\"_blank\" rel=\"noopener\">Teena Shetty\u003c/a>, a neurologist at New York City's Hospital for Special Surgery, agrees. “Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion,” she says.\u003c/p>\n\u003cp>Doctors are not even in agreement about how to treat concussions. Some advise resuming daily activities as soon as possible, others suggest avoiding demanding work and staying away from bright lights and loud sounds.\u003c/p>\n\u003cp>Existing guidelines are not backed by evidence, according to \u003ca href=\"https://www.urmc.rochester.edu/people/20187378-jeffrey-j-bazarian\" target=\"_blank\" rel=\"noopener\">Jeff Bazarian\u003c/a>, professor of emergency medicine at the University of Rochester Medical Center, in New York.\u003c/p>\n\u003cfigure id=\"attachment_437557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg\" alt=\"\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Tom Gal, 37-year old entrepreneur from San Francisco, recovering from a car accident at Zuckerberg San Francisco General Hospital and Trauma Center. \u003ccite>(Courtesy Tom Gal)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A New Approach Tracks Patients in Detail\u003c/strong>\u003c/p>\n\u003cp>Predicting which concussion patients will fully recover and which will be permanently debilitated is more or less a guessing game.\u003c/p>\n\u003cp>Tom Gal, a 37-year old entrepreneur from San Francisco, spent almost two days in a coma after being hit by a car last August. He woke up with no memory of what happened and had to learn the details from his medical report. But eight months after the injury, he says he is doing just fine. In contrast, 29-year-old bread baker Ana Diaz, from Richmond, Virginia, complains about short-term memory lapses and increased anxiety six months after a biking accident that left her with no signs of head trauma on a CT scan.\u003c/p>\n\u003cp>In light of such counter-intuitive outcomes, many researchers feel it is now time to make the diagnosis and prognosis of concussions more precise and evidence-based.\u003c/p>\n\u003cp>According to Mukherjee, \u003ca href=\"https://link.springer.com/article/10.1186/s12245-014-0031-6\" target=\"_blank\" rel=\"noopener\">15 to 30 percent of concussion patients\u003c/a> will experience \u003ca href=\"http://www.neurosymptoms.org/post-concussion-syndrome/4582101276\" target=\"_blank\" rel=\"noopener\">worsening brain function\u003c/a> later on, including problems with thinking, memory, attention and decision-making. Patients can also experience sleep disorders and headaches that persist for weeks, months or years. In the severest cases, people can develop epilepsy and seizures, with increased risk of Alzheimer’s disease.\u003c/p>\n\u003cp>As a result, about 3 to 5 million people live with the long-term physical, cognitive and psychological health disabilities of traumatic brain injury. Estimated annual direct and indirect costs are over $75 billion, \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/severe.html\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>What’s needed, some researchers believe, is a large study focused on improving how doctors measure concussions and predict the long-term effects on patients.\u003c/p>\n\u003cp>Baxter, Gal and Diaz may have found one. While recovering from their injuries, they signed up for a study called \u003ca href=\"https://tracktbi.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">TRACK TBI, \u003c/a>for Transforming Research in Clinical Knowledge in Traumatic Brain Injury.\u003c/p>\n\u003cp>TRACK TBI, spearheaded at UCSF, started in 2014 with just 75 enrolled patients. The cohort has now expanded to include over 2,000, with the goal of enrolling 1,000 more. The study spans 19 research centers across the country, and major funding comes from the National Institutes of Health and the Department of Defense. TRACK TBI is also partnering with CENTER TBI, a European sister-trial, monitoring 10,000 concussion patients.\u003c/p>\n\u003cp>Study researchers want to analyze the results of blood analysis, MRI scans and cognitive tests to find which patients are at higher risk of developing long-term cognitive problems after suffering concussions.\u003c/p>\n\u003cfigure id=\"attachment_437556\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-437556 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-520x293.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Pratik Mukherjee, neuroradiologist at UCSF, looking at a brain image. \u003ccite>(Julia Vassey/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Getting a Closer Look\u003c/strong>\u003c/p>\n\u003cp>The problem with diagnosing concussions starts in the emergency room. The majority of patients with mild, non-life-threatening traumatic brain injuries get released from ER without any follow-up evaluation.\u003c/p>\n\u003cp>“And that is a mistake,” says Mukherjee, who is also one of TRACK TBI’s principal investigators.\u003c/p>\n\u003cp>CT scans in the ERs across the country can miss subtle brain damage, as occurred in Baxter’s first CT scan. These diagnostics can only detect structural changes or internal bleeding in the brain, like the hemorrhage Baxter eventually developed.