Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, April 26, 2017

Empowering and Harnessing the Power of the Immune System

"To actually do these trials is extremely expensive and we can only rely on [government] grants for so long. We've come to the point where we need to attract money from outside investors."
"In mice, when we combine these two viruses and pembrolizumab [Keytruda], it's really very striking. We get mice with extremely advanced cancer ... and we can rescue essentially all of them."
Dr. John Bell, senior scientist, The Ottawa Hospital, Turnstone founder
Dr. John Bell poses for a photo in his lab at the Ottawa Hospital 
Research Institute Wednesday July 13, 2016. Tony Caldwell / Postmedia
"Metastatic lung cancer is a very serious cancer -- and the people who have progressed after a first chemotherapy [round] are often pretty sick."
"So anything that can prolong life, and improve the quality of life for these people [suffering from metastasized lung cancer], is important." 
"In recent years, immunotherapy has shown great promise in treating certain kinds of cancer, but we’re still at the early stages of understanding and optimizing this approach. We hope that this new combination of immunotherapies will make a difference for people with lung cancer."
Dr. Garth Nicholas, oncologist, The Ottawa Hospital

"I thought I might have pneumonia [of her troubling symptoms, before the diagnosis of metastasized lung cancer]."
"It's wonderful [the immunotherapy drug protocol]. I've been very fortunate: Immunotherapy is a new era of cancer treatment, but it's not working for everyone. There's more work to be done."
Andrea Redway, 47, Stage 4 lung cancer patient


Lung cancer qualifies for the dread recognition of representing the most commonly diagnosed cancer in Canada, killing greater numbers of people in the country than any other form of cancer. An estimated 20,800 Canadians died of lung cancer last year alone; a greater total number than those who succumbed to breast, prostate and colon cancers combined.

The Ottawa Hospital has launched an initiative to use a new treatment protocol called immunotherapy through a new clinical trial where fifty-five patients from Ottawa, Hamilton and Toronto will be treated with three immunotherapy agents. The combination of two viruses along with an immunotherapy drug meant to charge up the body's immune system is the goal; to direct a patient's personal immune system to battle the cancer cells afflicting the body.

The "combination therapy", is a new approach deploying a mix of agents to accelerate and give greater strength to the response of the body's immune system to the presence of cancer cells. The three immunotherapy agents are represented by an oncolytic virus AdMA3, (engineered using a common cold virus); a modified version of the Maraba virus (extracted from Brazilian sandflies); and pembrolizumab (trade name Keytruda) which is a checkpoint inhibitor.

Eligible patients must be seen to be resistant to chemotherapy to battle their advanced cancer, spread from the lungs to other bodily areas. In a new direction for Canada, the trial is being funded in large part by a private Ottawa biotech company, Turnstone Biologics. Last year $41-million in venture capital came its way. Scientists in Canada generally must rely on government agencies for the funding of human clinical trials.
Jeanette Edl receives immunotherapy treatment at Princess Margaret Cancer Centre in Toronto.
Jeanette Edl receives immunotherapy treatment at Princess Margaret Cancer Centre in Toronto.
16x9/Global News

In Andrea Redway's experience, with her diagnosis of lung cancer in 2015, it came as a complete surprise. She had never smoked in her life, and nor had roughly fifteen percent of others diagnosed with lung cancer. The chemotherapy, radiation and surgery meant to halt the spread of the disease all failed. She was in rapid decline when she began taking Opdivo. The immunotherapy drug succeeded in eliminating the cancer outside of her lungs, and shrank her original tumour less than half its size at diagnosis.

Both Opdivo and Keytruda function through blocking PD-1, a protein that tumours use to bypass detection of their presence by the body's immune system. Lab research suggesting the benefits of Opdivo and Keytrudawould be useful once the immune system is primed by viruses stimulating an immune response to the presence of cancer cells, propelled the new clinical trial.


