Ruminations

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

Friday, March 31, 2017

"Selfie" Epileptic Seizures

"There's a lot of data already about selfies being potentially dangerous in some circumstances because people don't think."
"There are even reports about people taking selfies while driving ... if you induced a[n epileptic] seizure behind the wheel, that would be a catastrophe, potentially."
Dr. Paula Brna, pediatric neurologist, Dalhousie University
Luca Bruno/AP
Luca Bruno/AP    Pope Francis poses for a selfie as he arrives at Milan's Linate airport, northern Italy, for a pastoral visit to Monza and Milan, Saturday, March 25, 2017.
 
The ego-boosting selfie so beloved of an ever-expanding range of people -- from politicians to celebrities, sport figures to performers, and the everyday public -- comes equipped with a not-so-innocent precaution: people susceptible to the effects of flickering light on the brain resulting in epileptic seizures had better set aside the ambition to take photographs of themselves at whimsically bored moments. Or even, come to think of it, as efforts to retain special moments photographically.

For the simple reason that the special moment not on the individual's thought-radar may turn out to be their last. Self-portraiture via smart phones and other types of digital photographic equipment that come so readily to hand are of particular danger as a trigger for seizures afflicting some epileptics.
A study of a case where a teen spent three days in a Halifax hospital hooked to an electroencephalogram monitored by camera to routinely assess her epilepsy revealed a surprise.

The camera verified what doctors suspected was the source of sudden bursts of action on the brain monitor, which typified epileptic seizures, matched against the bored teen taking selfies using an iPhone, sending the resulting photos of a head sporting Medusa-like electric leads, on to friends. An idle moment turned out to be a revelation which resulted in a paper published in the journal Seizure. Only one case, to be sure, but more studies will likely follow to validate the conclusions of this one.

Jeff Spicer/Getty Images
Jeff Spicer/Getty Images   Actor Tom Hiddleston takes a selfie with a fan at the Three Empire Awards on March 19, 2017, in London, England. 
 
The reason this is important is that the phenomenon has far-reaching consequences. People who have "photosensitivity", which is to say people who may suffer seizures on exposure to light flickering at specific frequencies, will be found to have experienced triggers through a hitherto-unsuspected source. And since many people use smart phones routinely, even when driving, being put out of executive function commission behind the steering wheel is pretty serious stuff.

Dr. Elizabeth Donner, head of the epilepsy program at Sick Children's Hospital in Toronto is of the opinion that though a fairly limited number of epileptics are photosensitive, the potential of incipient crises would call for counselling patients about such risks. Dr. Brna mentioned that observers were not quite certain whether it was the phone's flash or the pulsing red-eye-avoidance LED light which was responsible for the seizures.

A string of serious accidents have occurred while people taking selfies happened to be driving. Or not necessarily driving, but standing, for example at the edge of a sheer drop, or holding loaded firearms. Close to 150 deaths or serious injuries have been listed, connected with selfie-taking behaviour, between December 2013 and February of this year.

Jure Makovec/AFP/Getty Images
Jure Makovec/AFP/Getty Images    Members of Team Poland take a selfie after winning the Nations Cup of the FIS Ski Jumping World Cup in Planica on March 26, 2017.

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Thursday, March 30, 2017

Hypoxia's Effect on the Human Brain

"What we found is that there was a clear relationship between levels of hypoxia and brain function which has not been established before."
"It was possible to group people into three groups, some of whom had mild effects, and some [in] whom it was significant. We noticed that it was worse for older people."
"We know that a number of people who go back to work after surgery and find that they have cognitive problems but it was unclear what was causing it."
"We also noticed that the declines happened even when people were given oxygen and their oxygen levels returned to normal."
Professor Stanton Newman, dean, School of Health Sciences, City University of London and University College London 
Going under the knife may lead to cognitive decline, at least temporarily 
Going under the knife may lead to cognitive decline, at least temporarily  Credit: Christopher Furlong Getty

A new study whose findings were recently published in the journal PLOS One has some quite startling data with respect to patient outcomes after surgeries where general anaesthetic has been used. Researchers discovered that mental ability may be permanently affected when the brain has been unable to obtain sufficient oxygen.

Medical ethics prohibit experimentation with human subjects, where oxygen is deliberately withheld, so the researchers turned to studying the effects of high-altitude oxygen deprivation afflicting many alpine summiteers.

Tests were conducted on climbers setting out to scale the highest peak on Earth, Mount Everest. Symptoms of wheezing, confusion, high blood pressure, and in dire cases, heart failure and even death may result when people develop a condition called hypoxia. Seasoned alpine climbers are always on the alert for symptoms of hypoxia. Those symptoms signal that the sufferer must ascend, and quickly, for treatment before the level of hypoxia increases and disaster strikes.

Using the vital life signs experienced by climbers to guide them, researchers from City University of London and University College London, extrapolated what they learned to similar outcomes experienced by patients after having been administered general anaesthetic before a surgical operation. The study embarked upon a mission to monitor 198 climbers who were exposed to extreme heights on their summits where oxygen is depleted the higher they ascend.

Cognitive decline of a significant nature was discovered once the teams had descended. Ordinary functions such as speech and language, learning, planning, focusing and organizing capabilities were all severely affected. Subjects' performance levels were seen to have fallen by close to 20 percent comparing tests taken before and then after the ascent. When the climbers returned from base camp on Everest to Kathmandu, eleven days later, the brain-debilitating effects were still detectable.

Trekkers pass through a glacier at the Mount Everest base camp, Nepal
198 climbers were followed on their way to the summit  Credit: Tashi Sherpa

On many occasions climbers manage to summit, reaching their goal of achieving the top of Everest. and soon afterward beginning their descent. Timing is of the essence; summit too late, and the descent is then too late in the day when night descends and vision is compromised, not to speak of weather conditions changing swiftly as storms linger over the Himalayan peaks. The phenomenon of successful summits, only to have the climber die on the descent, could be attributed to many things; inclement weather closing in, or just sheer exhaustion.

