Ruminations

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

Tuesday, February 28, 2017

Disease Super-Conductors

"It's similar to looking at a blood spatter pattern and figuring out where the shooter was standing."
"Superspreading was more important in driving the [Ebola] epidemic than we realized."
"[Public health authorities should think about] What are the scenarios where superspreading might occur [in future epidemics to help in protocols leading to outbreak controls]."
Benjamin Dalziel, assistant professor, population biology, Oregon State University
Monrovia, Liberia, was hit hard during the 2014-2015 Ebola epidemic in West Africa. (Zoom Dosso/AFP via Getty Images)

Random contamination within a community is one thing that nature has designed where infectious diseases become epidemic in nature. Another, apparently, is to nominate individuals through their biological genetic inheritance as carriers of infection, people who, through no fault of their own and unbeknownst to themselves actually are involved in spreading infection on a wide scale. These people have been labelled "superspreaders".

This minority of people whom science recognizes have been vectors whose presence spells a large-scale increase of the number of people whom morbidly infectious diseases strike, thus spreading the reach of the disease much beyond any other process is capable of doing through the process of contamination and infection. Scientists engrossed in a study to comprehend how it was that Ebola spread so rapidly in the 2014 -- 2015 epidemic in West Africa, concluded.

New research has led to the discovery that a large role was held by superspreaders; findings recently published in the Proceedings of the National Academy of Science. Now, it is understood that had there been control of superspreading, close to two-thirds of the resulting infections could have been avoided, according to scientists. Obviously, candidates for superspreading would have had to be identified and isolated from vulnerable populations.

Over 28,000 confirmed, probable and suspected instances of Ebola had been reported during the outbreak in West Africa, resulting in over 11,000 deaths, according to the World Health Organization. That is a huge mortality percentage for any infectious disease, explaining more than adequately just why the medical community worldwide was on such tenterhooks and local health authorities felt helpless until the Ebola epidemic was well in hand.

A retrospective analysis of the timing and location of 200 community burials, taking place between October 2014 and March 2015 in urban areas around Freetown, Sierra Leone was undertaken by researchers from Princeton University and Oregon State University. With the use of a mathematical model the transmission network was reconstructed to determine the proportion of cases caused by superspreaders.
A dead body being carried on a stretcher by nurses in protective clothing
Getty Images -- a dead body carried on a stretcher by nurses wearing protective clothing

The estimate was that roughly three percent of infected people had been responsible for the infection of around 61 percent of resulting cases. That pattern was detected as well in Guinea and Liberia which, aside from Sierra Leone, represented the three countries hardest hit by Ebola. Children under age 15, or adults between the ages of 40 and 55 were those identified as within the superspreader community who spread the disease in their communities.

From the communities those who were first infected went to treatment centres and there transmission was under much improved control. And it was not only Ebola where superspreaders were seen to have played a major role in transmission of infection, but in the 2002 - 2003 outbreak of severe acute respiratory syndrome (SARS), one of the features of the outbreak was its transmission by superspreaders.

To the extent that in Hong Kong, a 26-year-old patient who had been admitted for treatment to a hospital, himself infected another 156 people, that number inclusive of hospital staff, patients and visitors.

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Monday, February 27, 2017

Lavatory Waste: Adding Insult to Injury

"It was like an explosion. It sounded like all the dishes, pots and pans had come crashing out of the cupboard, but it was ice."
"We wouldn't be here today if that ever hit us [the grapefruit-sized chunks of ice that crashed through her house roof]."
"I usually have a bath every night, but last night I didn't -- I didn't want to be the woman found dead in her bathtub."
"It's probably the same as getting struck by lightning. We're leery now, but we're alive and that's the main thing. It's very dangerous those planes going over, but there's not much we can do."
Therese Couch, Calgary resident

"We are in the process of inspecting the aircraft to determine the cause of this incident."
"This is a most unfortunate incident for the family whose home was damaged, and we will be reaching out to pay for all necessary repairs to their home."
Lauren Stewart, spokeswoman, WestJet
Daylight is visible through a hole in the roof of the Ottawa home of Stephanie Moore's mother.
Daylight is visible through a hole in the roof of an Ottawa home penetrated by a 'bomb' of "blue ice" (Supplied) CBC

Theresa and Richard Couch of Calgary have the misfortune to own a home in the southwest neighbourhood of the city where they have lived for 42 years. In all those years they have lived with the annoying sound of aircraft passing over their homes, a constant background sound. Because their home sits directly beneath the flight path where planes landing or taking off at the Calgary International Airport fly.

A peculiar phenomenon is known to take place randomly and infrequently, when 'blue ice' falls from a passing plane to the ground below. And sometimes that ice falls through a roof before it has the chance to hit the ground. It's a rude intrusion to say the least, and a potentially dangerous one. Falling from such a height should such a very solid, robust piece of frozen matter hit a soft, yielding object, it is not the ice that would shatter and be destroyed.

In the experience of the Couches, one they would prefer not be repeated, the startling sound and the realization of what had occurred was nothing if not sobering. WestJet confirmed that the ice had fallen from a WestJet Encore Bombardier Q400 arriving in Calgary from Regina this past Friday. What is being politely spoken of as "ice" has been known to fall at times elsewhere, hitting the roofs of unsuspecting homeowners, and penetrating their fastness.

The ice often has a faint blue colouration, and this is because it is permeated with a disinfectant used in plane lavatories. No one actually activates the release of this waste; it is meant to be discharged after the plane lands in a safe manner threatening to no one, disposed of routinely. On occasion things go awry and without anyone actively switching a trigger to release the waste, it breaks away while in flight.

Where it becomes a frozen bomb of human waste.

A very similar incident occurred to a woman living in Ottawa, exactly a year ago, when the roof of her mother's home was penetrated by a piece of "blue ice". "My head was only about 12 or 15 feet away", she stated, disbelievingly. "At first I thought it was just damage to the ceiling. I couldn't tell it went right through the roof when I first saw it", she elaborated. And then she said: "I teach kids Grades 2 and 3 and I told them the story today and they were completely enthralled by it. They said, 'It's aliens!'"

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Sunday, February 26, 2017

When In Doubt, Abstain

"Women are thinking of this as medical marijuana in that they are treating some condition."
"If you're going to consider it like medicine, then treat it like medicine and talk to your doctor about it."
Elizabeth Nash, policy analyst, Guttmacher Institute

"Even early in development, marijuana is changing critical circuits and neurotransmitting receptors."
"Those are important for regulation of emotions and reward, even motor function and cognition."
Dr. Yasmin Hurd, neuroscientist, director, addiction center, Icahn School of Medicine, Mount Sinai, Manhattan

"While current evidence on health consequences is inconsistent, some studies have found risks associated with marijuana use during pregnancy, such as low birth weight or preterm birth."
Centers for Disease Control and Prevention, U.S.

