Despite the beautiful views and respite from street noise, living on the upper floors of a high-rise apartment or condo building may have a hidden health-related downside.

Canadian researchers have found that the survival rate for high-rise residents who experience a cardiac arrest is poorer for those who live on the upper floors compared to those who live on the lower ones. In fact, the higher up people live, the smaller their chances of surviving, according to the study’s findings.

And we're not talking very high up. The study, which was published Monday in the Canadian Medical Association Journal (CMAJ), defined “higher floors” as the third floor and above.

The most likely reason for these findings, say the study’s authors, has to do with something they call “vertical response delay”: It takes longer for first responders to reach people on higher floors.

As background information in the study points out, more than 400,000 out-of-hospital cardiac arrests occur in Canada and the United States each year. A cardiac arrest strikes when the heart suddenly malfunctions and stops beating. It is not the same as a heart attack, which occurs when a blockage halts blood flow to the heart.

The survival rate is extremely low for people who experience cardiac arrest. Less than 10 percent live to be eventually discharged from a hospital. Rapid defibrillation and high-quality cardiac pulmonary resuscitation (CPR) are crucial for survival. Each one-minute delay to defibrillation, say the study’s authors, is associated with a drop in survival of 7 percent to 10 percent.

That’s why it’s so essential that first responders reach the patient quickly.

Study details

For the current study, researchers examined data collected from 8,216 Canadians who suffered out-of-hospital cardiac arrest in private residences (homes, townhouses, apartments and condos) and were treated by paramedics in the greater Toronto area between 2007 and 2012. Of these cardiac arrests, 5,998 (73.0 percent) occurred below the third floor, and 1,844 (22.4 percent) occurred at or above the third floor. The researchers had to exclude 374 events (4.6 percent) from their analysis because the floor number was missing from the records.

The average age of patients in the study was 71, and 60 percent of them were male.

Overall, 3.8 percent of the patients (300 of 7,842) survived and were eventually released from a hospital. The researchers then dove deeper into the data to see if survival corresponded to the floor the patients were on when they experienced their cardiac arrest.

They found that 252 (4.2 percent) of the 5,998 patients with cardiac arrest below the third floor survived, compared with 48 (2.6 percent) of the 1,844 patients on the third floor or above.

The data also revealed that survival was “negligible” for people living on the 16th floor or above (2 of 216 patients, or 0.9 percent), and that there were no survivors among the 30 patients who lived above floor 25.

In a floor-by-floor analysis of the data, the researchers found “a statistically significant decrease in survival to hospital discharge for each floor of patient contact.”

The study’s authors say that one of the most likely explanations for the study’s findings is the increased time it takes for first responders to reach patients on upper floors — and to then get them to the hospital.

A previous study by one of the authors found it takes an extra 90 seconds for first responders to reach patients on the third floor or higher.

Research has also shown, write the researchers, that "once a decision has been made to transport a patient who is in refractory cardiac arrest, there are prolonged periods during the extrication to the ambulance and en route to the hospital when the quality of CPR is sub-optimal. As the patient is carried down stairs or is transported in an elevator, there is a shift in focus from providing continuous, high-quality CPR to removing the patient from the scene and getting him or her to the hospital quickly and safely. These disruptions in care could have a detrimental effect on patient outcome."

Limitations and implications

This study, like all studies, comes with plenty of caveats. Most notably — and as the authors themselves point out — this is a retrospective observational study and therefore cannot establish a direct causal relationship between cardiac arrest survival and the floor on which the event took place.

Also, the number of cardiac arrests that occurred on very high floors was small and therefore may have biased the floor-by-floor analysis.

Still, the study raises some issues that residents of high-rise buildings may want to consider — the importance of knowing CPR and how to use an automated external defibrillator (AED), for example.

The study’s authors make the following recommendations to help improve the survival rates of people living in high-rise buildings:

• Give first responders universal access keys so that they have sole access to elevators in emergencies (such as firefighters have during a fire). Currently, first responders often have to wait for elevators to discharge passengers and get to the ground floor before they can take command of it.
• Make sure a building’s staff is alerted to the medical emergency before the first responders arrive so that the responders have clear access to the person in need.
• Increase access to defibrillators in high-rise buildings — and educate residents on how to use them.

FMI: You can download and read the study in full on the CMAJ’s website.

Even if progress stopped tomorrow, the fact that the nuclear agreement with Iran has gone into effect is already a big deal. If Iranian President Hassan Rouhani can find a way to build off of it to forge broader changes inside of Iran, it could turn out to be even bigger. 

For starters, it’s worth paying attention to how Iran conducts elections that will be held late next month. 

One doesn’t have to be – and shouldn’t be – starry-eyed about what has happened so far. Yes, Iran has shipped 98 percent of its enriched uranium out of the country, dismantled centrifuges and mothballed a reactor capable of producing plutonium. Yes, many sanctions have been lifted and Iran is quickly being reconnected to the global economy and financial system. Most important, yes, military action seems to be off the table — at least for the time being.

But if Iran’s leadership, including Supreme Leader Ayatollah Ali Khamenei, find it useful now to downplay differences with the United States that goes only so far.

The Revolutionary Guards and other bastions of the conservative, anti-U.S. establishment haven’t exactly disappeared.

For the foreseeable future, relations between Iran and much of the rest of the world, including the U.S., will be largely transactional. Areas of cooperation such as the release of U.S. sailors last week or the prisoner swap that accompanied formal implementation of the nuclear agreement will be offset by Iran’s support of Hezbollah and Syrian President Bashar Assad, its missile program and many other deep differences.

The U.S. still considers Iran to be a sponsor of terrorism, and many other U.S. sanctions remain in effect. The Obama administration is under pressure (and seems inclined, anyway) to keep the screws on the Iranians. So it imposed some new, limited sanctions to punish Iran for its missile tests, which violate U.N. resolutions. 

Iran now gets access to an estimated $100 billion stashed offshore, it will increase oil and gas exports, and open its doors for badly needed investment. It’s already buying a lot of new passenger planes and looking for oil markets in India and Europe. But it’s not as if Iranians think all their problems are over.

The deal comes into effect, of course, as global oil prices are plummeting. They fell Monday to below $30 a barrel. So, even though Iran plans to quickly increase production by half a million barrels a day, each barrel will be worth a lot less than when the deal was being negotiated. 

Reporting from inside Iran suggests that a lot of people who have struggled for years with a weak economy are skeptical that they’ll see huge improvements.

That brings us to the elections. While Iran’s not exactly a democracy, its politics are quite diverse and free-wheeling.  

Rouhani was elected in 2013 on a promise to improve the economy, and he is touting the nuclear agreement as a huge step toward doing just that. He appeared to race to meet Iran’s obligations to get the sanctions lifted so his allies could benefit in the Feb. 26 election from a bump in support. Beyond that, he himself faces reelection in two years.

He has to try to build up as much enthusiasm as he can among those weary and doubtful voters. Down the road, he’ll have to show some results. And he’ll have to try to counter the pushback that is certain to come from the conservative establishment. 

Iran actually will have two elections at the end of February. One is for the Majlis, its 290-member parliament. A second body called the Assembly of Experts, which is composed of 86 senior clerics, is also up for election. That group is important because among its duties is selection and monitoring of the supreme leader. Khamenei is in his late 70s, and is said to be ailing. So within its new eight-year term, the Assembly of Experts elected next month may choose Khamenei’s successor.

Candidates for both of those bodies must be vetted by a third group, the 12-member Council of Guardians, which regularly plays politics with the process. Prominent reformers in particular are often disqualified from running.

There already are some reformers and moderates in the Assembly of Experts. Among the new candidates this time is none other than Hassan Khomeini, the 43-year-old grandson of the founder of the Islamic state. This younger Khomeini appears to have the conservatives a bit worried – although it might be hard to disqualify him because of his famous name, he is thought to be close to Rouhani. Even if there are far from a majority, reformers in the Assembly of Experts could find themselves becoming kingmakers if and when it comes time to choose a new leader.

Although the parliament has limited power, analysts also expect elections to be hard fought, and for moderates and reforms to have a decent shot at winning a majority. That would help Rouhani build support for the deeper reforms he says the economy needs.

Iran’s conservative clergy and military will remain powerful for a long time to come. Regardless of who runs it, the country will pursue a number of policies that the U.S. adamantly opposes. But if Rouhani can demonstrate a hunger for change and is lucky enough to have a few key allies in important posts, Iran might find itself edging slowly away from habitual confrontation to become a more-or-less normal member of the global community.

The Dalai Lama is returning to the Mayo Clinic in Rochester this week. His website said today that the exiled Tibetan spiritual leader will be at the Minnesota medical center for prostate treatment.

The 80-year-old Buddhist holy man is a Mayo regular; most recently he had an annual exam there last September. He then cancelled some appearances when the doctors prescribed rest.

