TBI may increase risk for dementia, Alzheimer's disease

Results from a nationwide cohort study in Denmark of more than 2 million people aged 50 years and older showed that those who sustained a traumatic brain injury were 24% more likely to develop all-cause dementia and Alzheimer’s disease than those with no history of injury.

Furthermore, this risk increased as the number of traumatic brain injuries (TBI) and the severity of injury increased, according to findings published in The Lancet Psychiatry.

“Dementia and TBI are major causes of disability worldwide, and their relationship to each other has been thrown into the spotlight in recent years among military veterans and participants of contact sports. There have been conflicting data published on the impact of TBI on risk of developing dementia,”Jesse R. Fann, MD, MPH, professor of psychiatry and behavioral sciences, University of Washington, Seattle, told Healio Psychiatry. “These conflicting findings are due in part to limitations in study samples and methodology. Our research group sought to address this important question by capitalizing on the advantages of the Danish national health registry.”

To investigate the relationship between TBI — including severity and number of injuries — and the following long-term risk for dementia, researchers conducted a nationwide population-based observational cohort study in Denmark of adults aged 50 years and older. Using data from Danish registries spanning 36 years, the investigators performed survival analysis to determine the long-term risk for dementia after TBI. They used three models that measured different time periods since the TBI, multiple TBIs, and sex; the first model was adjusted for sociodemographic factors, the second for medical and neurological comorbidities and the third for psychiatric comorbidities.

People aged 50 years and older who sustained a traumatic brain injury were more likely to develop all-cause dementia and Alzheimer’s disease than those with no history of injury, according to data from a nationwide cohort study in Denmark.

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Out of nearly 2.8 million people included in the cohort, 132,093 (4.7%) sustained at least one TBI during the 36-year period, most of which were mild (85%), and 126,734 (4.5%) developed dementia during the 14-year follow-up. In the adjusted model, the risk for all-cause dementia in people with a history of TBI was higher (HR = 1.24; 95% CI, 1.21–1.27) than the risk for those without a history of TBI. The risk for Alzheimer’s disease was also higher among those who experienced a TBI (HR = 1.16; 95% CI, 1.12–1.22).

Fann and colleagues found that the risk for dementia was highest in the 6 months following TBI (HR = 4.06; 95% CI, 3.79–4.34). Furthermore, the risk for dementia increased with the number of events (HR = 1.22; 95% CI, 1.19–1.25 for one event and HR = 2.83; 95% CI, 2.14–3.75 for five or more), and with the severity of the TBI. In addition, when stratifying the risk for dementia by time since TBI, the researchers found that the risk for dementia was higher among people who were younger when they sustained the TBI.

“Although their risk is elevated, a person who sustains a TBI is not guaranteed to develop dementia later in life,” Fann told Healio Psychiatry.

“Importantly, a person who has sustained a TBI should do what they can to prevent further TBIs, as the risk of dementia increases with the number of TBIs, and we know that people with a history of TBI are at higher risk for subsequent TBIs,” he continued. “It also is important to address other known risk factors for dementia that are potentially modifiable, such as limiting alcohol and tobacco use, engaging in regular exercise, preventing obesity, and treating hypertension, diabetes and depression. Evidence-based cognitive rehabilitation strategies may also be helpful in minimizing the negative impact of TBI on cognitive functioning.”

These findings warrant further study of the way clinical research evaluates TBI exposures and outcomes,Carol Brayne, MD,Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, U.K., wrote in a related comment.

“The long-term outcomes of TBI are challenging to understand, but given improvements in survival in more recent generations, because of transformation of care in the immediate stages following injury, there are changing considerations about such long-term outcomes,” she wrote. “It will be many years before the outcomes of the mildest TBIs studied in younger adults will be known, as it will be decades before the age groups in which this is of greatest interest to society and health services will reach the age of highest dementia risk.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures. Brayne reports no relevant financial disclosures.

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Khloe Kardashian Devastated After Seeing Tristan Thompson Looking Cozy With Woman

Khloe Kardashian has been painfully crying after seeing shocking photos of Tristan Thompson getting close to another woman when she’s about to give birth. Get the EXCLUSIVE details here.

