Understanding Cancer

"At an airplane terminal, you have all of your paperwork in place and there are guards to check it and make sure you're secure. The body is the same way."
"The immune system checks cells as they escape and filters them. This process of escape from the bloodstream is an important checkpoint where most of the cancer cells are destroyed. But if they're able to produce these invadopodia -- the right paperwork -- they're able to escape."
"No man will die of prostate cancer if it stays in his prostate. It becomes dangerous when it spreads. The prostate is not life-threatening if you lose it."
Dr. John Lewis, associate professor, University of Alberta, department of oncology

Cancer cells are cells that grow and divide at an unregulated, quickened pace. Although cancer cells can be quite common in a person they are only malignant when the other cells (particularly natural killer cells) fail to recognize and/or destroy them.^[1] In the past a common belief was that cancer cells failed to be recognized and destroyed because of a weakness in the immune system. However more recent research has shown that the failure to recognize cancer cells is caused by the lack of particular co-stimulated molecules that aid in the way antigens react with lymphocytes.[2

Scanning electron microscopy image of a lymphocyte

Dr. Lewis must know of what he speaks, with such ease and familiarity. He is, after all, the holder of the Frank and Carla Sojonky Chair in Prostate Cancer Research at the university. And knowledge about how cancer spreads is of huge importance. So it can be detected, prevented if at all possible, and if not, how to manage it before it becomes too late.

For example, research conducted by the university research team of which Dr. Lewis is an integral part, found that doctors could use drugs or genetic means to halt the development of invadopodia.

And what in the name of heaven is invadopodia?!


It is described as cancer cells forming "tentacles" enabling the cancer to spread from one body part to another. Those tentacles are invadopodia...makes sense doesn't it? It took three years of intense observation to discover how cancer cells the size of microns developed invadopidia, allowing them to move within the bloodstream to invade another organ. This is a phenomenon never before observed in a live model.

And, as Dr. Lewis said, the deadliest thing about cancer is its spread to other organs in the body. The spread of cancer, called metastasis is the cause of death for 90% of cancer patients. The diagnosis of metastatis is recognized by most people as a death sentence, often sooner than later.  There is now evidence that performing a biopsy or surgery on a cancerous tumour can cause cancer to spread.

In which instance an invadopodia inhibitor drug would be particularly important to use in such cases.

The drug that was used by the University of Alberta research team is now in clinical cancer trials; "encouraging", comments Dr. Lewis. He and his team of researchers made use of a $500,000 microscope and the protein of a deepsea jellyfish for their work. The protein glows fluorescent green, showing clearly in images of the cancer cell on a blood-red backdrop.

A University of Alberta research group injected fluorescent cancer cells into the bloodstream of test modules, then used high-resolution, time-lapse imaging to see what happens to them. Photo: Supplied

Purpose-built for the study, it is one of only two such microscopes in the world. The Alberta Cancer Foundation helped to fund the microscope and the study, and helped to bring Dr. Lewis's expertise from Ontario's Western University to Alberta, and the University of Alberta.

The team’s work was published in the most recent issue of the journal Cell Reports. Some of the study work was done by scientists at the Lawson Health Research Institute in Ontario.

Working on a Cure for Ebola

Gary Kobinger works in a mobile laboratory installed by the National Public Health Agency of Canada, in Mweka, Congo, in 2007. The drug ZMapp was produced in collaboration with the agency. The Canadian Press

A Cure for Ebola

"What's quite remarkable is that we could rescue some of the animals that had advanced disease. For us, advanced disease is an animal that is just a few days from the end, if not only a few hours."
"I was quite surprised that we would be going as far, and this time rescue animals up to day five -- and all of them -- which was fantastic news."
"We know there is a point of no return when there is too much damage to major organs, so there's a limit."
Dr. Gary Kobinger, chief of special pathogens, National Microbiology Laboratory, Winnipeg, Canada