"All those really good earlier studies on marijuana effects aren't telling us what we need to know about higher concentration levels."
"We need to do a whole lot more research now."
Therese Grant, epidemiologist, director, University of Washington, fetal alcohol and drug unit

Research in the area of marijuana use during pregnancy was originally conducted at a time when marijuana was nowhere near as potent as it is at the present time. Marijuana's main psychoactive ingredient -- tetrahydrocannabinol/THC -- is capable of crossing the placenta, carrying its effect from mother to fetus, according to medical experts. In 1995 the THC content in marijuana was 4 percent; in 2014 it registered 12 percent of content.

Among pregnant women in the United States -- younger women in particular -- there seems a consensus that marijuana use in moderation harms no one, neither mother nor child, according to a recent survey. Women going into and in pregnancy are increasingly using marijuana, as various states have begun to legalize its medical and recreational use. This, at a time, when medical science does not fully understand the depth of its effects on human health.

Women are motivated by various factors in their lives, to use marijuana to ease the effects of depression, anxiety, stress, pain, nausea and vomiting, effects most commonly cited by women who had reported in a 2014 survey of low-income mothers receiving nutrition assistance in Colorado, among whom 6 percent used marijuana during pregnancy. The general thought being that cannabis use has no particular consequences.

THC can be present in the breast milk of nursing mothers. Experts note that marijuana use has the potential to harm brain development, cognition and birth weight. "There is an increased perception of the safety of cannabis use, even in pregnancy, without data to say it's actually safe", commented Dr. Torri Metz, obstetrician at Denver Health Medical Center whose specialty is high-risk pregnancies.



Two sets of researchers, in Pittsburgh, Pennsylvania, and in Ottawa, Canada, have produced some of the most extensive data on the issue thus far. Six-year-olds in Pittsburgh whose mothers had smoked one or more joints daily in the first trimester, were found with a decreased ability to understand concepts in listening and reading, while at age ten, children exposed to THC in utero were more impulsive than others, less capable of focusing attention.

It was discovered that lower scores in reading, math and spelling were evident at age fourteen among children whose mothers were heavy marijuana users in the first trimester of pregnancy. "Prenatal exposure can affect the adolescent pretty significantly", stressed Dr. Lauren M. Jansson, director of pediatrics at the Center for Addiction and Pregnancy, John Hopkins University, Baltimore, Maryland.

Studies have discovered that the brains of fetuses 18 to 22 weeks reflected changes linked to maternal marijuana use.

The fact that the developing brains of teenagers can be altered, even eventually reducing I.Q. with regular marijuana use, has been well documented. What has not yet been seen is a definitive link between smoking cannabis during pregnancy and obvious birth defects. But that was when research was being conducted at a time when the THC content in marijuana was less than half what it currently is.
Line graph showing increases in the last decade in treatment admissions for pregnant women reporting any marijuana use and for pregnant women reporting marijuana as their primary substance of use.
Recent Trends in Treatment Admissions for Marijuana Use During Pregnancy
Source: Martin et al., 2015


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Saturday, February 25, 2017

The Death Drugs

"Submit a cocaine sample, it's got fentanyl in it. Submit a heroin sample it's got fentanyl in it. Submit what we thought was Ecstasy, it's got fentanyl in it. Submit Percocets, it's got fentanyl in it. Submit methamphetamines, it's got fentanyl in it."
"That's what we're telling people: You think you're getting one [drug], there's no guarantee, there's no control system, it's an unknown."
"The difficulty is trying to say this person, unfortunately, passed away as a result of this drug. Well, where did that come from?"
"People think, 'I'm at a party with my friends and it's my friend who gave it to me so it should be OK', but you have no idea where they got it from either."
Staff Sgt. Rick Carey, Ottawa Police drug squad
Vancouver firefighters Jason Lynch and Jay Jakubec try to revive an addict who has already had two doses of Narcan after overdosing on fentanyl in Vancouver’s downtown eastside.
Vancouver firefighters Jason Lynch and Jay Jakubec try to revive an addict who has already had two doses of Narcan after overdosing on fentanyl in Vancouver’s downtown eastside. (CBC)

The Coroner's Service of British Columbia has reported that since the arrival of fentanyl on the scene, the death toll in that province has been elevated to 914 documented overdose deaths for the year 2016, representing a figure that exceeds the overdose death statistics for 2015 by 80%. British Columbia's problems with this laboratory-created chemical opioid leads the nation, but other provinces are realizing high death figures due to opioid overdoses as well.

Older people are viewed as likelier to use opioids that have been prescribed for pain. Their risks increase if they mix those drugs with alcohol. But what has really raised the alarm stakes is not only the drug users on the street who have been overdosing in records numbers resulting from the street drugs they use which have been adulterated with cheaper 'fillers' -- primarily fentanyl, a far more powerful drug, 50 to 100 times stronger than morphine -- is that teens have now begun to die from fentanyl overdoses.

No one is, at this time, ignorant of the fact that fentanyl is hugely dangerous, that it shows up regularly in unknown quantities in drugs sold as being known substances. No one using these drugs doesn't know of the growing number of fatalities due to overdoses. But they are propelled by their addiction and their self-assurance that these fatalities occur to others, nothing untoward will happen to them; the world they inhabit is absent of concern.

Ottawa police several days after the deaths of two teens in that city, conducted the largest fentanyl seizure yet, along with arrests of a dozen people. What that translates to is a temporary plug in a flood of illicit drugs reaching an eager and easy market. The known antidote to these overdoses, nalaxone, has been made available through the Province of Ontario in a kit, made available at drugstores free of charge to anyone wanting to become proactive among the general public or within the drug-using community.

Fentanyl, primarily sourced through the Internet from China (China has just recently placed fentanyl on its proscribed list of drugs), is popular with organized crime groups in Canada for the creation of their illicit products, irresistible to those addicted to pain killers. There are also local labs producing fentanyl. At this point, fentanyl is a known and dangerous substance circulating widely, damaging peoples' lives and creating fear among parents of teens.


The eventual, inevitable introduction of its more powerful cousin carfentanil, meant for the control of large animals like elephants, brings shudders of apprehension to the minds of those having to deal with this disastrous turn of events.


Of course, parents and users can always seek help. Say, from addiction counselling services. In Canada, unfortunately, it is an unregulated field. Anyone, irrespective of their backgrounds, can claim themselves to be a reliable counsellor in addictive behaviour. And that concerns Crystal Smalldon, executive director of the Canadian Addiction Counsellor Certification Federation.

"All you have to say is, 'I'm an addiction counsellor' and people believe you. You could go hang up a sign on Bank Street and the next day you could probably see ten people a day at $200 a pop. We regulate taxi drivers. We regulate hairdressers. We don't regulate addiction counsellors. It makes no sense. If you have $25,000 you could get treatment right now. But the problem is, you don't know who's doing the treating. You can pay the money and send your daughter to any facility that has a bed for a teenager right now, but if you walk in you just trust they know what they're doing", she argued.

