Ruminations

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

Tuesday, June 19, 2018

Grim Deprivation

"The Charter [Canadian Charter of Rights and Freedoms] does not protect against trivial limitations of rights."
"I find that the provision of powdered milk does not constitute cruel or unusual punishment."
Federal Court Judge Alan Diner

"Not surprisingly, when these changes were introduced, inmate grievances related to food issues spiked."
"Unresolved demands regarding inmate dissatisfaction with food [likely played a role in triggering the December 2016 Saskatchewan riot]."
"Playing with the food of hungry and frustrated prisoners can have unintended detrimental effects."
Ivan Zinger, correctional investigator, Office of the Correctional Investigator
Warkworth prison. Pete Fisher/Postmedia

The Correctional Service of Canada introduced a new National Food Menu in January of 2015. as a cost-saving measure. The new menu brought in standardized meals to be served across the country to federal inmates. Part of a larger cost-cutting program, federal costs for inmates' meals were cut back by an estimated total of $6.4 million, the 2017 annual report o the Office of the Correctional Investigator pointed out.

The new, standardized menu reduced the cost of the prison service on meals to $5.41 daily for each inmate in the federal incarceration system. The menu is construed to provide 2,600 calories as a daily intake as recommended for men between the ages of 31 and 50, while meeting all the nutritional requirements for good health set out by Canada's Food Guide. An estimated $3 million was saved with the elimination of fresh milk alone, and the substitution of powdered milk.

English muffins were replaced with toast, and vegetable selection was also reduced; type, not quality or quantity served. The investigator, Mr. Zinger, attributed this very issue, the food menu change, to a riot that left one inmate dead, and eight inmates injured as they went berserk in January of 2016, at Saskatchewan Penitentiary. The riot caused roughly $3.6 million in damages to register inmates' ostensible dissatisfaction with the newly-introduced food cost-saving measures.

More latterly, another inmate has registered his outrage that fresh milk is no longer available for his breakfast cereal, that he must make do with powdered milk, claiming that his Charter rights have been infringed. The man is a dangerous offender, locked up at Warkworth Institution in Ontario. Being forced to use powdered milk, argues 58-year-old William A. Johnson, represents cruel and unusual punishment, violating his right to "security of the person".
There is no constitutional right to fresh milk.Getty Images

This convicted sex offender, serving an indeterminate sentence and imbued with a robust sense of entitlement, filed his grievance back in January of 2015. Warkworth, he insists, unfairly denies its inmates fresh milk, bacon, and french fries, none of which appear on the National Food Menu for federal inmates. This violent sexual predator clearly has a dim awareness of his obligation within society to respect others' right to "security of the person", much less realize that the food menu is favouring his health by withholding bacon and french fries.

Much less does he quite understand the obligations of citizens to respect the social contract between civilized people that views it as a severe criminal offence to viciously harm other people. The correctional investigator speaks of food as being "foundational to health and safety" within a prison. Food of choice clearly in his estimation, viewed as a reward by society to criminals who prowl about on the lookout for opportunities to do harm to innocent people.

Food complaints evidently rank as the third most common grievance spelled out by inmates during the past three years. Over 6,000 complaints were received by the prison service about the food it has served since 2014, clearly pre-dating the introduction in 2015 of the inmate-offensive new menu. These grievances were outnumbered by complaints focusing on prison staff and outside communications.

The moral of the story: If you want personal free choice, obey the law and respect the human rights of others. The unfortunate lack of tablecloths and cloth napkins alongside well designed silverware may in the future represent a new focus of complaints. Could be if word gets out about this lamentable lack of attention to proper table settings, it might be enough to turn the criminal element toward embracing the law and becoming model citizens.