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Gary Kobinger works in a mobile laboratory installed by specialists of the National Public Health Agency of Canada, in Mweka, Congo, Friday, Sept. 28, 2007. The experimental Ebola drug ZMapp was able to save infected monkeys even when treatment was only begun five days after the animals were infected, a new study shows. THE CANADIAN PRESS/AP, WHO, Christopher Black, HO

- See more at: http://www.princegeorgecitizen.com/life/scientists-at-canada-s-national-lab-created-tested-the-anti-ebola-drug-zmapp-1.1334370#sthash.3H3j349n.dpuf

"I never thought that 40 years after I encountered the first Ebola outbreak, this disease would still be taking lives on such a devastating scale."
"It is now critical that human trials start as soon as possible."
Peter Piot, director, London School of Hygiene and Tropical Medicine

"The gap between animal studies and first time, in-human studies even in the top institutions in the world is enormous."
"It's not ethically neutral to raise hopes in this way. Everyone is on the same page -- no one wants everyone to be dying. Everyone wants the game-changer."
"But I don't think that it's responsible or even respectful of the populations that are affected right now to be even reporting these things in ways that suggest it might be simpler than it really is. There's nothing simple about this."
Dr. Jim Lavery, managing director, Ethical, Social & Cultural Program for Global Health, St.Michael's Hospital, Toronto

"[The World Health Organization can't handle [the outbreak]. I don't see how, with the current measures, we're going to control the outbreak."
Mego Terzian, Doctors Without Borders president for France

The results of a Canadian-led study was published in the journal Nature online on Friday. Canadian scientists have succeeded in rescuing monkeys infected with a lethal dose of Ebola from certain death, in the latest study of an experimental drug already used, though officially unapproved, on a handful of Ebola victims in West Africa. This is the antibody-based compound known as ZMapp.

One hundred percent of the 18 rhesus macaques infected with Ebola survived, even when the drug was administered up to five days after they were exhibiting the symptoms of Ebola infection. All of the treated monkeys had full recoveries, with no side-effects, stated Dr. Kobinger, chief of special pathogens in Winnipeg. This represents the first study reported in monkeys of the version of ZMapp being administered currently in the West African outbreak.

As yet unlicensed, it is produced in collaboration with the Public Health Agency of Canada, and still requires testing in humans. Even so, it is unlikely ever to be produced in sufficient batches to make any impact on the current Ebola outbreak in parts of West Africa. According to a notice placed on the website of ZMapp's San Diego-based developer, Mapp Biopharmaceuticals Inc., the available supply has been exhausted.

Generated in tobacco plants that have been genetically modified to produce the antibodies, it takes a full month to produce 20 to 40 doses. Last November, a study was published on the testing of an earlier version of the drug, finding Ebola-infected macaques survived after being given the mixture within 24 hours of infection. In humans the infection is often fatal; the current outbreak has a fatality rate up to 90%.

The drug was given to seven patients infected in the West African outbreak, two of whom died, despite treatment. ZMapp, produced in collaboration with the Canadian federal public health agency, is comprised of three "humanized" monoclonal antibodies which are designed to bond to Ebola virus proteins. In humans, Ebola virus has an incubation period of between three to 21 days after exposure.

The first symptoms appear as a flu-like illness rapidly progressing to haemorrhage, multiple organ failure and shock-syndrome.

The monkeys had been infected with a strain of Ebola different than the one behind the current West African outbreak, but Dr. Kobinger explained that when tested in cell cultures, ZMapp stopped the new strain from replicating. 

Ebola's Genetic Variances

"Twenty-thousand is a scale that has, I think, not ever been anticipated in terms of an Ebola outbreak."
"That's not saying we expect 20,000 cases. That is not saying we would accept 20,000 cases. I think that's completely unacceptable."
"[But a robust plan is required in preparation for a] very bad case scenario."
Dr. Bruce Aylward, World Health Organization assistant director-general

"We've uncovered more than 300 genetic clues about what sets this outbreak apart from previous outbreaks."
"Although we don't know whether these differences are related to the severity of the current outbreak, by sharing these data with the research community, we hope to speed up our understanding of this epidemic and support global efforts to contain it."
"[The outbreak is] expanding exponentially [emerging from remote, forested villages to major cities which] raises the spectre of increasing local and international [spread]."
Stephen Gire, research scientist, Broad Institute and Harvard University