His office says that this treatment will be "followed by a period of rest from the end of January 2016 for approximately one month. His regular engagement schedule will resume in March."

Bukola Oriola, a longtime advocate for victims of trafficking and domestic abuse in Minnesota, is looking forward to serving on the newly formed U.S. Advisory Council on Human Trafficking.   

“It’s unbelievable that I could get such a platform,” she said. “I see it as the highest platform I could have to really lend my voice to help victims and survivors of human trafficking.”

Oriola was among 11 council members that President Obama picked last month from states across the country to identify issues and make recommendations to the federal government on policies addressing human trafficking in the United States. 

“I am honored that these talented individuals have decided to serve our country,” President Obama said in a statement. “They bring their years of experience to this administration, and I look forward to working with them.”

Oriola, the only council member from Minnesota, described the appointment as a victory for her and for human trafficking victims and survivors. She said the new status would enable her to expand the advocacy she’s been involved in over the past seven years.      

Last week, Oriola was invited to the White House to meet with the president and her fellow council members to discuss the role the council will play in the fight against human trafficking. 

An immigrant from Nigeria, Oriola knows the ordeal of trafficking and domestic abuse all too well. Ten years ago, when she was new to the country, she said her then-husband abused and starved her as he took her earnings from a hair-braiding job she established inside her house.

After two years of abuse, Oriola — who was an undocumented immigrant at the time — turned to her nurse for help. The move eventually led her to escape the man who held her captive, as she later wrote about the experience.

Since 2009, the former journalist has become an advocate for victims of human trafficking and domestic abuse, especially immigrant communities in Minnesota. Last summer, she travelled to her country to raise awareness about the issues. 

She’s written a book, “Imprisoned: The Travails of a Trafficked Victim,” about her experience to inform people about the hidden danger that some undocumented immigrants in the country face.

“I’m representing the immigrant community on the council,” she said of her two-term seat. “I’m glad the government has chosen actual survivors of human and labor trafficking, people who were abused by those they thought were helping them.”  

Ibrahim Hirsi can be reached at ihirsi@minnpost.com. Follow him on Twitter at @IHirsi

They’re called nail laminated timber panels, NLT for short, and they helped make some construction history on Monday.

That’s when crews began laying the wooden panels on the cage of posts and beams at the Minneapolis site of what will eventually be the seven-story office building known as T3 (Timber, Technology and Transit). When it’s finished sometime in this fall, the building will be the first modern tall wood building in the United States.

Not everything in T3 — which was designed by Vancouver's Michael Green Architecture and Minneapolis'DLR Group and is being developed by the Houston-based Hines — will be made of wood, of course. The elevator core as well as the parking level and foundation of the structure, which sits across the rail lines from the Designers Guild Building and behind Dock Street Landing in the city’s North Loop neighborhood, are concrete. But atop that deck are large glue-laminated timber posts and beams that will be covered by the NLT panels to form the flooring and ceilings of the office building.

Modern version of an old method

The construction method is actually a modern version of an old technique, said Lucas Epp, an engineer for StructureCraft, the Vancouver company that designed and built the timber panels, posts and beams that make up the building's structure.

To create the NLT panels, two-by-eight wooden boards are stacked together on end and nailed together to form flat panels that can be up to 10-feet wide and 42-feet long. No glue is used in the process. Plywood is then attached “to give it shear capacity, a structural diaphragm,” Epp said.

“It’s a very old technology in a lot of ways,” Epp said. “We’ve taken it and kind of reinvented it.” Rather than nailing the boards together on site, the panels are prefabricated in a factory in Canada and trucked to the building site. They are then lifted by crane and placed on the glulam beams, where they are attached with quarter-inch and half-inch screws that can be as long as two feet. That's the process that began Monday.

Michael Green Architecture

The site for T3 is surface parking behind the Dock Street Flats at 333 Washington Avenue N., a trapezoidal parcel that abuts the I-94 ramps from 3rd Street N. and the Cedar Lake Trail.

“It’s essentially like assembling a bunch of Lego blocks,” Epp said. “That’s one of the big things about building with timbers. You can erect significant components of a structure just one crane pick at a time. We’re planning to erect this structure in two and a half months. For a 220,000 square foot structure, that’s pretty fast.”

The panels do not need fire-proofing. During a fire, the timbers and panels would char and form a protective layer, according to StructureCraft, which allows the wood to remain exposed and visible inside and outside the finished building.

More sustainable than steel?

T3 will be the first mass timber construction building in the U.S., but such structures have been built in Canada and Europe for several years. A taller wooden building is being designed for the Pearl District of Portland, one of two structures — the other is in New York City — that will split a $3 million prize for winning the U.S. Tall Building competition, sponsored by the U.S. Department of Agriculture to encourage the construction method.

StructureCraft

Lucas Epp

Epp said T3 likely would have won that prize had the timing been right for the Hines project, which will be the first mass timber building in the country to open. Of T3, Epp said it was a highly competitive bid environment. “All the big timber players in the world were bidding on it,” he said.

Robert Pfefferle, Hines’ director of development, said the construction process does present new challenges for the builders. While engineered wood panels are well understood, the size, height and configuration of the materials for T3 are unusual. And because so much of the material will be exposed, Pfefferle noted, it must be handled with particular care during assembly.

T3 architect Michael Green has become one of the leading advocates for mass timber construction. His firm designed one of the first such buildings in North America, the Wood Innovation and Design Center in Prince George, British Columbia, and his paper “The Case for Tall Wood Buildings” goes deep on the process and the benefits of the technique.

In a TED Talk on the topic, Green makes the case that wood is more sustainable than steel and concrete with a lower carbon footprint. He also asserts that using blow-down timber or trees killed by pests is a way of sequestering the carbon that might otherwise be released through decomposition.

MinnPost photo by Peter Callaghan

On Monday, crews began laying the wooden panels on the cage of posts and beams at the Minneapolis site.

Epp said a substantial amount of the lumber used in the materials for T3 were from trees killed by the mountain pine beetle. That, he said, contributes to the sustainability of the project because the dead timber might otherwise not have been used. The beetle lives under the bark and leaves a bluish stain on the wood. That stain can be seen in some of the panels, Epp said.

Part of the allure of the technology is that much of the wood is left exposed to tenants and visitors. In his TED Talk, Green said, “I’ve never seen anyone walk into one of my buildings and hug a steel or concrete column. But I’ve actually seen that happen in wood buildings.”

Republican presidential candidate Sen. Marco Rubio’s visit to the Twin Cities Tuesday wasn’t a lengthy one, but it was long enough to establish that he is the choice of many of the state’s mainstream Republicans. 

Former Speaker of the House Steve Sviggum and former Minority Leader Marty Seifert are part of Rubio’s leadership team. Charlie Weaver, head of the Minnesota Business Partnership, is also a supporter. They join Rubio’s Minnesota chair, Jeff Johnson, who has always stressed Rubio’s electability.      

Rubio spoke for himself at an event Tuesday morning in Minneapolis, where he combined a fundraiser with a brief media availability, stressing his unifying credentials.  

“The bottom line is: I remain in this race the only candidate that can achieve two things,” he said. “Unite the Republican Party and attract new people to our cause.”

In the first few of the Republican debates, Rubio appeared to struggle communicating his positive messages against the doomsday scenarios outlined by fellow candidates Donald Trump and Ted Cruz. 

Rubio has since taken a tougher stance on issues like immigration and taxes and sharpened his rhetoric, a tactic that was on display Tuesday. “The road we are on right now is the road of decline,” he said. “Our prestige on this planet has also been diminished.”

But Rubio did not hold on to that theme for long, turning to topics that evoked more compassion than passion.

“We are going to win young voters because we are speaking on behalf of them,” he said, referring to his concerns about college debt. “That’s why I spend so much time talking about single mothers. When I’m our nominee they will hear from us. They will hear about us and they will hear what we are fighting for.”

It’s personal, he said, because he has shared these struggles. “What you’re trying to achieve is happiness, which for them means being able to own a home and raise a family and retire with dignity.”

Sviggum believes that’s the message that will convince a majority of American voters in November. “I think that Marco brings that nice balance that is very electable in this country,” he said. “I think that he has an empathy and a sympathy that comes across for voters, especially young voters in this country.”

Rubio didn’t reach out to too many Minnesota voters — young or otherwise — on Tuesday; there were no public events on his schedule, and he soon left Minneapolis for fundraisers in Missouri, Chicago, and Boston before heading to New Hampshire to campaign.

But Rubio’s staff said that he is likely to return to Minnesota before March 1 for more direct contact with a critical group of voters: those who attend the state’s precinct caucuses to vote in the binding presidential preference poll.

The Minnesota Timberwolves reached the halfway point of the 2015-16 season last Friday, getting tenderized by the Oklahoma City Thunder, 113-93, in a game that wasn’t as close as that score would indicate.