The researchers have added another plausible reason for death on the descent; oxygen starvation to the brain, irrespective of the fact that most climbers without exception don oxygen-delivering masks, using supplemental oxygen cylinders once they reach a certain height on the mountain, even after careful acclimatization, in hopes of forestalling the effects of oxygen depletion.

A series of neuropsychological tests were administered to the test subjects to assess their memory, language, attention and executive function. Administered in London initially, at sea level, once again at Namche Bazaar in Nepal at the 11,400 foot-level, and at 17,000 feet at Everest Base Camp. On return, tests were once again conducted in Kathmandu, at the 4,200 foot level.

And the conclusion was convincing enough to the researchers, that the same symptoms that afflicted climbers deprived of the normal amount of oxygen their brains were accustomed to, to be enabled to function normally at optimal levels, could be anticipated occurring to patients being prepared for their surgical procedures through the administration of anaesthetic and subsequent diminished oxygen to the brain.

Similar levels of oxygen deprivation are encountered by Everest climbers as patients in a state of hypoxia
Similar levels of oxygen deprivation are encountered by Everest climbers as patients in a state of hypoxia Credit:  Daniel Prudek

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Wednesday, March 29, 2017

Detecting Cancer

"Had I not done the dog screening, I truly believe I would not have had the colonoscopy."
"I would have waited a year, two years, who knows? ... I was lucky to find it [his cancer] early."
Jim O'Mallay, Chicago fire department

"You see a guy who's telling you 'I got tested by a dog and they found my cancer', and people start listening."
Chief Steward Mike Butkus, firefighters union, Chicago

"It is a disgrace, it is an absolute disgrace that this thing [dogs' extraordinary sense of smell and teachability] isn't being grabbed onto like the invention of radar."
"It's the kind of thing that's going to save thousands and thousands of lives."
Glenn Ferguson, co-owner, CancerDogs, Aylmer, Quebec
Chris Roussakis for National Post
Chris Roussakis for National Post    Glenn Ferguson, owner of CancerDogs, shows how his animals indicate they think they smell cancer in breath samples.

No fewer than 50 fire department unions throughout the United States work with CancerDogs and that work has meant that 40,000 men and women working in an environment and in a career known to make such people susceptible to cancers resulting from their work-related exposure to cancer-causing chemicals and cancer-causing conditions, have been screened through the auspices of CancerDogs at a cost of $20 per test. A cost-effective, concern-comforting test that has the potential of forewarning of the presence of cancer in its early stages.

Dogs are well known for the acuity of their sense of smell, and Mr. Ferguson has trained his Beagle hounds, bred for their hunting instincts utilizing their extraordinary sense of smell, to identify and to signify that they have found the lingering odour of cancer in test samples they are exposed to. The co-owner (along with his wife) claims his dogs' cancer finds to be accurate 60 to 70 percent of the time, enabling people to be informed and to receive early treatment; alternately to take preventive measures.

There are a number of limited "proof-of-concept" studies that have been done in the past, that suggest dogs are capable of detecting cancers in breath samples or in urine, with an astonishing degree of accuracy. They are able to detect the chemical byproducts of cancer cells' metabolism, theorized as "volatile organic compounds". Screening using medical technological devices is available for breast, colorectal and prostate cancers, which give people the opportunity to begin treatment early, leading to improved chances of success.

Malignancies such as ovarian and pancreatic cancer, however, are most commonly discovered only when they have reached a late, and often terminal stage. Mr. Ferguson was moved five years ago to train dogs for the purpose of offering a screening method that had the potential of detecting cancers that no technological means had yet addressed. And he made his focus of service offering to firefighters' unions, organized groups whose members are at fairly high workplace-induced risk of acquiring cancer.

CancerDogs' clients range from California, to Texas and Oklahoma. The individual to be tested places a surgical mask on their face and leaves it there for a ten-minute period, after which the mask is placed in a sealable pouch and mailed off to Aylmer, Quebec. The samples are then placed on trays where the dogs are set to sniff them. When a dog seems convinced there is cancer present, it places a paw over the sample. If other dogs also identify that same sample, another sample is requested from the individual, the process repeated, and the test confirmed positive.

Chris Roussakis for National Post
The hounds of Ottawa area's CancerDogs pose in front of breath-sample jars. The company has screened 40,000 U.S. firefighters for cancer, but scientists question whether research supports the work. 
Chris Roussakis for National Post

At that juncture, CancerDogs routinely recommends to anyone whose test has been given a positive diagnosis suggesting they have a type of cancer, to undergo a specialized blood test developed by a company called OncoBlot to identify where the cancer is and what type it is. OncoBlot's test is able to identify 25 specific types of cancer. From that point forward, it is up to medical doctors specializing in cancer treatment (oncologists) to recommend the best course of treatment.

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Tuesday, March 28, 2017

Deconstructing an (Ancient) Crime

"He's in better condition than recent homicide victims I've worked on who have been found out in the open."
"Imagine, we know the stomach contents of a person [who lived] 5,000 years ago. In a lot of cases we are not able to do that even now."
"It was a very active defensive wound, and interesting in the context that no other injuries are found on the body, no major bruises or stab wounds, so probably he was the winner of that fight, even possibly he killed the person who tried to attack him."
"Roughly half an hour before his death he was having a proper meal, even a heavy meal."
"If you're in a rush and the first thing is to get away from someone trying to kill you, that's not what you do [pay attention to details]."
"The aim of the offender was to kill him, and he decides to take a long-distance shot -- could be a learning effect from what happened one or two days before. Which is pretty much what you see all the time nowadays. Most homicides are personal and follow violence and an escalation of violence. 'I want to follow him, find him and kill him.' All the emotions we have in homicide, these things have not died out in all these years."
"This was not a robbery gone bad or something. You go back to your village with this unusual [copper] axe, it would be pretty obvious what had happened."
Detective Inspector Alexander Horn, Munich Police
Otzi the Iceman: Forensic artists put face to victim of 5,300 year old murder
Dutch forensic experts Alfons and Adrie Kennis create the first image of Otzi (inset) Photo Heike Engel, South Tyrol Museum of Alchaeology

The man was not lean, not overweight, but well muscled and in fine shape for someone of 45, obviously accustomed to moving about a lot on his size 7-1/2 feet. He had brown eyes and shoulder-length dark brown hair, was five feet, five inches tall, weighed 110 pounds, and lived and died five thousand years ago. His body was found intact, encased in a glacier at the northern Italian border with Austria, by two hikers, in 1991. And his discovery caused a worldwide sensation. His well-preserved body was the finest and most complete ever discovered of a human being who lived during the Copper Age.

