Ruminations

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

Saturday, December 09, 2017

Healthy, Nutritious, Delicious, Pesticide-Laden

"Each of these foods [dozen foods that included strawberries, spinach, nectarines, apples peaches, pears, cherries, grapes, celery, tomatoes, sweet bell peppers, cucumbers] tested positive for a number of different pesticide residues and contained higher concentrations of pesticides than other produce." "Pears and potatoes were new additions to the Dirty Dozen, displacing cherry tomatoes and cucumbers from last year’s list."
"Apples tend to have the most pesticides because of the chemicals applied to the crop before and after harvest to preserve them longer."
Environmental Working Group Dirty Dozen list
Photo: Pixabay

Apples are likelier than any other fruit, because of their portability, ease of eating, taste and reputation as a healthy fruit, to be included in most peoples' packed lunches, including those that mothers prepare for their school-age children. That old adage, "an apple a day keeps the doctor away" didn't appear out of nowhere; it recognized the health benefits of eating an apple daily. The benefits, from cleaning teeth, to providing roughage and minerals and vitamins galore, are numerous.

Sadly, the apple appears as number four on the Environmental Working Group's list of the twelve most pesticide-ridden foods. Their residue load is taken to be harmful to human health. We do, of course, know that we are supposed to wash fruits and vegetables before using them. And that certainly includes fruits with skins that are discarded, like  oranges, grapefruits, and melons, for example, as well as bananas, just as much to remove harmful moulds that might be present, as pesticides.

Placing grapes in a bowl of clear, cool water to which lemon juice has been added, works well to clean pesticides and dirt off grapes, followed by a thorough rinsing. In Japan fastidious consumers go so far as to peel grapes before eating them. Potatoes can be left unpeeled, but well scrubbed with a stiff brush, then rinsed. Researchers at University of Massachusetts produced a study published in the Journal of Agricultural and Food Chemistry recently, suggesting that soaking apples in a baking soda solution is the best method of removing pesticide residues.

Apples have already gone through a commercial bleach solution wash before they appear on supermarket s helves. According to the study's lead author Lili He, that initial washing is meant to remove dirt and contaminants, not necessarily pesticide residues. And her study points out that the longer produce sits unwashed, the deeper the chemicals can be absorbed. So much for the common wisdom that produce lasts longer if washed only before eating.

Testing the efficacy of three variants on washing of organic Gala apples was undertaken by the UMass Amherst researchers after they had been sprayed with two often-used pesticides. The apples were left for 24 hours after spraying, then they were washed with plain water, or the bleach solution commercially used, alternately a baking soda-water solution. In two minutes' time the baking soda solution succeeded in removing the most pesticides, while plain water turned out to be more effective than the bleach solution.

However, for the baking soda solution to succeed in entirely removing pesticide residue, a 12 to 15-minute bath in baking soda solution  was required. "One thing that surprised us was how long it took to wash the pesticides away", added Dr. He. Her successful formula was to dissolve one teaspoon of baking soda for every two cups of water, to soak the fruit for a minimum of two minutes, then rinse with tap water prior to consuming.

The short cut of peeling apples before eating, thus bypassing the pesticide residue issue completely, sacrifices the nutritional benefits of the skin's fibre and nutritious qualities.