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Tuesday, April 25, 2017

The Developing Brain and Opioids

"Many of the young adults that I see are actively seeking fentanyl over heroin. One 17-year-old girl had received a large dispense of oxycodone from her surgeon for pain following cosmetic surgery. She began refilling it every two weeks, saying she had ongoing pain, but confided that she was really using it for sleep and to share with her friends to get high. She was cut off by her doctor after about a month, then developed opioid withdrawal and ended up buying it on the street."
"Over time oxycodone became too expensive, so she turned to cheaper heroin and fentanyl."
Rashmi Chadha, addictions physician, Vancouver Coastal Health

"Simply put, the teen brain is not the adult brain. Through adolescence into the mid-20s, our brain gradually strengthens our ability to self-reflect, organize toward goals, plan out steps toward those goals, and perhaps more importantly, inhibit impulses that aren't the wisest and regulate emotions -- basically, things we would associate with a mature adult."
"I talk to parents all the time and say, 'You still need to be [your teens'] prefrontal cortex during this time'."
Sion Harris, co-director, Center for Adolescent Substance Abuse Research, Boston Children's Hospital
"While there are no published neuro-imaging studies on fentanyl and the teen brain, we can see from research on oxycodone that these opioids decrease the connectivity in the pre-frontal cortex and alter the thickness of the cortex."
Dr. Marisa Silveri, professor of psychiatry, neuroscientist, Harvard Medical School

"We know that fentanyl binds very tightly to the opioid receptor and it permeates the blood-brain barrier quickly. All this translates to a small dose of the drug having a huge effect. Essentially, you would need 40 to 50 times more heroin to get the same effect."
Hakique Virano, public health and addictions medicine specialist, University of Alberta
"[U.S.] studies of teens show a decline in experimenting with opioids, but an increase in the risk of overdose, which in part may be due to fentanyl making its way into the drug supply."
"In my practice it's common to have a 15- or 16-year-old with opioid addiction tell me they remember having a different experience with codeine in cough syrup when they were a child, that they could feel it affected them more than [it would] other kids."
"Those of us who are pediatric addiction specialists know that one of the most important things we can do is intervene quickly when early signs of addiction are present."
"Rather than jumping in and asking a teen directly whether they've used substances, it may be easier for parents to start the conversation by first asking what they are seeing in school among their peers -- that gives a sense of their risk environment, and is a nice opener to a discussion in which a parent can then find out whether their teen has used substances."
Scott Hadland, specialist, adolescent and addiction medicine, Boston Medical Center 


The Canadian Institute for Health Information reported last November that Canadian youth between the ages of 15 to 24 were responsible for a 62 percent increase in hospitalizations since 2007, related to opioid use, establishing that this age group represented the fastest increase in opioid use and addiction in the country. The Ontario Drug Policy Research Network reported more recently that fentanyl-related deaths in the province in all age groups has seen a whopping increase of 548 percent  from 2006 to 2015.

And a report issued in 2014, from the Centre for Addiction and Mental Health, released the data that ten percent of Ontario students in Grades 7 to 12 self-reported the use of prescription opioids for non-medical reasons on at least one occasion during the year previous, while four percent reported having used these drugs on six occasions or more, in the past year. Numbers that are suspected to represent underestimations.

"It is more difficult for teachers and parents to detect opioid use as compared to the use of alcohol or marijuana so we are relying more heavily on self-report", explained the study's co-author. The 2014 study failed to ask specifically about fentanyl, but this year's survey, underway currently, does. Statistics out of British Columbia are particularly troubling, with 12 overdose deaths from illicit drug use among 14 to 18-year-olds last year, according to the B.C. Coroners Service; half of which were confirmed to be fentanyl-related.
File/ Hand Out/Edmonton Sun/Postmedia
A bag of Fentanyl pills -- Edmonton Sun/Postmedia

The period identified as adolescent-young adult, biologically represents a key transition for the brain where "neurons" (brain cells) undergo pruning, a process where some connections are retained while others are abandoned. The volume of white matter increases, becoming increasingly organized, and grey matter - cell bodies themselves -- decreases.  The prefrontal cortex development represents the most significant change in the teen brain, involving that part of the brain tasked with executive functioning: "higher order" functions such as decision-making.