The Correctional Service of Canada provides 2,600 calories worth of food a day at a cost of $5.41 per prisoner per day. Some say it's not as tasty as it looks. (Office of the Correctional Investigator)

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Monday, June 18, 2018

New Life, Old Problem 

"[The increase in trauma rates] suggests that the safety of the procedures is declining in Canada, especially after forceps use."
Newly-published UBC study negative on forceps deliveries

"When I put my forceps on I'm 99 percent sure I can get this baby out."
"The problem of doing a C-section after pulling the baby down to the opening of the vagina is also very challenging as well, and fraught with difficulty. A lot of OBs [obstetricians] will actually favour forceps because they know they can get the baby out."
"There's also a tremendous patient satisfaction with a vaginal delivery as opposed to C-section."
"We do need a measured response here, as opposed to just abandoning these procedures."
Dr. Christopher Ng, Department of obstetrics and gynecology, University of British Columbia"

"[Women should ask about risks and benefits of all modes of delivery] so they have time to digest what those risks mean to them."
"Women are very angry when things like this [trauma to new mothers and newborns] occur to them and they haven't been informed about how frequent [sic] we know it occurs."
"These perineal lacerations or tears that we are seeing, those accounted for 87 per cent of the cases of obstetric trauma among women who had forceps or vacuum deliveries in our study. Those aren’t anything to scoff at. These cause long-term quality of life implications such as having severe perineal pain or sexual dysfunction or abscess formation. Perhaps the most disabling complication from these lacerations is an inability to control your bowels or your bladder."
Giulia Muraca, post-doctoral lead author, study, University of British Columbia
forceps
The rate of obstetric trauma during operative vaginal deliveries jumped from 16.6 per cent in 2004 to 19.4 per cent in 2014 for first-time mothers, according to the study. CBC

The just-published study out of UBC points out that the most common injuries to women following forceps or vacuum deliveries turn out third- and fourth-degree perineal tears. Far less frequent, albeit the most common harms to babies included brachial plexus injury, damage to the nerves that come from the spinal cord in the neck and travel down the arm. Higher rates of injuries to mothers and babies are being seen in forceps and vacuum assisted vaginal deliveries.

The recent study published in the Canadian Medical Association Journal is the second turned out by this same team out of UBC which shows higher rates of injuries to mothers and babies in forceps and vacuum deliveries. The UBC-led team reported last year rates of severe birth trauma five to ten times higher in mid-pelvic deliveries where the baby's head is stalled midway through the birth canal. The study looked at close to two million one-baby deliveries in Alberta, Saskatchewan, Manitoba and Ontario in the years 2004 to 2015.

There was an increase among first-time mothers suffering physical injuries, from severe tears and lacerations to injured pelvic organs, joints and ligaments. Women with a previous C-section over the study period were similarly prone to suffering these injuries. The increase, however was most concentrated among "operative" vaginal deliveries; forceps and vacuum-assisted births. The largest trauma increase involved forceps deliveries, at a rate of 19.4 percent in first-time mothers in 2004 that saw an increase to 26.5 percent in 2014.

The conclusion is led by the understanding of concern over rising C-section rates, resulting in doctors being urged to consider forceps [or vacuums] when labour fails to proceed smoothly. These delivery options are considered to be safer than C-sections. Ironically, it is the thrust to lower the number of C-sections performed in delivery that has resulted in the once-common use of forceps by doctors skilled in their use, being used far less frequently currently by doctors who have familiarity with forceps skills.
forcep deliveries
CBC

Trauma to babies increased as well among first-time mothers, from 4.5 to 6.8 per one thousand deliveries over the period being studied. Doctors themselves admit to dwindling skills and lack of training in forceps use. A greater number of babies being delivered via C-section [equating to a third of all deliveries at the present time] leaves fewer opportunities for medical graduates to be taught correct and safe forceps usage.

A mere half of graduates of an American residency program, according to a 2007 study, felt competent in the use of forceps. Australia has seen recommendations to ban the use of forceps during deliveries completely, while some U.S. hospitals already prohibit forceps use. Malpractice lawsuits reflecting babies injured through forceps deliveries in Canada represent another consideration. An Ontario court awarded a family $2.8 million, finding a gynecologist negligent in the use of forceps in a delivery resulting in catastrophic brain injury to the newborn, in 2012.

The baby had suffered 'profound' asphyxia when the forceps caused umbilical prolapse when the compressed cord cut off blood supply and oxygen to the fetus. Used properly, forceps make for faster post-birth recovery with new mothers able to leave hospital the day following birth. Forceps have the appearance of a pair of metal salad tongs, while vacuums resemble and operate like a suction cup, both in use when concerns arise relating to the birthing mother being unable to push the baby out of the birth canal, the baby is stick there, or the fetal heart rate is concerning.