Getty Images



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Friday, December 08, 2017

Bicycle Commuting in Europe

"I didn't intentionally set out to visit the world's No. 1 and 2 best bike cities, although cycling was certainly on the agenda when I booked my tickets. And I had no way of anticipating what it would look like when an entire city is designed to prioritize two-wheeled transportation. I had thought that I'd lived in bike cities before. I spent a year in D.C., where I zipped past cars and around traffic circles to arrive at work each morning. Or rather, as I now realize, where I squeezed myself past and around bumper-to-bumper traffic and narrowly avoided death on a daily basis, helmet tightly fastened, entire body on alert to oncoming hazards, trips torturously [sic] rerouted to include, for as much of them as possible, the semblance of a bike lane. Back in New York, I gave up the commute, clinging instead to the strip of paths that will get me around Central Park or up and down the waterfront on the Brooklyn and Manhattan sides of the East River, but rarely to practical destinations like a supermarket, or my midtown office."
"'The Dutch all bike in the rain,' an Amsterdam local assured me as we dined side by side at a neighborhood Moroccan restaurant. 'They bike in snowstorms. It's just our culture: it's easy, it's affordable, it's healthy'. I didn't quite believe that last part, given the tendency I'd observed for the Dutch to steer their bikes with one hand while holding lit cigarettes in the other. But some quick Googling confirmed that the Dutch and the Danish aren't intimidated by the elements. And my new friend's explanation for why this was so left me at once envious, and dismayed. Because if what it takes to get people out on bikes is some deep, engrained attitude that it's just what you do, then I couldn't imagine bicycling ever truly taking off the U.S. the way it has there."                                                     Lindsay Abrams, Salon magazine
Bike traffic at Copenhagen road shows European bike-transit integration
Fifty percent of people in Copenhagen bike to work or school: Bike traffic at Copenhagen road shows European bike-transit integration; Copenhagen cyclists on a dedicated bicycle path. Reliance Foundry
Mayors of European cities are increasingly vying with one another in the creation of cycling cities through a view of the future they call "cycling visions". And possibly the most famous bicycling city in the world, Copenhagen, is seen as a blueprint for all other cities anxious to compete for the approving environmentalist title of 'cycling city' extraordinaire. Both Paris and London are hoping to compete in this cycling revolution to be acknowledged "the cycling capital of the world".

Now that the recognition of the benefits of cycling to cities hoping to diminish vehicle traffic and convince residents of the safety, efficiency and health effects of cycling has been well established, new European Union statistics may place those ambitions in question, because according to statistics, across the EU cycling deaths have latterly seen a steady rise, accounting for eight percent of all traffic fatalities, an increase of a third in the last decade. In urban areas, cyclists account for a surprising 2 percent of all road fatalities.

Cyclists are seen to be responsible for 30 percent of fatalities in the Netherlands, recognized as a top cycling nation, held as a model to be emulated everywhere. Unbelievably, bicycle fatalities now are five to ten times that of automobiles per kilometre travelled, a complete reversal of a decade earlier when motor vehicle deaths were falling dramatically, along with bicycle deaths in the European Union. Progress in diminishing vehicle deaths has come to a standstill.

And some regard the initiative to make cycling safer, allowing the bicycle a larger share of the road has managed to backfire on all kinds of vehicles. Of all those seriously injured in road accidents in the Netherlands, 63 percent are represented by cyclists, increased from 51 percent ten years ago. Soberingly, in 80 percent of these injuries there were no motor vehicles involved. What is now acknowledged is that that cycling accidents are mostly caused either by poor road conditions or cyclist negligence.

The addiction to checking smart phones, cycling while intoxicated, racing, using handlebars to carry baggage or having poor brakes or tires are all being identified as contributing factors to cycling accidents. And when collisions occur, it is more frequently with another bicycle than with a car, and even when a motor vehicle is involved, the fault can often be attributed to the cyclist having run a red light, swerved into the motorist's path, or being in a state of intoxication; alcohol or recreational drugs.

In two Dutch city centres, surveys of evening bicycle excursions discovered that 42 percent of cyclists registered blood alcohol levels exceeding the legal limit, and that number of impaired rose to 68 percent by the time one a.m. rolled around. In North America, cycling is represented by road deaths at a two percent rate, with U.S. Department of Transportation reporting cycling accidents have gone up six percent over the last decade; intoxication a frequent factor. Some 19 percent of cyclists who died had blood alcohol concentrations consistent with the phenomenon of binge drinking.
Cyclists wait at traffic lights in London.  Photograph: Carl Court/Getty

As in Europe, in the United States 29 percent of bicycle fatalities were linked to collisions with motor vehicles. In the remaining 71 percent of such cases falls, collisions with other bicycles or with stationary objects, the appearance of potholes and distracted riding were all cited as causatives. Authorities in cities in Europe are contemplating banning mopeds from bicycle lanes, persuading cyclists that quieter residential roads should be used, and thinking of measures such as redesigning buses so cyclists cannot slide beneath them.