Not fully developed until past age 25, the prefrontal cortex functions to override impulsivity in risk-taking. So while adolescents are undergoing a still-developing prefrontal cortex, it is at a stage where it can facilitate drug-seeking behaviour, enabling the drug to alter the development of this area of the brain's function. Powerfully addictive opioids, particularly fentanyl, act on special opioid receptors in the brain; the strength of the opioid depending on how swiftly it reaches the brain through the blood and  how tightly it binds to the opioid receptor regulating the reward pathway of the brain.

The more powerful version of fentanyl, carfentanil, is being distributed now, binding even more tightly to the opioid receptors, reaching the brain far more rapidly than its weaker cousin fentanyl. Fair Vassoler, a neuroscientist at Tufts University who studies the effects of opioids on rats advises: "We have to remember that our bodies make opioids -- the 'feel-good endorphins' from pleasurable activities for instance. They help us deal with stress, and bind to these receptors we have in the brain. These external drugs can alter that."

When an overdose occurs, pinpoint pupils occur, the victim becomes unconscious and breathing stops (respiratory depression); the typical, feared and powerful "opioid overdose triad". 

Image of the brain's reward circuit.Image by NIDA The brain's reward circuit



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Monday, April 24, 2017

Children With Heart Defects

"The hardest part was coming to terms with the news that our baby would be born with significant challenges and not just get to be a baby. It's a time when you want to be decorating a nursery and celebrating his life but instead you have even more uncertainties and fears than most first time parents have. You ride a rollercoaster of emotions. But you just find something within you that makes you go on."
"It was a week before we could hold him. When they gave him to us for the first time in NICU we all cried, even the nurses. I’ll never take any of the ‘normal’ baby moments for granted." 
"When he's four or five he will have a second open heart surgery, and subsequent surgeries every five to ten years as he grows to replace his pulmonary valve. Our hope is that technology advances to the point he never has to have it again."
"He [the anaesthetist, pre-surgery] started humming a lullaby to Logan. That was the only thing that willed our feet to move. They understood he was a baby and we knew he was in good hands."
Heather Irvine, mother of newborn Logan

"One second you’re there for an ultrasound, the next they’re showing you pictograms of the heart and talking about surgery. It’s like being hit in the gut again and again. It’s become an infatuation with how the human body works [immersing himself in learning about cardiology."
"It was amazing what they had to do to get the heart to pump effectively without being over or under worked. Think of it like plumbing. They installed a shunt to bypass the artery and get blood going to the lungs."
Graham Irvine, Logan's fatherRelated image
Congenital heart disease (CHD) is a condition that affects one in every one hundred newborn babies in Ontario, representing about 1,440 children born with this condition on an annual basis. Babies born with the condition have a defect in the structure of their hearts, some of which defects can be minor not requiring treatment, while other defects are quite complex and require surgery. These are serious conditions which, without remedial surgery, threaten a baby's very existence.

During the 1960s only roughly half of those children born with CHD were able to live to adulthood. Since that dismal time, research has enabled surgeons to make great advances forward in the treatment of these tiny patients. Now, the vast majority of CHD patients -- those with complex problems certainly included -- survive into adulthood and beyond. Greater attention is now being focused on quality of life for the growing population of adult survivors of CHD. 

The Children's Hospital of Eastern Ontario has instituted a "fearless" trial project whose purpose is to encourage various types of physical activity which CHD children can be involved in without risking concerns over damage to their hearts. "Fearless Physical Activity" events are being planned across the province for 2017. The first such event in the series is to be held in a number of locations, introducing children to Tai Chi lessons.

Adeline Mahoney plays with some toys with her mother Sandra at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa Wednesday April 19, 2017. Adeline has congenital heart disease and is taking part of a two-year clinical trial called "Fearless Physical Activity." Tony Caldwell Tony Caldwell / Postmedia
One family whose newborn Adeline, was diagnosed with a combination of heart defects three years earlier, was cautioned they were not to allow their infant daughter to cry because, according to her doctors, the exertion could result in muscles in Adeline's chest contracting, thus exacerbating her heart condition, restricting the amount of oxygen carried in her blood. Adeline's mother recalls those first eight months after her daughter's birth as beyond difficult and worrying, when Adeline's mouth and feet often turned blue from a lack of oxygen.