\u003c/p>\n\u003cp>Even following severe traumatic brain injuries, as Gal suffered, neither CT nor standard MRI can detect microstructural changes and alterations in brain functioning.\u003c/p>\n\u003cp>But it is these subtle changes that may predict the likelihood of lasting problems, including impaired focus, attention, memory and decision-making.\u003c/p>\n\u003cp>TRACK TBI researchers are looking for biochemical signals that could ensure reliable, speedy diagnoses and good predictions of whether patients will suffer long-term effects.\u003c/p>\n\u003cp>Mapping is another focus of TRACK TBI. Powerful MRI scanners with software that allows precise reconstruction of high resolution MRI images could help scientists create brain maps.\u003c/p>\n\u003cp>The study is using the latest MRI scanners, at least twice as powerful as the ones installed in many of the country’s hospitals and imaging centers, to peer deeper into the brain and search for abnormalities in the fine-grain structure of the brain’s “white matter.” If this is damaged, it can disrupt brain functions like imprinting memories, maintaining focus and making decisions.\u003c/p>\n\u003cp>Patients enrolled in the TRACK TBI study get scanned two weeks after their head injury and then again six months later to reveal the presence of any chronic effects.\u003c/p>\n\u003cp>Researchers are also scanning for the presence of specific types of proteins in the blood that can be detected in brain-injury patients. TRACK TBI is particularly focusing on GFAP (glial fibrillary acidic protein) and Tau protein.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>“This is similar to how they diagnose heart attacks,” says Mukherjee. “If you are having a heart attack, the heart will spill particular proteins that can be detected, and provide a good objective test.”\u003c/p>\n\u003cp>In the 1950s and 1960s an electrocardiogram was the only way to measure a patient’s heart for signs of heart disease. But a patient could show a normal-looking EKG even while suffering a heart attack. With time, blood tests measuring proteins have proven to be more reliable. Using a similar approach could transform concussion diagnoses as well.\u003c/p>\n\u003cp>Shetty, who is not involved in the study, believes it has “a tremendous potential to understand relationships between biomarkers, neuroimaging and cognitive data.”\u003c/p>\n\u003cp>\u003ca href=\"https://www2.eecs.berkeley.edu/Faculty/Homepages/chunleiliu.html\" target=\"_blank\" rel=\"noopener\">Chunlei Liu\u003c/a>, an associate professor of the Helen Wills Neuroscience Institute at UC Berkeley, who also has no relationship to the study, is glad to see TRACK TBI’s multipronged approach.\u003c/p>\n\u003cp>Because brain trauma involves systemic changes in different parts of the brain, Liu says, “A single biomarker won't make a definitive answer.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>This approach is part of a trend. The \u003ca href=\"http://www.careconsortium.net/\" target=\"_blank\" rel=\"noopener\">CARE Consortium\u003c/a>, funded by the NCAA and the U.S. Department of Defense, is similar in many ways to TRACK TBI, but focuses on student-athletes and military service members. At the University of Pittsburgh. the \u003ca href=\"http://www.adapttrial.org/\" target=\"_blank\" rel=\"noopener\">ADAPT Trial\u003c/a> is focusing on children with severe traumatic brain injury, hoping to determine the best care procedures.\u003c/p>\n\u003cp>If prognostic biomarkers can be identified by TRACK and other studies, it could help scientists resurrect once-promising treatments that were abandoned after failed clinical trials. One of the most disappointing failures was the PROTECT trial, which in 2015 experimented with treating acute traumatic brain injury with progesterone, a steroid found to sometimes have powerful neuroprotective properties.The study showed promising results on lab animals, but it collapsed after moving to phase III human trials.\u003c/p>\n\u003cp>“Currently with the clinical trials, it has been one-size-fits-all for every patient,” says Mukherjee. He says researchers often enroll participants without knowing if they are prone to developing complications. “But this is a mistake, because patients are affected in many different ways, and types of pathologies are different.”\u003c/p>\n\u003cp>If biomarkers can be discovered, researchers can determine exactly which patients will or will not benefit from treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And patients recovering from brain injuries may be able to face their future with a clearer idea of the path ahead.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/437552/just-because-you-have-a-mild-concussion-doesnt-mean-youre-ok","authors":["byline_futureofyou_437552"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1413","futureofyou_717","futureofyou_1414","futureofyou_1275","futureofyou_80"],"featImg":"futureofyou_437555","label":"source_futureofyou_437552"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. 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