Seniors, to date the cause of the highest rate of cycling accidents, might be encouraged to make use of tricycles, while planners think of re-designing bike paths in hopes of reducing intersection accident rates where half of cycling accidents take place, in high-cycling cities. The overwhelming majority of cycling accidents might be reduced by additional measures  such as apprehending negligent cyclists, by fixing potholes and by recognizing that cycling infrastructure has an opposite effect to what is intended; increasing accidents particularly at intersections.

So, it would then appear that the belief that cars result in city streets being dangerous to cyclists which has led cities to investing in expanding bike lanes and allied bicycle programs, might be wrongheaded. Where cycling deaths had previously been diminishing in incidents, they have, in concert with greater expenditures on municipal cycling infrastructure, been rising. No word whether the proliferation of cycling lanes and infrastructure has influenced greater numbers of people to venture out on bicycles for commuting and recreation, possibly accounting for the rise in accidents and fatalities.

Man and woman on bicycles reveals Amsterdam’s bike culture in historical center
Cycling is the cultural norm in many European cities.  Reliance Foundry


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Thursday, December 07, 2017

Victimizing Health Care Workers

"We had no idea of the magnitude of the problem or  how serious it was. We actually ended up being quite disturbed."
"It is very hard to ignore the parallels of gender and violence against women in our society with what we were hearing. It mimicked in so many ways the way domestic violence has been treated."
"We do not believe in workplaces that employ mostly women that health and safety is being given the same priority that it is in industrial facilities that employ mostly men."
"There were terrible physical traumas, people whose lives have been changed forever, people with post-concussion syndrome, people whose faces had been smashed and they now are disfigured."
"We spoke to a nurse who had — all in separate incidents — a fractured leg, a fractured arm, a deep bite wound, a stab wound. And these were not unusual stories."
"Somehow people have been told in a lot of ways that they are to expect this sort of treatment. But what I see, looking at it in a broader way, is it’s very similar to what’s coming out now in Hollywood, that there’s this culture of silence and shame."
"One of the things that came out is they [workers reporting abuse] received so little support. It was really different from one community to another, one facility to another. There were some people who said they had had very sympathetic supervisors who helped to support them through that difficult post-incident period, but I would say the majority felt that they got no support and, in fact, it was the opposite."
Margaret Keith, occupational and environmental health researcher, University of Windsor, Windsor, Ontario

“Even when the incidents were reported, there was very little action taken to remediate the situation to prevent it from happening again."
"It’s a barometer of what is going on in the health-care system. And if we don’t want our mothers and fathers and our neighbours and ourselves being treated that way, then I think we really have to be seriously thinking about what the culture is that all that occurs in."
"In some of the facilities, it's a daily occurrence: women being grabbed, verbal harassment. It is hard to imagine having done this study that one could ignore the role of gender in this story."
"It's one of the reasons that this issue has been kept out of the public view because the victims are not allowed to speak, which is another parallel, I think, to violence against women."
Jim Brophy, occupational and environmental health researcher, University of Windsor
The study looked at 54 hospital workers across Ontario, according to Jim Brophy,  who co-authored the report, Assaulted and Unheard: Violence against Health-care Staff.
The study looked at 54 hospital workers across Ontario, according to Jim Brophy, who co-authored the report, Assaulted and Unheard: Violence against Health-care Staff.    CBC

Two researchers have produced a study, entitled Assaulted and Unheard: Violence Against Healthcare Staff, which sets out the impressions they gained from interviewing health-care workers across Ontario, with a focus on workplace violence in health-care settings. Their study was published in the Journal of Environmental and Occupational Health Policy. In their interviews about the research they conducted and those whom they interviewed, they point out that this is a topic that is seldom addressed because it is quite simply ignored, although the fallout is serious and health-care workers are in a state of perpetual concern and distress.

The two university researchers, James Brophy and Margaret Keith, both with the University of Windsor, both occupational and health researchers, were aided by the work of Michael Hurley, president of the Ontario Council of Hospital Unions, part of the research team. They reached the conclusion that vastly under-reported violence perpetrated upon health staff workers in Ontario is ubiquitous and although a primary concern to the workers, is concealed from public awareness reflecting a culture of silence in the health-care field.