Since there are fewer forceps or vacuum delivery procedures being performed, with that type of delivery accounting for only 14 percent of all vaginal deliveries in 2014 in Canada, new doctors are not being exposed to real-life training with forceps, to the detriment of confidence and technique. As reliable instruments developed in the 17th Century, they have more than proven themselves over time but the vital confidence and skills in their use are being lost.

On the other hand, the universal concern over the part they play in vaginal deliveries when required, has spurred some action, with studies from the United States pointing out the value of simulation training's role in improving outcomes for mothers and their babies.

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Sunday, June 17, 2018

Deficits in the Healing Arts

"We need an infusion of new ideas. Cognitive neuroscience would help us characterize the deficits people have and allow us to connect them to particular brain systems."
"Patients and their families want to know what to expect during and after treatment [chemotherapy following cancer surgery]."
"Cancer-related cognitive impairment is real. And those of us in the field are intent on figuring it out."
Todd S. Horowitz, cognitive psychologist, program director, Division of Cancer Control and Population Sciences, National Cancer Institute, U.S.
[Woman undergoing chemotherapy]
Chemotherapy is known to interfere with cognitive abilities, but for how long? MedicalNewsToday
 
For every action there is a corresponding reaction. Pharmaceutical and medical science has allowed us to live longer and ostensibly better. When we have the misfortune to acquire a chronic illness, or when any untoward medical condition of however long a duration assails us, there is a formulaic therapy, a specific drug that will minimize symptoms, or 'cure' the illness, or enable us to live with the inconvenience to our daily health outcomes. Far from ideal, however, since even though the medication addresses the illness itself, the prescription will invariably impact not only on the condition it is engineered to target, but create another condition in the process, minor or major.

Dr. Horowitz and two other researchers at the institute they all represent produced a paper published in the journal Trends in Neurosciences, last week addressing a puzzling and important issue with the hope that they can influence an outcome where specialists in brain science can put their expertise to work to figure out why it is that so many cancer patients suffer from a condition known officially as cancer-related cognitive impairment, and which people who suffer from the condition and their doctors more familiarly term "chemobrain".

The estimates are that between 17 to 75 percent of cancer patients suffer from this condition where sufferers mention a range of impairments. And then to make it even more complicated patients with various types of cancers or those who have been put through a different set of therapeutic protocols speak of a wide range of disabilities in a malfunctioning brain. Researchers, to date, are stumped. There are theories but nothing has been proven. Some believe that chemobrain owes its presence to treatment for cancer destabilizing the immune system, so a toxic flood of inflammatory agents is unleashed on the central nervous system.

The condition is more commonly compared to living with a mental fog. Long after the recovery period from surgery and chemotherapy has passed and medical check-ups post-surgery have been lifted patients are exposed to a "new normal" situation that includes concentration difficulties, inability to recall words, short-term memory, and the end of multi-tasking. The onset of these symptoms lumped together as foggy brain syndrome or chemobrain is as mysterious as its presence. No one knows if it will eventuate, how long it will last, and what precisely is involved, let alone whether it can be treated, or, best case scenario, avoided altogether.

Not much is known about the mechanics involved in the phenomenon which experts attempt to use standard neuropsychological tests for, to determine the extent of cognitive impairment in various "domains", inclusive of attention, processing speed, visuospatial skill and various types of memory with clinical measures devised for the purpose of diagnosing or assessing injury caused through severe brain diseases like Alzheimer's, traumatic brain injury, or stroke. What works for those conditions seems unhelpful in the detection, measurement or explanation of the subtle impairment that stalls the return to normalcy for many cancer survivors.

Return to a normal lifestyle is stalled, temporarily or permanently. That mentally demanding work role for an employee suffering the after effects of cancer treatment becomes an impossibility. Some people are unable to resume driving, much less plan for their future. Experts speak of the possibility that chemotherapy may be responsible for brain inflammation, and DNA scrambling in the brain, or that chemotherapy promotes an acceleration of the aging process, or disables the brain's normal repair mechanisms. A simpler explanation might be that chemotherapy designed to eliminate certain cells, manages to breach the blood-brain barrier, attacking neurons directly.