Medical staff in protective clothing transport a patient infected with the Ebola virus from an airplane to an ambulance at Hamburg Airport, northern Germany, on Aug. 27, 2014. Agence France-Presse/Getty Images

West Africa has been afflicted with the worst outbreak of Ebola virus disease that any nightmare scenario might have predicted would one day occur. A U.S.-led team of international scientists has produced a report stating its success in deciphering the killer strain's genetic code with the use of samples from 78 patients infected in the early days of the outbreak in Sierra Leone.

The report has the opinion that the outbreak in Sierra Leone was initiated by the burial of a faith healer who had himself treated Ebola patients in Guinea where the hemorrhagic fever virus had been on low simmer for months previously. At that burial thirteen mourners developed Ebola. To date, 1,552 people are known to have died in Liberia, Sierra Leone, Guinea and Nigeria, out of a total of 3,069 people infected. And now Senegal too has been affected.

Of the researchers involved in the international group effort to understand the situation better and parse the virus's genetic code, five of the almost 60 researchers became infected and died of the disease they were decoding. But the team published the results of their research in the journal Science, to reveal that the West African variant, though related to the first reported Ebola strains has genetically altered itself.

Even as the WHO is warning that the outbreak is accelerating and might exceed 20,000 cases, the study reveals that the virus is swiftly undergoing genetic mutations whose effect has the potential to make it difficult to diagnose, treat or prevent with vaccines. It is understood that the caseload, in reality, is without doubt much higher than reported. Particularly in large urban areas where infections are breaking out faster than they can be reported.

A Liberian health worker disinfects a corpse Friday after the man died in a classroom now used as Ebola isolation ward in Monrovia. John Moore/Getty Images

Canada's three scientists have been moved by the country's public health agency out of the mobile laboratory set up in Sierra Leone, as a protective measure after three people living in the same hotel as the Canadian scientists contracted Ebola. Many of the mutations discovered by the scientific team have altered protein sequences which are the very targets for experimental vaccines and antibody-based therapies.

The U.S. National Institutes of Health will begin testing an experimental Ebola vaccine on humans next week. The preliminary trial will test the vaccine in healthy American adults in Maryland, while British experts will test the vaccine in healthy people in the U.K., Gambia and Mali. The trial accelerated to respond to the outbreak emergency that has been the source of riots as quarantines were put into place and people reacted adversely, fearing a conspiracy of the West.

Those infected with Ebola are felt to be contagious when they are sick with it only, not while the virus is in its incubating stage. The time from exposure to verifiable, symptomatic infection can range from two to 21 days, with the virus transmitted through contact with bodily fluids.

Britain's Shameful Conscience

"There were examples of children who had been doused in petrol and threatened with being set alight, threatened with guns, made to witness brutally violent rapes and threatened they would be next if they told anyone. Girls as young as eleven were raped by large numbers of male perpetrators."
"The collective failures of political and officer leadership were blatant. From the beginning, there was growing evidence that child sexual exploitation was a serious problem in Rotherham."
"Some councillors seemed to think it was a one-off problem, which they hoped would go away. Several staff described their nervousness about identifying the ethnic origins of perpetrators for fear of being thought racist; others remembered clear direction from their managers not to do so."
Alexis Jay, author, independent report

"Cultural sensitivities should never stand in the way of protecting children."
"It is hard to imagine the damage caused to victims who were preyed upon with almost impunity over many years, because of a reluctance to comprehend or address what was widely happening."
John Cameron, head of helpline, National Society for the Prevention of Cruelty to Children

"[Rotherham victims: They were the ones with troubled family backgrounds, with] a history of domestic violence, parental addiction, and in some cases serious mental health problems. A significant number of the victims had a history of child neglect and/or sexual abuse when they were younger. Some had a desperate need for attention and affection. [A third were already known to social services because of child protection and child neglect, domestic violence and school truancy.]"