Khloe Kardashian, 33, is extremely upset after seeing pics of her baby daddy Tristan Thompson, 26, getting close to another woman in New York over the weekend and it’s causing a painful time right when she’s about to give birth. “Khloe is devastated and has been brought to tears after seeing the pics of Tristan with another woman,” a source close to the Kardashians EXCLUSIVELY told HollywoodLife. “Her pregnancy is supposed to be the most special time in her life, and instead it has been ruined by Tristan and is becoming the most painful. It breaks her heart to see the man she loves with someone else. It hurts and she is feeling super emotional right now especially because she is really pregnant so all of her feelings are more intense. The whole situation is horrible and Khloe doesn’t know what she is going to do right now, she can’t stop crying.”

We can definitely understand Khloe’s feelings about the whole situation. Tristan’s pics from his eventful outing at PD-D lounge were just released and there’s even speculation that he’s kissing the mystery woman in one of them. Although we don’t know for sure what happened at the club with the NBA player, Khloe is definitely upset about the possibility that her love and father of her child could be having some romantic time with someone other than her, especially when they’re supposed to welcome a baby any day now.

“Khloe is not taking this lightly with Tristan,” another source close to Khloe EXCLUSIVELY told us. “He needs to own up to her immediately on what he did or did not do because if she finds any truth to it he is going to be in a world of s**t. Khloe would lose all the trust she has with Tristan and would highly consider breaking up with him ASAP. She doesn’t want her child to know that her mother dealt with such awful behavior even if it is the father of her child. She dealt with Lamar [Odom] and what he did and promised herself she would never deal with anything like that again. It is mind blowing to Khloe that Tristan would even be caught flirting with another women let alone doing anything else.”

Apart from the recent incident with Tristan, Khloe’s seemed to be enjoying her pregnancy. From sharing her cravings on social media to showing off her baby bump in adorable pics, the mom-to-be has been embracing all the firsts that come with being pregnant. After announcing that she’s expecting a daughter on a previous episode of Keeping Up with the Kardashians fans have been anticipating the arrival and have even wondered what she will name her baby girl.

We wish Khloe a healthy birth and we hope things with her and Tristan will work out for the best!

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Roma, Not Man City, Completes Stunning UCL Comeback, Sends Barcelona Reeling

There were two sides facing three-goal deficits in the Champions League quarterfinals on Tuesday. One was widely considered to have at least a chance of going through–but it was the one that didn’t that pulled off the unlikely miracle after all.

Roma overcame a 4-1 loss to Barcelona in the first leg, scoring three unanswered at the raucous Stadio Olimpico to oust Lionel Messi & Co. and secure an improbable place in the semifinals.

Liverpool, meanwhile, after a difficult first half, finished off the job against Manchester City with a 2-1 win, advancing 5-1 on aggregate.

The story of the day, though, was Roma. An early strike from Edin Dzeko and a Daniele De Rossi penalty put Roma one goal from an away-goals victory, and the winner came from Kostas Manolas with eight minutes remaining. What was once an academic Barcelona edge turned into a 4-4 aggregate draw, with Dzeko’s first-leg away goal proving to be decisive.

At the Etihad, City had put Liverpool under pressure, taking a second-minute lead through Gabriel Jesus, hitting the post and having a goal wrongly ruled out before halftime. Pep Guardiola was sent to the stands for his protests at that decision, and City never developed the same momentum after the break. Goals from Mohamed Salah and Roberto Firmino settled the tie, sending Liverpool on to the final four, where it’s joined, improbably, by Roma.

Here are three thoughts on the day in the Champions League:

Roma stuns vulnerable Barcelona

Only two sides in the Champions League era (plus nine others in the European Cup) had ever overturned a first-leg deficit of three goals or more. Barcelona was one of them, overcoming a 4-0 defeat to beat PSG last season, but this was more akin to Deportivo La Coruna’s 5-4 aggregate win over AC Milan in 2004. Like Depor, Roma had an away goal from the first leg. And like Depor, nobody gave them a chance.

But this is not the Barcelona of 2009 or 2011, or even of 2015. It may still be unbeaten in La Liga, but it was fortunate to beat Chelsea as comfortably as 4-1 on aggregate, and 4-1 against Roma in the first leg similarly seemed a greater margin than the performance deserved. This Barcelona has a good defensive record domestically–just 16 goals conceded in 31 league games–but didn’t impress against Chelsea and was undone by a simple ball over the top after six minutes, with Dzeko running on to score.

Suddenly, it looked vulnerable. Sergio Busquets, sapped by age, no longer offers the same control in front of the back four. The fullbacks no longer inspire the same terror. Andres Iniesta, it turns out, is fallible. Thirteen minutes into the second half, Roma had a second, with De Rossi converting from the spot after Gerard Pique had fouled Dzeko. Suddenly Roma was one goal from going through on away goals against a Barcelona side that had lost any sense of control.