Adeline's mother would immediately begin breastfeeding her baby every time the little girl evinced signs of any agitation. "We treated her like a newborn for eight months" she recalls, of those early times in her daughter's life. And then, when she was eight months old, Adeline underwent open-heart surgery to correct no fewer than four heart defects related to the rare condition named Tetralogy of Fallot. Two years following the baby's surgery, her mother must adjust to trusting that her active little girl is sufficiently robust to play and exercise just as any other preschooler would.

"I don't worry so much now because I've learned about her condition, and I've talked to the cardiologist a lot to make sure she can do everything." 'Everything' relates to the two-year clinical study mother and child are involved with, which the Children's Hospital of Eastern Ontario and the Canadian Congenital Heart Alliance recently launched, named Fearless Physical Activity. The idea being to encourage youngsters with congenital heart disease to become involved in normal physical actions, allaying parental fears.

The plan is for researchers to follow the families involved to document and fully understand whether the program will end up as hoped, resulting in the kind of enduring benefits that cardiologists trust will be the case. "The goal is to show families that there are very few cardiac patients who are actually limited from activity -- very few", assured Dr. Lillian Lai, a CHEO pediatric cardiologist, one of the principal investigators of the new study.

  

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Sunday, April 23, 2017

The Looted Gift That Keeps On Giving

"She grew up in the very rural South during the era of segregation. She was descended from slaves who had worked this tobacco plantation that eventually she came to own a piece of."
"She was sort of like this uber-mother. She just took care of everyone; her kids, her cousins' kids, the neighbours' kids. If you didn't have a girlfriend, she'd find you one; if you didn't have a place to stay, you slept on a mattress in her hallway."
"They [the Lacks family] talk about that [scientific advances HeLa cells have supported], how they feel it's so important for scientists to really learn the story of Henrietta and her family and the impact  this had on them. They hope that in the future other people don't have to have the same experiences."
"Nothing like this ever happened where either research participants or tissue donors are part of the process. [The family] wanted this genome to help the world, but also basically wanted this whole [lack of consent] process to stop with this generation."
"They went in and they took these samples and it was totally standard at the time. They were taking samples from really anybody they could get their hands on. We didn't even have the term 'informed consent' [until recently]."
Rebecca Skloot, writer, author: The Immortal Life of Henrietta Lacks

Henrietta and David Lacks
Henrietta Lacks' cells were essential in developing the polio vaccine and were used in scientific landmarks such as cloning, gene mapping and in vitro fertilization. (Courtesy of the Lacks family)


"Pretty much every university, every hospital research lab has these cells [the legacy cells named HeLa after Henrietta Lacks]." 
". . . Normally cells will divide only a certain number of times, even under the best conditions, and then they'll stop."
"Immortalized cells will just divide and divide and divide and they don't tend to be contact-inhibited. They'll pile up on top of each other and they also grow indefinitely."
Dr. Jim Woodgett, biochemist, director, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto

"If Henrietta Lacks were to walk into John Hopkins today and get her cervical cancer biopsied [for research] ... they would need to get her consent prior to doing that."
Dr. Michael Szego, acting director, Centre for Clinical Ethics, St.Michael's Hospital, Toronto
These very special cells named 'immortal' in recognition of their special ability to forever divide, giving scientists and research the upper hand through an endless source of biological cells, have given immeasurable assistance to science and medicine for the past sixty-six years. Because they are plentiful and reliable, they comprise a kind of even playing field whereby scientists anywhere in the world can begin their scientific medical process of enquiry with the very same platform, enabling replication of successful formulae and findings.

And all this endless supply of biological cells used as a basis for scientific enquiry and work can be traced to one single individual. She had never been informed that her cells had been casually harvested, much less a request made for her permission, nor had anyone in her family. Those thriving cells with their unique properties whose duplication is ongoing, favouring science and strides in medicine were named HeLa cells to distinguish them as having been sourced from Henrietta Lacks, who died at age 30, a mother of five young children, from cervical cancer.