"I didn't want the story to be true because it made me deeply uncomfortable. [However] I could not escape a nagging feeling that I hadn't done my job properly [in 2003 in Leeds; stories of young teenage girls targeted by 'Asian men']. I'd looked the other way rather than sought to establish the truth."
"[His conscience nagged by 'strikingly similar' stories from towns and cities across northern England and the Midlands]. It was always more than one man in the dock. And it was hard not to notice that ... the convicted men in each case had something else in common. They invariably had Muslim names."
Andrew Norfolk, reporter, The Times

The report found 1400 children were abused in Rotherham from 1997 to 2013. Photo: Getty Images

What was widely happening was the gross sexual and violent abuse of defenseless children by predators whose success in their venture went unopposed, leaving them with the correct impression that because they were of Pakistani origin no one would dare confront them for fear of social backlash in a country that has become too 'liberal' in its multicultural consciousness to 'stand in judgement' of violent crime committed by minorities.

Rotherham, a borough of 250,000 people, sits in England's industrial north. Photo: Getty Images

And not just any minorities, but those of southeast Asian descent, Muslims whose takeover of parts of Great Britain is so complete that their cultural heritage predominates leaving them to feel quite at home in their demands for Sharia law and unquestioning surrender to their very particular entitlements. So the "collective failures" by authorities over a period of sixteen years to protect children from the gang violence and sexual predation of criminals was left unchecked.

This, even while in some media reports were being circulated of these despicable crimes against children and no one in authority appeared ever to take notice. Not that the abused children and their frightened families never complained to authorities. More that those in public office chose not to react in fear of exposing themselves to charges of racism.

Those accusations seemingly more to be avoided than to act in defence of the defenceless. Britain does have a well-earned reputation for the lax manner in which it chooses to give safe haven to child predators ranging from public figures to these gangs.

Ms. Jay, formerly chief social work advisor to the government of Scotland, informed the British Broadcasting System that she was "very shocked" by what was revealed to her when she investigated what had been happening in Rotherham. From her understanding that police "regarded many child victims with contempt", to the first of the reports being "effectively suppressed" because senior officers chose not to place any trust in the data.

So, in a town of some 250,000 individuals as many as 1,400 children were beaten, raped and trafficked between 1997 and 2013. Blame points directly now to mostly British Pakistanis who trafficked children to other towns and cities in northern England; the children abducted, beaten and completely intimidated. Five men were jailed in 2010 convicted of grooming teens for sex. And from that time forward the full spectrum of the sex trade in young children was finally revealed.

Implicating Pakistani criminal rings plying their trade in Rochdale, Derby and Oxford, as well as the now-infamous Rotherham, England.

Making Babies

"There was a lot of excitement, and many people were jealous."
"If I weren't this old, maybe I would have done it myself [offered herself as a surrogate birth mother]."
"This is a poor village. We make money by day and it's gone by evening."
Thongchan Inchan, 50, Pak Ok shopkeeper, Thailand

"This is a symbol of moral erosion. It's a symbol that people are concerned above all with money."
Kaysorn Vongmanee, Pak Ok public health department head

"There's nothing wrong with surrogacy -- you are helping people who can't have a baby."
"I understand the feeling of a mother who really, really wants a child."
Pakson Thongda, 42, Pak Ok resident

This house of a 26-year-old woman in Phetchabun's Ban Huai Chan Moo 14 that accommodates 10 members unveils part of her motive to become a surrogate mother for money. (Photo by Pattarapong Chatpattarasill)

Pakson Thongda understands, in fact, the marketplace commodity of a young, healthy Thai woman wanting to make a windfall for herself by offering her strong body to carry a child to term for those wealthy enough and certainly willing to hire her so that they may have a child of their own, when their own bodies fail the test of fertility brought to closure. Her daughter sold eggs twice to a fertility clinic, and through this process earned $1,000 for each occasion.