Manolas had scored a desperately unfortunate own goal in the first leg, his clearance hitting the post, bouncing back onto him, and then cannoning back off him into the net. Here, he had glorious redemption, darting across the near post and glancing in a deft header off Cengiz Under’s corner kick.

Barcelona, at last, was prodded into urgency. Pique added his height as an auxiliary center forward, but a string of long balls seemed to play into Roma hands and Eusebio Di Francesco’s side held on with surprising ease.

Roma is on to the semifinals, while any and all thoughts of a potential Clasico semifinal or final went up in smoke.

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Man City’s comeback fizzles out

Guardiola had been a Camp Nou ball boy when Barcelona came back from 3-0 down against IFK Gothenburg in the European Cup semifinal in 1986 to win on penalties, and for a time it had seemed he might inspire a similar result as coach. City had to attack and set up with an astonishingly attacking lineup. Guardiola used a back three for the first time since the dead-rubber group game against Shakhtar Donetsk, with Kyle Walker deployed on the right of the three with a license to push on. Fernandinho was a lone holding midfielder, with Kevin De Bruyne and David Silva as inside forwards and Bernardo Silva and Leroy Sane as wingbacks, leaving Raheem Sterling to play just off Gabriel Jesus.

Quite apart from anything else, that meant Sterling was able to initiate the press very high up, and it was him closing down on Virgil van Dijk that led to the opening goal after 117 seconds. The Dutch defender seemed to think he was fouled and half-stopped as he cleared straight to Bernardo Silva, the ball ricocheting inside to Fernandinho, whose pass laid in Sterling to square for Gabriel Jesus to knock in.

With the ball boys notably quick to get the ball back into play, the plan was clearly to keep the pressure on Liverpool, to suffocate them, to induce panic and, to an extent, it worked. Liverpool’s use of the ball was poor and it could easily have fallen a further goal behind before halftime. Luck was with Jurgen Klopp’s side as a Bernardo Silva shot flicked off Dejan Lovren and hit the post when it had probably been curling in, and then Leroy Sane had a goal wrongly ruled out just before halftime.

City never developed the same momentum in the second half, exhausted, perhaps, by its first-half efforts, and Salah’s calm finish 11 minutes into the second half leveled the score, which, with the away goals rule, effectively ended the tie. Roberto Firmino capitalized on a Nicolas Otamendi error to make absolutely certain with 13 minutes remaining, giving Liverpool a third win over Man City in a three-month span across the Premier League and Champions League.

Referee takes share of spotlight at Man City

Criticizing referees is one of the more tedious tactics of conspiracy theorists, but it’s fair to say the Spanish official Antonio Mateu Lahoz did not have a good game. His biggest error came with the disallowing of Sane’s apparent goal. Although the German winger was beyond goalkeeper Loris Karius as the ball bounced back into the goal area and would normally have been in an offside position, the ball had ricocheted to him off James Milner, therefore putting him onside. Mystifyingly, Lahoz added no additional time in the first half, despite booking five players.

Before Lahoz had been appointed to the game, Guardiola had made reference last week to his performance in the last-16 tie last season, when he booked Sergio Aguero for diving after he had seemingly been taken out by the Monaco goalkeeper Danijel Subasic, who should probably have been sent off.

Guardiola dragged away players who were berating Lahoz as they left the field at halftime, but his fury with the official was clear, as he repeatedly pointed at his eye and then the penalty area where the incident had taken place. He was banished to the stands in the second half, the first time he has been sent from the touchline in his City career. There’s no telling how the result may have been altered had Sane’s goal been allowed to stand.

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LeBron James Says He'll Ditch Social Media Again for 2018 NBA Playoffs

Tony Dejak/Associated Press

CLEVELAND — In a year that has included team meetings, midseason trades and an ailing head coach, LeBron James has spurned rest and instead suited up for every regular-season game. He’s on track to play all 82 games for the first time in his career, and he’s doing it at a level that has garnered plenty of MVP discussion.

If he is willing to deviate from the plans of seasons past, would he be willing to deviate from his standard postseason routine of unplugging from social media?

No chance, said The King in advance of the Cavs’ final regular-season game against the New York Knicks.