She was being treated at the Johns Hopkins Hospital in Baltimore, a poor African American woman whose husband was a tobacco farmer from Virginia, when a biopsy was taken of her cancerous tumour as was common practise at the time, to be used for human tissue research. And then they were recognized as biomedical tools of semi-miraculous provenance. Henrietta Lacks died of her cancer, but the cells that hosted the cancer that killed her now serve the biomedical research community universally.
2-polio-vaccine-injection_000043628986_Small

The Involvement Of HeLa Cells Helped To Create The Polio Vaccine

Dr. Jonah Salk's polio vaccine of the early 1950s owe their success to those HeLa cells, as do likewise countless drugs and research advances valued in billions of dollars, over the years that followed her death. Once it became publicly known that this woman who died of cancer unknowingly and without her permission has provided the wherewithal for biomedical research to proceed, the issue of ethics and compensation entered the picture, a hugely controversial subject.  One woman's cellular immortality had an enormous impact on worldwide medical research.

HeLa cells have been used for a wide variety of purposes; to grow viruses for vaccine development, to study cancer, AIDS and cell division as well as to test radiation effects and poisons on human tissues. Normal cells will grow in a laboratory Petri dish until they touch one another, which signals them somehow to stop growing; the contact inhibiting further growth. To persuade them to grow again they must be separated, but even then their growth becomes limited and eventually stops, whereas 'immortalized cells', an extreme rarity, go on forever.

Henrietta Lacks died in 1951, and in 1973 researchers contacted her family to hope to persuade them to take part in studies, the purpose of which was initially puzzling to them, since they had no idea that wife and mother Henrietta Lacks's cells had been purloined for use among the international medical research community. Some family members were appalled and resentful that consent was never sought nor given. The fact that this was a poor family eking out a living on the land, while their family member's cells had generated billions of dollars in profits was infuriating.

A public outcry arose, and those in the medical community responded with their own shame at the neglect of this woman's contribution to medical science. Two of Henrietta Lacke's descendants now sit on a U.S. National Institutes of Health board whose purpose is to determine who will be given clearance to use her genetic information as well as for what purposes. As Dr. Szego of St.Michael's Hospital points out, no tissues of genetic anomalies used in research today can be used without a patient's consent, nor can it be labelled with identifying data.

Even so, cells or other biological materials taken through routine surgical treatments; an artery snipped out in heart surgery as an example; are thought of in the light of medical waste and thus conventionally can be used with conscience in laboratories, without the approval of the patients from whom they have been taken, according to Dr. Szego.

6-hela-cells
HeLa cells -- Photo credit: National Institutes of Health

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Saturday, April 22, 2017

So, You're a Vegetarian?

"Eating vegetarian is like the new Prius [Toyota's hybrid vehicle]. You're telling the world the kind of individual you are, the personal brand."
"We all do those things [publicly show how different we are from others]."
"The key message here is that there is no magic to the [vegetarian] diet."
"They're [vegetarians] probably thinking about what they're eating more than the rest of us. And, probably most important, they're eating more fruits and vegetables."
Dr. Timothy Caulfield, University of Alberta, Canada Research Chair in health law and policy

"[Meat eaters evaluate vegetarian and vegans] equivalently or more negatively than several common prejudice target groups [more negatively than nutritional 'out-groups']. Strikingly, only drug addicts were evaluated more negatively than vegetarians and vegans."
Calgary University/Brock University research paper, 2015

"It's important to note that the news [that there is no life-expectancy advantage for vegetarians over non-vegetarians] is not that bad for vegetarians -- they basically have much healthier lifestyle behaviours than non-vegetarians."
Seema Mihrshahi, senior research fellow, University of Sydney
Getty Images
Organic farm vegetables : Getty Images
Another fond myth dashed by scientific scrutiny. Not that people who eschew eating any kind of meat are not admirable for their forbearance in denying themselves the taste of animal flesh, in favour of respecting the life of other animals on this planet. But for those who believe that bypassing any animal product in their daily diet they will be prolonging their own lives as a result, in the belief that refusing to eat meat is healthier and will be a guarantor of greater longevity, new research findings will come as a disappointment.