Coincidentally, a substance-abuse counsellor in California was sentenced to 25 years to life in prison in California, She had pleaded no contest to second-degree murder and two drunken driving counts. Sherri Lynn Wilkins hit and killed a 31-year-old man, driving with his body embedded in the windshield of her vehicle, his upper body faced down on the hood of her car until other drivers stopped her.

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Friday, February 24, 2017

Proactivity on Peanut Allergies

"You have the potential to stop something in its tracks before it develops."
"[There appears to be] ...a window of time in which the body is more likely to tolerate a food than react to it, and if you can educate the body during that window, you're at [a] much lower likelihood of developing an allergy to that food."
"This [the new recommendations on early introduction] won't outright prevent every single case of peanut allergy -- there will still be some cases -- but the number could be significantly reduced by tens of thousands."
Dr. Matthew Greenhawt, chairman, American College of Allergy, Asthma and Immunology, food allergy committee

"If we can put this into practice over a period of several years, I would be surprised if we would not see a dramatic decrease in the incidence of peanut allergies."
Dr. Anthony Fauci, director, National Institute of Allergy and Infectious Diseases, U.S.
baby eating
Babies who already have skin rash eczema or egg allergies should get a checkup before being exposed to peanut-containing foods, new guidelines say. Photograph: KidStock/Getty Images/Blend Images


New parental guidelines for the introduction of peanuts to children at an early date were released in January to the American public by the National Institute of Allergy and Infectious Diseases. Pureed food or finger food with peanut powder or extract are now to be offered before infants turn six months of age. Earlier yet, if it has been determined that a child is moderately prone to allergies. Parents should rest easy in doing so, since medical specialists have given this a green light.

They also caution that whole peanuts should be reserved for older children since they can represent a potential choking hazard to very young children.

There are more deaths attributable to peanut allergies resulting in anaphylaxis -- or constriction of the airways -- than for any other food allergy. Children who do develop a peanut allergy will not leave that allergy behind as they mature. With these children a strict avoidance of peanuts will permeate their consciousness for their entire lives. For them, it truly is a matter of life or death, should they falter in the need to be ever-vigilant.

Children determined to be at high risk while babies are to be referred to an allergy specialist who may proceed to order further allergy testing. The parental advice from the American Academy of Pediatrics renewed as recently as the year 2000 was that parents were to ensure children seen to be at high risk for allergies were never to be given peanuts until they reached three years of age. These precautions, however, did nothing to decrease the prevalence of peanut allergies.

The new guidelines have turned that advice around, not only in the United States but in the United Kingdom, Canada and Australia as well. Studies undertaken in more recent years have led to the formation of the guidelines which divide young children by their medically identified risk level, where infants at low risk who don't have eczema or an allergy to eggs, and for whom solid foods have been initiated, can be safely introduced to peanut-containing foods at about six months of age.

And the same is true for children identified as being at moderate risk, those with mild eczema. It is the high-risk infants who should be introduced to peanuts as early as four to six months, but under the supervision of a doctor's office, once they begin eating solid foods. Thereafter they should continue to be evaluated by a doctor. Tests showing positive for sensitivity to peanuts don't necessarily translate to allergies, and babies may benefit from eating peanut foods as long as no strong reaction to a skin test demonstrates an allergy in which case avoidance may be prescribed.

Mixing a few teaspoons of smooth peanut butter with an equal amount of warm water to a soupy consistency is recommended by Dr. J.Andrew Bird, a Dallas pediatric allergist. Still, Dr. Greenhawt cautions that foods containing peanuts should not be seen as appropriate for the first solid food given a baby. The peanut-containing food should be given regularly, roughly three times weekly, throughout childhood, for the pre-emptive allergic reaction to remain effective.


Parents and doctors are encouraged to proactively introduce peanut-based foods early.
Parents and doctors are encouraged to proactively introduce peanut-based foods early. (iStock)

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Thursday, February 23, 2017

Compromised Intelligence

"The food industry funds initiatives that it thinks will further the sale of its products. Industry's job is not to fund scientific research, it's to protect products and improve sales."
"The struggle for grant money is very real. If the only person who's gonna fund you is the food industry because you didn't get your grant this year -- it's pretty hard to tell someone not to take that money, because their livelihood and career are in question."
"It's not about being principled. It's about doing your job and wanting to do good research."
Dr. Yoni Freedhoff, medical director, University of Ottawa Bariatric Medical Institute

"There is a lot of confusion about nutrition today, and industry-funded research has definitely contributed to it."
Cristin E, Kearns, DDS, MBA, postdoctoral fellow, UCSF School of Medicine
A recent study revealed the sugar industry's efforts 50 years ago to shape medical opinion on how sugar affects health. But today, scores of companies continue to fund food and nutrition studies.    Caspar Benson/Getty Images

Dr. Freedhoff revealed to the wider public the involvement of the food industry in the Heart and Stroke Health Check program, now suspended. He discovered that its logo was made available to food producers on a purchase basis for $20,000, which this health and diet expert criticized as representing a clear violation of the public trust. The incidence of health professionals and academics conducting research in the promotion of nutritional information paid for by food companies is not, however, a new one.

The food industry would be loathe to surrender this powerful marketing tool, of paying experts to conduct research on their behalf, lending their names and their expertise and their reputations to a compromised exercise in blessing that which is obviously tainted, suborning their own credibility through association with the very industry research often finds fault with. But these compromised findings -- abandoning neutrality in favour of publishing oblique approvals of food industry products as healthy when they are not -- are published in journals of merit, and it is never revealed that the researchers have been paid for their troubles by the food industry.

An analysis published in the journal PLOS Medicine in 2013 found studies funded by Coca-Cola, PepsiCo, the American Beverage Association and the sugar industry were far likelier to discover no linkage between sugar and weight gain than research conducted by those with no link to the food industry through a financial conflict. Last year, a paper published in the journal Research Integrity and Peer Review, concluded that conflicts of interest are under-reported, inconsistently described and are manifestly problematical to access.
We know very little about the association between industry sponsorship or authors’ conflicts of interest and the results of nutrition research. Jordan Whitfield/Unsplash
Such highly respected groups as the American Society for Nutrition and the Academy of Nutrition and Dietetics have been criticized by advocates for public health, when it was discovered they had formed partnerships with Kraft Foods, McDonald's, PepsiCo and Hershey's. Dietitians have bee discovered to be accepting payment from Coca-Cola to declare that company's soda as representing a healthy beverage. The New York Times in 2015 was in possession of compromising emails revealing Coca-Cola had funded research that claimed exercise, not poor diet to be responsible for obesity.