All of the 54 health-care workers who were interviewed had witnessed violent events borne by health workers. Only one among them had not personally had similar experiences when they too were victims of violence. This was reflected in the results of another survey which concluded that 68 percent of health workers in Ontario spoke of having experienced violence in the year past, and for some of those workers not merely one occasion but on multiple occasions. It is worth considering whether the rise in opioid-related use causing health emergencies has had some impact in this respect.

Some of those whom the researchers interviewed spoke of having had teeth knocked out, their faces smashed, and having suffered concussions along with other serious injuries leaving them in a state of debilitation and traumatization. Many others described having been sexually assaulted, and though they may have reported these episodes of shocking violence, their complaints were brushed aside by superiors informing them that what they had experienced was simply to be regarded as part of the job they had committed to.

The impression overall that the three researchers gained through these interviews was that health workers are fearful of speaking about the issue, let alone reporting them in many instances. And as a result of that lapse of reporting because the victims know their concerns will not be taken seriously let alone expecting that anything might be done to remediate the situation, the problem remains unacknowledged. For speaking up about violence against nurses while at a conference, a nurse working in North Bay was fired.

The conclusion reached by the researchers was that an increase of resources could assist in reducing violence against  health workers, making a link between staffing cuts and a rise in such events, where the health-provision workplace has become a toxic environment for workers, dangerous to their physical and psychological well-being. Earlier in the year a clerk in a Smiths Falls hospital had been stabbed by a patient using scissors he snatched from a desk. The simple enough expedient of having a Plexiglas barrier would have avoided this attack.

Hospital
Researchers conducted focus-group interviews with more than 50 hospital staff members who had experienced verbal, physical or sexual assault, mostly perpetrated by patients.  CTVNews

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Wednesday, December 06, 2017

Disruptive Passenger Threats on Air Flights

"The kind of behaviours that ... might be acceptable on the ground take on a completely different complexion when you’re in the air."
"I don’t think anybody knows exactly the reason driving the rise. Perhaps it’s just reflective of societal changes where anti-social behaviour is more prevalent and perhaps more accepted."
"For bar operators and restaurateurs, we’re also saying to them, look: you also have a responsibility to make sure ... you’re not promoting binge drinking."
"We expect to see more countries become parties to the 2014 international treaty allowing authorities to arrest passengers at a plane's destination] protocol in the coming weeks and months ahead."
Tom Colehan, IATA’s assistant director of government and industry affairs
‘Frustrations with journey’ believed to account for increase in plane rage.
Frustrations with journey’ believed to account for increase in plane rage. Photograph: Sam Diephuis/Getty Images
The latest report including statistics by the airlines industry's main trade group, the International Air Transport Association, reveals that incidents of air rage are on the increase. That violence is expressed by some passengers on some flights, somewhere in the world is no big mystery; the news media always carries coverage of those events. Let's face it, when you're in a confined space with a horde of strangers, seated uncomfortably, anxious for the flight to be over, until you're back on solid ground anxiety over misadventure allayed, the second worst possible scenario other than the plane running into mechanical problems is passengers creating an incident threatening the flight.

And threaten the flight they do. Creating disruptive events and spreading fear among other passengers that their psychotic and all-too-often alcoholic displays of loss of control tinged with a perceived level of disinterest in the welfare of everyone sharing the flight, creates an atmosphere of terror. Mind, it isn't only passengers on air flights who occasionally display irritated episodes of bad and threatening behaviour; there are times when airlines employees themselves create episodes of alarming displays of abuse, sometimes with violence thrown in for good measure.

As when infamously, security personnel on a United Airlines plane manhandled a passenger seated in his allocated space that he had paid for and who was anticipating a trouble-free flight because he knew he was expected the next morning to conduct surgery on a patient, who refused to obey the dictate that he relinquish his seat because the airlines had overbooked the flight and seats were needed, not for passengers in the lurch, but for transiting airlines employees. Still, it is the issue of passengers themselves acting out and behaving atrociously, creating tense and dangerous situations in flight that the IATA report singularly addressed.