Confoundedly MRI scans capable of capturing portions of the brain's more elusive structures have shown before patients undergo treatment, breast cancer patients, as an example are seen with reduced volumes of white matter, the brain's vital connective tissue. The scans reveal that paying attention exacts more of an effort on the part of the patient with chemobrain, that their cortical structures show both early- and long-term brain volume losses.

And then, MRI studies capturing activation in particular brain regions have shown a reduction in connectivity in a neural circuit named the default mode network with its central role in diseases of aging, along with those involving inflammation and cell stress. The hope is to be able to achieve a more accurate, dependable understanding of the aspects of chemobrain to give hope to cancer patients, to enable their brain to work as well as their medical-protocol-healed body. The hope is to be able to select specific treatments as strategies in the hopes of reducing the effects of chemobrain, or eliminating it entirely.
Signs and symptoms of chemo brain may include the following:
  • Being unusually disorganized
  • Confusion
  • Difficulty concentrating
  • Difficulty finding the right word
  • Difficulty learning new skills
  • Difficulty multitasking
  • Fatigue
  • Feeling of mental fogginess
  • Short attention span
  • Short-term memory problems
  • Taking longer than usual to complete routine tasks
  • Trouble with verbal memory, such as remembering a conversation
  • Trouble with visual memory, such as recalling an image or list of words
Mayo Clinic

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Saturday, June 16, 2018

Legalizing Pot in Canada

Ginette Petitpas Taylor @GPTaylorMRD
Minister of Health: I want to again thank the @SenateCA for their study of Bill C-45 over the past seven months. We will be accepting most amendments, while respectfully disagreeing with others. Our bill is improved going forward. #C45 #cannabis
"Every New Year's Eve for 20 years, I'd say goodbye to my wife and go and do ride spot checks with my guys [as Toronto's chief of police]."
"It's not the government's intent to promote the use of this drug [marijuana, soon to become legal in Canada]."
"I don't like it [cannabis]. My father was a cop and I had a great respect for him. Didn't want to let him down. Later when I became a cop, I was glad that I had made that choice because I thought it would be pretty hypocritical to enforce a law I had broken. I have actually never used any illicit drug."
"Organized crime will engage in whatever enterprise makes money for them and they're quite willing to operate outside the law. It's not all motorcycle gangs and street gangs and mafia. But it's all criminal enterprises and therefore unregulated and not subject to any rules. There's lots of different ways to fight organized crime and it's not just enforcement. Sometimes you have to outflank them. We've [Canada's federal Liberal government] now created competition in the market-place -- they've never had competition before."
"I thought my job wasn't just to enforce the law but it was to keep communities safe. The rule of law is meant to act in the public interest but what we saw was pretty strong -- a ridiculously high percentage of our kids using this drug but not being subject to any regulatory control or oversight. And so changing the law [as a Member of Parliament] made sense to me. You don't arrest your way out of these complex problems."
"My experience as a cop was to go into these crappy grow-ops, where the houses were covered in mold and my guys had to wear white space suits; there were hydro bypasses, they were fire hazards, it was a mess."
"The houses were rendered completely uninhabitable. We estimated there were close to 10,000 houses being used that way in the GTA [Greater Toronto Area]. I had two grow-op teams, they were doing about 350 a year and we were just touching the edge. You close one and three more would pop up because it was a lucrative business. The consequences were not nearly sufficient to deter the profit. We were fighting a losing battle."
Member of Parliament Bill Blair, former Toronto Chief of Police
There are many serious concerns about legalized marijuana that the government still hasn't addressed. (Joe Mahoney/Canadian Press)

On the cusp of legalizing cannabis in Canada, Bill Blair -- as the parliamentary secretary to both the Minister of Justice and the Minster of Health -- is the appointed point man overseeing the broad legislation set in motion to legalize marijuana. He has been tasked with ushering the drug's legalization through Parliament and the Senate for approval. And he has been the contact person between government and the pot-producing industry. As for his credibility and the respect with which he is held by both, it owes much to his lengthy time in law enforcement and first-hand knowledge of the illegal status of the drug.