The pummeling brought the Wolves’ record to 12-29, which telescopes to 24-58 for the entire season, less than the 25.5 wins set by the Las Vegas odds-makers back in September. The Wolves proceeded to blow out the hapless Phoenix Suns on Sunday, however, ending a nine-game losing streak and upping their winning percentage (30.9) to almost exactly what Vegas had predicted for them.

So, the team is as inept as expected. The gut punch for the fan base has been the in-season regression.

It doesn’t help head coach Sam Mitchell and his crew that the high-water mark of the season, 8-8, has such a memorable, aesthetically pleasing symmetry to it.

During those first sixteen games, rookie Karl-Anthony Towns was playing like the second coming of sure-fire Hall of Famer Tim Duncan. Second-year swingman Andrew Wiggins was owning crunchtime with relentless, daredevil drives to the hoop, spinning and slamming his way through the painted area for a bevy of buckets or fouls that sent him to the free throw line.

The other second-year swingman, Zach LaVine, seemed to have received important elements of his long-hidden clue about how to perform in the NBA, with improved defensive awareness, fewer turnovers off the dish and the dribble, and more confidence and accuracy on his jump shot.

Meanwhile, veteran mentors Kevin Garnett and Tayshaun Prince set the template for taut team defense from the starting lineup, teaching cornerstones Towns and Wiggins how to seal the seams with sound positional judgments and aggressive rotations, all of it manna to point guard Ricky Rubio, who has been craving some defensive-oriented grown-ups on the court since he entered the NBA more than four years ago.

After 16 games, Towns and Wiggins were burgeoning superstars and it no longer seemed ridiculous to cite LaVine’s potential to join them in that rarefied atmosphere. With KG and Rubio working their complementary intensity with Prince as the calming ballast, the Wolves rode their top-ten defense to road wins over Chicago, Atlanta and Miami. In what has been a down season for the middle rungs of the Western Conference, some poor, deluded souls among the fan base even dared to consider the Wolves as a contender for the playoffs.

Since then, the Wolves are 5-21, a record of futility nearly as wretched as last season’s chaotic tanking to 16-66. “Bait-and-switch” feels like an understated description of how hopeful fans have regarded this pratfall back to incompetence. Something more vicious, like “sucker-and-fillet,” better captures their sense of betrayal.

How did such a young, promising roster, without any major injuries to deter it, suddenly find itself in the dregs of dysfunction?

A complete answer to that question is multi-faceted, and beyond the space requirements of this column. So today we’ll just pick the low-hanging fruit and study the team’s antiquated offense.

Idiotic shot selection

The Wolves have won just two of the past 15 games. During that stretch, they launched more midrange shots — between 15-19 feet away from the basket — than any other team by a fairly wide margin, 17.4 per game compared to the next-highest mid-rangers, Miami, at 15.7 per game.  

By distance alone, analytics have demonstrated that the midrange is not as efficient as a three-pointer or a shot at the rim in terms of points-generated per attempt. But the Wolves compound that flaw by being inaccurate midrange shooters — their 36 percent from that 15-19 foot distance over the past 15 games ranks 27^th among the 30 NBA teams.

Those numbers are from the stats page at nba.com. The website Basketball Reference is better at breaking down so-called “long twos,” the shots taken from 16 feet out to the three-point line. Once again, the Wolves shoot more often from this distance than anyone in the NBA this season — 25.8 percent of their total attempts. And once again, their 39.5 percent accuracy from that range is below the league average of 40.1, 16^th best among the 30 teams.

Put simply, they are emphasizing an inefficient mediocrity in their offense.

Meanwhile, for the second season in a row, the Wolves are shooting the lowest frequency of three-pointers among their total shot-selection than any team in the NBA. Mitchell maintains that the culprit is a dearth of reliable three-point shooters on the roster, along with his inability to institute a more free-flowing offense at the beginning of the season, due to uncertainty over the health and return of the late Flip Saunders.

Both of these explanations are somewhat justified. But even so, the overwhelming evidence is that the Wolves would be better off taking more threes.

Back to that 15-game sample from the nba.com site. The Wolves are next-to-last in the number of three-pointers taken in that span. But when they do launch from behind the arc, their 34.5 percent accuracy is 17^th among the 30 teams.

Let me repeat those numbers. Over the past 15 games, the Wolves take way more 15-19 footers than any other team, and make 36 percent of those two-point, midrange shots. They shoot fewer three-pointers than all but one team and make 34.5 percent. It doesn’t take an Einstein to realize that 36 percent on twos isn’t as efficient as 34.5 percent on threes.

Knock the sample size down to the past ten games — nine of them losses — and you find the Wolves still ranking 29^th in the number of threes taken, while rising to 11^th among the 30 teams in three-point accuracy.

The positive, generous argument is that Mitchell is slowly but surely tweaking his offense to get better looks from long-distance for his team — hence the recently higher accuracy. The rebuttal is that he either isn’t presenting enough of those opportunities or his players are ignoring them.

The primary culprit

It should come as no great surprise that Zach LaVine is one of the worst offenders when it comes to inefficient shot selection on the Wolves. Thus far this season, LaVine has made 39-of-121 shots from a distance between 16 feet and the three-point arc. He has made 41-of-124 shots from three-point territory.

In other words, if LaVine makes two of his next three “long twos,” he’ll be exactly as accurate from that inefficient distance as he is from three-point range. To buttress Mitchell’s point, he isn’t particularly accurate from either spot — 32.2 percent from long twos versus 33.1 percent from deep. But in terms of effective field goal percentage, which adds in the extra-point value of treys, LaVine’s eFG percentage from behind the arc rises to 49.6 percent.

Mitchell was quite critical of LaVine during the long interview I had with the coach earlier this month, which you can find here and here.

Shortly after the interview was published, LaVine remarked that Mitchell’s treatment of him is “sometimes unfair.” I agree. Sometimes a fair judgment of LaVine’s game by Mitchell should be harsher.

For example, Mitchell keeps defending LaVine’s struggles at the point guard position by saying that he is “learning a new position.” Well, LaVine played 94 percent of his 1,902 minutes last season (third-most on the team) at point guard. He has played 65 percent of his 981 minutes this season (fifth-most on the team) at the point.

Specifically in terms of shot selection, Mitchell criticized LaVine in our interview for frequently receiving a pass behind the three-point arc and then turning down that open trey by dribbling into traffic for a contested two-pointer. A decent 56.1 percent of LaVine’s 41 three-pointers have been assisted by a teammate’s pass. Just 17.9 percent of his 39 long twos were assisted. Translation: LaVine dribbles his way into long twos, and shoots them slightly less accurately than he does three-pointers.

(For those who think 56 percent is a high assist percentage, the Wolves’ primary point guard, Rubio, is shooting approximately the same frequency and accuracy on his three-pointers, and, despite being the main ball-handler, has been assisted on 92.3 percent of his makes.)

The reluctant marksman

In a much different way, the shot selection of Nemanja Bjelica is also hindering the Wolves’ efficiency on offense. But unlike LaVine, Bjelica is turning down treys in favor of passes rather than long twos.

Following a strong start, Bjelica fell into a horrible slump after coming back from a slight knee injury and reacquainting himself with the more physical play and faster pace of the NBA game. But whether he has been in rhythm or out of sorts, Bjelly has shown a maddening tendency to forego open treys on a team that desperately needs him to knock down those shots and space the floor.

Coming into the season, he and Kevin Martin were regarded as the team’s best three-point threats. Now that Martin has been relegated to spot duty in order to secure more playing time for Wiggins, Bazzy Muhammad and LaVine, Bjelica is the most proven long-range shooter in the team’s regular rotation.

On the plus side, he is attempting more treys per minute than anyone on the roster other than seldom-used three-point specialist Damjan Rudez (a subpar defender) and LaVine. On the other hand, Bjelly is next-to-last on the roster, behind only Tayshaun Prince, on the number of shot attempts per minute.

Obviously, the overwhelming majority of Bjelica’s shots are three-pointers. But just as obviously, relative to the rest of his teammates, he almost never shoots. Some of this is the inability of the Wolves to look for him. But much more of it is Bjelly himself deciding that further ball movement is a better gambit than taking that jumper. That he is only sixth on the team in assists per minute (behind Garnett, among others) despite frequently playing with teammates who hunt for their own shots indicates that this is a self-defeating, and team-defeating, strategy.

In the past couple of weeks, a couple of Timberwolves — Rubio and Muhammad — have conspicuously escalated their three-point attempts. It is time for both LaVine and Bjelica to follow suit.

That won’t address all of the Wolves offensive woes, let alone the decline in their overall defensive prowess. But it is a fundamental start almost guaranteed to enhance both the present and the future of this ball club.

A new Minnesota House select committee has been set up to look at child-care affordability and a shortage of providers.