“My focus hasn’t changed,” James told Bleacher Report of this year’s upcoming hiatus. “[The current social media climate] doesn’t matter to me. We all know how this season has been. With our ball club and all the noise that’s either irrelevant or relevant—whatever the case may be—for me, maintaining my focus hasn’t changed.”

In film circles, “Zero Dark Thirty” is an award-winning film that dramatized the decadelong hunt for Osama bin Laden. In NBA circles, a slightly altered term carries an entirely different meaning.

LeBron James@KingJames

Zero Dark Thirty- 23 activated. #StriveForGreatness

“Zero Dark Thirty-23” is code for LeBron James’ annual disengagement from his social media channels. James typically brings notice to this dark period by posting an image that serves as his final moment of connectivity to the social media world. It can be a simple as a tweet and a hashtag, or an elaborate artistic rendering of James melded with a lion’s head. It becomes the subject of television segments and is even the name of a new sneaker.

LeBron James@KingJames

Zero Dark Thirty-23 Activated!! #StriveForGreatness https://t.co/HE6VWEaWB8

When it comes to the playoffs, James’ self-imposed social media blackout is as much about tradition as it is leading a team to the NBA Finals.

But what about this season?

With James’ growing embrace of his platform outside basketball, his social media usage has garnered plenty of headlines this season. He’s used it like a civilian, like when he tweeted about a movie he’s looking forward to watching with his wife. He’s used it to promote a civil rights documentary that he produced. And he’s used it to call the president of the United States a “bum.”

On Twitter, James’ number of followers has ballooned to 41.3 million—the second-most among athletes, trailing only Cristiano Ronaldo. On Instagram, James is followed by 36.4 million users, placing him among the top 40 profiles on the photo-sharing application. With so many people tracking his social media use, it’s easy to see how getting away from it all can actually bring more attention.

Tony Dejak/Associated Press

James, who didn’t use social media publicly until 2010, started his postseason blackouts in 2012, one year after his Miami Heat were eliminated in the NBA Finals by the Dallas Mavericks. James said it was a way for him to block out noise. 

“There’s too much nonsense out there,” he said in 2015, per the Associated Press (h/t USA Today). “Not during this time, this is when I lock in right now, and I don’t need nothing creeping into my mind that don’t need to be there.”

Those who have been able to watch James’ “Zero Dark Thirty-23” period up close speak of his increased focus on and off the court. There is a decrease in levity, his silly Halloween parties being nothing but distant memories. Filling that void is a renewed sense of urgency—a recognition that any series is just four games from being over. 

James says he has changed his sleep patterns this season and that it’s been a boon to his success in his 15th year. But once the playoffs roll through, he’s not just well-rested, he’s laser focused.

“A lot of the smiles are gone,” Cavs head coach Tyronn Lue said. “Coming into practice, he’s a lot more focused. He gets everyone else focused, in the right mindset. … He’s more serious about what’s going on. Throughout the course of the season, 82 games is so long. … You have to enjoy it. But he understands that when it comes to playoff time, this is our bread and butter. We want to win a championship. He becomes a lot more serious.”

Darron Cummings/Associated Press

The blackout is also James’ way to lead his team and live out the behaviors he feels lead to improved results. 

Only three other players remain on the Cavaliers roster that won the NBA Championship in 2016 (Tristan Thompson, Kevin Love and J.R. Smith). This season, the Cavs acquired four players (George Hill, Rodney Hood, Larry Nance Jr. and Jordan Clarkson) who have never been to an NBA Finals, two of whom do not even have playoff experience (Nance and Clarkson).

Nance has heard of James’ blackout period, but only since moving to the Cavaliers from Los Angeles. Though he’s not the most active NBA player on social media, he admits that opening a phone only to mindlessly flip through a feed can be a substantial waste of time.

“It depends how much you care about what people have to say on there,” Nance said. “If you want to find someone saying you’re the greatest player who ever lived, you can find that. If you want to find someone saying you belong in the trash can, you can find that. It all depends how much you pay attention to it. It doesn’t bother me.”

There are plenty of social media users ready to crown James the best player who ever lived, but also no shortage of individuals primed to pounce upon the first hint of anything less. Was he aggressive enough? Did he pass when he should have shot? Does he still have it?

“You have to keep the main thing the main thing,” James said. “In the postseason, you lose one game and it’s the end of the world. You win one game and everyone praises you. When the postseason happens, it’s one game at a time. That’s all that matters. The outside noise doesn’t matter.”

In a matter of days, Zero Dark Thirty-23 will be activated, and that outside noise won’t even exist, at least in the world of LeBron James.