The scientists whose studies were paid for by the beverage company reported that sugar consumption was of less importance than exercise in weight management. Their reports appeared in medical journals, at conferences and were disseminated through social media. The truth of the matter is that scientists now recognize the role of sugar in the consumption of harmful calories. The composition of glucose/fructose encourages fat storage in the body.
Partnerships between industry and research institutions aren’t uncommon. shutterstock.com
The Associated Press also was able to obtain emails demonstrating a trade association whose clients were the producers of Butterfinger, Hershey's and Skittles paid for studies concluding that children who consume candy end up with healthier body weight than children who do not consume these types of products. While the authors of the papers qualified their results by cautioning that the data "may not reflect usual intake", as well as "cause and effect associations cannot be drawn", the press release from the candy association made no mention of these study limitations.

"New study shows children and adolescents who eat candy are less overweight or obese", is what they trumpeted. According to an article published in the journal JAMA Internal Medicine last year, the sugar industry paid three Harvard scientists to conduct research to prove that sugar had no impact on initiating heart disease, 50 years ago. The research had been published in the New England Journal of Medicine, stating major problems surfaced with other studies whose findings were that sugar was indeed harmful to human health. And this, without disclosure relating to the source of their funding.

There is a lack of transparency about funding sources and conflicts of interest in the area of nutrition research. shutterstock.com

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Wednesday, February 22, 2017

The Quicksilver of Child Hand-to-Mouth

"It wouldn't be at all surprising for a two- or three-year-old to find a tablet and put it into his or her mouth."
"And it's important to understand that a single tablet could kill a small child. These are very dangerous drugs at the high end of the dose range."
"We don't know why the younger kids, under one, might have been exposed. It could have been an accident, it could have been a sibling. I suppose there's the possibility it could have been malicious. We simply couldn't say."
"It's incumbent upon parents and grandparents to keep their pills well out of reach -- ideally under lock and key, but certainly inaccessible -- and simply having a child-resistant cap isn't adequate."
Dr. David Juurlink, senior scientist, Institute for Clinical Evaluative Sciences, Toronto

"[Overprescribing of drugs and the growth of illicit drug use in Canada leads researchers to feel] there's some evidence that these numbers of cases are creeping up now with more accessibility of those medications in the house."
Dr. Yaron Finkelstein, emergency medicine specialist, Hospital for Sick Children, Toronto
About Sickkids
Sick Kids'

Drs. Juurlink and Finkelstein co-authored a new study on the rising incidents of young children being rushed to hospital because of inadvertent ingestion of prescription drugs. The study was published this week in the journal Pediatrics. 2002 to 2015 health records were used to identify 103 children age ten or under treated in a hospital in Ontario for exposure to a drug meant for an adult. These were children whose mothers were in receipt of prescriptions for an opioid, which was publicly funded.

It might not, under the circumstances, be too far a theoretical stretch in imagining that these are children growing up in underprivileged circumstances, where welfare services include providing pharmaceuticals to their families. It's also fair to say that in these circumstances children's needs may be somewhat neglected in some of these households, perhaps due to lack of awareness of the consequences that would ensue should young children be exposed to the harm posed by opioids.

It is precisely those infants and children whose mothers use opioids by prescription that are recognized as being at increased risk of hospitalization resulting from an overdose of pain medications. A control group of children who had not suffered incidents of opioid overdose, whose mothers had been prescribed an anti-inflammatory pain killer, matched each case of overdose for risk comparison.

And so it was made clear that children in families where the mother was prescribed an opioid were exposed to over twice the risk of being involved in an overdose incident compared to those children whose mothers were using anti-inflammatory pills. Codeine, oxycodone and methadone represented the commonly recognized cause of such drug overdoses, where over half the children given remedial treatment were under two years of age.

Nine of those children were babies under a year, while thirty-nine of the children were admitted to hospital, thirteen to critical care units. None of the 103 in the study died, resulting from their overdose incidents. Which is not to say that no children have died as a result of ingesting drugs. During the study period over 700 cases of opioid overdoses had been identified, with the researchers able to link only 103 of them through Ontario's drug benefit plan to maternal prescriptions.

Within the larger group, some of the children affected did die, but for privacy reasons, figures were not available.

It's difficult to credit that those in charge of the care of vulnerable children are not aware of the need to ensure that children not be exposed to medications whose ingestion could be lethal to them. Presumably, some of that larger number of 700 could not be traced for the simple reason that the adults had accessed illegal drugs on the street. Which hardly makes it excusable that the adults would not be fully aware of their guardianship obligations to the children in their midst.

Codeine, oxycodone and methadone were the most common cause of the drug overdoses in young children, according to the new study.
Codeine, oxycodone and methadone were the most common cause of the drug overdoses in young children, according to the new study. (Toby Talbot/Associated Press)

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Tuesday, February 21, 2017

The Imbecility of Paramedic Abuse by Patients

"I find that the worst cases of abuse don't leave a wound. It is the sexual assaults that are the most frustrating because it is often not brought on by people in an altered mental state, such as dementia, but by people who are disgusting."
"Most often drunks, who don't believe women should be in uniform and don't respect them in the field."
"I don't get too bothered by stuff [exposure to insults, violence while on the job]. And if that person was in an altered state when something happened -- then I honestly don't think twice about it afterwards, because they have absolutely no idea what they are doing."
"I see people on their worst day. Even if it isn't something we'd consider an emergency -- it is that person's emergency -- and if we can make that day even a little better, that's the high of doing this [job as a frontline first-responder as a paramedic]."
Jennie Cubitt, paramedic, rural Ontario
Paramedic Jerry Patton
BBC News   Paramedic Jerry Patton had a brick thrown at him while he was treating a patient

Canadian society is hugely dependent in times of urgent medical situations, on the knowledge that they can dial a simple set of three numerals -- 911 -- to alert professionals skilled in the medical sciences and the art of patient care, to their emergency. They do so out of desperation, finding themselves in a situation they cannot themselves either solve or help themselves out of. If it isn't the individual themselves who calls, then it is an onlooker, someone else who recognizes the gravity of the situation.

Once that call is made, another trained professional at the other end of the telephone line asks critical questions and guides the caller, based on the response to those queries, how to act until the brief moments pass when an ambulance will respond to their emergency and the paramedics in charge of that ambulance will efficiently and expertly take over all the necessary reactions in response to the critical health/medical situation; the results of an accident, of the onset of a health crisis, a violent assault; whatever has occurred.

The paramedics come to the situation prepared in every conceivable way. They are experienced, having faced many and varied situations to which they have previously responded. They are exquisitely trained in medical procedures. Their vehicle is equipped with high-tech medical and diagnostic machinery, as well as drugs and medications which most medical emergency situations may call for in the perhaps desperate, interim treatment of a patient, until arrival at a hospital emergency department.