And his body is being preserved at the South Tyrol Museum of Archaeology, in Bolzano, Italy. He is known as 'The Iceman', and also as 'Otzi', named for the geography where he was found, close to the crest of the Otztal Alps. Detective Inspector Horn had been approached by Angelika Fleckinger, director of the Bolzano, Italy museum where Otzi was being kept, with the request that he agree to some forensic work in determining the cause of the Iceman's death, and Mr. Horn was agreeable to the prospect, the 'coldest case' he had ever been assigned to.

Because the high humidity of the ice in the glacier in which he had been frozen after death was instrumental in preserving his organs and skin in intact condition, the forensic experts who went to work on Otzi the Iceman were able to reach useful conclusions on the basis of the evidence they found. Traces of pollen found in his digestive tract enabled scientists to place his death to have taken place in late spring or early summer.
Otzi the Iceman’s Homeland


In the several days preceding his death, he had eaten three substantial meals, and descended from an elevation of some 6,500 feet to the floor of the valley below, then ascended the mountains once again. He was discovered 10,500 up the mountain where his death had occurred. A deep, disabling cut which had been sustained mere days before his death, was noted in his right hand, penetrating the bone. Mr. Horn theorized from what he saw, and from his vast store of experience as a detective, that Otzi might have been embroiled in a violent altercation in his village.

The theory went so far as to assume that whoever the violent contest was with, Otzi might have prevailed, then decided to leave the village, provisioning himself for a trip with food, fire embers wrapped within leaves inside a birch-bark cylinder, and assorted equipment. He had with him a small flint dagger, and an almost completed bow, along with arrows, also in a state of near completion. Clearly, he meant at some point in his journey to finish his weapons, but seemed in no particular hurry to do so. He was not expecting to encounter any problems on his journey.

He made camp in a gully on the saddle of the mountain, had his dinner of Ibex meat, einkorn wheat, fat and bracken. A half hour later someone appeared behind him at a distance of  30 metres, took aim and shot him in the back. The arrow entered under his left armpit, ripping a half-inch section of his subclavian artery, a deadly wound. The angle of the wound led to estimations that he would have been shot from below and behind.

Nothing, it seems, from the investigation, that Otzi had taken with him was spirited away. He had a copper axe, which at the time would have been a tool/weapon of estimable value. And nor was his clothing disturbed, made from leather and fur of ten animals representing six species common to the geography. To take possession of either axe or clothing items, returning to the village with them, would have represented a dead giveaway of the perpetrator's intent, success and spoils.

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Monday, March 27, 2017

From Tragedy Knowledge in Mapping the Ocean Floor

"It's an incredible trove of data. I've been working in this part of the Indian Ocean for 30-plus years, and over many voyages in the eastern Indian Ocean I've never seen this level of resolution."
"When we look at these data, we're constantly keeping in mind that we wouldn't have this data if it weren't for a terrible tragedy."
Millard F. Coffin, marine geophysicist, Institute for Marine and Antarctic Studies, University of Tasmania, Australia

"There are all kinds of things you can't do if you don't know the shape of the ocean bottom, or don't know it properly."
"I wanted people to realize that it's not just Malaysia Airlines straying into the southwest Indian Ocean where it shouldn't have been."
"Even when your aircraft is exactly where it's supposed to be [on a trans-oceanic flight], it might be [flying] over unknown ocean."
Walter H.F. Smith, geophysicist, National Oceanic and Atmospheric Administration, United States
Oceanographers created this chart one year ago showing the potential drift of MH370, starting from the Indian Ocean search zone. Experts say the chart's predicitions are 'entirely consistent' with the location of newly-found debris on La Reunion, off the coast of Madagascar
Oceanographers created this chart one year ago showing the potential drift of MH370, starting from the Indian Ocean search zone. Experts say the chart's predicitions are 'entirely consistent' with the location of newly-found debris on La Reunion, off the coast of Madagascar


In a scientific paper published in the journal EOS, Dr. Smith and his colleagues took pains to elucidate the simple fact of oceangraphic science, that most of the world's oceans remain unmapped. And because that underwater terrain is unmapped, experts are hindered in their capability of predicting tsunamis, in their understanding of oceanic currents, and in making climate forecasts, along with the study of marine life -- let alone the search for missing planes.

But it was the dreadful occasion of a missing plane, a plane that went dramatically off its expected flight trajectory and whose flight pattern was soon lost to the vital tracking of air traffic controllers who had no idea what had happened to Malaysia Airlines Flight 370 on March 8, 2014 that led to mapping detail in a significant part of the Indian Ocean. The mystery of where the plane's final resting place and that of its 239 passengers and crew happens to be, remains unknown.

The mystery of why the pilot took the plane so dramatically of course, equally unknown.

The painful agony of the families of those missing cannot be assuaged; their loved ones are gone, vanished into the great unknown. Leaving some of those mourning their dead with the faintest of hopes that the plane landed somewhere and all aboard remain alive, stranded in some unknown place, to be discovered at some time in the future. It is simply much too painful for people whose hearts have been broken to resign themselves to the reality of those they love losing life in a vast, watery grave.