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Xi Pledges a More Open China, Increased Imports and Lower Auto Tariffs

Xi Jinping, speaking at the Boao Forum in China on Tuesday, addressed some of the persistent criticisms leveled at Beijing by the Trump administration.
Photo:

Qilai Shen/Bloomberg News

By

Lingling Wei

• Lingling Wei
  The Wall Street Journal
• Biography
• Lingling.Wei@wsj.com

April 10, 2018 10:09 a.m. ET

29 COMMENTS

BOAO, China—President

Xi Jinping

offered to further open up China’s markets to foreign business, though fell short of proposing the thoroughgoing changes the Trump administration says it is seeking to avert a trade fight.

In a speech Tuesday that Chinese officials billed as packed with major policy initiatives, Mr. Xi promised increased imports, accelerated access to China’s insurance and other financial sectors, greater protections for intellectual property, and lower tariffs and reduced ownership restrictions for foreign car makers.

While Mr. Xi didn’t mention President

Donald Trump

or the trade friction with the U.S. once in his 40-minute speech, his proposals offered an olive branch to Washington, addressing some of the persistent criticisms leveled at Beijing by the Trump administration.

Markets surged following the remarks. The Dow Jones Industrial Average rose 369 points, or 1.5%, to 24348, and the S&P 500 climbed 1.3%.

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Mr. Xi’s initiatives, however, included some previously offered policy changes, left out a definite timetable for action and skirted core complaints by the U.S. about China’s industrial policies that the White House says favor domestic companies and force the transfer of U.S. technology.

Overall, Mr. Xi’s address to political and business leaders attending a government-backed conference signaled that any market opening will be gradual, with Beijing keeping a heavy hand in managing the process.

“While we’re crossing the river by feeling the stones, we’re also strengthening top-level planning,” Mr. Xi told the annual Boao Forum on China’s tropical island province of Hainan.

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Business executives and policy analysts described Mr. Xi’s offers as at best a missed opportunity to tamp down U.S. criticism and at worst likely to be read as the kind of holding action the Trump administration says Beijing has long used to defer substantive concessions.

“This speech was about modestly expanding market access, not constraining industry policy,” said

Scott Kennedy,

a deputy director at the Center for Strategic and International Studies, a Washington think tank. “I expect the Trump administration to criticize the speech as too little, too slow.”

The U.S. has in recent months imposed some limited penalties on imports of Chinese steel, aluminum and other goods and threatened tariffs on $150 billion worth of other Chinese products to reduce a $375 billion trade deficit with China. Beijing has mirrored those actions and threatened stern measure-for-measure retaliation. Prospects for an outright trade war between the world’s largest economies have rattled global markets, and Chinese officials have said in recent days that current tensions and rhetoric preclude negotiations.

Ultimately, Beijing is aiming for a negotiated settlement to the disputes, Chinese officials and analysts said—something that Trump administration say it wants too.

“China has shown its muscle,” said Chen Deming, former Chinese Commerce Minister while attending the Boao Forum. “But at the end of the day, both sides will have to sit down and talk.”

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A question, some analysts said, is whether Mr. Xi’s speech provides any opening—or whether he is taking a hard line to wait out the U.S.

For some analysts and economists inside and outside China, Mr. Xi’s remarks are further proof that when Beijing talks of reform today, it doesn’t mean economic liberalization of the 1980s and 1990s, when the leadership closed legions of state plants, laying off tens of thousands, to prepare for an influx of foreign capital. Rather, reform today means continued fine-tuning of a government-led model.

“President Xi’s remarks do not represent a dramatic departure from existing Chinese policy, but rather a reiteration of the same themes Xi has promoted throughout his tenure,” said Zhu Chaoping, a Shanghai-based global market strategist at J.P. Morgan Asset Management. That means China “will gradually open up at its own pace and in the manner the government believes is most suited for China.”

Mr. Xi is an avowed nationalist, who believes in the Communist Party’s right to rule, according to Chinese officials and analysts. Mr. Xi has sought to bulk up state-run companies and kept China’s internet isolated behind its Great Firewall. He’s cultivated an image through state media as a strong leader who won’t cave in to foreign pressure.

Beijing is increasingly confident in shielding the economy from too big of a shock from a trade fight with the U.S. Chinese officials and government advisers attending the Boao Forum touted the country’s reduced reliance on trade to bolster growth, even though robust overseas orders kept China’s economic expansion on track last year. They also noted that China doesn’t finance much of its investment with foreign debts, which should shield the economy if foreign investors decide to pull out.