Paramedics have witnessed and been engaged in aiding the most vulnerable people caught in medical emergencies, and this continual exposure cannot help but have a traumatizing effect on their sensibilities. But these highly trained, socially and emotionally motivated professionals take as much as they can in stride and forge on, knowing that their response can be critical to whether or not a child or an adult, victims of accidents or health breakdowns, survive an episode in their lives requiring aid.

So it comes as something of a shock to be informed that these selfless, dedicated professionals are on occasion subjected to verbal and/or physical abuse; contempt for them as human beings, and belittling as health professionals, even while they are in the process of aiding the individual determined to inflict abuse on them. In an interview with a writer for the National Post newspaper, Joe O'Connor, Jennie Cubitt speaks of being kicked, punched and bitten.

She has been physically beaten, resulting in black eyes, split lips, as well as having been humiliated and assaulted sexually, even by those she has been administering life-saving protocols to. She ventilates on occasion by posting some of her miserably adverse experiences on a social media platform, popular with health-care workers such as doctors, nurses and paramedics, worldwide.
Heidi, 29, was sexually assaulted by a 75-year-old patient in the back of her ambulanceThe Sun.Co.UK
Heidi, 29, was sexually assaulted by a 75-year-old patient in the back of her ambulance
A 2010 survey of over 1,300 paramedics from Ontario and Nova Scotia  reported that 26.1 percent of respondents had been subjected to physical assaults in the year previous to the survey, with over 40 percent speaking of having been physically intimidated, while close to 70 percent were verbally abused and 2.7 percent were victims of sexual assault. Drexel University in Philadelphia conducted a study in 2015, finding paramedics more than a dozen times likelier to be injured by a patient than a firefighter would be on the job.

Paramedics do have a right to defend themselves, but they will be charged with assault should they fight back. It's difficult to imagine how one might defend oneself without fighting back, actually. Yet, according to Jennie Cubitt, the prevalence of assaults against paramedics is vastly under-reported. Mot considering it, with a mental shrug, as 'part of the job', a situation she feels " . . . needs to be addressed".

In Australia, the situation of attacks against paramedics has become such a problem that the idea of body cameras was considered. The 12-hour shift is hugely stressful, and for obvious reasons, apart from the prospect of being assaulted while on the job. Yet these are the people that society depends hugely upon to respond in a timely and efficient manner, using their skills and their experience to bring people in desperate situations out of their most immediate danger.

"Nobody wants to go to work worried about being attacked," says Leeds paramedic Richard Bentley

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Monday, February 20, 2017

Wait!!! Proceed . . .

"In seven out of eight measures of timely access to care, Canada was significantly below the international average."
"I think timely access to care has been a challenge for a while that we've noted from these surveys and from patient experience more generally in Canada."
"We're not really seeing improvements over the last ten years in timely access to care from a patient's perspective, particularly when we look at timely access to family doctors or primary-care doctors or to specialists and for emergency department wait times."
"[Surveys indicate Canadians have a tendency to arrive at hospital emergency departments more frequently than counterparts in other countries] and often they tell us it's for a problem that could have been treated by their regular doctor."
"So all of these data help to shed light on the bigger picture, which is what is it in our system that may not be working so well and where could we concentrate or focus improvements?"
"When we looked at measures of what we call patient-centred care, where patients have a good experience once they do get their foot in the door with their regular doctor, where care is well co-ordinated for them, we see that's really an area where Canada shines."
"I think that what is useful about a report like this is it really provides that international perspective. You might think you're doing really well here at home in one thing, but when you compare yourself, especially beyond our borders, you can see maybe we can do a lot better."
"The report doesn't provide all of the answers, but it does point to where we should be looking."
Christina Lawand, senior researcher, Canadian Institute for Health Information, Ottawa

The issue of long, really long waits in hospital emergency rooms for hour after hour before a doctor can be made available for consultation and aid, is one that is of long standing in Canada, and it rankles. On the other  hand, if you're a 70-year-old woman and you present on a Sunday with symptoms easily read by the duty nurse logging in each arrival, you will be speedily placed in a wheelchair, wheeled into a room set apart, and immediately be seen by a number of health care workers, including a cardiologist-in-training.

For other things, more routine, you won't be fast-tracked, even if you're concerned, if you're in pain and discomfort, and the wait time feels excruciating. You wait until it comes time for your turn, when a health-care worker can be assigned to you. This works on the assumption that you're not close to expiring, despite how you feel about it. Nurses are pretty good at evaluating people as they present. If a true emergency presents itself it will receive expedient, swift treatment; run-of-the-mill, not so much. No one thinks their problem fits into the run-of-the-mill category, needless to say.

Canadians report in high numbers having experienced extremely long waits in emergency departments, according to a report released by the Canadian Institute for Health Information. And there aren't many Canadians who will be shocked or surprised at this conclusion, it has been well documented and published. Part of the problem is that instead of going to their general practitioner for some health problem, people head for an emergency department. Sometimes that's because their problem erupts out of normal office hours.


And on occasion it can be because they have turned first to their family doctor, who then instructed them to head to a hospital emergency department. Relatively routine and simple things such as stitching up a wound, or lancing a boil or removing a deep splinter that family doctors used to do, they no longer perform; they prefer to send their patients on elsewhere, to stand-alone emergency clinics or to hospitals, or to specialists. Perhaps this can be accounted for by the fact that family doctors take on too heavy caseloads of patients, as a result of a chronic shortage of family physicians.

Could also be that they feel they are not adequately compensated by the universal health care system that pays doctors' salaries. Part of a survey of residents from eleven countries sponsored by the Commonwealth Fund based in the United States, the Canadian survey indicates that 29 percent of Canadians waited in excess of four hours before a practitioner was able to see them, at their most recent visit to an emergency department. Which represents three times the international average of 11 percent of patients waiting that long.

In France, Germany and the Netherlands, only one to four percent of patients reported four-hour-long wait times. Canada also represented the country with the highest proportion of patients reporting long delays after being referred to specialists, as 56 percent of patients waited over four weeks, when the international average was closer to 36 percent. The proportion of patients in Switzerland waiting that long was 2 percent; 24 percent in the United States.

Interviews were conducted between March and May of 2015 with 4,200 Canadian adults. The very same queries took place in ten other developed countries: The U.S., Britain, Australia and Sweden among them. Physicians in Canada have moved increasingly to electronic medical records, though Canada lags other countries using digital health applications. It may be viewed as a positive in some ways, but in others perhaps not, since doctors, instead of focusing on the patient before them using traditional hands-on techniques, focus more on the computers before them, while interviewing patients.

The interesting and most comforting part of this exercise, however, revealed that in 21 of 28 areas measuring patient satisfaction, Canada exceeded the international average, or at least matched them.
More to the point, close to three-quarters of Canadians who were questioned for the purpose of the study, rated the quality of care they were exposed to in the universal health care system in Canada as very good or excellent. That response ranked well above the international average of 65 percent.