State Rep. Mary Franson, a Republican from Alexandria, will head the group, which, House officials say, will work "with providers and parents to facilitate solutions for more affordable child care choices for Minnesota families."

House Speaker Kurt Daudt, who announced the effort, said:  "This committee is ready to get to work finding solutions to make child care more affordable and accessible across the state."

The announcement says that the state has lost 3,000 child care providers in the last decade.

The committee will tour the state to meet with providers and parents in preparation for legislative changes.

Franson, who has worked as a day-care provider, said: "Minnesota has many top-quality child-care providers who offer a safe, quality environment for children to learn, grow, and thrive. However, too many Minnesota families cannot find available or affordable child care in their community."

Gov. Mark Dayton last year proposed an expanded child-care tax credit.

Some people aren’t interested in what Mayor Betsy Hodges has to say.WCCO reports on the Minneapolis mayor’s (attempted) Martin Luther King Jr. Day speech: “Minneapolis Mayor Betsy Hodges’ planned comments at a Martin Luther King Jr. Day event were interrupted on Monday by protestors. … Video posted by the group Black Liberation Front shows Betsy Hodges at the podium at the Monday night event, which was taking place in Martin Luther King, Jr. Park on Nicollet Avenue and 40th Street South. … As Hodges was at the podium, a number of other people joined her on stage, shouting ‘If Jamar don’t get it, shut it down.’ ”

What’s going on in northern Minnesota?The Guardian’s Zoe Sullivan examines a disturbing series of crimes: “A recent spate of cases involving Native American women from northern Minnesota being murdered or going missing has raised questions about how seriously such disappearances are taken by the police and other authorities. … As Duluth, Minnesota, marks trafficking awareness month, local activists say some of the disappearances and deaths are linked to this issue, and argue that the invisibility of the Native American population contributes to neglect by police, media and social services and point to the need for better data collection in order to track the number of missing and murdered women.”

On the mean streets of Fargo, not even a brightly colored bison sculpture is safe. Inforum’s Tu-Uyen Tran reports,“After Sunny, downtown's bison statue, was again struck so hard overnight Saturday that its legs broke, Dayna Del Val wondered what kind of community would let its public art be treated that way. … ‘In the five and a half years that I have been at the Arts Partnership, almost every single piece of public art that has gone up has been vandalized,’ said Del Val, who is executive director of the group that represents much of the Fargo-Moorhead arts community.”

Not bad. In this afternoon’s list-of-the-moment, Business Insider calls Minnesota the 15th best economy of all states, plus D.C.: “Minnesota's November 2015 unemployment rate of 3.5% was tied for seventh lowest among the states and DC, and the state's Q2 2015 GDP growth rate of 4.5% was tied for 13th highest. However, nonfarm payroll jobs increased by 1.1% in Minnesota between November 2014 and November 2015, lower than the national growth rate of 1.9% over that year.”

In other news…

Thin ice isn’t the only hazard facing ice fishers:“Victim identified in fish house carbon monoxide poisoning” [Duluth News Tribune]

The all-powerful “bicycle lobby” strikes again:“Bicycle lobby to seek lower speed limit for cities in Minnesota” [Star Tribune]

Minneapolis culinary star Adam Vickermanis leaving Cafe Levain for the Seward Friendship Store. [City Pages]

5 Mayo clinic referencesin TV and movies. [Rochester Post Bulletin]

Please stop citing windchill to make Minnesota seem tougher than it is: “Wind chill is a terrible, misleading metric. So why do we still use it?” [Vox]

Bye, bye, Guppy:“Any fish or plant will be accepted; no questions asked.” [Sea Grant MN]

Apparently that frozen pants thing from last week got a lot bigger. [NBC News]

Here’s Former Minneapolis Public School HR director and Black Lives Matter activist Deray McKesson on Colbert last night:

St. John’s Abbey on Tuesday released personnel records on 18 monks accused of sexual abuse against minors.Ben Rodgers of the St. Cloud Daily Times reports that the files were released to Jeff Anderson & Associates law firm, which notes that seven of the 18 monks were allowed to work in diocese after initial reports of abuse. The files are available at The Minnesota Transparency Initiative’s website. The monks are Andre Bennett (dead), Michael Bik (on restriction), Robert Blumeyer (dead), Cosmas Dahlheimer (dead), Richard Eckroth (dead), Thomas Gillespie (on restriction), Francis Hoefgen (no longer a monk), Othmar Hohmann (dead), Dominic Keller (dead), John Kelly (no longer a monk), Brennan Maiers (on restriction), Finian McDonald (on restriction), Dunstan Morse (on restriction), James Phillips (on restriction), Francisco Schulte (on restriction), Allen Tarlton (on restriction), Pirmin Wendt (dead), Bruce Wollmering (dead).

A man who sued two Fergus Falls police officers because he says they caused him to miss the birth of his son had his case dismissed from court. Jacob Tellers of the Fergus Falls Journal reports that Otter Tail County Judge Vicki Landwehr dismissed the case filed by Dennis Fronning of Battle Lake against Officer Robb Foreman, Sgt. Andrew Miller, the Fergus Falls Police Department and the City of Fergus Falls. In 2014, Fronning was rushing his pregnant wife to Lake Region Healthcare when he was stopped and detained by the officers. His wife was taken the rest of the way via ambulance. The civil suit claims officers denied him the chance to see the birth. Fronning sued for damages for suffering mental pain and anguish, severe emotional trauma, embarrassment and humiliation. Landwehr found that the officers’ actions didn’t rise to the level of malice and they have immunity whether the detention was lawful or not.

A family-owned grocery store in Atwater closed last weekend after 42 years.Shelby Lindrud of the West Central Tribune writes that Keith Passmore, the owner of Vern’s Town & Country Foods in Atwater, says he can’t compete against chain grocery stores in Litchfield and Willmar. “The big corporations have taken over the world,” Passmore said. He added that he has operated the store at a loss for a year. He inherited the store from his parents.

Officials are warning of the danger of carbon monoxide poisoning in ice fishing houses.The Bemidji Pioneer reports that Jared Nels Johnson, 34, of Akeley, died after carbon monoxide poisoning Sunday in an ice fishing house on Walker Bay of Leech Lake. Cass County deputies also found three other adult males with symptoms believed to be carbon monoxide poisoning. The fish house was a converted camper-trailer.

It’s not just the weather that’s cold. Jenae Hackensmith of the Austin Daily Herald reports that an 11-year-old boy stole a mobility scooter Monday from a 69-year-old man at The Cedars of Austin. The four-wheeled, blue scooter with a flag on the back was taken from the garage at The Cedars. The scooter’s estimated value is $1,500. Security footage showed three juveniles were involved. The 11-year-old was taken to the Olmsted County Detention Center while the other two males were taken to their parents or guardians. The scooter was found at the 11-year-old’s home and returned to the owner.

When kids get unruly on his bus, Rochester driver Philip Bologna, 63, bursts out in song.Matthew Stolle of the Rochester Post-Bulletin writes that in 1984, the tenor was one of 11 winners of the Metropolitan Opera National Auditions. He later soured on the career when it took him away from his wife and son nine months out of each year. He moved to Anoka to become conductor of an opera company, then produce children's operas at Anoka schools. He founded the Lyric Arts Company of Anoka and was drama director of the Elk River High School. When funding for arts at schools dried up and his wife lost her job, he moved to Rochester to be near his son and daughter-in-law. When he saw a sign advertising openings for bus drivers, he applied and became a driver.

Former Alaska Gov. Sarah Palin has decided to endorse Donald Trump for the Republican Presidential nomination, and will do so publicly Wednesday. People who claim to know such things say Palin is influential with the Tea Party types, a group that one might think would be in play between Trump and Sen. Ted Cruz.

Also Monday, Iowa Republican Gov. Terry Branstad came out against Cruz. He did not endorse Trump or anyone else, and he says he will not. Iowa governors usually stay neutral in the caucuses. But Branstad, who conceded that Cruz is ahead in most polls, said Cruz is the candidate of the oil industry and a leading opponent of renewable fuels (including ethanol, which is made from Iowa grain). Branstad said it would “be a big mistake for Iowa to endorse” Cruz.

Branstad is generally considered a moderate Republican. If he is influential, it might lead some Iowans to support some of the relatively moderate candidates, not necessarily Trump. But if the polls are right, the race in Iowa has been between Cruz and Trump for several weeks, so anything that that hurts Cruz would likely help Trump.

On the other hand, the caucuses are still two weeks off, and — as Democratic Howard Dean demonstrated in 2004 — even a big lead in the polls two weeks out doesn’t guarantee anything.

If you’re a light rail operator, the final weeks of 2015 were probably disturbing. Within just a few weeks, there were three separate fatal crashes involving a train, ranging from a bicyclist to a wheelchair user to someone crossing a platform. Each one is a unique tragedy. 