His personal aversion to any kind of drug use is fairly well known, giving his point of view on pot's legalization greater clout. He speaks from the perspective of a long-time police chief in a major North American metropolis attempting to deal with the issue of illegal drugs, their proliferation and the crimes associated with their production and distribution adding to his conclusion through experience that overall prohibition was "failing on every front". As a practical, intelligent man he supports the obvious; that if something vital to the well-being of society as a whole isn't working, a new tack is called for.

An opportunity presented itself with the emergence of legalizing marijuana production, distribution and use for medical purposes. Medical marijuana supply was legalized in Canada in 2013, and as then-police chief, Blair had the opportunity to look at the facilities close up and personal, to discover that these new 'pharmaceutical factories' rivalled their conventional drug-producing counterparts for cleanliness, cutting-edge technology and security. "It shows there's a way this can be done right. This is a better way", he emphasized.

Measuring impairment on the road will be left to officers' judgments. (File Photo/CBC)
 

As a practical man he knows there are no guarantees, only optimism that perhaps a different way of doing things will result in a far better outcome than currently exists. Legalization could conceivably fail, just as prohibition has. An example is that in Colorado, one of four American states where pot is now legal, the black market still thrives. Mr. Blair has no expectation that legalizing pot will overnight kill the black market. Again, looking to Colorado, four years on from its legalization around 70 percent of the market is claimed by legal pot with much of the illicit stuff sent out of state where it remains illegal.

"Smoking is probably the least healthy way to do this [edible marijuana has not yet got a green light]. Philosophically, we're on the side of the healthier choice but there's a lot of risk in edibles. If you're going to allow them,  you've got to regulate them properly so people know what they are consuming, what the dosage is. Cannabis smoke metabolizes differently than cannabis when it's ingested. You don't want people having one biscuit and 30 minutes later having another because the first hasn't had any effect, then 30 minutes later taking out the tray. Two hours later they're not doing well at all."

Still from video: Global News

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Friday, June 15, 2018

Unveiling the Brain's Mysterious Ways

"I realized I was blind."
"It's almost as if everything is under water, and it's all fuzzy and hazy."
"Am I ever going to get even a little bit back [eyesight] in one eye so that I can at least see my family and friends? I hope it keeps on improving. But this might be it. Nobody knows."
"I can’t see like normal people see or like I used to see. The things I’m seeing are really strange. There is something happening and my brain is trying to rewire itself or trying different pathways."
Milena Canning, 48, Scotland
"And that particular piece of tissue [intact in the patient's occipital lobes] is an area that responds vigorously in everybody -- in her, in you and me -- to things that are moving."
"This may be the richest characterization ever conducted of a single patient's visual system. She has shown this very profound recovery of vision, based on her perception of motion."
"She is missing a piece of brain tissue about the size of an apple at the back of her brain – almost her entire occipital lobes, which process vision."
"In Milena’s case, we think the ‘super-highway’ for the visual system reached a dead end. But rather than shutting down her whole visual system, she developed some ‘back roads’ that could bypass the superhighway to bring some vision – especially motion – to other parts of the brain."
"Patients like Milena give us a sense of what is possible and, even more importantly, they give us a sense of what visual and cognitive functions go together."
"It’s important for patients and physicians to realize vision isn’t necessarily an all-or-nothing thing. It’s not that someone is blind or sighted and there’s nothing in between."
Dr. Jody Culham, neuro-psychologist, professor, Department of Psychology and Graduate Program in Neuroscience,Western University, London, Ontario

In 1999, Milena Canning of Glasgow, contracted a lung infection which led to severe respiratory collapse. Severe enough that her organs began to fail, and doctors placed her in a coma induced by drugs for a 52-day period. While still in that coma she suffered a stroke, perhaps more than one. Finally she awoke to the realization that she no longer had vision, due to damage of her brain tissue. Surgery followed to clear away the dead brain tissue, leaving large, dark vacuums. They appear as black holes on brain scans.

Her condition while rare is not entirely unique. It is a phenomenon known as Ridoch syndrome, first described, ironically enough in 1917 by Scottish neurologist George Ridoch. Five of his patients had presented with injured occipital lobes -- located at the back of the brain where most visual information is processed. They informed Dr. Ridoch they could see nothing that was stationary, but were able to see anything that moved.