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Sunday, February 19, 2017

Future Wave -- Cancer Immunotherapy

"What it means is that any scientist in this country who has a good idea will actually be able to get it into the clinic."
"All of the discoveries that are sitting in labs now and haven't had the chance to move forward could rapidly be put into the clinic once this is established."
"I think we've learned a lot by what has gone wrong. But any time you use a new therapeutic, you're going to find things you didn't possibly anticipate."
Dr. John Bell, senior scientist, The Ottawa Hospital

"This form of therapy [genetic fabric-added virus to infect T cells], this manufacturing facility, will lead to personalized cancer treatment, which is really the next frontier."
Linda Eagen, president, Ottawa Regional Cancer Foundation

CAR-T cell cancer therapy is a promising new therapy that has been used with some patients in the United States. These have been patients with incurable, advanced cancers. And of course the reason why a new therapy has been offered to patients with nothing left to lose, in the hope that the therapy will produce results no other existing and approved therapies have been successful for in extending life, is precisely because patients with such advanced, incurable cancers look upon an emerging therapy that has such glowing promise, as their last hope.

Clinicians harvest immune cells from a patient's blood to re-engineer them for the purpose of transforming them into more assertive fighters targeting cancer cells. This is CAR-T cell therapy. Cancer cells are stealthy and determined attackers, with the capacity to somehow sidestep the body's natural immune response. Such modified T cells are multiplied in a laboratory, at which point billions of the cells are infused back into the patient's bloodstream, where their augmented presence is immediately put to work, fighting the cancer cells.

CAR-T clinical trials using these augmented T cells are available to American patients, but since the costly and sophisticated equipment required to manufacture CAR-T cells is absent from Canada, Canadian patients are unable to benefit from association with such clinical trials. Now, Canadians suffering from advanced leukemia or lymphoma, have a brighter future in battling their cancers looming on the near horizon. A new plan has been revealed, with the Biotherapeutics Manufacturing Centre in Ottawa on tap for an expansion.

In the interests of advancing research into cancer immunotherapy, including a new treatment with huge potential using genetically modified immune cells to fight leukemia and other blood cancers, Canadian scientists have been the recipient of an $11 million fund, meant to focus on making such advances available. The federally funded BioCanRx network announced the funding, designed to enable the building of the scientific and manufacturing capability needed for the launch of Canada-based human clinical trials of CAR-T cell therapy.

Grants totalling $5.5 million have been allocated to Ottawa, where a multimillion-dollar manufacturing centre is to be established for the production of a key component of CAR-T cells. Dr. Bell -- one of Canada's leading immunotherapy researchers -- will be supervising this new advance where Canadian researchers will initiate the first phase of clinical trials, with the use of generically modified immune cells, scheduled for 2019.

The production of CAR-T cells represents a costly process which up to the present relies on American suppliers to conduct experiments, a source of frustration for Canadians in the field, swiftly evolving as immunotherapy moves to the front of leveraging the potential of the body's immune system to fight cancer. An expansion to have Ottawa's Biotherapeutics Manufacturing Centre's function in the production of a virus capable of infecting T cells, adding genetic material, is vital to these plans.

The Ottawa Regional Cancer Foundation has dedicated its auspices to raising an additional $2.5-million for the purpose of aiding in the finance of this plan. All to the good, for patients and for the research community within Canada. Medical scientists in this field, however, are well aware that among the promising good news there have also been a number of disturbing setbacks.

As, for example, last July when the U.S. Food and Drug Administration ordered a high-profile CAR-T clinical trial to be halted. And for obvious reasons, when three leukemia patients died while undergoing therapy, from swelling of their brains. While the Phase 2 trial was permitted to restart, it was once again shut down in November, when two more patients died.

Fully aware of unwanted surprises when launching new therapies, and thinking ahead, a two-year study is set to be launched to examine previous CAR-T clinical trials, to identify potential pitfalls. Dr. Manoj Lalu, assistant professor in the department of anesthesiology at University of Ottawa, will also interview patients so that mutual awareness of their needs as well as the research goals are fully understood.

"By doing that homework, we're hopefully going to build the safest and most potentially beneficial trial possible", noted Dr. Lalu, associate scientist at The Ottawa Hospital Research Institute.

Dr. John Bell, senior scientist at The Ottawa Hospital, professor at the University of Ottawa and Scientific Director of BioCanRx: “CAR-T therapy is a new approach that has the potential to revolutionize cancer treatment. As with all experimental cancer therapies, there is a need to carry out additional studies to optimize the safety and effectiveness of the treatment. BioCanRx funding will allow us to give Canadian patients across the country accelerated access to this exciting new therapy as safely as possible. We will also continue to learn how to make this treatment even better at fighting cancer.”

Dr. Natasha Kekre, scientist and bone marrow transplant specialist at The Ottawa Hospital and assistant professor at the University of Ottawa: “I came to The Ottawa Hospital last year because I wanted to help translate exciting laboratory discoveries into new therapies for patients, and Ottawa is one of the best places to do this. I’m delighted to be playing a role in four of these new projects.”

Dr. Manoj Lalu, anesthesiologist and associate scientist at The Ottawa Hospital and assistant professor at the University of Ottawa: “We want to make Canada’s first CAR-T trial safe and effective. We’re going to review all the previous research and consult with patients, clinicians and scientists to create a world-class trial protocol. This will help us bring this exciting technology to patients in a responsible way that works within Canada’s health system.”

Dr. Rebecca Auer, surgical oncologist and scientist at The Ottawa Hospital and associate professor at the University of Ottawa: “Cancer-fighting viruses have shown promise in both laboratory and clinical studies, but we want to make them even better. Our approach uses viruses to create a kind of personalized vaccine for each patient, which we hope will help the patient’s own immune system attack their cancer.”

Dr. Dean Fergusson, senior scientist and Director of the Clinical Epidemiology Program at The Ottawa Hospital as well as a professor at the University of Ottawa: “While many exciting discoveries are made in laboratories every year, few ever become successful human treatments. Our goal is to improve the design, analysis and reporting of cancer immunotherapy studies in laboratory models, so that researchers can efficiently and effectively translate their most promising discoveries into clinical trials.”