An increase in the number of serious incidents where alcohol and violence were involved when travellers imbibed in the former and exerted the latter, that has become an increasingly troublesome concern where airlines must react by having their staffs physically restrain a growing number of disorderly passengers. The statistics indicate a 50 percent rise in 2016 over the year before, with 169 passengers globally forcibly confined. This confinement resulted as a reaction to everything from verbal threats and physical abuse to life-threatening actions, including efforts by passengers to enter the plane cockpit.

An intoxicated passenger struggled to breach the cockpit door of an American Airlines plane en route to Honolulu, necessitating the escort of the flight by fighter jets until the fright was resolved, the plane landed, the obstreperous passenger removed. The types of incidents vary, but what remains unvarying is the threat is there and it is growing, and the airlines must face the need to respond while at the same time reassuring other passengers that the flight is not being imperilled. Aside from which airlines now must be aware of local laws enabling prosecutions for offences. Moreover, airline crews must be trained to respond to violence.

As it happens, the total number of reported incidents of passenger disruptions in flight fell by close to ten percent to 9,837, but the proportion considered to represent a higher risk was increased from 2015 figures. One incident was reported for one of every 1,434 flights on average, while in twelve percent of such incidents physical assault occurred, and a third of all incidents involving 3,288 passengers were linked to intoxication, among which 444 events were noted as cases that had physically escalated.

As for those incidents related to safety rules, linked offences involved passengers smoking on board, in the main cabin or in the bathrooms. Such figures, accounting for 190 of the world's airlines "are likely to significantly underestimate the extent of the problem", cautioned Tim Colehan, IATA's assistant director for external affairs.

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Tuesday, December 05, 2017

Haven't We Seen this Somewhere Before?

"Teachers should not be allowed to be transferred to another school who have been found guilty of some type of sexual misconduct or indiscretion with students."
"It bothers me that these individual teachers are allowed to move to another school and start all over again."
"One wrong just creates another wrong by transferring. I don't think the answer is to transfer them, but as I said, to deal with it."
Nick Scarfo, assistant professor, Ontario Institute for Studies in Education, University of Toronto

"Something is not aligning. I don't understand how the changes that were made in Bill 37 in particular and the process changes that the Ontario College of Teachers have put in place, how this hasn't prevented these kinds of issues."
"This is non-negotiable. You do not want people who have engaged in sexual abuse of students in the Classroom. Full stop."
MPP Peggy Sattler, education critic for the Ontario NDP 

"De Luca easily moved from school to school, leaving behind emotionally wounded victims, with a fresh opportunity to victimize others."
"How could this abuse have gone unchecked for 20 years [Justice Robins wrote 20 years ago]? What can be done to ensure that this will not happen again?"
(retired) Judge Sydney L. Robins

"My school wasn't his first stop, believe it or not. I didn't have a choice in the matter."
"I was totally compromised."
"You have these predators that are in the school system, and everybody wants to give them a chance, but nobody says 'OK, that's enough'."
Retired School principal
Francesco Ciraco (left), sexually assaulted his colleague inside the school elevator in April 2009. He was sent home for three days and transferred to a new school. Ciraco was charged criminally and found guilty in court for the assault, but received an absolute discharge – a finding of guilt without registering a conviction or giving a criminal record. Richard Knill (centre) is currently facing criminal charges for sexual assault and sexual exploitation of two female students. Riaz Khamis (right) pleaded guilty at the College to allegations of professional misconduct including taking non-consensual photographs of his students and storing them with downloaded images of naked women.
Francesco Ciraco (left), sexually assaulted his colleague inside the school elevator in April 2009. He was sent home for three days and transferred to a new school. Ciraco was charged criminally and found guilty in court for the assault, but received an absolute discharge – a finding of guilt without registering a conviction or giving a criminal record. Richard Knill (centre) is currently facing criminal charges for sexual assault and sexual exploitation of two female students. Riaz Khamis (right) pleaded guilty at the College to allegations of professional misconduct including taking non-consensual photographs of his students and storing them with downloaded images of naked women.  (Carlos Osorio / Toronto Star/submitted image)

People in places of trust, betraying the belief that the trust placed in them in their moral obligation to treat their colleagues and the students their profession is meant to guide through the education system have spurned that trust as they chose to release their basest instincts in a succession of predatory pursuits. It was a bleak, dark open secret among parishioners in churches throughout the civilized world that there were some priests and other clerics who abused the trust placed in them as the gossip circuit warmed to the need to be vigilant but failed to protect children exposed to the wiles of such predators.