The spate of fatal accidents remains something of a mystery, spanning both of the Twin Cities’ light rail lines, one of which has been operating continually for over a decade. After all, trains are as predictable as it gets in urban transportation. They’re large, loud and don’t swerve, they meet carefully designed safety standards, and they’re all driven by trained professional drivers. If the Twin Cities can’t keep our light rail systems safe, what hope is there for our chaotic car-choked streets?

Contrasting contexts of light rail

First of all, it’s important to note that a) a lot of time and thought goes into light rail station design and safety procedures, and b) depending on context, the safety variables for light rail can be radically different.

Also, would-be riders shouldn't run across the street to “beat” or catch a train. It’s very dangerous. (I know this firsthand; while chasing the Green Line through downtown Minneapolis I caused my own bike accident.) It's better to wait for the next train.

That said, the tragic fatalities of 2015 don’t really fit a pattern. The Green Line and Blue Lines are quite different from a safety perspective. The Green Line runs through the middle of University Avenue, a busy main street full of pedestrians, while the Blue Line runs alongside Highway 55 (aka Hiawatha Avenue), a semi-separated urban freeway.

“We start out designing crossings or station areas by working closely with the operations folks and designers who have experience in this arena, to develop as safe crossings as we can,” said Jim Alexander. He is the director of design and engineering for Metro Transit's Southwest Light Rail, and formerly designed the Green Line stations. “We use the tools we have ... signage to get people aware of LRT down the middle of the street, a combination of signals. And trains have bells or horns to use as well, to alert passengers and pedestrians crossing the street.”

Adding to the complexity is jurisdictional overlap. While Metro Transit controls the station areas and operations of vehicles, and budgets for things like gate arm crossings and flashing signs, the surrounding environments and streets are designed by other agencies. For example, the recent attempts to improve the crosswalks along busy Hiawatha (to prevent jaywalking) involved county, city and state agencies.

Courtesy of Sam Newberg

Crossing Hiawatha

“It’s quite an in-depth process in terms of trying to get all the stakeholders — internal and external — together,” Alexander told me. “We're really trying to understand and get into the mind of the pedestrian, how they would want to cross the roadway and the tracks.”

Human-centered thinking

In urban design, there’s a lingering tension about how to deal with unpredictability. On one hand you have the law-and-order approach, which argues that clear rules, combined with enforcement and education, will encourage compliance and lead to safer streets.

On the other hand, there’s a more “human-centered” approach where design accommodates and “forgives” errant human behavior. Human-centered design (also called “user-centered design”) is where, as Wikipedia puts it, one tries to design around "how users can, want or need to use the product, rather than forcing users to change their behavior.” The idea cuts broadly across multiple fields, from software design to office ergonomics, but it gets really interesting when you start discussing city streets.

“The key is to design things intentionally that really channel attention and behavior through designing from a human-centered systems design perspective,"Kathleen Harder told me. Harder holds a Ph.D. in cognitive psychology, and directs the Center for Design in Health at the University of Minnesota.

Courtesy of Cameron Conway

The Washington Avenue transit mall is a case study for design details, where signage is almost always ignored.

From this perspective, the problem of light rail safety revolves around passengers having access to information because, as Harder says, people are very goal-oriented. When confronted with an approaching train, and the question of whether they will “make it” if they run across the road, people lose track of other pieces of the urban environment.

“If train riders are intent on reaching a goal, a light-rail or crossing-a-street objective, everything else pales in comparison,” Harder explained. “They will take riskier behaviors if they think not crossing the street will cause them to wait 20 minutes for a next train.”

One way to alleviate this risk might be to make “next train” information even more obvious. If you know you'll only have to wait 10 instead of 20 minutes, you're much more likely to be patient.

MinnPost photo by Bill Lindeke

One way to alleviate risk might be to make “next train” information more obvious.

Other important variables from a human-behavior perspective include: transit frequency (how long you have to wait for the next train), sightlines, barrier placement, signal timing (e.g. green lights, walk lights), signal priority (does the train stop at intersections), pavement markings and texture, signage and flashing lights, sounds (bells, whistles), sidewalk width and demarcation by street furniture, and the number of conflict points in the area.

Safety and the ‘cognitive load’

One key variable for street safety is the concept of the “cognitive load,” or the amount of attention that people are able to devote to processing their surrounding environment. Especially in an area of high complexity, like the corner of University and Snelling, home to one of the Green Line's busiest stations, the amount of information can be overwhelming.

“What causes people to decide to cross or not depends on what cognitive zone they find themselves in,” Harder explained. “Are they distracted? Cognitively engaged in the environment? Or is their mind somewhere else attending to a piece of music? Where are they in terms of visual orientation? All these variables form a complex delicate balance.”

At Snelling, this might involve devoting more attention to sidewalk or street design, reducing the "decision points” and “actions” grabbing people’s attention. For example, currently the light rail does not have proper “signal priority” at key corners like this, and its halting progress through the intersection increases the uncertainty for drivers and transit riders alike. (Is it going to stop? How many extra seconds do I have to reach the train?)

“Some information isn’t presented in a cognitively digestible way,” Harder told me, speaking more generally about street design. “Some signs aren’t at appropriate heights, or what information they need, they don’t know, such as when the next train is coming. But if it is designed in such a way that attention is channeled, so that people can use the information readily, the probability of an error is reduced, because there aren’t so many variables in the fray.”

Signs vs. design

Another big lesson for urban design and safety is that there are diminishing returns to signage. For example, when Hennepin County attempted to make one lane of a downtown street into a “bus-bike-only” lane, no matter how many signs they installed, drivers didn't follow the rules. There are stark limits to what signs can accomplish.

“Signs are not for people who know where they’re going,” Harder told me. “A sign isn’t going to grab your attention in an area where you really need to be captured. That’s why signs need to be designed in a very effective and judicious way.”

Harder recommends what she calls “deep design” instead of signage. The built environment should have easy cues that let people know when it changes. This can be done with architecture, street furniture, different types of pavement; for example, Harder points to the intersection of Church Street and Washington Avenue (on the Green Line at the University of Minnesota campus) as a place that needs more design detail, particularly on the ground where many eyes tend to fall.

“Different kinds of pavement, and even that has to be smartly,” Harder told me. “Deep design is not something you just splash on and say “we’re done.” You have to think about variables, the context, about the flow. You’ve got to be systematic and keep eye on the goal.”

A related design factor is the usefulness of educational campaigns: for example, fliers for university students, billboards or announcements for drivers or transit riders. But if you pay attention to human psychology, you find that design cues can easily trump a public-service announcement.

“People often say, ‘Why don’t we just teach people that they have to wait to cross the street,” Harder told me. “That’s all fine and good, but [a transit rider’s] goal is not to have to wait 20 minutes for the next train. Telling them to wait to cross the street is not going to percolate into the conscious awareness, because it’s more important to reach the train. It’s better to use design to give people the information they need.”

Solving the sticky and tragic problem of street safety isn’t easy, and with the increasing influence of distracting technology in our everyday lives (for drivers and pedestrians like), is only going to become more important. If 10 years of public-service announcements haven’t made light rail safe, what will?

The tick species that spread Lyme disease are now present in half the counties of the United States, according to a new analysis by the Centers for Disease Control and Prevention, and the territory in which they are most firmly established has doubled in the last two decades.

As you can see from this map, the expansion in Minnesota has been especially pronounced:

Courtesy of R. J. Eisen et al., Journal of Medical Entomology

This map of changes in black-legged tick prevalence from 1998 to 2015 shows in red and orange, respectively, the counties where tick populations became newly established or confirmed during the period. Green counties had potential populations that weren’t detected until after 1998. Black counties had established populations in both years; gray counties had potential populations in both years.

To arrive at these findings, published Monday in the Journal of Medical Entomology, researchers began with a map of black-legged tick prevalence across the U.S. as it stood in 1998, then updated it with tick counts made through August 2015.

Counties were classed into three tiers based on tick-collection reports gathered from public health or environmental agencies:

• Counties with “established” tick populations were those where at least six individual ticks had been collected in a calendar year, or where fewer ticks representing at least two out of three disease-spreading life stages were found.
• Counties with “reported” or potential populations had tick collection data that fell short of those minimums.
• Counties with “no records” had no ticks officially recorded, which the paper helpfully explains “does not imply that ticks are absent from that county, only that records ... are lacking.”

In 1998, 1,058 counties across 41 states were classed as reported or established; by last summer, the number had grown to 1,531 counties in 43 states. That’s an increase of 45 percent.

Two species of black-legged tick are involved here — the so-called deer tick of the central and eastern U.S., and the western blacklegged tick of the Rocky Mountain and Pacific coastal regions. Both are the “primary vectors” bringing Lyme disease to humans; both also transmit other serious but less headline-grabbing diseases, including anaplasmosis, babesiosis and a viral form of encephalitis.