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Saturday, February 18, 2017

Disciplining Vulnerable Employees

"Mr. Mohammed did not consider the particular circumstances or make any assessment of the actual seriousness of Ms. Ram's conduct before deciding to terminate her employment."
"He claimed that he did not do so because it is necessary to ensure that employees know that taking food without authorization will not be tolerated."
"[Mr. Mohammed had testified that Usha Ram] was a good and valued employee, with no record of any formal discipline] with the Burger King chain before she was fired."
"[Janif Mohammed and co-owner of the franchise Michael Lacombe] behaved in an unreasonable, unfair and unduly insensitive manner."
B.C. Supreme Court Justice Lisa Warren
Usha Ram has been awarded $46,000 after being fired from a Vancouver Burger King.
Usha Ram has been awarded $46,000 after being fired from a Vancouver Burger King. (Jesse Johnston/CBC)

A 55-year-old woman who had come to Canada in 1987 from Fiji with a basic amount of English at her disposal having achieved a Grade 8 education in her country of birth, worked as a cook in a Burger King franchise for 24 years. As a full-time worker the woman, who was the sole family earner whose salary enabled her to care for a physically handicapped husband and an adult daughter who is mentally disabled, earned an annual wage of $21,000.

Her long employment and dependability marked her as a valuable employee, a fact her employers agreed upon. Yet she was fired because of a miscommunication and a company policy that ensnared this woman into a situation that was both demeaning and crudely and cruelly dismissive of her work record, her dignity as a human being, as well presenting as an acute instance of total disinterest in her welfare at age 55, with few other skills and poor English, in a search for replacement employment.

Her firing transpired as 2013 came to a close when her employer accused her of stealing from the company. Her crime was that she understood she had been given permission to take home with her a fish sandwich, french fries and a soft drink as she went off shift. She had asked the duty manager at the fast food outlet for permission to take home with her a "fish fry" free of charge as she had forgotten her wallet.

The manager agreed, under the impression that she would be taking the fish sandwich only, not accompanied by french fries and a soft drink. At the Burger King franchise employees were given entitlement to free drinks during shifts and outside of shifts, half-price food. Miscommunication aside, the cost of the the food items that Usha Ram had taken home with her would represent a value of $1.00. But management was offended that she was under the impression that she owed them nothing.

The manager bided his time, waiting for Ms. Ram to pay for the 'extra' food she had taken, but when she neglected to do so, he notified the owners. That resulted in Janif Mohammed accusing Usha Ram of theft. She wept, offering to pay for the food, hoping her job would not be in peril. But the decision had been made to fire her. This is a woman whose loyalty to her employers was evident in her willingness to be assigned to various sites.

The franchise locations in Vancouver, included a number of sites, and she was transferred to one site after another over the 24-year period when she was employed by the franchise owners. Justice has now finally been done. She has been awarded $46,000 for wrongful dismissal. Justice Warren ordered that the franchisee pay this ill-done-by woman general damages of $21,000, reflective of a year's salary, along with $25,000 in aggravated damages.


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Friday, February 17, 2017

The Complexity of Nature's Human Neuro-wiring

"Addiction is a form of learning in the reward circuits of the brain. Where you don't get synapse strengthening, you aren't getting learning and you aren't getting addiction."
"Simply increasing cadherin would likely prevent [addicts] from learning anything new. That's not a very good trade-off."
Dr. Shernaz Bamji, neuroscientist, professor, University of British Columbia, Vancouver, B.C.
Vice.com
"Researchers are pretty confident now that addiction is a form of learning where the same mechanisms involved in regular learning kind of go haywire and are used in a pathological way in a circuit of the brain."
"We wanted to figure out what was happening in the cellular and molecular level."
UBC PhD candidate Andrea Globa  
Professor Bamji and her team of collaborators have been working with genetically engineered mice in an effort to understand what motivates human beings to become addicted to habitual drug use. Their latest study was published recently by the journal Nature Neuroscience. Building on previous work done at Johns Hopkins University in Baltimore, Maryland, the UBC team discovered that people with certain genetic mutations associated with a protein class called cadherins in their brains are more susceptible to substance abuse.

The mice they used in their study are unlike normal mice in that even after repeated injections of cocaine over a period of time, their behaviour showed no symptoms of addiction. This led the researchers to the assumption that genetics may be at play in the onset of addictive behaviour. Normal as well as the genetically engineered mice were injected with cocaine while in one area of a multi-sectioned cage. Mice were placed in the other section on alternating days to be injected with saline. Six days of alternating treatment passed and the mice were permitted to move freely to any of the cage's sections.
lab mouse
The cocaine-associated section was chosen preferentially by the normal mice while the high-cadherin mice bypassed that chamber, leading to the theory that the presence of additional cadherin interferes with the learned response to cocaine. "Normal mice always gravitate to the chamber where they received the drug, looking for that high, but the mutant mice didn't", explained Dr. Bamji. Cadherin interfered with the capacity of a specialized protein receptor to function at the point where neurons communicate chemically to form memories.

The brain's learning circuitry was unable to retain the pleasurable memory of cocaine when the connection between synapses failed to connect. The research team's conclusion has the potential to lead to a test identifying which individuals may be at greatest risk of addiction. With that knowledge people could be empowered to act on that personalized information. That a biochemical model for addiction exists and those people should proceed with the caution their genetic risk deserves.

Cadherin aids in the binding of cells and thus plays a vital role where brain circuits are strengthened during learning -- including learning that specific drugs deliver pleasure. Dr. Bamji had proceeded with the study on the theory that higher levels of cadherin present in the engineered mice might lead the way to increased addictive behaviour. The study results, however, indicated the reverse to be true. The researchers had engineered mice capable of producing excessive cadherin proteins in their brains.

Despite which, the engineered mice with increased cadherin did not respond to the tests by gravitating to the cage's chamber where they were introduced to cocaine, unlike the behaviour of the normal mice with less cadherin, but with the genetic marker leading to increased addiction. Still, a problem arose because of the fact that many synapses in the brain use the same learning strategy. If ongoing research reveals a protein or enzyme in the brain acutely specific to addiction functioning solely in the brain's reward circuitry, that protein or enzyme could present as a medication target.

Until then, it is highly unlikely that a strategic use of some chemical in pill form to medicate people with a genetic propensity to addiction could be formulated to offer protection against a very real harm mechanism  recognized as addiction.

Still from video

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Thursday, February 16, 2017

High Heart Risks in Men Shovelling Snow

"We didn't go to their homes to find out whether they were shovelling or not."
"We looked at the relationship between snowfall and risk of MI [myocardial infarction/heart attack]."
"It's the first study that looks at actual risk in population."
"We don't know why that is [that men appear at greater risk than women]. It's possible that men shovel more than women. Or that women do it in a way that's less risky or causes less exertion. Snow shovelling is a demanding cardiovascular exercise requiring more than 75 percent of the maximum heart rate, particularly with heavy loads."
"In the big picture, very few people who shovel will actually have a heart attack. [Those with risk factors should shovel] slowly and with less exertion."
Nathalie Auger, Quebec Public Health Institute

It has always been common knowledge that winter, plus snow shovelling is hazardous, in particular for older men. Older men in poor physical shape, likelier. Since such winter-time shovelling takes place in front of a house, to clear a driveway, it's also likely that a family lives in the house. A family where, given the age of an older man at risk, no longer has sons living at home. So if there are only two people in the home, a man and a woman, it is more habitual for the woman to remain indoors and the man to go out to do the shovelling; a division of household tasks across traditional gender-role lines.