The search that was launched from many points on the regional compass in a desperate effort to find survivors and finally to discover the remnants of the missing plane and with good fortune, clues to what had occurred; available should critical technological devices maintaining data ever be recovered, failed to meet with any degree of success. The mystery has baffled searchers, governments, scientists, aviation experts for years, and seems destined never to be solved.

Something positive, however, did arise out of that tragedy in the sense that a byproduct of the search over an estimated 350,000 square kilometers of seafloor resulted in the mapping at a close range that oceanographers have never been able to accomplish on their own; neither the length and breadth of the search range, nor the infinitesimally minute details taken at close range. Now, Dr. Coffin and a group of scientists from Geoscience Australia have been given access to those invaluable maps.

Data retrieved previously from satellites gave scientists information relating to the Indian Ocean reflecting a resolution of roughly five square kilometers. In contrast, the instruments used in the vast search area by specialized ocean-going vessels and their highly technical equipment enabled the collection of information with a resolution of meters, and in addition in some areas remote operating vehicles and underwater autonomous vehicles enabled the gathering of details on the scale of centimeters.
A 3-D image of the Diamantina Escarpment on the seafloor of the Indian Ocean. The search for Malaysia Airlines Flight 370 has helped create maps revealing the ocean floor’s topographical complexity. Credit Kim Picard and Jonah Sullivan
A three-dimensional series of maps of the ocean floor revealing topographical complexity enables researchers to delve into and understand unique features such as the oceanic plateau named Broken Ridge as well as the southern-flank Diamantina Escarpment. Scientists now have in hand information relating to tectonic and volcanic activity on the ocean floor, reflecting further enriched, invaluable data never before available to oceanographers.

A mere eight percent of the world's oceans have been mapped, to date. With only five percent of the southeast Indian Ocean having been previously mapped, according to studies. Dr. Smith and his colleagues made a comparison of data retrieved from both mapped and unmapped portions of the world's ocean segments utilizing a database used by commercial airlines relative to their routes.

They concluded, based on the data available to them, that some 60 percent of all commercial flights crossing oceans, travel over oceanic areas whose depths are unmeasured, with the longest contiguous route over unmapped ocean identified as that from Kennedy International Airport in New York, to Chongqing Jiangbei International Airport in China, an airtrip extending greater than 1,200 nautical miles over unmapped ocean.

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Sunday, March 26, 2017

Endocrine Disrupters : Falling Birth Rate

"Your odds of getting into Harvard or Stanford are higher than your chances of being accepted as a donor at the major sperm banks."
"The bar is lower for members of ethnic groups that tend to be shorter. And given a perpetual lack of African-American donors, height may not be a disqualifier for black donors."
Tamar Lewin, The New York Times

"[Scientists report an increasing proportion of sperm] are misshapen, sometimes with two heads or two tails."
"Even when properly shaped, today's sperm are often pathetic swimmers, veering like drunks or paddling crazily in circles. Sperm counts also appear to have dropped sharply in the last 75 years, in ways that affect our ability to reproduce."
Nicholas Kristof, The New York Times

"Semen quality and fertility in men have decreased. Not everyone who wants to reproduce will be able to. The costs of male disorders to quality of life, and the economic burden to society, are inestimable."
Dr Andrea Gore, professor of pharmacology, University of Texas at Austin, editor of the journal Endocrinology

A sperm under the influence of an endocrine disrupting chemical in sunscreen. Because of chemicals like these, sperm have trouble swimming properly to deliver the goods. Credit Prof. Timo Strünker, Münster, Germany
"I think we are at a turning point.  It is a matter of whether we can sustain ourselves", stated Dr Niels Erik Skakkebaek, a Danish fertility scholar and pioneer in the field. This failure of the human body to continue to produce viable sperm in convincing numbers to ensure that the biological imperative to reproduce, thus sustaining the species remains intact, appears to be a scientifically universally-recognized global phenomenon of frightening proportions.

In Hunan province, China, where in 2001, 56 percent of sperm-donor applicants met health standards, that number descended precipitously to 18 percent by 2015. This was a large study, involving over 30,000 men. The findings led to the obvious conclusion that "The semen quality among young Chinese men has declined over a period of fifteen years."


What an irony; couples who are turning increasingly to medical interventions when they find themselves unable to procreate, look for help with sperm or eggs healthier than their own as they launch themselves into a long, frustrating and very often failing effort to achieve parenthood through assisted reproduction technology. Yet they have become dependent on sperm increasingly more difficult to harvest because failing sperm health is afflicting availability of suitable alternatives at sperm banks.

Sperm banks are increasingly finding it difficult to accept sperm from donors when the men  being recruited are seen to increasingly have low sperm count and sperm whose condition is far less than optimal in condition. The growing relative rarity of healthy sperm has driven the price of a sperm vial up astronomically. Sperm banks look for a good personal health history in recruits. A sparsity of sperm, those of poor quality, and white males of short stature tend not to qualify.

Scientific studies have indicated that a chemical type known as endocrine disrupters are likely responsible for the sub-par quality of sperm in male populations. If it were any other kind of chemical the warning could be circulated that the chemical is to be avoided by all means. But if that chemical is one used in many of the most common products utilized by society today, it becomes difficult to distance oneself from it.

These are the chemicals in plastics, in pesticides, in cosmetics and other products whose safety is taken for granted, and which manufacturers regard as indispensable to the manufacture of their frequently- and commonly-used products. A seven-year experiment was conducted on an Ontario lake by Canadian scientists who added endocrine disrupting chemicals to the water to observe the impact on fathead minnows. Males were turned into intersex fish, incapable of reproducing.

Denmark, along with South Korea, Spain, Germany and Italy are sufficiently concerned with sustainable reproduction, as to look elsewhere for additional answers to the cause of the dilemma, not entirely convinced that quantity and quality of spermatozoa is responsible for the notably lower success in achieving pregnancies.