But deer ticks (Ixodes scapularis) are expanding their range much more rapidly: For them, the number of counties in the “established” category more than doubled from 1998 to 2015, from 396 to 842.

The data presented here suggest that I. scapularis over the past two decades has expanded from its northeastern focus northward into upstate New York, Vermont, New Hampshire, and northern Maine; westward across Pennsylvania, eastern Ohio, and New York; and south- and southwestward into West Virginia, Virginia, and North Carolina. A similar geographic expansion ... appears to have occurred from the long-established focus in the North-Central states, with notable spread of counties where the tick is now classified as established in all four cardinal directions. The two previously distinct foci in the Northeast and North-Central states appear to be merging in the Ohio River Valley to form a single contiguous focus.

And Minnesota is among the places where the spread has been most pronounced.

The Minnesota picture

Macalester College

David Neitzel

The Minnesota figures in the national paper were contributed chiefly by Dave Neitzel, an epidemiologist at the Minnesota Department of Health who works on tick- and mosquito-borne diseases and has been tracking deer ticks since Lyme disease became a health concern here in the 1980s.

Lest there be any doubt that the CDC paper is more than an academic exercise, Neitzel told me on Wednesday that the methods used in the mapping work are a reliable way to gauge the spread of both ticks and the risk of tickborne illness, because the results have been shown to correlate well with statistics on the incidence of Lyme and other infections.

Nationally, about 300,000 Lyme cases are diagnosed each year, with about 1 in 10 confirmed by laboratory  tests, which is difficult. In Minnesota, 896 confirmed cases and 520 probables were reported to the health department in 2014.

In fact, Neitzel said, finding two ticks at different life stages may be a more meaningful indicator than finding a bunch of the same age because it shows that the ticks are healthy and maturing in the local conditions.

Just nine Minnesota counties were in the “established” category back in 1998. Clustered mostly in the metro area, and shown in black in the map above, they are Anoka, Carver, Chisago, Dakota, Morrison, Pine, Ramsey, Scott and Washington. 

Twelve more, shown in orange, were in the “reported” tier: Aitkin, Beltrami, Carlton, Crow Wing, Douglas, Houston, Isanti, Kanabec, Mille Lacs, Olmsted, Todd and Winona. All are now in the higher tier.

Twenty-seven counties with no ticks counted by 1998 are now mapped in the danger zone. Of these, the 24 shown in red are in the “established” tier (Becker, Benton, Cass, Clearwater, Cook, Fillmore, Goodhue, Hennepin, Hubbard, Itasca, Kandiyohi, Koochiching, Lake, Lake of the Woods, Mahnomen, Otter Tail, Pope, Sherburne, Sibley, St. Louis, Stearns, Wabasha, Wadena and Wright) and the other three, shown in green, are in the “reported” tier: Brown, Nicollet and Rice.

No counties went from a higher tier to a lower one between 1998 and 2015. The 39 counties colored white had no tick reports in either year, but Neitzel said that luck is unlikely to hold everywhere: Ticks need wooded, brushy habitat but they don’t necessarily need a lot, and they do get around.

A mobile disease agent

Under its own power, he said, a black-legged tick may cover only a meter or two of territory in its lifetime. But its horizontal movement is less important than its vertical movement up a deer’s leg, or a hiker’s, and its limited locomotion matters less than its ability to find transport while feeding on mice, chipmunks, birds ...

If you go up on the North Shore, ticks are established in parts of those counties, but the distribution is more spotty. Kind of the last frontier was the northern tier of counties right along the Minnesota/Ontario/Manitoba borders, but there are scattered infestations being seen in most of those counties now, too.

I’ve collected one – one lonely – black-legged tick in New Ulm, a few years back, and that’s as far into farm country as we’ve found 'em. So far.

There are areas of interest to us out in the farm lands – probably the best example is, cutting right through the middle of the state, we have the Minnesota River Valley, which in a lot of areas is a half-mile to mile-wide strip of woods on either side of the river, and I think there’s a lot of potential there. I think it’s only a matter of time.

Neitzel said he wasn’t particularly surprised by the national findings, but thought it might offer some clarifying reassurance to certain tick-free regions of the country – particularly in the lower Midwest – that they have little to worry about.

On the other hand, it might have the opposite value in alerting others, on the spreading westward fringe of tick territory, that they’d better be on the lookout.

A while back, he said, North Dakota officials called him to consult on the possible spread of black-legged ticks across the Minnesota border. He gave them some ideas of where to look and now eight counties are on the map, up from zero in 1998.

It remains unclear, he said, how deer tick populations first became established in the upper Midwest in a fairly narrow band along the St. Croix River, whence it spread rapidly in all directions. Until Lyme disease became an issue, there wasn’t much interest in studying ticks; once that interest arose, the populations had already exploded.

How to count ticks

Every wonder how a tick census works?

We’ll have several hundred-meter transects where we’ll do drag sampling – we have a piece of cloth we pull behind us in the woods, and stop every 15-20 meters to pull ticks off of ourselves and the cloth. From that we can get an idea of the density of feeding ticks.

We also keep track of infection prevalence of various disease agents — Lyme disease spirochetes, anaplasmosis bacteria, babesia parasites, and also a few other less common tickborne disease agents.

What we’ve been finding over the years, unfortunately, is you don’t have to go too far before you find infected ticks. Lyme disease, for instance, anywhere from about a third to half of the adult ticks are infected and roughly 20 percent of the nymphs.

So if people are coming into contact with many black-legged ticks at all, they’re going to be coming into contact with infected ticks. And we’re entering into a reality now where it’s hard to find extensive wooded areas that don’t have a population of black-legged ticks.

So I had to ask – has he managed to get through all these years of close-up tick study disease free?

Yes, but I’m extremely aware when I’m in good tick habitat. I get several hundred of these things on me in any given year, but I remove most of them before they even get a chance to feed, and for the ones that do attach I’m generally pretty good at getting them off me within a matter of hours – and that’s the important thing.

With Lyme disease, for instance, the ticks have to be attached for one to two days to effectively transmit the bacteria. So the quicker you get them off, the better.

***

MinnPost event: On Monday, Feb. 22, MinnPost’s Earth Journal Circle will present its fourth annual event focusing on substantive discussion of critical issues in the environment. This year’s topic is “Land of 10,000 Lakes: Can We Achieve Water Sustainability?” The speaker is Deborah Swackhamer, former director of the University of Minnesota’s Water Resources Center, who will discuss issues threatening regional water quality and quantity. Earth Journal writer Ron Meador will moderate the Q&A session.

Traditional Chinese acupuncture is no more effective than a sham version of the procedure at relieving menopausal hot flashes, according to an Australian study published online this week in the Annals of Internal Medicine.

Women in this study reported improvements in the number and intensity of their hot flashes whether they received the real or the fake treatment — a strong indication that the placebo effect was at work with both.

The study also found “no evidence of an advantage of acupuncture over sham acupuncture on quality of life, anxiety, or depression," write the study’s authors.

And before anybody jumps on this study for being conducted by conventional physicians who are antagonistic to nonconventional medical treatments, I’ll point out that the lead author is Dr. Carolyn Ee, a family physician at the University of Melbourne who is trained in — and uses — Chinese medicine, including acupuncture, with her patients.

A common experience

As background information in the study points out, about 75 percent of women experience hot flashes as they transition through menopause, and the flashes tend to continue for an average of five years. For most women, hot flashes are more of an annoyance than a problem, but for some, they can be debilitating, particularly when they occur at night (“night sweats”) and interfere with sleep.

Because conventional drugs used to relieve severe hot flashes — most notably, hormone replacement medications — are associated with serious adverse effects, including an increased risk of blood clots and cancer, many women turn to alternative therapies, including acupuncture. There’s no good, solid evidence, however, that any of these therapies actually work.

Past studies on the effectiveness of acupuncture have suggested it might relieve hot flashes, but those studies have been riddled with methodology problems, and were not able to come to any definitive conclusions.

Study details

To try to resolve the issue, Ee and her colleagues designed a randomized controlled trial, considered the gold standard in medical research. They recruited 327 women who were either postmenopausal (more than 12 months past their final menstrual period) or transitioning toward menopause. All the women reported having at least seven moderate-intensity hot flashes daily — symptoms that apparently would be part of a “kidney yin deficiency” diagnosis in Chinese medicine, according to the study.

The women were randomly assigned to receive 10 treatments for eight weeks of either a standardized acupuncture protocol for treating kidney yin deficiency or a sham treatment. The sham treatment used a blunt-needle device that gives the visual and physical impression of being inserted into the skin. The sham “insertions” were done only on sites on the body that are not used in real acupuncture.