This represents a lot of money for people living in this remote Thai village of about 12,000 people located a six-hour drive from the capital, Bangkok. According to local officials, around two dozen women out of the entire community have taken to contracting out as paid surrogate mothers. For at least a decade this kind of commercial enterprise has been available to people with the means to engage.

Thailand is one of a few countries where commercial surrogacy is legal and represents only one of two in Asia. It has become a prime destination for couples in the near geography coming from countries where this kind of commercial enterprise is banned. When the opportunity to contract as a surrogate mother first came to this village, neighbours took note of conspicuous home renovations and a new car.

As most residents of Pak Ok live in wooden houses, alongside tamarind groves and rice paddies, this incident gained great notice, and of course, envy. The womb rental business has great appeal for young women in this country where free enterprise of a sometimes sordid nature takes place, related to sex-tourism with those whose age would land the pedophiles and child-abusers in jail in their own countries.

The two issues are hardly to be compared, needless to say. One is a disgustingly horrendous practise, the other a practical means by which childless couples are able to attain parenthood with the assistance of someone glad to be paid to offer the service. The estimation is of several hundred surrogate births taking place in Thailand annually, not all that huge in terms of numbers, but huge in terms of opportunity and happiness for those engaged in the trade.

Thai surrogate mother Pattaramon Chanbua with her baby Gammy, born with Down Syndrome, at the Samitivej hospital in Sriracha district, in Thailand's Chonburi province on August 4, 2014 (AFP Photo/Nicolas Asfouri

Unless, like the couple from Australia who contracted through an agency with a young Thai mother to carry their egg-and-sperm to term, but chose to take with them the tiny girl, and leave behind her male twin who had Down Syndrome. Leaving the child with its surrogate mother who loves the baby and cares for it. After all, said the father David Farnell, as he disowned his own biological child, "I don't think any parent wants a son with a disability".

Surrogacy clinics in Bangkok recently were raided by police who revealed that a 24-year-old Japanese man had fathered a dozen babies through surrogates whose births were weeks or months apart. This is rather embarrassing to Thailand which winces as it is at its reputation for casual prostitution with males and females of all ages. The man insisted he was not interested in selling the babies on the Asian black market, but in an entirely legal way wanted to 'have a large family'.

Thai police display pictures of the surrogate babies during a press conference at the police headquarters in Chonburi, Thailand. Photograph: Sakchai Lalit/AP

Surrogates, according to Thai officials, earn about $10,000 at the conclusion of a successful pregnancy, and greater amounts for twins. They also receive a monthly allowance of around $450 and live rent-ree in Bangkok, where women are given instructions to carry out their pregnancies. Commissioning parents are usually from Japan and other wealthy Asian nations, according to Mr. Vongmanee.

The village of Pak Ok has lately been the subject of the news media in Thailand, which saw throngs of reporters descend to write their stories with personal interviews relating to another national scandal. Villagers in Pak Ok are furious at the witch hunt by authorities, interfering with a legal practise undertaken by impoverished young women, eager to earn a living, however they can.

Agony, Trust and Hope

"That really stuck with me [that many suffering from the rare Stiff Person Syndrome commit suicide]. Their lives are really affected in ways you can't imagine."
"We approach these cases very carefully and are always aware that there have just been a few patients treated and followed for a short time. Seeing these two patients return to their normal lives is really every physician's dream."
"We went in with the feeling that the patients made a very good case about how devastating this disease was on their lives and they were willing to trust us with our technology. We thought if nothing else had worked, this might."
"It is not a cure. We don't know how long these remissions will last; it is just a few patients with a short follow. And there are risks associated with this procedure, it is not like taking a pill."
"It should only be considered where nothing more conventional is working … the symptoms have to be severe and the impact on their life very, very profound because there are risks associated with this. [One in 20 patients receiving a bone marrow transplant for the treatment of leukemia or lymphoma will die of a complication.] And we don’t think stiff person syndrome patients … would have a lower risk [of complications from chemotherapy, including infertility, premature disorders like heart disease and diabetes.]"
“I think for the right patient it might offer some benefit in helping them improve, but it’s too early to say that this is the answer to Stiff Person Syndrome. It’s a pretty dramatic treatment and we need to keep thinking about better ways to do what we’re doing — getting rid of the immune system perhaps with less toxicity and being able to grow back a new one more quickly.
“So I think there are a lot of unanswered questions yet.”
Dr. Harold Atkins, bone-marrow transplant specialist, Ottawa Hospital Research Institute