Perhaps those who feel vegans and vegetarians are out of their mind, and that the new findings validate their own beliefs should not too hastily celebrate their own wise choices, since there are other dietary elements and lifestyle habits that more frequently accompany the kind of diet that accepts all forms of nutritional edibles. Which is to say, people dedicated to a more casual and 'normal' eating style also find no fault all too often in accepting pre-packaged and processed foods whose nutritional and caloric-dense properties are absent the basic characteristics of good nutrition.

The study, appearing in the journal Preventive Medicine, began by tracking close to 240,000 adults from age 45 and older in New South Wales. It discovered by examining all indices pertinent to the study that no differences of any significance could be isolated between a normal, meat-eating diet and a vegetarian-type diet to account for a difference in mortality between the two. The likelihood of dying was not advanced for those with a complete, semi- or pesco- vegetarian diet and regular meat eaters, as well.

An emerging body of evidence supports the reality that vegetarian diets will not reduce the risk of premature death, despite that vegetarianism has reached a cultural-social trend in the West.  And omnivores who already view vegetarians as morally righteous will now, with the release of this new finding, only have their views strengthened. In that 2015 paper, points out co-author Dr. Gordon Hodgson, professor at Brock U's department of psychology, "we show that vegetarians FEEL negative social pressure from meat eaters".

Which in a sense seems fair enough, since vegetarians often place deliberate pressure on meat eaters by launching efforts to inform the public of the cruel practises involved in preparing farmed animals for slaughter to be placed on the dinner table. This appeal to conscience, while formed on an informed and true platform, becomes evangelized in the effort to convince meat-eaters that to continue their dedication to meat on the table directly consigns innocent animals to a miserable life and a wretchedly violent death.

A '45 and Up Study' formed the basis for the Australian study which has been described as the largest such study relating to healthy aging ever undertaken in the Southern Hemisphere, with its analysis based on 243,096 men and women with a mean age of 62.  Taking into account smoking, obesity and underlying diseases like cancer, hypertension and heart disease, no evidence that any of the variations of vegetarian diets protected from early death was discovered by the researchers.

It was pointed out however, that vegetarians were less likely to indulge in excessive smoking, drinking, let alone eating to excess, resulting in being overweight or obese. As well, they were less likely to report problems with heart disease or cancer, when the study commenced. And diets which emphasize fruits and vegetables have certainly been linked to lowering the risks of heart disease and other illnesses.
Vegetarians are less likely to be obese.   www.shutterstock.com

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Friday, April 21, 2017

Underwater Cave Exploration Dilemma

"In the end, I thought they wouldn't find me because Guillem couldn't get out."
"He didn't know the caves well and I was scared he would end up without air."
"We are used to being alone, but to stay in a pocket without being able to leave and nobody finding you is a diver's worst nightmare."
"[The water was] brackish, but quite sweet."
Xisco Gracia, speleologist, Spain

"I think they made the right decisions and that's why [Gracia] is still with us."
"They could have tried to stretch out the remaining oxygen [between them], but surely that would have been suicide and they would have both died."
Enrique Ballesteros, civil police underwater task force
Divers spent days looking for the man

People can get lost or trapped in the most desolate, isolated places on Earth, brought there by their immense sense of curiosity, of scientific enquiry, or simply the adventure inherent in reaching those inhospitable places where nature never really intended people to inveigle themselves, and where to survive the elements and the geology represents a feat of impossible endurance. There are vast, empty deserts and impossible heights of the world's tallest mountains, underground caves that beckon spelunkers, as well as great white frozen wastes of permafrost-covered land -- and there also are underwater caves.