The study used 15 different Chinese acupuncture clinics across Australia, and the clinicians had a minimum of five years of clinical experience. Everybody except the acupuncture therapists were blinded as to whether the treatment was real.

The women kept daily diaries of their hot flashes, and ranked each one as either mild, moderate, severe or very severe. They also filled out questionnaires that measured other outcomes, such as quality of life, depression and anxiety. This data was collected up to six months after the treatments had ended.

Key results

Sixteen percent of the women in the acupuncture group and 13 percent of those in the sham group dropped out of the study before it was completed.

An analysis of the data collected from the women who remained revealed that both groups reported about a 40 percent improvement in the number and intensity of their hot flashes when their “treatment” ended — benefits that continued through the six-month follow-up period of the study.

The data also did not reveal any advantage of acupuncture for outcomes related to quality of life, anxiety and depression.

These findings suggest that the placebo effect was at work. In other words, just the belief that they were receiving help for their hot flashes led the the women perceive their symptoms as being less troublesome.

Cannot be recommended

Ee and her colleagues conclude that acupuncture cannot be recommended to women for the treatment of hot flashes.

"This was a large and rigorous study and we are confident there is no additional benefit from inserting needles compared with stimulation from pressuring the blunt needles without skin penetration for hot flushes," Ee said in a released statement.

"If women want to consider having acupuncture for hot flushes,” she added, “they should know that although previous studies show it is better than doing nothing, our study demonstrates that needling does not appear to make a difference."

FMI: You'll find an abstract for the study on the Annals of Internal Medicine website, but the full study is behind a paywall.

Minnesota employers added 9,100 jobs in December, bringing the state seasonally-adjusted unemployment rate down to 3.5 percent, according to the state Department of Employment and Economic Development.

The national unemployment rate is 5 percent.

DEED Commissioner Katie Clark Sieben said: “The state labor market finished the year with a strong surge, adding 18,300 jobs in the final two months. Nearly all signs point to continued growth in Minnesota in 2016.”

The highest gaining sector in December was government, adding 4,300 jobs, the report said.

Other gaining sectors:

• Leisure and hospitality (up 2,800)
• Education and health services (up 2,100)
• Financial activities (up 2,000)
• Manufacturing (up 1,600)
• Construction (up 1,300)
• Other services (up 500)
• Information (up 200)

It wasn't all rosy. Sectors losing jobs were:

• Professional and business services (down 3,200)
• Trade, transportation and utilities (down 2,000)
• Logging and mining (down 500)

And the state reports this regional breakdown, by Metropolitan Statisticacl Areas, of job growth and loss over the past 12 months:

• Minneapolis-St. Paul MSA (up 1.8 percent)
• Duluth-Superior MSA (up 0.5 percent)
• Mankato MSA (up 0.1 percent)
• Rochester MSA (down 0.3 percent)
• St. Cloud MSA (down 0.1 percent)

During a break in protest clamor at the Jan. 12 Minneapolis Public Schools board meeting, board member Don Samuels posed a logistical solution for bringing the superintendent search to an end that evening: voting by a show of hands.

After rejecting earlier that night top candidate Sergio Paez — who lost board support following allegations that staff abused special-education children during his tenure as superintendent in Holyoke, Mass. — the school board had punted a number of possible next steps before gaining traction around a motion to appoint Interim Superintendent Michael Goar.

Before the board could take a vote on Goar, however, protesters filed to the front of the room and shut down the meeting, interrupting all verbal attempts by the board to regain order. The turmoil was enough to undermine the board’s confidence to push through. They ended up tabling the decision for a later date, which has yet to be announced.

While some options at this point seem more likely than others, it seems plausible that anything could happen at the board’s next meeting. So what, exactly, are the options left on the table? Based on a number of interviews with key stakeholders this week, here's a look at the possible next steps.  

Appoint runner-up Michael Goar. Goar began serving as interim superintendent Feb. 1, 2015, after former Superintendent Bernadeia Johnson’s resignation. The promotion seemed to be a natural transition, as he had worked alongside Johnson as the district’s chief executive director for more than a year and a half. His professional history with the MPS district dates back even further, to his nearly five-year tour of duty as executive director of labor relations and human resources.

In terms of related school leadership roles, he left the district to gain experience as the deputy superintendent for Boston Public Schools from 2007 to 2012. Before that he served four years as an associate superintendent for Memphis City Schools.

He’s well aware that there’s a segment of the community that objects to his candidacy. Their concerns were largely voiced by protesters at the last board meeting who demanded the board restart the search. Recapping the incident, Minneapolis NAACP President Nekima Levy-Pounds says protesters still have a number of concerns about Goar’s leadership abilities. Chief among them, the community is still hurt over the literacy curriculum deemed to contain racist material that was purchased under Goar’s watch.

Minneapolis Public Schools

Interim Superintendent Michael Goar

“It’s important for us to understand how something like that could have happened,” she said, noting people are still looking for reassurance that a lapse in judgment like that won’t happen again.

The more pervasive issue, she says, is a lack of confidence in Goar’s ability to connect with the African-American community and create real change.

“People feel Goar has not been responsive when they have grave concerns about how the district functions, how fiscally responsible the district has been. ... We need to know what has changed under Goar’s leadership as far as the academic proficiency ratings, particularly for children of color,” Levy-Pounds said.

If a performance evaluation were to show that Goar is, in fact, performing at an optimum level and he were to smooth out relations with community members who feel their concerns are not being heard, Levy-Pounds says there’s still a chance Goar could win broader support.

“I’m not saying it’s impossible, but those are two hurdles that would have to be overcome,” she said.  

Controversy aside, Goar says he’s still interested in the job, so long as it comes with the support of a unified board.

“They have not offered me the job,” he said this week, noting nothing is official yet. “I would certainly have to look at the landscape [if they offered me the job]. But I am deeply committed to this community.”

He’s not ashamed to admit he’s made mistakes while serving in an interim capacity, adding he’s always open to constructive feedback so he can improve.

It’s this display of grit and humility that could very well propel him into the position.

Board Chair Jenny Arneson isn’t the only stakeholder who’s voiced support for Goar as of late. In a MinnPost interview, Johnson also named Goar her top pick after Paez was rejected. Likewise, former MPS board member Pam Costain, who retired last week from her leadership position with AchieveMpls, has gone public with her support of Goar in favor of avoiding any further delays in the search that has sparked a great deal of instability in the community.

“I feel strongly they should offer this position to Interim Superintendent Michael Goar,” she said. “I think the longer they take, the more damaging it is for our district and for our city.”

She also pointed out that board support for Goar, early on, was actually quite strong. In November, when board members completed a matrix sheet exercise to determine their top three finalists prior to the official vote, Goar emerged as the favorite for five board members.

“He had very decisive support from the board at that point,” Costain said, noting that fact seems to have been lost in the discussion at this point.

MinnPost file photo by Terry Gydesen

R.T. Rybak

While Next Generation leader and former mayor R.T. Rybak says he is more concerned with the need for the board members to find some common ground, in order for the next superintendent to be successful, he’s ready to get behind Goar as well.

“I am very confident that Michael could be a very successful superintendent,” he said. “I’ve told the board I would support their decision. I did that with Paez. I’m going to help whoever they pick be successful.”

If the board were to offer the position to Goar, he’d be well-positioned to keep school business moving forward. He’s already taken care of renewing his superintendent’s licensure through an alternative licensing program. His initial license, which expired Dec. 31, 2015, was granted through a variance approved by the state Board of School Administrators.

And although board member Tracine Asberry’s proposals to further vet Goar’s out-of-state experiences prior to offering him the position were largely shot down by the rest of the board, Goar says he’s not opposed to any such actions.

In the meantime, as much as he’d like to get the job, he’s doing his best to not get distracted from his current duties as interim superintendent. With a referendum on the horizon and a number of initiatives he’s been working on for the past few years poised for execution, he’s not discouraged by his interim status.

“Until that decision by the board, whatever that is, I have to serve as superintendent. And I will serve as superintendent to make sure our district is moving forward,” he said. “We aren’t leaderless. We have a leader and it’s me.”

Look again at both remaining finalists. At the Jan. 12 meeting, board member Carla Bates initially spoke in favor of revisiting the remaining finalists — Goar and Charles Foust — before taking any further actions. While she later put her support behind the motion to move ahead and appoint Goar, Foust’s potential remains a question mark.

When he applied for the position, he was working in his third year as assistant superintendent in the Houston Independent School District. The bulk of Foust’s student experience can be traced back to North Carolina. He then moved to Houston, where he pursued a degree in professional leadership and started out as a middle school principal.

After being named one of three finalists, he came in third place, failing to get a single vote with the board voting 6-3 in favor of Paez.

While attempts to reach Foust were unsuccessful, his colleagues confirmed he is still working for the Houston Independent School District.

Reopen the search. Board member Nelson Inz first suggested re-opening the search for an abbreviated period, to explore qualified candidates who may not have applied initially.