Milena Canning had residual tissue that remained functional despite the horrible damage to her occipital lobes; a tiny piece of tissue, teaspoon-sized, that remained intact in both hemispheres. She is a patient of two Western University scientists who have tested her eyesight for years, validating that she can 'see objects' while they are in motion; swirling bathwater, wind blowing clothing on a clothesline or the movement of clothing in a laundry clothes drier, dangling foliage blown by the wind.

That tiny amount of residual tissue enables her to see steam rising from a kettle, her daughter Stephanie's ponytail swinging as she moves briskly along; not clear and concisely, but notionally and occasionally with a colour background of something appearing wet and shiny like a forest landscape after a heavy downpour. Like an impressionist landscape, not detailed or with any kind of perspective.

She had been referred to the Brain and Mind Institute at Western University back in 2007. Her peculiar vision has undergone a number of tests there over the years and formed a test study whose conclusions were reported for publication in the journal Neuropsychologia. Present-day advanced technology has led to sophisticated brain imaging techniques to allow scientists an improved understanding of the involvement of neural circuits.

This woman living with severely limited eyesight proved capable of catching balls in experiments where the balls were rolled or thrown at her. She was able to identify rainwater running down a windowpane. The team reported on her "remarkably robust preserved ability to perceive motions". As limited as is her ability to see stationary objects, she remains optimistic that she may one day recover more of her lost vision.

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Thursday, June 14, 2018

New Hope Potential Out of Personal Tragedy

"With the opioid crisis and persistent high rates of intravenous drug use, we have a great number of potential lung donors who are hepatitis C-positive, many of whom didn't even know they were sick when they were alive."
"The current protocol is to not use these organs [from deceased hepatitis C donors] but we started to question if that still made sense in an era when direct antiviral agents can cure hepatitis C."
"So I think it's a big gain and patients will get transplanted sooner as well, as more organs become available for transplantation."
Dr. Marcelo Cypel, thoracic surgeon, Toronto General Hospital
Donor lungs from individuals infected with hepatitis C have been successfully transplanted into 10 patients at Toronto General Hospital (TG), University Health Network (UHN)

Harvesting organs from the deceased to enable those with failing organs to receive an award of another chance at prolonging their lives, has a kind of ghoulish atmosphere about it, but the recipients are universally grateful that this opportunity to live longer with the removal of their failing, diseased organs and the replacement of healthy alternatives giving them that proverbial 'new lease' on life. hepatitis C affects an estimated 250,000 Canadians.

Moreover roughly 40 to 70 percent of people living with hepatitis C remain unaware that the blood-borne virus enjoys harbour in their bodies. The disease, when it is identified, has a 98 percent cure rate for those infected, with the use of antiviral drugs. So it makes perfectly good sense to use organs of those who are infected. Those transplant organs solve the problem of failing organs, even given the fact that they carry the blood-borne disease, since post-surgery with a treatment protocol of antiviral drugs hepatitis C is eliminated.

The treatment following organ transplantation serves as an effective preventive of the organ recipient becoming infected with the virus that has the potential to destroy their liver. Surgeons at Toronto General Hospital have committed to performing transplants of lungs from deceased donors with hepatitis C for eleven patients, representing a pilot study, to evaluate the safety of these infected organs transplanted to prolong life.

The very idea of using hepatitis C-infected organs for transplantation was unthinkable previously, before the introduction of antiviral drugs with the capacity to cure the disease. Now that drug overdoses with the advent of opioid substitutes like fentanyl and carfentanil has caused an explosion of inadvertent deaths, some good is seen to come from a dismal situation of expanding numbers of drug-user deaths.
Dr. Marcelo Cypel estimates there could be 1,000 more lungs available for transplant every year in North America by using hepatitis C positive organs (Photo: UHN)

Researchers from the hospital located in Toronto initiated their study last fall; their goal, to enrol twenty patients whose desperate need of a lung transplant would drive them to agree to what might seem risky to some; receiving an organ known to be hepatitis-C-positive. The compelling argument -- that a device known as the ex-vivo lung perfusion (EVLP system) developed as it happened, at that same hospital in 2008, will ensure that the blood-borne virus would be cured -- is persuasive.