“At most, China would suffer some loss of fortune, but not a whole lot,” said Li Yang, chairman of the National Institution for Finance and Development, a Beijing think tank.

Still, President Xi has reasons to prevent an escalation in trade frictions with the U.S. The Trump administration’s threats of trade and investment penalties could affect other Xi priorities. While the Chinese economy roared ahead last year, government efforts to rein in debt, clean up the environment and reduce poverty are dragging on growth.

President Trump has taken particular aim at a central Xi initiative to upgrade China’s manufacturing sector to dominate frontier sectors like biomedicine, clean cars, semiconductors and aerospace. Trump administration officials have said those policies force American companies to transfer technology and allow cyberthieves to obtain proprietary information.

To those criticisms, Mr. Xi’s remarks offered little encouragement beyond much-repeated promises to bolster protections of intellectual property. While the speech touched on the concerns of U.S. companies, Jacob Parker, vice president of China operations at the U.S.-China Business Council, said it “falls short of offering paradigm-shifting announcements on ending joint-venture and licensing requirements that give China leverage to force technology transfer for market access.”

China’s actions so far “have greatly undermined the optimism  of the U.S. business community,” Mr. Parker said. “Ultimately, U.S. industry will be looking for implementation of long-stalled economic reforms.”

Write to Lingling Wei at lingling.wei@wsj.com

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LeBron James, new-look Cavs finding open path to NBA Finals at perfect time

This always seems to happen. 

LeBron James and the Cavs appear to be vulnerable. The questions come. Will they actually miss the NBA Finals this year? Will this force James to consider another team as a free agent? And then everyone remembers that Cleveland plays in the East, and that no team is beating James in a seven-game playoff series.

But if there ever was a year that King James’ reign would come to end, it felt like this would be it.

After early-season drama and a wild trade deadline, the Cavs were left with a young and relatively untested roster. And while several pundits felt that Cleveland’s deadline moves did improve both the short-term and long-term outlook, they were still more vulnerable in the East than they had ever been before, looking to become a cohesive unit with little time left before the playoffs.

Since the complete roster overhaul, Cleveland is 17-9. While the Cavs have looked unstoppable offensively at times, they don’t give off an air of invincibility.

Defensively, they have been an embarrassment, often showing complete indifference to the concept of team defense. (Yes, even LeBron has been guilty plenty of possessions.) The Cavs’ defensive rating (109.5) is the second-worst mark in the league behind only the lowly Suns (110.7). Opponents have regularly torched the Cavs in the paint and on corner 3-pointers, the exact kind of shots modern NBA teams should try to discourage.

The Cavs’ defensive woes and relative inexperience on top of an immense workload for James had many curious to see how the Eastern Conference playoffs would play out.

And then the past week happened.

Irving’s season-ending knee procedure took the team with the best chance to dethrone James out of the equation. Behind the NBA’s top defense and Coach of the Year candidate Brad Stevens, the Celtics could have challenged the Cavs and forced James to use all of his talents. With Irving sidelined, Boston could struggle in the first round against the Bucks, Heat or Wizards.

But what about the Raptors, the East’s top team? Their 59 wins are a product of a much-needed culture reset. Toronto has become much less stagnant on offense, as team assists, 3-point attempts and pace are all up from past years. The Raptors’ bench overhaul has produced one of the best reserve units in the NBA. They have the third-best net rating in the league behind only the Rockets and Warriors. They are solid defensively with switchable players. Kyle Lowry and DeMar DeRozan have also been their usual productive selves.

But we have seen great regular seasons out of the Raptors before. Toronto’s success should not go unnoticed, but unfortunately for the Raptors, they always seem to hit a ceiling. They have been knocked out of the playoffs the past two years by the Cavs, including last season’s decisive sweep in the conference semifinals. 

Hey, what about those “Process” guys in Philadelphia?

The 76ers have won 50 games in a season for the first time in 17 years. They have won more games this season than the past two seasons combined. The Sixers are also gelling at the right time, winning their last 14 games, with the last six victories coming without Joel Embiid in the lineup.

Ben Simmons has been a revelation. The likely Rookie of the Year has been unguardable during Philly’s winning streak, including a 27-15-13 triple-double in an exciting win over Cleveland on Friday.