There has been a increase in testicular cancer among young men. There is the biological problem of undescended testicles, as well as a congenital malformation of the penis, called hypospadias. Both, of course, could also be derived from the prevalence in the products we use of bio-disruptive chemicals.
Additives known as endocrine disrupting chemicals (EDCs) compromise male fertility by interfering with a membrane-bound calcium channel that normally controls motility of sperm cells, according to researchers in Germany and Denmark. EDCs are used in hundreds of household products—including toothpastes, sunscreens, cosmetics, plastic bottles, and toys—and scientists determined that they can cause fertility problems in previous studies. But a study published in the journal EMBO reports yesterday (May 12) is the first to posit a mechanism for how the chemical additives affect fertility in the human reproductive tract.
The Scientist, May 2014



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Saturday, March 25, 2017

Life On Hold

"Our whole family went in because we didn't know if she was going to make it -- for quite a number of days, it was very up and down."
"She was going to go on maternity leave, but now will go onto long-term disability -- she will have a long rehabilitation because of what happened."
"Cognitively, she's incredible -- she's one thousand per cent. She has said she just wants this to be done so she can go home and be a mom. She's being as strong as she can."
Susan Hubley, Halifax
Lindsey Hubley and fiance Mike Sampson pose with their newborn baby Myles Owen Sampson at the IWK Health Centre in Halifax on March 2.
Lindsey Hubley and fiance Mike Sampson pose with their newborn baby Myles Owen Sampson at the IWK Health Centre in Halifax on March 2. (Susan Hubley/The Canadian Press) 
"Having the odd case here or there is something that we see and it doesn't seem at this point to [be] any more unusual than our typical patterns, but it's something that we aggressively watch for."
"I don't think people need to be overly concerned about this at this point. We do see  cases every year, but it's always tragic when someone has a really bad infection."
Todd Hatchett, head, microbiology, Nova Scotia Health Authority
"What happened" was entirely unexpected; after all, what could be more normal than a young, healthy woman entering hospital for the delivery of a child? What happened was that after delivery -- when this new mother, a 33-year-old woman who experienced a normal delivery on March 2, and was discharged with her newborn -- she was suddenly rushed by ambulance right back, four days later, suffering excruciating pain.

On arrival back at hospital she was taken directly into surgery. A group A streptococcal infection was what happened. An infection linked to necrotizing fasciitis. And what happened was that this woman was going into septic shock, her life immediately threatened. The young woman was put into a coma then gradually brought out of the coma in the wake of several surgeries to remove diseased tissue. The prognosis is that she will recover, but it will be a long, arduous process.

The house the woman, her partner and her child live in will have to undergo some changes for the home to adapt to the young mother's new and limiting physical resources. She is scheduled to remain in hospital, however, for an estimated several months before medical authorities feel she will be in sufficient shape to once again be discharged, to begin the long journey back to health and a normal life, or whatever will represent normalcy in this woman's new reality.

The long-term consequences of her brush with death are unknown. How deeply her physical limitations will be and how permanent, will take time to assess and to help her adjust to. Flesh-eating disease is a horrible condition to attack seemingly healthy people, who suddenly find themselves in a nightmare of painful physical collapse as fortune decides whether or not it will permit them to survive that dreadful ordeal.

But not to be overly concerned, assures Dr. Hatchett; it is normal for one or two of such necrotizing fasciitis cases to suddenly occur yearly in the province. The very serious and mounting problem of hospital-acquired infections that defy increasingly the use of antibiotics is sufficiently worrisome; best to stay out of hospitals, if one can. The onset of those infections can be a mortal blow to the physically vulnerable.

The added nightmare of susceptibility of a fragment of the population to the haphazard occurrence of this lightning-strike disease serves to increase the anxiety level of anyone sufficiently informed with respect to the opportunistic bacteriums, viruses and diseases lurking prospectively to find new victims. Just as well, the general public remains blissfully unaware of such potential dangers.

After all, as the old saying goes, you could just step off the sidewalk inattentively (busy on your not-so-smartphone) and be struck fatally by a passing tractor-trailer .... ?

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Friday, March 24, 2017

Generational Report on Health

"Statistically, we're not doing so well. It's profound, just to summarize, that a 12-year-old is taller, heavier, rounder, weaker, less flexible and less aerobically fit than a generation ago."
"These are very profound and, from a health perspective, very important changes we've seen over time."
"Scientifically the fitness of our nation has declined. We've demonstrated quite recently that aerobic fitness in children around the world has declined, in a systematic way across the last several decades. Again, not that surprising."
"The decline is slower in mid- and lower-income countries where they walk to school, do their chores, and need to lift things."
"You can't go out in the morning because of mosquitoes and the risk of West Nile [virus]. Later in the day, there is rush-hour traffic ... pollution. Sun causes skin cancer."
"[A societal change is required] Incidental eating is reduced [by habitually going outdoors]. Steps increase. Connection with the environment is improved. The chances of authentic interaction with people, animals, plants is infinitely greater. And on it goes."
"You've got to eat well, move well, sleep well and avoid toxins. It's as simple as that. We can make it as complicated and as sexy as we want. Sell supplements and fancy gadgets or whatever, the basics always rise to the top."
"As we reflect back on 150 years, we have a heritage as frontierspeople -- nature and the outdoors are almost synonymous with what it was like to be Canadian, whether it's canoeing across a lake or snowshoeing through a forest."
"And the great outdoors is still there. We are the second-biggest country in the world, probably the most beautiful, and physical activity opportunities are endless."
Dr. Mark Tremblay, professor of pediatric medicine, University of Ottawa, Canada

Dr. Tremblay who is director of the Healthy Active Living and Obesity Research Group at the Children's Hospital of Eastern Ontario Research Institute, several years ago published a scientific paper. He used Statistics Canada data from 2007 to 2009 to establish that a typical 12-year-old boy and girl in 1981 were far more healthy, agile, stronger than their 2007 counterparts. And that disparity over the succeeding years only intensified. The reason is simple enough; far less time spend outdoors and far less time devoted to exercise, sports and just being what was at an earlier time, a typical child.