That the institution of the church had itself established a long tradition of never examining the issue to eradicate that black whisper of bad priests and ruined young lives, choosing instead to protect its reputation by seeing no evil, hearing no evil and routinely moving the evil to another location where a predator-priest's proclivities and actions were unknown to the locals and where he could simply repeat the predations was a moral scandal of incredulous proportions that severely diminished the respect in which the church was held, helping in no small part to accelerate the already-in-progress loss of community support.

Aside from the sanctity of the church environment, only the educational system of community-based primary and secondary schools represented a more safe environment for children in parents' minds. And then there were rumours and the occasional public airing of sexual abuse of schoolchildren on the part of teachers. That these occurrences were rare did not much affect the outrage of the public, aghast that children were being violated. And when the same things were being revealed in sports where trusted coaches were revealed to have similarly abused those in their care, the widespread nature of abuse was fully revealed.

In a climate of sexual persecution and harassment amid increasing reports of violent sexual attacks being aired regularly in the world of celebrity culture, comes word that in Ontario, teachers who have offended the social and professional moral code through sexual misconduct have been treated in the very same manner as the church did their criminal-conduct priests; spiriting them away to other schools where their crimes were unknown, enabling them in effect, to continue their predation in fresh hunting grounds their new school assignments represented represented another betrayal.

The Toronto District School Board had active files on 13 teachers known to have been sexually abusive to their teaching colleagues or to the students they taught. These abusive teachers in their state of authority betrayed were given fresh assignments outside the school where they had offended, placed in a new school where five of the teachers went on to re-offend and eight still remain employed in Toronto while two retired since their alternate placement.

In 2003, the Ontario College of Teachers considered a case that has now been presented before the courts in Brampton, Ontario just outside Toronto, where Richard Knill faces criminal charges on sexual assault and sexual exploitation of female students. This is a man who had allegations levelled against him of sexual abuse of students dating back to 1992 and for the following 25 years he practised sexual abuse of students at various locations, and in that period was transferred to other schools no fewer than three times.

One of the charges involved a sport team where he coached and became involved with a 15-year-old girl. Driving her to a church "While the vehicle was stopped at a traffic light, the member [Knill] then leaned over, pulled down the front of the student's top and started kissing and licking her left breast", wrote the college in their disciplinary decision, after the student had reported the incident to authorities. Criminally charged with sexual assault and breach of trust, he was found not guilty, was suspended for two months, was required to be assessed by a psychiatrist and to take a boundaries course.

He went on to continue teaching at various schools, the final one from 2004 to 2017. And in June was criminally charged in the sexual exploitation of a 17-year-old girl at the high school he was currently teaching at. Once that charged was announced, another woman brought allegations of sexual misconduct against this serial offender, following decades when she had remained silent about the abuse she had been exposed to.

Back in 2008 a Toronto district teacher, Riaz Khamis, was accused by a group of girls at the high school he taught at of touching them with inappropriate comments. He was transferred to another school in the same board. Five years on he pleaded guilty to allegations of professional misconduct for taking non-consensual photographs of students at the new school, storing them with downloaded images of naked women on a phone which he permitted students access to. When the photos were seen by female students, four reported him to their principal who reported to the disciplinary committee of the Teachers' college. This man now teaches at Scarborough's Woburn Collegiate Institute in the same school board.

Francesco Ciraco of Toronto's Catholic board in 2009 assaulted a teaching colleague inside the school elevator. Alone inside the elevator together, he kissed the woman, cupped her breast, squeezed her buttocks, kissed the exposed part of her breast. She shoved him away from her. He was transferred to a new school. Charged criminally, he was found guilty, requested a retrial and was once again found guilty. Despite which he received an absolute discharge. Having served a period of probation, the college found him guilty of professional misconduct suspending him for six months.