But the Sixers are incredibly young. The starting unit has a total of 88 playoff games as a team — with all 88 coming from veteran shooting guard J.J. Redick. If Embiid’s injury lingers, that will severely hurt their chances to advance. The Sixers have a bright future ahead, but it is hard to believe that they are ready to beat James in a playoff series.

This year is different by definition. The Cavs aren’t the same team, and in certain areas, they’ve gotten worse. But in a weakened East, it’s hard to bet against James dragging this new group to another NBA Finals.

What they do when they get there is another story. Just don’t expect the path to be all that difficult.

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Strawberries again top 2018's 'Dirty Dozen' fruits and veggies

Every year since 2004, the group— a nonprofit, nonpartisan environmental organization — ranked pesticide contamination in 47 popular fruits and vegetables for its Shopper’s Guide to Pesticides in Produce.

Pesticides include a wide array of chemicals that kill unwanted insects, plants, molds and rodents.

Spinach is the second dirtiest item on the “Dirty Dozen” list, followed by (in order of contamination) nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery, potatoes and sweet bell peppers. Each of these foods tested positive for pesticide residues and contained higher concentrations of pesticides than other produce.

In fact, nearly 70% of conventionally grown — non-organic — produce samples were contaminated, the tests indicated.

The 13th suspect

The shopper’s guide is based on results of tests by the US Department of Agriculture and the Food and Drug Administration on more than 38,800 non-organic samples. The Environmental Working Group looks at six measures of contamination including the average number of pesticides found on samples and the average amount of pesticides found.

When testing samples, the USDA personnel wash or peel produce to mimic consumer practices.

A single sample of strawberries showed 20 pesticides, the report indicated. More than 98% of strawberries, spinach, peaches, nectarines, cherries and apples tested positive for at least one pesticide residue. And, on average, spinach samples had 1.8 times as much pesticide residue by weight than any other crop.

This year, the Dirty Dozen list is actually a “baker’s dozen” and includes a 13th suspect: hot peppers. These were found to be contaminated with insecticides toxic to the human nervous system, according to the organization. Anyone who frequently eats hot peppers should buy organic, it says.

“If you cannot find or afford organic hot peppers, cook them, because pesticide levels typically diminish when food is cooked,” the authors of the report noted.

‘Chronic health implications’

Children are of special concern as younger bodies have greater susceptibility to pesticides than adult bodies, the report emphasizes.

Research “suggests that pesticides may induce chronic health complications in children, including neurodevelopmental or behavioral problems, birth defects, asthma, and cancer,” noted the authors of a 2012 American Academy of Pediatricians report quoted by the Environmental Working Group.

Other studies indicate that a child’s earliest exposure to pesticides — through the mother during pregnancy — may also be harmful.

Consumers who want to eat the dirty dozen fruits and veggies should buy organic, according to the organization.

Rinsing produce under tap water is an effective way to eliminate pesticide residues from produce, according to the Connecticut Agricultural Experiment Station, a government-run scientific group. Scientists there advocate rinsing all fresh produce under tap water for a minimum of 30 seconds before using.

Water is enough, the scientists say, as mild detergents or commercial vegetable washes do not increase the amount of pesticide residues you are able to wash away. However, a recent study from the University of Massachusetts, Amherst, suggests that soaking produce in a solution of baking soda and water is a more effective way to rid fruits and veggies of pesticides.

Tom Stenzel, president and CEO of the United Fresh Produce Association, says consumers should not rely on a shopping guide when deciding which fruits and vegetables to purchase. The industry group represents growers, shippers, fresh-cut processors, wholesalers, distributors and retailers.

“Consumers have more choices now than ever before when it comes to the fruits and vegetables they consume,” Stenzel said.

“Food safety is a top priority for the industry, from field to fork,” he said. “The fresh produce industry seeks to ensure a safe, efficient and timely supply chain, allowing consumers to experience fresh fruits and vegetables at the peak of their performance.”

He encourages consumers to continue educating themselves about food safety and consult the Safe Fruits and Veggies website from the Alliance for Food and Farming, which represents both organic and conventional farmers.

“Empowering consumers with knowledge is key to helping them make healthy choices for their diets and that of their family,” Stenzel said.

‘Clean 15’

On a positive note, the Environmental Working Group also creates a lesser-known companion to the Dirty Dozen: the “Clean 15” guide to produce containing the least amount of pesticides.

Avocados lead 2018’s clean fruits and veggies list, followed by sweet corn, pineapples, cabbage, onions, frozen sweet peas, papayas, asparagus, mangoes, eggplant, honeydew melon, kiwi, cantaloupe, cauliflower and broccoli.