It was underwater caverns with their labyrinthine tunnels that the power of water on rock has etched out over the vast space of time and erosion, that motivated Professor Xisco Gracia, an experienced speleologist and his friend and diving partner Guillem Mascaro, to indulge their curiosity. These underwater caves were discovered in the 1800s, with their three kilometers of tunnels, not all of which, given their remoteness and difficulty in approaching, have been explored. An irresistible lure for a specializing scientist.

And while it is perfectly true that such resolute, enquiring minds are prepared to take great risks to fulfill their search for answers to the great mysteries of life and the natural world, none among them deliberately gamble with risks that might turn out to be inimical to the continuation of their lives. Yet this is just what happened to the pair, 40 metres underground, researching the undersea topography of the Cova de sa Piqueta in Manacor, Spain, when they were jolted by the realization that their guide wire had snapped.

A swift response to attempt to fix the guide wire took so much time that their oxygen store had been almost depleted. Insufficient oxygen to allow both men to return to the surface became their existential dilemma. Leading them to make a choice. And that decision was made by 55-year-old Dr. Gracia who urged his partner to return to the surface with the use of the remaining oxygen and he would himself await his eventual return with a rescue team. Dr. Gracia assured his friend that he would survive by remaining in a cavity in the cave that had an air pocket.

Little did they both realize at the time the decision was made that the one left behind would be stranded for fully 60 hours, unable to move from the place where some oxygen was available to  keep him alive. Without food to sustain him, Dr. Gracia drank from a thin spread of murky water. But the air that he was breathing was heavily laced with carbon dioxide, which weakened him, affected his brain, resulting in hallucinations and the loss of much of his executive function. After awhile Dr. Gracia was convinced that his diving partner hadn't reached the surface.

He had been unable to sleep since the poor air quality and extreme humidity bore heavily on him. All he could do was remain, uncomfortable and wet, in the pocket of the cave. When hypothermia threatened, Dr. Garcia clambered over nearby jagged rocks to a site close to the thin water pool which provided him with potable water. And in that place no light, only darkness prevailed. He had flashlights, using them when he had to source the water. And he resigned himself to the inevitable, that he would never be found, and there his life would end, just where he was.



Yet, his friend had not been lost, he had reached the surface and alerted authorities who prepared to mount a rescue operation by the civil police. However, rescue divers, despite being armed with precise instructions provided by Mr. Mascaro where they would find Dr. Gracia, were held back by conditions that turned the water opaque, making vision extremely difficult; if they were unable to see where they were swimming they placed themselves in a situation where they would themselves become lost inside the labyrinth of tunnels.

A few days later they managed to reach the cave and thought they knew where Dr. Gracia was.

They drilled into the cave wall hoping to deliver oxygen and food to Dr. Gracia, before discovering they hadn't found him after all. But from the cavity where Dr. Garcia was located, he felt he could hear faint sounds and that raised his expectations and his hope for rescue. The sounds stopped echoing through the cave walls when the divers realized they were not in the right place for a rescue, leaving Dr. Garcia deflated and resigned, that if a search had been underway, it had also been called off and he was now, once again, and finally, on his own.

Visibility improved, however, and the 60 people and more that comprised the rescue team waited another 15 hours, then set out again. Two divers finally discovered where Dr. Gracia was -- locating him 900 metres from the entrance of the cave.To return to the surface Dr. Gracia had no option but to swim for an hour and a half, through his exhaustion, but the canister oxygen the rescuers had brought along had the effect of "charging the batteries", enabling him to forge ahead.

The video that the civil police took shows the rescue team pulling Dr. Gracia from the depths of the cave he was trapped in, back to the surface. At that point, the rescued man was able to walk independently on his own two feet around midnight, when the surface had been reached. A short hospital stay ensued, during which Dr. Gracia's condition was diagnosed as fit and well recovered from his ordeal.