A special solution baths the donor lungs for a six-hour period after which doctors evaluate their condition and asses suitability for transplant purposes. The perfusion technique has the effect of removing about 85 percent of residual blood in the lungs. Once the transplant has taken place, a follow-up within two to four weeks tests recipients for the presence of hepatitis C, and a 12-week therapeutic course of antiviral drugs takes place in prevention of liver infection.
Developed at UHN, the Toronto Ex Vivo Lung Perfusion System (EVLP) perfuses organs outside of the body. (Photo: UHN)

Should the virus take up residence in the liver, it can often take decades before it manifests itself through inflammation the virus causes which can then lead to severe cirrhosis or liver cancer. Eight transplant patients have thus far completed treatment for hepatitis C, and given a virus-free diagnosis. Two of the patients remain on the drugs, while one awaits the medication protocol to begin, post-surgery.

As far as Dr. Cypel is concerned, this new protocol will result in "a huge boost in organ donations", with a potential for adding approximately one thousand more donors annually in North America, which sees about two thousand lung transplants performed each year. There were over 240 patients awaiting lung transplant in 2015 in Canada; one in five died while on the waiting list, as a result of insufficient organs available for transplant.
"Obviously, when you first think about infecting someone, it raises some concerns."
"But we also recognized that these people are on a transplant list waiting for a life-saving organ, and without a transplant or even a delay in their transplant, it can sometimes be too long a wait and there can be grave consequence if they have to turn down these organs."
"I hope that if we can show that this is a very safe and effective strategy, which I think our results already show, then I think this can be expanded to other organs. So we could likely expand this from lungs to kidneys and heart, as well as pancreas and small bowel transplants."
"And it’s important because sometimes one single donor can be a donor of multiple different organs."
Dr. Jordan Feld, TGH liver specialist, study co-author
Lungs are seen in a device known as an ex-vivo lung perfusion or EVLP in this undated handout photo. Toronto doctors have successfully transplanted lungs from deceased donors with hepatitis C into patients in need of the life-saving organs, followed by treatment to prevent them from becoming infected with the potentially liver-destroying virus. THE CANADIAN PRESS/HO/ University Health Network

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Wednesday, June 13, 2018

Ending It All

"It's a troubling and a sad stat[istic]." It shows the seriousness of suicide and how important it is that we not shy away from conversations about suicide."
"We did have a very slight decrease [down slightly from 2014], but it's definitely not something to celebrate."
"This report is really a starting point for us. We hope this report will help us explore other questions. Where are the gaps in the data? What opportunities do we have from this data that can help inform or shape future policies or programs? We have the data. Now we want to hear the stories."
"The wonderful awareness campaigns we have are a great step, but it's also important that these young people feel confident and that they trust those who they're reaching out to."
Benjamin Leikin, supervisor, mental health unit, Ottawa Public Health
Hands holding
"We weren't reaching the young people themselves [through the 24/7 crisis line operation]."
"We all know that technology and mobile services are where kids typically communicate more, so we looked at a chat line as part of our crisis line."
Jeanne Lowe, executive director, Youth Services Bureau
KNOW WHAT TO WATCH FOR
Mental health experts advise parents and others working with children and teens to watch for changes in behaviour. These can include:
  • Changes in behaviours, friends, or normal activities
  • Changes in physical health and/or hygiene
  • Low energy, poor concentration
  • Declining school performance
  • Increased absenteeism
  • Marked personality change
  • Increased risky behaviour
  • Prolonged negative mood or attitude
  • Sudden positive mood after a long period of being ‘down’
  • Preoccupation with appearance and/or body image
  • Comments about feeling worthless, helpless, or hopeless
  • Comments about suicide and/or dying
Teens in crisis may talk more easily to their peers than to adults. All kids and teens should be encouraged to speak up if they are concerned about a friend—to tell a trusted adult, whether their own parents, a friend’s parent or a teacher, guidance counsellor or coach.