The waist circumference of a 12-year-old girl increased, according to Dr. Tremblay's report, by
six centimetres in the 1981/2007 comparison period, while the grip strength of a boy of the same age in the very same period of comparison declined by ten percent. The shift in childhood activities over the past thirty years has not been kind to the health of the younger generation. And youth grow into maturity, becoming adults whose health has already been compromised from a younger age.

Once, generations ago, it was a common sight to see children out and about on their own or in groups everywhere. In parks climbing trees, tossing balls, playing games, wrestling about after school. "Just thinking about grip strength, children today grip, very gently, their smartphones, not a tree branch, and not the scruff of someone's neck", commented Dr. Tremblay. "

Physical inactivity remains the fourth-leading risk factor for mortality, contributing to an estimated 3.2 million deaths each year, around the world, according to figures released by the World Health Organization. That kind of sedentary behaviour, quite unnatural for human beings, but becoming the cultural norm, has another cost; because of the impact on health, the wider impact is on the Canadian economy, costing it an estimated $6.8-billion in 2009.

Rising rates of Type 2 (adult onset) diabetes and heart attack, hits the economy, resulting from increased and ever-spiralling health costs, along with the impact of workplace absenteeism. And it will only become more so as time goes on if there is not another, ameliorating, cultural shift that encourages children to get out more in the natural world and once again begin behaving as children everywhere are meant to do; explore, play, be active.

A simple alteration of the culture, leading to an increase in physical activity to reduce sedentary behaviour would have the effect of reducing health-care spending by over $2-billion by the year 2040, according to calculations by the Conference Board of Canada, in a 2014 report. As for adult fitness, the prognoses is grimmer still. Health Canada reported in 2015 that 54 percent of Canadian adults are considered to be overweight or obese, while the percentage in the overweight/obese category for adolescents 12 to 17 is 23.1 percent.




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Thursday, March 23, 2017

Battling the Extinction of the Ash Tree

"We're hoping to raise about 10,000 [wasps] for this summer. That will be enough to do five or six more sites across Ontario and Quebec."
"[The Tetrastichus planipennisi wasps represent a] bio-control [program operating in a laboratory, the only] large-scale attempt to manage the emerald ash borer."
"The wasps will eat and kill the larvae and then you get more wasps coming out instead of the emerald ash borer. Over time the wasp population builds up and we hope that they'll help kill a fair number of emerald ash borers out there."
"The spread is a major concern. We're finding that 99 percent of ash trees are killed within five to seven years of emerald ash borer getting into an area and causing extensive mortality."
Krista Ryall, lead researcher, Natural Resources Canada

The emerald ash borer is a beetle originating in Asia. Like all foreign-origined flora and fauna once they are removed from their native environment they thrive because their natural predators are absent from the new environment, and they become a threat to native species. These foreign invaders often arrive along with shipments of goods by sea. Sometimes they are deliberately introduced for one reason or another; seen as a solution to a local problem, but they rarely turn out to solve anything. Instead, they become giant headaches as they run riot in a new environment that they have successfully adapted to.

The beetles were first noticed in 2002 in Michigan, and they have steadily moved on to colonize larger areas, ranging across the United States and Canada. The United States Forest Service in Brighton, Michigan discovered that the Tetrastichus planipennisi wasp was a natural predator for the beetles, imported them from Asia and began raising them and releasing them in forested areas in hopes of saving some of the ash trees that haven't yet been impacted. But the beetle has cut a wide swath in North American forests, destroying native ash trees, leaving forests bare of their presence.

Much has happened with trees native to North America; in the 1950s with the American Chestnut, a giant species of chestnut that dominated forests and was struck with a blight that eventually wiped out those forest giants, taking species of insects out of circulation that depended on the chestnut as well. There was a wide-spread effort to save the Elm trees when Dutch Elm disease struck with catastrophic consequences, and later Spruce Budworm, hitting the forests, destroying indigenous stands of spruce. The die-off of ash is simply the latest phenemenon to strike another valued tree species.

Millions of ash trees have died across Canada and the United States thanks to the deadly march of the emerald ash borer. Natural Resources Canada has been importing the wasps that lay their eggs on the larvae of the borer from its American counterpart federal forest service to release them in stages in Quebec and Ontario. The female wasp finds trees that have been infested with the emerald ash borer larvae and lays fifty to sixty eggs on the larvae so that when the larvae of the wasps appear, they feed on the emerald ash borer larvae.


When the wasps mature they fly out and about and and their natural cycle commences; they breed, they  lay eggs and then they die a month after taking flight, with the cycle repeating itself several rounds throughout the summer months. The assurance is that the wasps, also native to China, will have no deleterious effect on other organisms, according to American research. Windsor, Ontario was the first site where the emerald ash borer was seen in Canada in 2002, and it continued to move on, reaching Toronto by 2007.

The beetle spread relentlessly, reaching western Quebec in 2008, and finally Montreal by 2011. It has even been seen in Thunder Bay, in northern Ontario. Now that Natural Resources Canada has initiated its own wasp breeding program, about 60,000 wasps have been released to target the emerald ash borer, and the hope is that what is left of the ash trees may yet be saved, even while botanists attempt to breed ash trees that will be resistant to the borer.





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Wednesday, March 22, 2017

The World Medical Science Community's Obligation to Universal Health Research in Combating Disease

"Since there is no vaccine or specific approved treatment for Ebola virus disease (EVD), there is a 'moral obligation' to collect and share all data generated, to understand the safety and efficacy of any intervention, and to evaluate promising interventions to inform future research, says Dr. Eleanor Fish, the senior author and senior scientist in the Toronto General Hospital Research Institute (TGHRI)."