He is employed still as a teacher at Our Lady of the Assumption in North Toronto. The legislation meant to prevent students from being abused by teachers, Bill 37, the Protecting Students Act, under which there is no requirement for teachers to have their licenses automatically revoked by the college other than for cases of sexual abuse against their students which includes intercourse, masturbation, child pornography of genital-to-genital, genital-to-oral, anal-to-genital, and oral-to-anal contacts. Outside of these gross infractions, there is no provincial requirement for a teaching license to be revoked.

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Monday, December 04, 2017

DNR Tattoos

"The tattoo was such a dramatic display of rejection. I think this was someone who really didn't want to be resuscitated."
"The ethical standard is, you should do to an unconscious patient what they would want if they were conscious. But the problem with all advanced directives --even a document signed with a witness -- is that someone can change their mind at any time."
Dr. Kenneth Goodman, director, Institute for Bioethics and Health Policy, University of Miami

"Unless the Supreme Court says a tattoo is a legally binding document, then it's nothing more than an expression of emotion."
"A tattoo doesn't obligate a physician to not provide care if they don't have more information, and I wouldn't advise my colleagues to be worried that they'll have to justify their actions."
"When I read a document, I don't just say 'this is what I will or won't do' because DNRs are not black and white. People will write things like 'I'll be on dialysis but only for a week', so they think they've thought things through, but it's really more confusing for the physician."
"Things like better communication in hospitals need to be addressed, but I don't think [getting DNR tattoos] is the way to fix it."
Dr. Bojan Paunovic, executive member, Canadian Critical Care Society

"I would argue that in the absence of a clear indication that the tattoo represents a patient's current position, then the doctor would be well within their rights to proceed [in caring for the patient]."
Osborne Barnwell, lawyer, medical malpractices

One man's "Do not resuscitate' tattoo left doctors with no idea on how to react. New England Journal of Medicine

Dr. Paunovic points out that it has been his experience that many people have a change of attitude faced with a serious medical situation. Where they might have been convinced that they had no intention of permitting doctors in an emergency medical situation that looked grim in its outcome to use all possible technological and professional expertise to prolong a life not at that point worth preserving, when the actual moment arrives, they give it second thought, deciding that life is, after all, preferable to death; even a severely impaired life.

In 2012, an article describing a situation where a man who'd gone to the trouble of having a 'do not resuscitate' tattoo placed on his chest, irrespective of its prominence and the attitude it presented, really did want to be resuscitated. The reason for that article to have seen publication was to alert physicians that the tattoo had resulted from a lost poker bet. It did not in actual fact express the wishes of the man who wore it. Presumably the article did not need to delve into the inadvisability for anyone to recklessly display such an existential threat.

Yet this is the kind of thing that increasingly emergency room physicians are faced with, one that tests the ethical, moral framework of their profession What to do when such a tattoo is prominently placed on the body of a patient in extreme medical distress? Honour the tattoo as a significant authorized request to hold of on any extraordinary measures to save a life, or proceed, using every measure available to modern medical science to save the life of the individual expressing those sentiments?

This was an actual case that appeared in the New England Journal of Medicine recently, where doctors initially attempted to save the life of a man who had a tattoo on his chest. Addressing their uncertainty, in a desperate last minute appeal, the medical team queried an ethics counsellor and in the event made the decision to take the tattoo as an official endorsement of the man's wish to stop resuscitation efforts. Supporting documentation in the hospital's files were found, confirming the man's wishes. He died soon afterward.    

An increasing number of such mute, but highly legible attestations to intent are being seen in hospital emergency rooms. And Dr. Paunovic, an ICU physician, states that his attention would briefly fixate on the request, but it would take supporting documentation to convince him that the patient really did want resuscitation efforts to be withheld. Awareness of context, as far as Dr. Paunovic is concerned, is critical with any type of DNR order, inclusive of a signed document.