Dr. Harold Atkins had the results of his treatment of Stiff Person Syndrome published in the Journal of the American Medical Association on Monday.    Photo Credit: CBC / Laurie Fagan

"It is tremendously difficult. Your hope for a positive future is so bleak, the disease starts to chip away at you."
"Now I feel like the possibilities are endless. I appreciate life so much and everything it has to offer."
"I went to visit Dr. Atkins and meet the team [of scientists from the Ottawa Hospital Research Institute] and I was able to thank them. My gratitude for them can't be expressed in words. What they are doing to change peoples' lives is extraordinary. I wouldn't be thriving today without Dr. Atkins and The Ottawa Hospital."
Tina Ceroni, Stiff Person Syndrome sufferer in remission, Toronto

Tina Ceroni is seen in this undated handout photo. Canadian doctors have begun using stem cell transplants to treat "stiff person syndrome," a rare neurological condition in which a patient's leg and other muscles suddenly contract painfully, often leaving them immobilized like a tin soldier. THE CANADIAN PRESS/ HO, Ottawa Hospital Foundation

Tina Ceroni was the second individual to have been treated with the medical pioneering stem-cell transplant developed by by Dr. Atkins and his research team at the Ottawa Hospital (using her own purified cells). A 36-year-old kinesiologist and talented triathlete, her symptoms began in 2008 as she was training for an Ironman half-triathlon. As the disease progressed she realized it was not an injury on the way to healing. When her condition was diagnosed she began to deteriorate, losing muscle control, losing mobility, losing her business, losing her ability to drive, losing her independence.

She had to return to living with her parents and several  times monthly she would be rushed to hospital by ambulance when something inconsequential led to a consequential episode of severe muscle stiffness in her legs, her torso, her abdomen, a disability that could promote itself to threaten her very life. She underwent a stem-cell transplant in 2011, and that event caused her life to take an unbelievable turn for the better; a miracle, she calls it. Her experience and that of another patient preceding her represent case studies Dr. Atkins and his team published in the prestigious JAMA Neurology journal.

She is once again taking her life up where she was forced to leave it; incapable of doing anything physical. She is now cycling again and competing in triathlons. She has also embarked on a fund-raising venture to help raise funds for Dr. Atkins and his team at the Ottawa Hospital Research Institute. Dr. Atkins has been involved with stem cell transplants for quite awhile in its more traditional use to treat leukemia. The procedure has been modified enabling doctors to treat people with severe autoimmune disease, including multiple sclerosis and scleroderma.

Stiff Person Syndrome is a rare and painful disease, a condition that can leave people erect like tin soldiers, incapable of moving their bodies normally. Ms. Ceroni and the previous patient treated by Dr. Atkins have been symptom free for two years. Originally, a patient with the disease had contacted Dr. Atkins beseeching him to consider performing a stem-cell transplant on her. Dr. Atkins did some research on the disease, and then decided to proceed with the request. He was terribly moved when the patient told him how horrible life is with the syndrome.

The procedure developed by Dr. Atkins requires removing blood-forming cells from a person's blood (autologous stem cells), purifying them to remove misdirected immune cells, knocking out the patient's immune system using chemotherapy, and then returning the treated stem cells with the purpose in mind to regenerate the body's immune system with a now-properly operating immune system. The stem cells are young new immature cells capable of maturing to become various types of specialized body cells.

This procedure requires a month in isolation while the risky business of a rebuilt immune system slowly proceeds. A one-in-20 chance of death resulting from the procedure is certainly a daunting feature of the process. Researchers, emphasizes Dr. Atkins, are uncertain what they can expect down the road with this treatment of Stiff Person Syndrome. But patients whose lives have been placed in suspension while their bodies gradually deteriorate and they become other than what they were, horribly suffering, now have the choice to turn their symptoms completely around.