MinnPost photo by Craig Lassig

Board member Nelson Inz

It’s the sort of alternative that seems to align well with the community’s demands to consider a homegrown candidate —  someone who’s already familiar with the culture and diversity of Minneapolis schools, as well as the size of the district.

Some speculate there must be a number of untapped candidates already working in the district who might rise to the challenge. According to the Minnesota Department of Education, 17 principals and assistant principals in the Minneapolis Public Schools district currently hold a
superintendent's license. Counting those currently licensed in the St. Paul Public Schools district would add another 15 to the candidate pool. But that’s not to say all of them would be willing to enter such a volatile search process.

Samuels spoke to this possibility at the Jan. 12 meeting, where he pointed out many candidates in the initial search pulled their names early on, not wanting to jeopardize relations with their current employer. Also, he pointed out that MPS is not the top-paying district.

“Thirdly, we had a painful process with a painful outcome for our top choice,” he said. “We’re going to lose candidates because of that. The benefits of a new search are diminished.”

If the board were to reopen the search, it’s safe to say they wouldn't be using HYA, the national search firm they hired to conduct the failed initial search. 

Turning back to Goar, it’s worth noting that he identifies strongly as a homegrown candidate. It’s the thing that’s kept him grounded in his commitment to the district.

Born in South Korea, he was adopted by a couple in south Minneapolis when he was 12. He learned English in the very district he’s now serving and he’s a proud graduate of Washburn High School.

“I have a great affinity for this community and this school district that gave me this remarkable opportunity,” he said.

What about Michael Thomas? A number of community members said they’d throw their support behind the district’s chief of schools, Michael Thomas, when they addressed the board at its last meeting.

Minneapolis Public Schools

Michael Thomas

Thomas says rumblings of support for him to serve as superintendent are nothing new, but it’s the first time they’ve become so public.

“It was quite the surprise to hear it out in public at our board meeting like that. That, I was not prepared for,” he said.

He’s open about his intentions to become a superintendent one day, but he chose not to run initially because he felt the timing wasn’t quite right.

“I have not committed anything around a specific district,” he said of his future aspirations. “If it were Minneapolis, what a special opportunity that would be.”

That being said,  he doesn’t seem too keen on jumping into the arena at this point, stating he’s respectful of the board’s process and focused on serving the students in the midst of this distraction.

Further delay. Perhaps the most pressing question right now, is: What sort of timeline is the board working on? The next regular Committee of the Whole meeting is scheduled for Jan. 26. Here, the board could discuss next steps, but no votes will be taken. The next scheduled business meeting lands on Feb. 9.

“The chair has the ability to call a special meeting, and while we may decide to address this issue outside the regular business meeting, it would not be before our Committee of the Whole meeting,” Arneson said.

Their original timeline was to have a superintendent in place by June, for the new school year, she adds, noting they’re still on track to meet that deadline. In the meantime, Goar’s contract states he will continue serving in an interim capacity until the next superintendent is selected.

MinnPost photo by Craig Lassig

Nekima Levy-Pounds

Well aware of the sense of urgency many have expressed in the need for the board to make a decision and move on to other business, Levy-Pounds welcomes a delay.

The board’s rush to conclude the search immediately after its rejection of Paez indicated a lack of due diligence and commitment to developing community buy-in, she says. The fact that the majority of the board members are resistant to the idea of further vetting Goar before entering contract negotiations with him makes her question their leadership even more.

“Why wouldn’t they want to evaluate [Goar]?” she said. “To me, that makes leadership good, to want to exercise due diligence. It’s not like they have to go to another state to determine how well Goar has already performed in this interim position. For them to not be willing to do that raises a lot of red flags.”

Asked if the board might reconsider conducting a performance evaluation on Goar, Arneson holds the board is, and has been, doing its best to move forward in a responsible manner.

“Our board hasn't taken action on additional vetting for any candidates at this time,” she said. “While no one wants to be where we are at today, we did initially set up a careful process that was based on best practice and  included many opportunities for public feedback, public interviews with the board, and reference checks. We want to make a decision with kids at the center and recognize that we will need to unite behind a candidate to do so.”

Starting this month, Minnesotans turning 18 can expect a greeting  from the Secretary of State's office. It's more than a birthday wish; it's a reminder to register to vote.

Secretary of State Steve Simon said the first batch of about 10,200 reminders will be mailed this month, with a similar number scheduled each month through September.

The goals are to engage young people in the civic process and to shorten registration lines at election time.

To get the names, the state uses the multi-state Electronic Registration Information Center, to compare Minnesota’s voter rolls to Minnesota’s driver’s license database, the Social Security Administration’s death information, and other states’ voter rolls.

In addition to those turning 18, anyone of voting age who recently received a Minnesota driver's license will get the registration reminders.

Simon says: “This will not only help encourage pre-election registration and decrease wait times on Election Day, but by contacting voters on an ongoing basis we can help ease the volume of voter registration applications received by counties in the last few weeks leading up to the election.”

Creative Commons/A Gude

University of Minnesota

Welcome back, students. KMSP reports on campus crime: “The problem of armed robberies continues to plague the neighborhoods surrounding the University of Minnesota campus. Tuesday night, on the first day of spring semester, a U of M student was robbed at gunpoint near the Pillsbury Court Apartments at 11th Avenue SE and 6th Street SE. … Two additional robberies were reported the very next day, just a few blocks away. Between 10 p.m. Wednesday, Jan. 20 and 3:30 a.m. Thursday, Jan. 21, victims were approached by two men armed with a handgun. One of the robberies was reported at the intersection of 8th Street SE and 14th Avenue SE, and the other was reported at The Bridges Apartments at 930 University Avenue SE.”

Some people should probably just avoid social media all together.The Star Tribune’s Chao Xiong follows a long history of violent comments by the St. Paul cop who encouraged motorists to run over protesters:“The tone and content of JM Roth's comments are similar to the Facebook post regarding the MLK Day, Jr. march. In the more recent post, Rothecker commented under a Pioneer Press article about the march, which involved citizens converging in the middle of the Marshall Avenue-Lake Street bridge over the Mississippi River. They demonstrated on behalf of Jamar Clark and Marcus Golden, who were killed by Minneapolis and St. Paul police, respectively.”

Great background before you head to the 2016 U.S. Figure Skating Championships in St. Paul.MPR’s Nancy Yang has a primer on the outfits:“Figure skating has long been known for its bedazzled, over-the-top and sometimes crazy costumes: Johnny Weir famously competed in a swan-inspired costume with a single red glove (aka the beak) that he named Camille. … At times, it has seemed like there are no rules when it comes to skating costumes — which will be on display this week at the U.S. Figure Skating Championships in St. Paul. But, surprise! There are plenty. … We got the lowdown on costume rules from Juliet Newcomer, director of technical services for U.S. Figure Skating.”

Somehow we don’t see something like this lasting very long in Minnesota.City Pages’ Mecca Bos explains why she’ll never go to newly opened faux (or should that be bro?) speakeasy “Volstead’s”:“A fairly significant queue of quietly shuffling hopefuls had formed in the frigid air, next to the dumpsters and dreary brick surroundings of the alley. By comparison, the warm, fluorescent confines of a Walmart would seem charming. Perhaps that's the point. After being forced to linger in below-zero temps adjacent to a garbage heap, the experience inside couldn't help but impress. … Every few minutes, the door would swing open, and a couple would be let inside, or not. It was up to the whim of the selective bouncer. Try to approach the door from the outside yourself, and you'll find it utterly locked.”

Rep. Keith Ellison brought a friend from Congress to town to advocate for new worker protections in Minnesota.The Southwest Journal’s Nate Gotlieb writes, “Minnesota's low-wage workers are stretched thin in part because of low wages, pay gaps and wage theft, panelists said Tuesday at a forum hosted by Congressmen Keith Ellison and Bobby Scott, a Democrat from Virginia. … The six panelists spoke about Minnesota's lack of paid sick, family and medical leave as well as instances of wage theft and the need for fair-scheduling practices. Minneapolis City Council Member Lisa Bender (Ward 10) and Council Vice President Elizabeth Glidden (Ward 8) also spoke in support of the measures at the forum held at Richfield City Hall.”

In other news…

A Republicanhas filed to take onRep. Betty McCollum. [Pioneer Press]

And state Sen. Jeff Hayden is getting a DFL challenger. [Star Tribune]

That showed ’em?“Angry Hudson customer shoots cellphone, returns it to store” [Pioneer Press]

#EcolabGate:“Vikings and Ecolab Announce Partnership, Unveil Ecolab Gate at U.S. Bank Stadium North Entrance” [Minnesota Vikings]

That was fast: “Controversial archbishop leaves Michigan parish” [M Live]

St. Cloud to test out credit card payments for parking meters. [St. Cloud Times]