Veggies placed in the top two spots — avocados and sweet corn — both showed pesticides on less than 1% of tested samples, the new report indicated. And more than 80% of pineapples, papayas, asparagus, onions and cabbages tested negative for pesticide residues.

The organization cautions that a small portion of sweet corn, papaya and summer squash sold in the US is produced from genetically modified seeds. It says anyone wanting to avoid genetically modified produce should buy organic varieties of these crops.

Through its healthy eating reminder, MyPlate, the USDA recommends that half your plate be filled with fruits and vegetables.

“Everything you eat and drink matters,” the agency says. “The right mix can help you be healthier now and in the future.”

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Colin Cowherd reacts to Pat Riley saying LeBron James 'did the right thing' by leaving Heat for Cavs

COLIN COWHERD: Pat Riley is writing a new book. He’s actually not writing it– a writer is –but the book’s about him, and he talks, and they take notes, and it’s Pat Riley’s book. That’s how it works. He now acknowledges LeBron, quote, “did the right thing when he left Miami.” Riley is quoted– this is a good one –says, “my beautiful plan all came crashing down suddenly. The team, in 10 years, could have won five, six titles. But I get it. I get the whole chronicle of LeBron’s life. While there may have been some carnage, he did the right thing.”

The book will be called “The Soul of Basketball.” Excited to read it. Every time LeBron leaves, anger, dismay, disloyal, guy’s a bum. And every time he leaves, the team he leaves is inept an hour later.

Of course he should have left Miami. They were old. Dwayne Wade was always hurt; so was Bosh. Think about this. In the last game LeBron played in Miami– think about this, let this soak in –four players on the roster, two starters, never played in the league again. Battier, Birdman, Mike Miller, Ray Allen, Udonis Haslem, old, older, oldest, whatever word is older than oldest.

I would argue the Miami Heat roster, when we look back 100 years from now– I won’t be here, let’s just say 20 –at the weakest dynasties and mini-dynasties ever, the Miami Heat will be the weakest roster to ever dominate the league for four to five years. It will be the weakest.

Think about this. They had no center. There’s never been a team that won titles with no center. It was 6′ 8″ Joel Anthony, who didn’t dominate college. They had no real size at all, to be honest. They were near the last– bottom of the NBA in rebounding.

How about point guard? They had the goofy, completely limited Norris Cole or Mario Chambers– Chalmers, excuse me –take your pick. They were atrocious at point guard. They had no center. They weren’t particularly deep. They had a kid coach, and their two stars, Dwayne Wade and LeBron, were never a perfect fit. LeBron, to some degree, is just a bigger Dwayne Wade.

And LeBron left, and Miami didn’t even make, the following year, the playoffs in the East. LeBron carried this roster. If you compare this roster that LeBron was on in Miami to the Golden State dynasty, it’s not even close. The Golden State dynasty is among the top three or four of all time. Magic’s Lakers, Jordan’s Bulls– I mean, Durant, and Steph, and Klay, and Kerr, and Draymond, and coaching, and system, and defense, and–

The Miami Heat had no center. They had no size. They were weak at point. They were old. In the end, they couldn’t play defense. The two stars never worked, perfectly. And they had a kid coach– who I liked –but he was a kid coach.

We’re always mad at LeBron for leaving. But if you’re an actor, and you leave a movie and it bombs, you were right. If you leave a marriage, and he goes totally sideways, you were right. If you leave a company and it erodes significantly, you were right.

Lebron’s always been right leaving Miami. It was never even arguable. When he left Cleveland the first time, he was right. They were inept. He left Miami– and by the way, Miami is well-run. Mickey Harrison is a top-five owner. Pat Riley is a top-level GM– president. This is a well-run organization, and they couldn’t make the playoffs.

Why do we celebrate mobility in America for everybody except LeBron? It’s OK for baseball players to go. You’re OK with NFL free agency– Ndamukong Suh’s on another team, yeah! Marcus Peters, another team, yeah! LeBron leaves, an old, beaten down mess. Boo, that guy’s the worst. MLS celebrates stars coming over to Los Angeles from teams in Europe. We celebrate Silicon Valley youth– young, growing, evolving, ideas. We celebrate mobility everywhere in the world except LeBron.

And now, Pat Riley admitting, like Dan Gilbert, who got on his knees to get LeBron back admitted, LeBron was right both times.

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