"To date, no treatments or post-exposure prophylaxis are available for Ebola. Clinical trials for several vaccines are in various phases, with promising published results in humans."
"Nine individuals with Ebola virus were treated with Interferon ß-1a, and compared retrospectively with a matched cohort of 21 infected individuals receiving standardized supportive care only during the same time period at the same treatment centre in Guinea, West Africa from March 26, 2015 to June 12, 2015."
"Despite the limitations of a single arm, non-randomized study, we infer from these data that Interferon ß-1a treatment is worth further consideration for the treatment of Ebola virus disease', said Dr. Fish, who is also a Professor in the Department of Immunology at the University of Toronto, noting that the decision to undertake the clinical trial was based on previous preliminary scientific data, and on the fact that no currently approved antivirals exist to treat Ebola."
Alex Radkewycz, Senior Public Affairs Advisor, Toronto General Hospital, University Health Network
Handout
Dr. Eleanor Fish, centre, with local health-care team in Guinea. Handout
A serendipitous discovery made by researchers led by Dr. Eleanor Fish of Toronto General Hospital raises hopes once again that the crisis represented by the deadly Ebola virus has a dependable tool in the too-sparse arsenal of its management. This is a discovery of vital importance given the fact that at the present time no treatment exists for Ebola, a virus that killed 11,000 people in the outbreak declared by the World Health Organization an epidemic of serious proportions in Guinea, Liberia and Sierra Leone.

Of those infected with the Ebola virus, the mortality rate of 60 percent made it a dread disease of high morbidity. The Toronto General Hospital Research Institute conducted laboratory experiments that pointed to the drug Interferon Beta-la used to treat chronic hepatitis B and C, was effective as well as a weapon against Ebola. It was given as an experimental treatment to nine Ebola patients; the results compared to 21 similar, Ebola-patients who were given the standardized "supportive" care.

The findings of the study were published in the journal PLOS One, that following 21 days after treatment, 67 percent of the Interferon-treated Ebola patients remained alive, while of the others who received supportive care, 19 percent of the patients survived. The virus, according to the researchers' conclusions, cleared more swiftly from patients' blood who had been given Interferon. Symptoms such as abdominal pain, vomiting, nausea and diarrhea were faster to subside in the Interferon-treated patients.

The paper concludes that further investigation is warranted, given the positive results and the fact that there is currently no effective treatment for patients of Ebola. Despite that the Ebola outbreaks in Guinea, Sierra Leone and Liberia have been declared by the World Health Organization over, resurgent incidences of Ebola occur randomly, and the expectation is that another epidemic can be expected to once again surface at some time in the future.

An earlier Canadian-assisted innovation did prove effective in a large-scale clinic trial, with an Ebola vaccine developed by the national microbiology laboratory in Winnipeg. Interferons represent a grouping of naturally occurring proteins triggered by viral attacks. With certain diseases, in drug form they have proven to be effective in curbing infection through prevention of the virus from entering cells and by blocking stages of viral replication.

Red Cross workers remove the body of an Ebola victim in Guinea, where a Canadian study found that the drug Interferon may slash Ebola's death rate.
CELLOU BINANI/AFP/Getty Images    Red Cross workers remove the body of an Ebola victim in Guinea, where a Canadian study found that the drug Interferon may slash Ebola's death rate.
 

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Tuesday, March 21, 2017

MAID: Medical Assistance in Dying and Organ Harvesting

"If we accept people can make decisions to end life, and we accept the idea of cardiac death being sufficient for organ donation, t his should be acceptable."
"The concern that comes up is, could the decision for one drive the decision for the other?"
"There's a lot riding on this. If somebody has organs that would be appropriate to donate, you'll never get better organs than you would by this process [harvest post-] MAID."
Dr. James Downar, co-chair, Canadian Blood Services committee organ donation guidelines

"This [feeling compelled to pursue decision] is a theoretical possibility. Imagine a situation where the workup is done -- people have gone out and done the medical tests and found the recipients and set everything up. And then you change your mind."
"One wonders if perhaps that might create pressure to continue with the MAID. It would be very important in these scenarios to make it very clear to people that they can change their mind at any time -- that someone shouldn't stick with MAID just because they feel an obligation, having set the process in motion."
"I'm torn between a sense of, is it any harm to let people know [the donor died by assisted death]? After all, if it really bothers them, there will be someone else who will benefit greatly from this donation. They will just bypass the person who objects and go to the next."
Jennifer Chandler, professor, centre for health law, policy and ethics, University of Ottawa

"I think it's really important we keep the public's trust, in all of this."
"We have to be transparent. And it has to be clear that the two must be kept separate, that there is no pressure to go for MAID to procure organs [for transplantation]."
"[The terminally ill] may feel they would better serve society by dying and saving other people's lives." 
Dr. Marie-Chantal Fortin, transplant nephrologist, Centre hospitalier de l'Universite de Montreal
Medical team performing surgery on patient who had undergone medically assisted suicide. Getty Images
The conventional major source of transplant organs has been people who have been declared "brain dead", where patients are removed from ventilators and similar life support mechanisms meant to keep hearts and lungs functioning. Live-donor donations have more recently become another means to produce organs for transplant, when people decide to voluntarily donate pieces of their liver or a lung out of a sense of public duty and charity sometimes related to a specific patient, sometimes altruistically.

The Canadian medical community has recently adopted a practise of urging organ donation after cardiac death involving people on life support for whom the chance of recovery is medically dim. When life support is withdrawn and the heart stops beating, a five- to 10-minute "no touch" period ensues, after which the organ/s can be harvested. Because death takes its time; up to two to three hours; vital organs such as the heart and lungs begin deteriorating, resulting from lack of blood flow and oxygen.

When assisted dying is involved, organs have the potential of being retrieved swiftly once the heart stops within two to three minutes of the injection. What troubles ethicists, however, is the coupling of assisted death and organ donations. What is also to be considered is whether those organ recipients whose moral or religious objections to euthanasia entitles them to be informed that the organ offer has come from someone who chose an medically assisted death. In most instances cause of death is not routinely revealed, such as in the case of suicide, barring a valid medical reason for disclosure.