So a male is out in the winter cold far more frequently than a female, shovelling snow. Little wonder there are more men who suffer dangerously adverse heart effects than women. Lead researcher, epidemiologist Nathalie Auger, in an affiliation with University of Montreal Hospital Research Center, spoke recently of her group's study for the Quebec Public Health Institute, which was published by the Canadian Medical Association Journal. A study that examined data collected over a 33-year period, on the connection between snowfall, heart failure and death.

The study took under consideration factors that would certainly impact on morbidity when snow and shovelling were combined; obesity, diabetes, a smoking habit and high blood pressure. The study obviously looked at hand shovelling, perhaps overlooking the fact that snow blowers or snow throwers are now in fairly universal use by many home owners. And people getting on in age and who can afford a now-common mechanical device to aid in clearing away snow, generally tend to use them. Even with their use, it's true some minimum hand shovelling is also required.

The research team looked at days with no snowfall to the opposite; those with 20-centimetre snowfalls, during the winter months of November through April, from 1981 to 2014, in Quebec. They identified a firm link between the amount of snow fallen and resulting hospitalizations and deaths related to heart attacks. Almost 200,000 people were included in the study; 128,073 individuals admitted to hospital with an MI, and 68,155 deaths from MI, with the acknowledgement that some of those affected died before making it to a hospital.


Some experts theorize that combining a snowstorm with cold weather and hard work resulting in great physical strain to shovel wet, heavy snow, conceivably causes a sudden surge in blood pressure and heart rate. The study conclusion suggested that a snowfall of 20 cm increases the chance of being hospitalized by 16 per cent — dying from a heart attack by 34 per cent. One third of heart attacks occurred a day after a storm, while  10 per cent took place after snowfalls of five cm or more.

The association was even stronger after snowfalls lasting two to three days. 

In Ottawa last week a 49-year-old interventional neuroradiology expert who was a fitness buff was taking part in a ski marathon. This was a talented expert who performed skilled medical interventions, removing deadly blood clots and saving peoples' lives, a man whose professional talents were peerless and whose healthy lifestyle marked him as a model doctor who was intimate with the major problems that arise in cardiac arrest. His colleagues trusted and admired his professionalism and expertise, committed to his patients.

A nurse and a doctor on the scene directly followed by paramedics were unable to revive this athletic health professional at the ski event when he suddenly suffered cardiac arrest. He was dead at the scene. "I have seen patients with no family history [of heart disease], with a pristine lifestyle, who are endurance athletes at a very high level and all of a sudden they have a sudden, dramatic cardiac arrest", noted Ottawa cardiologist, Andrew Pipe, chief of rehabilitation and prevention at the University of Ottawa Heart Institute.


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Wednesday, February 15, 2017

The Reach of Chemical Pollutants on the Ocean Floor

"The only Northwest Pacific location with values [concentrations of organic chemical pollutants] comparable to the Mariana Trench is Suruga Bay [Japan], a highly industrialized area with historically heavy usage of organochlorine chemicals."
"[All of this is to say] our proximity to these extreme locations [deep and distant ocean trenches] is far from remote, which is why even the deepest chasms of the ocean are no longer pristine."
Research paper, Ocean Trench environmental pollutants

"[The paper's authors] have provided clear evidence that the deep ocean, rather than being remote, is highly connected to surface waters and has been been exposed to significant concentrations of human-made pollutants."
Katherine Dafforn, marine ecologist, University of New South Wales
Image result for photos, mariana trench
Graphic representation of the Mariana Trench and surrounding terrain. Daily Mail

It is unclear how identified contaminants made their way into deep ocean trenches, let alone how it is that their saturation levels of pollution are high in the Mariana Trench, one of the deepest in the world's Western Pacific. Its very remoteness and depth led scientists to believe that it and other deep-water trenches would be protected from the presence of environmental pollutants. Researchers from the University of Aberdeen and the James Hutton Institute in the U.K. do have their theories, however.

They theorize that the chemicals whose presence was identified in the Mariana Trench originally came from the "great Pacific garbage patch", referencing a mass of swirling debris present in the northern Pacific, and that chemical pollutants in that great arc might cling to plastic waste which eventually drops through the water column to reach the bottom of the ocean. The authors of the study, recently published in the journal Nature Ecology and Evolution note also that large-scale oceanic currents are capable of transporting chemical-absorbent particles over long distances.

Research previously undertaken has suggested that contaminants on the surface of the ocean can eventually sink, within a few months' time, to deep places as they cling to garbage or the carcasses of dead animals. The very particular pollutants that the researchers focused on were polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs), both are chemical pollutants capable of causing adverse health effects; neurological, immune and reproductive issues as well as cancer, in humans.

Once commonly utilized in electrical equipment before health and environmental concerns saw them banned in the 1970s, PCBs can still be found, penetrating the ocean depths. PBDEs were used as flame retardants, but they too have been restricted for use in the United States, despite one common type of the chemical still legal for use. It is their presence in marine organisms today that is troubling, despite the reduction in their use, since each has the potential for their potency to be intact for long periods, with a propensity to bind to other particles capable of carrying them throughout the ocean.
Image result for photos, mariana trench
2016 Deepwater Exploration of the Marianas    Extreme Tech

There is as well a tendency to "bioaccumulate"; where they can build their presence in marine organisms, over time. A study last year undertaken by researchers from the Scripps Institution of Oceanography tentatively concluded that organic pollutants such as PCBs and PBDEs are now present in a widespread arc throughout the world. The targets of this current research for investigation of the presence of chemical agents were the Mariana Trench and the Kermadec Trench north of New Zealand.

The researchers made use of devices they called "deep-sea landers", small vessels which ships released and which dropped to the ocean bottom, before again floating up to the surface. Each of these landers came equipped with traps fashioned to capture minuscule crustaceans called amphipods, known to be present in some of the ocean's deepest and extreme environments. The amphipods were tested for the presence of PCBs and PGDEs.
seacreatures.jpg
Hirondellea gigas, which are amphipods, taken from the Mariana Trench were found to contain high levels of persistent organic pollutants Dr Alan Jamieson

And the researchers discovered both PCBs and PBDEs to be present in all examined species of amphipods retrieved from both trenches and at all sampled depths, up to 10,000 metres deep, from both locations. The Mariana Trench appeared to have higher concentrations, but both trenches had higher concentrations of the target pollutants than concentrations found typically in clean coastal areas.

Alarmingly,  the highest observed concentrations of PCBs discovered in the Mariana Trench, heretofore considered immune to the presence of environmental pollutants, were approximately fifty times greater than levels present in crabs living near the Liaohe River in China, one of the country's waterways known to be its most polluted.


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