KNOW WHAT TO SAY
So if a parent, teacher or friend is noticing these changes, what can they do?  Sometimes it’s not easy talking to our kids.
  • Say something! Don’t be afraid of sounding clumsy
  • Be patient, compassionate, and non-judgmental
  • Ask the person how they are feeling and if they are thinking of suicide
  • If someone is suicidal, talking about suicide will not put them at greater risk
  • Really listen. Give 100% of your attention
  • Be sensitive, but direct
  • Let the person know you are concerned, and give examples of why
  • Example:  “I’ve noticed that you’ve been not yourself lately, I’m concerned about you. Could we talk about it?”
It cannot be considered anything but a mystery that so many people in any society seek to end their lives. In the New England States, suicide rates are on the increase, and though youth are thought to make up the greater proportion of those seeking to end their lives before they have even lived them into adulthood, statistics appear to belie the common perception that suicidal teens lead the death rate by one's own hand. There, it seems to be rural dwellers in their mid-50s and beyond who seem to top the scales for suicide.

People who suffer from mental illness, those who are facing economic turmoil, those who are lonely and/or have no one to depend upon to see them through emotional upsets. Figures in the Province of Ontario and more particularly in the nation's capital area appear to point elsewhere. The bulk of the increase leading to hospital admissions for mental-health conditions and addictions were seen to rise between 2007 and 2015 a whopping 45 percent, that increase led by those between the ages of 15 and 24.

Among Ottawa high school students, fifty-six percent surrender between two to four hours daily of their time to the use of smartphones and other electronic devices; over a quarter of that number claim to spend five or more hours daily using these devices. The question might very well be, are they a communication assist or an alienation tool taking constant users in a widening disconnect of normal social values?

The Champlain health region which includes Ottawa and the greater Ottawa Valley sees twenty-nine percent of Indigenous youth reporting symptoms of substance abuse in a truly problematic scenario. That represents one viral clue of alienation both from the wider society and the community group, the solution to which situation appears frustratingly elusive.

A newly published report by Ottawa Public Health, titled the Status of Mental Health in Ottawa, has determined that one of every nine students in the city has considered committing suicide in the year just past, with over 1,300 claiming to have made the attempt. Of those claiming to have attempted suicide, 60 percent made an effort to seek out guidance and emotional support, but failed to succeed in so doing for the simple reason it wasn't clear to them whom to turn to.

Of those questioned, it was discovered that 91 percent of those aged 12 or older felt satisfied with their lives, while 75 percent responded their feelings of happiness buoyed them on a daily basis the month previous. Clearly, this segment of society felt little in common with a much narrower segment for whom life satisfaction is elusive, leaving them to cope with darker emotions and puzzling over where they can find relief and support.

Ottawa's population is often thought of as a transient one, owing in no small part to the fact that a significant proportion of the population is employed by government as public servants. An average of 80 suicides take place each year in the city, of which roughly ten percent represent youth between 15 and 24 years of age. These numbers are reflected elsewhere in the Province of Ontario. A sense of belonging to their community is reflected in 63 percent of the city's residents, a rate lower than elsewhere in the province.

Unsurprisingly that proportion of the population living in low-income areas of the city are three times likelier to report "fair" or "poor" personal mental health conditions. In recognition of the vulnerability of youth in particular, the city's Youth Services Bureau has adjusted its educational and help programs to reflect how young people communicate; with the introduction of a chat-based crisis line.

Apart from the chat line with its 24/7 monitoring function, the agency has tasked itself to provide counsellors in four area high schools, offering twice-weekly walk-in mental health clinics, from noon to eight in the evening. This is in recognition of a vital role to fulfill to narrow the gap of the number of young people who are  unaware that help is available, and where to turn to attain it.
Key facts about suicide
Every suicide is a tragedy, and affects people of all ages and backgrounds.
  • A prior suicide attempt is the single most important risk factor for suicide
  • In Canada over 4000 people die by suicide every year
  • For every suicide there are many more people who attempt suicide
  • Suicide is the second leading cause of death among 15-29 year olds
  • Men in their 40s and 50s have the highest rate of suicide
  • Women are three to four times more likely to attempt suicide than men
  • Men are three times more likely to die by suicide than women
  • Average of 66 people die by suicide every year in Ottawa

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