Even so, the pool of organs to be transplanted from those undergoing medically assisted dying is not a large one, given that most patients requesting assisted dying are suffering from advanced stages of cancer, making their organs transplant-unsuitable. Those, however, suffering from neurological disorders such as multiple sclerosis, have organs that are good candidates for transplant. Over 4,500 people were awaiting an organ donation in Canada in 2014, and from among them 278 died, while waiting for a transplant that never materialized.

So far, in Ontario, 26 people who chose to die by lethal injection have been donors of tissue or organs since decriminalization was passed last June. Since that time, 338 people have died through medical assistance altogether, in the province. Tissue donations represent eyes, skin, heart valves, bones and tendons. Experts feel that those who qualify for aid in dying could gain a sense of psychological comfort in the knowledge they have, through donating their organs, saved someone else's life.

And that comes up hard against those concerned that organ donation decisions might place pressure on those who qualify for assisted death. The issue appears to be, should someone agree to donate their organs, would they feel compelled by those circumstances involving the health and life of other people, to continue the procedure of assisted dying even though they may have decided they would prefer not to proceed?

Two countries that have long since legalized medically assisted death requests -- Belgium and the Netherlands -- appear to have solved the dilemma of their own concerns relating to the issue, and have long harvested organs after euthanasia. Infamously, China operates a thriving organ transplant/tourism 'business' in organs harvested from prisoners who have somehow died while incarcerated. The country stands accused of harvesting organs from still-living prisoners, as well.
“MAID (medical aid in dying) has the potential to provide additional organs available for transplantation. Accepting to procure organ donation after MAID is a way to respect the autonomy of patients, for whom organ donation is an important value. Organ donation after MAID would be ethically acceptable if the patient who has offered to donate is competent and not under any external pressure to choose MAID or organ donation”. Julie Allard and Marie-Chantal Fortin, bioethicists at the University of Montreal

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Monday, March 20, 2017

Millennials, Gen Xers at Risk

"People born in 1990, like my son, have double the risk of colon cancer and quadruple the risk of rectal cancer [in comparison to someone born in 1950]."
"They [younger people] carry the risk forward with them as they age."
Rebecca Siegel, epidemiologist, American Cancer Society

"I wasn't really trying to lose weight, but I just didn't enjoy eating [as a 29-year-old colon cancer victim whose symptoms were loss of appetite, weight loss]."
"I definitely want to get the word out: If you have symptoms that may be linked to cancer, colorectal cancer or any kind, get it checked out."
Chris Roberts, colon cancer patient
X-ray of colon tumor
ON THE RISE  For decades, colorectal cancer rates have been falling, but a new report finds an uptick in the rates among U.S. adults under 50. Here, an X-ray illustrates where a colon tumor (green) has constricted the large intestine. Biophoto Associates/Science Source

Thanks to the widespread screening that takes place with tests such as colonoscopies, colorectal cancer rates have declined substantially in the past years, with greater awareness due to information campaigns and physicians being alert for symptoms in their older patients. Screening by colonoscopy is recommended from age 50 onward. For African-Americans, screening is advised beginning at age 45, taking into consideration the higher risk among that community.

It was unthinkable to refer people in their 20s or 30s for screening, since those cancers were always known to strike older people. But just as the incidence of colon and rectal cancers have declined among the older population, for some mysterious reasons that researchers have been unable to identify, they have risen among younger populations. And, because this is still an emerging situation, when young people present with symptoms synonymous with those cancers, doctors diagnose other illnesses.

The American Cancer Society estimates that about 13,500 new cases of colon and rectal cancers will be seen to appear in the under-50 group in the United States this year. It is now recognized that rectal cancers are on a sharp rise in an younger age cohort, their incidence growing more swiftly than cancers that occur in other parts of the large intestine or colon. In the same time frame over 95,500 cases of colon cancer and close to 40,000 of rectal cancer in all age groups will be diagnosed.

Dr. Siegel, with the American Cancer Society is the lead author of a new report outlining these figures; her report recently published in the Journal of the National Cancer Institute. The risk of colon cancer among those born in 1990 was identified as five per million people of that birth group, a rise from three per million at the same age in 1950. As for rectal cancer, it has increased dramatically from 0.9 per million for those born in 1950 to four per million for those born in 1990.

What the medical community now realize is that because young people are not targeted for colon or rectal cancer as their older counterparts are, by the time their cancers are diagnosed they have all too often advanced to the point where their treatment may not succeed; some of the cancers so well established that treatment is no longer even feasible.

One young woman, at age 20, visited her doctor repeatedly with the complaint of blood in her stool. She was dismissed with the diagnosis of internal hemorrhoids, entirely because of her age, untypical for diagnosing cancer. Eventually the diagnosis of cancer was made, but by that point the colon cancer had advanced, at age 22. She underwent surgery and chemotherapy, and was pronounced free of cancer.

A 40-year-old woman, mother of four, experienced chronic constipation for years on end. Finally seeking medial help, she attended a clinic emergency room and a scan detected a tumour in her colon "the size of  a tennis ball". The cancer, however, had not yet spread. The young man quoted above, Chris Roberts, had moved to New York and was without a regular doctor's care. When he did find one and described his symptoms, including the loss of nine kilos, the doctor went right to work.

An ultrasound discovered that tumours had spread to his liver. Surgery followed to remove parts of his colon and liver, and then came chemotherapy. He is quick now to give advice to other young people who experience the tell-tale signs of cancer. And no one knows whether the trend for these cancers to strike young people will continue the upward trajectory.

<a href="http://www.cnn.com/2017/01/24/health/cancer-cluster-disparities-county-study/">A study shows</a> cancer deaths in counties across the nation, revealing clusters that have lagged behind national cancer efforts. Deaths from all cancers in 2014 were highest along the Mississippi River, near the Kentucky-West Virginia border, western Alaska and the South in general. Deaths were lowest in places like Utah and Colorado.
Deaths from all cancers in 2014 were highest along the Mississippi River, near the Kentucky-
West Virginia border, Western Alaska and the South in general. Deaths were lowest in places like Utah and Colorado.


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