Xisco Gracia was rescued

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Thursday, April 20, 2017

Civilizing Rural Pakistan

"Back home, you have to go anywhere with your father, mother or brother, because you are a girl."
"We are really proud. We follow her [Nobel Laureate Malala Yousafzai] and we will follow her in the future."
"In some areas, [of Swat, Pakistan] girls and boys are now even being taught in the same classroom."
"However we can help [by returning to Pakistan], we will."
Shazia Ramzan, 19, Pakistani woman studying in the United Kingdom

"If I'm wearing jeans and my friends [in Pakistan] see pictures online, they say: 'You forgot your culture'."
"Before [prior to being educated in the United Kingdom], my mind was closed. I thought education just related to my family. But now I think about all girls. I want to stand up for them."
"I believe I should go back to my country and try to make change there."
Kainat Riaz, 19, Pakistani woman studying in the United Kingdom
Malala Yousafzai (centre) with Kainat Riaz (left) and Shazia Ramzan, pictured in 2013. Picture: Jane Barlow
    Malala Yousafzai with Kainat Riaz (left) and Shazia Ramzan (right) in 2012. Photo by Jane Barlow

The two young women now studying abroad were 14 (Shazia) and 15 (Kainat) when they became victims of an infamous attack by Pakistani Taliban against young girls living in the Swat Valley who claimed an education for themselves. They were seated alongside their friend, 15-year-old Malala Yousafzai, when the encounter took place: "The Taliban stopped us, two boys -- or men. One was in the front and the other one came to the back (of the bus).

"He said: Who is Malala? [We had our faces covered (with niqabs) but Malala didn't. We were looking at him and then he shot Malala in the forehead. He shot me on my hand and shoulder, and Kainat's shoulder as well. Then he started shooting randomly", explained Shazia. The girls had been in fact, returning from a chemistry exam and the bus they were in was actually a converted truck, the girls sitting among others, on benches, when their attackers stopped the truck and entered it, searching for Malala.

Malala had gained a reputation for herself as a campaigner for girls' right to an education. She had deliberately made a target of herself by speaking up in an interview on Pakistani television, and by expressing her determination to become educated in an online blog posting, where she also emphasized that girls had a right to an education. Kainat went to a local hospital, and Shazia was treated in Peshawar, in a military hospital which hadn't the wherewithal to treat Malala.

Her injuries were too seriously life-threatening and too complicated and she was flown to the United Kingdom where surgeons there saved her life. The infamy of the attack spread like wildfire around the world, and focused on the plight particularly of Malala. Though other girls were in a similar position to Malala's own, it was she who had brought attention to herself through her public proclamations of dissent and defiance, supported by her father.

When Kainat and Shazia returned home to the Swat Valley after their recovery, the locals viewed them as unwelcome. Neighbours informed Kainat's family they should leave; her presence endangered the rest of the villagers because she had become a target for the Taliban. Neither bus nor taxi drivers would take her to school.The shooting of the girls took place in October of 2012, but by July of 2013 when Malala turned 16, she was invited to address the United Nations to deliver her message.

Offers came flooding in to her from prestigious schools eager to grant her the education she sought, at no charge to her family. Malala settled with her family in Birmingham, England and was enrolled at the private Edgbaston High School for Girls. Mindful of her two injured friends, she asked the international boarding school UWC Atlantic College in the Vale of Glamorgan which had extended an invitation to her which she declined for herself, if her friends could be offered the same opportunity.

And this is how Shazia and Kainat were recognized with full scholarships (paid attendance for a two-year period amounts to $100,000). Former British Prime Minister Gordon Brown, at that time a UN special envoy on global education, helped the girls procure visas. The girls settled in to study at Atlantic College, accustoming themselves to their newfound freedom to go wherever they wished, along with the pleasure of learning to swim.

Malala is now expected to go on to study at Oxford University. Both Shazia and Kainat have been given offers to study nursing at Edinburgh University, with mentor Gordon Brown assisting in finding the required funding. They both plan, on graduation, to return to their country of birth, to do what they can to ensure that all girls and young women have the opportunity to receive an education, and to never have to face the dread situation that they had encountered.
Malala's friends Kainat Riaz and Shazia Ramzan were also shot by the Taliban
Malala's friends Shazia Ramzan (left) and Kainat Riaz (right) were also shot by the Taliban Credit:  JAY WILLIAMS

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