For however long that health-rescue situation lasts, a valuable asset for people whose suffering is so great they see suicide as a release.

Iceland volcano: Bardarbunga hit by 5.7 earthquake

BBC News online -- 26 August 2014

Local authorities have closed roads leading to the area and evacuated several hundred people

Continue reading the main story

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Iceland's Bardarbunga volcano was hit by a magnitude 5.7 earthquake on Tuesday morning, the largest since tremors began in the area last week.

The country's Met Office said despite the shock - the fourth magnitude five quake in 48 hours - there is still no sign of a volcanic eruption.
On Sunday, Iceland lowered the aviation risk to its second highest level.
Iceland's Eyjafjallajokull volcano erupted in 2010, producing ash that disrupted air travel across Europe.
Bardarbunga is in a different range to Eyjafjallajokull, but the intense seismic activity has raised fears that an eruption could cause similar travel chaos.

No surface movement "There was one event during the night. It was a magnitude 5.7 [earthquake], the largest in this series," Palni Erlendsson, a geologist at Iceland's Met Office told Reuters news agency.
The activity was still deep below ground, Mr Erlendsson said, adding there had been no signs of movement close to the surface.
"We still can't say whether [the activity] will cease, continue like this for a while or erupt. It's impossible to say," he said.

The Vatnajokull glacier sits on top of the volcanic range. There are fears an eruption could cause flooding

The magnitude five earthquakes are the strongest to hit the Bardarbunga region since 1996.
The Met Office said the latest large tremor occurred at 01:26 GMT to the north of Bardarbunga, 6km (3.7 miles) below the surface, near the rim of Dyngjujokull, another nearby volcano.
Bardarbunga and Dyngjujokull are part of a large volcano system hidden beneath the 500m-thick (1,600ft) Vatnajokull glacier in central Iceland.
The region, more than 300km (190 miles) from the capital Reykjavik, has no permanent residents but sits within a national park popular with tourists. Several hundred people have been evacuated from the area.
Authorities have previously warned that any eruption could result in flooding north of the glacier.
But experts said the activity was migrating north, with the tip of the movement already 10km (6 miles) outside the glacier.
Scientists believe the earthquakes are a result of magma flowing out from beneath the volcano, causing a change in pressure.
This movement could stop, reducing the seismic activity, or the magma could reach the surface and lead to an eruption.
On Sunday, Iceland lowered its level of alert to the aviation industry from red, warning of an imminent eruption, to its second-highest level, orange.
Airspace over the site has been closed, but all Icelandic airports currently remain open, authorities say.
The Eyjafjallajokull eruption in April 2010 caused the largest closure of European airspace since World War Two, with losses estimated at between 1.5bn and 2.5bn euros (£1.3bn-2.2bn).

Yearning For Family

"His name came up. I said to my wife, 'I knew a Ron Cole when I went to public school and he lived on Woodlawn Avenue."
"We were chums in public school for about two or three years, not knowing that we were brothers. It's unbelievable."
72-year-old Duncan Cumming, Guernsey

"I was about to hang up [the telephone], but she had a little too much information on my adopted family. She knew things that normally people wouldn't know. I started to listen. When she mentioned Duncan Cumming, that name kind of rang a bell."
71-year-old Ron Cole, Saskatchewan

 

Ron Cole, left, and Duncan Cumming as children at an Ottawa beach in the 1950s. The two childhood friends recently discovered that they are biological brothers.   Ron Cole / Ottawa Citizen

Stranger things likely happen, but in this world of happenstance, circumstance and peculiar serendipity, the reunion of two biological siblings does have an extraordinary story behind it. All the more so that even while they had the same biological mother, both were adopted, living within a neighbourly distance of one another. And while even their step-parents had no idea that the family they became friendly with, that each of their adopted sons found playmates with on the verge of their teen years, were in fact, brothers.