Giving a tattoo
Joe Raedley / GettyImages
People do strange things. Could be that someone in a state of temporary depression decides to have a tattoo for DNR. They may change their minds, but tattoos are pretty close to permanent; their removal isn't conveniently and swiftly accomplished. The eradication process is time-consuming, expensive and painful as a procedure to undo what has been done when a change of mind occurs.                                                                                                                     

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Sunday, December 03, 2017

The Imagined Confirmed

"The observations showed we were observing a kilonova, an object whose light is powered by extreme nuclear reactions."
"This tells us that the heavy elements, like the gold or platinum in jewelry, are the cinders, forged in the billion-degree remnants of a merging neutron star."
Dr. Joe Lyman, University of Warwick

"The first discovery of gravitational waves from the merger of two neutron stars is a historic event."
"It is every bit as exciting as the first discovery of gravitational waves from merging black holes. Since this involves neutron stars that radiate light, for the first time we can also see what is going on in an extreme astronomical event that shakes up spacetime."
David Wiltshire, department of physics and astronomy, University of Canterbury

"We're all made of stardust, but gold, silver and platinum are made of neutron stardust."
"In this particular event, it's likely that hundreds or thousands of Earth masses of gold and other elements were made."
"If the rate of neutron star mergers is as high as we now think, these dying stars are now the source of most of these elements in the universe."
Dr. J.J. Eldridge, astro-physicist, University of Auckland

"This discovery has answered three questions that astronomers have been puzzling for decades -- what happens when neutron stars merge? What causes the short duration gamma ray bursts? Where are the heavy elements, like gold, made?"
"In the space of about a week all three of these mysteries were solved."
Dr. Samantha Oates, University of Warwick astrophysics group
New source in galaxy NGC 4993   space in images

The Advanced Laser Interferometer Gravitational-Wave Observatory  in Washington and Louisiana a few short months ago validated as a reality a prediction that Albert Einstein proposed fully one hundred years ago. Einstein's theories, clarity in his mind, imponderable in the minds of most humans incapable of grasping the intuitive leaps of imagining the mechanics of the universe, have over time been shown to be amazingly scientifically clairvoyant. His visionary genius guided the science of astrophysics, theoretical physics.

His successors have built upon his theories, his advice, his philosophical view of science and the natural phenomena that we struggle to fully comprehend. One can only wonder what he might make of the great strides that have been realized since his death? What, above all, he might have taken out of the latest observations of the heavens. That scientists' theories that cataclysmic collisions of neutron stars and the monumental explosive force that ensued would create the sought-after precious metals mined on Earth, have seen observable confirmation.

These events of unimaginable force, dimensions, time-space occurrences where supernovas created from the death of giant stars become neutron stars where protons and electrons combine forming neutrons in the creation of tiny, dense stars and then collide in a spectacular burst of fierce energy, spewing debris hundreds of millions of years in the past, in a sense mimic the creation of the universe as we know it, through the Big Bang theory when planets and stars emerged.
Neutron stars merging     Space.com

The sheer magnitude of the event, the concussion that followed, were picked up in a space-time ripple in the detection of gravitational waves. The signal picked up by the LIGO Washington/Louisiana observatory by American astronomers was the remnant of a cosmic event at a time on Earth when dinosaurs made their home here, 130 million years ago. Space and time were rattled, to send gravitational waves throughout the universe in a powerful reaction.

Once the exciting word got out, astronomers worldwide aimed  heir telescopes toward the identified area of space, to pick up the infrared afterglow caused by the monumental collision and within that light they found the unique chemical signatures for gold, silver and platinum. The stars, before colliding, were 10 kilometres wide, yet each as heavy as our own sun. (A teaspoon-size of neutron star material has an estimated mass of a billion tons.)Their galaxy was NGC 4993, and gravity drew them to each other over millions of years as they revolved around each other more and more swiftly until they span at a rate of 500 times per second before crashing.

Another bonus from the discovery appears to be the realization that the mystery of what creates shortwave gamma ray bursts picked up on Earth may lead to future discoveries including how fast the universe is expanding. Stardust produces sensate, animate forms of life, it seems, while neutron dust creates dense material, inanimate, rare and costly. Will this discovery spur a precious metals rush into space to mine it of its treasures?

This map shows the locations of all five gravitational-wave signals detected by LIGO since the first detection in 2015. In the background is an optical image of the Milky Way; the discoveries are plotted on the entire celestial sphere, which is represented as a translucent dome. The gravitational waves come from relatively small sources (the two neutron stars were each only about the size of a large city),   Space.com

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