Duncan Cumming, now 72, and Ron Cole, 71, played together as young boys, attending the same public school, and they went places together, as good friends. Their parents, living in the near neighbourhood to one another were also friends. While Mr. Cole became a cattle rancher in Saskatchewan, Mr. Cumming remained in Ottawa doing security work until he moved to Guernsey in the English Channel with his wife.

As boys the two spent quite a bit of time together. "My parents had a cottage, and he'd been there, and I'd been to his place", explained Mr. Cole. While Mr. Cumming said they hung around together after school until dinnertime, playing as good friends were wont to do. He would never, he said, have imagined they were brothers, they looked nothing alike. Mr. Cumming had been searching for his biological mother for decades. Discovering she had died, he began a search for a brother and sister he knew existed, somewhere.

Then one day Mr. Cole received a telephone call from someone telling him they represented Parent Finders, an organization he had himself contacted over ten years earlier, given his telephone number to, then promptly forgot that contact. Obviously expecting nothing to come of it, despite that someone had recommended the organization to him and he had followed up on the recommendation. When he did receive that call that might have been long-awaited, but wasn't, he thought it was a scam.

Just coincidentally he had a few days before that telephoned contact, been organizing some of his personal papers when a folder containing photographs fell off the shelf. "I was moving them to gt them out of the way. I dropped them, and out fell this picture of Duncan. I looked at this and I thought, 'Why did I save this picture? What is this?", Mr. Cole said in an interview. Then, soon after his conversation with Parent Finders he received another telephone call.

This time the call was from his old childhood friend, Duncan Cumming. As they spoke, Mr. Cumming stated he thought he had a photograph of them both, when they were young, playing together. "I said, 'Well, don't say any more. Am I holding a beach ball and you're wearing a ball hat?", asked Mr. Cole of his newly-discovered biological brother. The very same photograph he had come across a few days earlier. "Just totally weird, eh?"

Weird, yes. ... Unsurprisingly, they're planning a reunion.

Nowhere To Run To

"[When a high-risk sex offender is released from prison] society becomes a sitting duck. What we need is a systemic way of dealing with the issue so the community doesn't have to take it on."
"I believe in the law, so any form of activity that is not regulated is wrong, but for those raising children ... having access to information, to me, that is just a basic right."
"Given their crimes, I believe they have lost the right to anonymity. Do you not have the right to know who you're sending your kids to at Halloween?"
Rosalind Prober, president, advocacy group Beyond Borders ECPAT

"What purpose can there be to this legislation [Conservative government tough new legislation to establish publicly accessible database of high-risk child sex offenders] other than to further vilify child sex offenders, encourage vigilante justice and further drive them underground?"
Stephen Hebscher, Toronto criminal lawyer

"Hurt my kid and I'll bury you where they'll never find the body."
"Pedophile you came to the wrong neighbourhood."
"Hurt a kid ... deal with us."
"...willing to jump into action to protect abused kids 24/7."
Urban Bulldogs Against Kid Abuse [patch-wearing bikers]

Screengrab / ubaka.org   The homepage for Urban Bikers Against Kids Abuse.

"[It's] incredibly concerning [that people who go through the judicial system continue to offend]."
"That means we are dealing with a population of people that have come through a system that hasn't held them accountable. The system is under resourced, we still have judges and justices who don't understand what sex offenders are capable of ... you have people out on the streets who have not undergone counselling ... it's problematic, they come out the other end with very little intervention."
Danielle Aubry, Calgary Communities Against Sexual Abuse

"Maybe they (police) are watching him, [released-to-the-community sex offender Terrance Leger, 54] but it doesn't seem like it. We've seen kids in his yard, seen him hanging around an ice-cream parlour talking to children. ... People feel helpless."
Grandmother Lynn Hutchinson

"We had conditions put on him when he was released. He has a curfew and is not supposed to be around children. If people see that, they need to bring it to our attention. We will act on reports."
"If it's just about monitoring as a community, that's OK, but if there's false information, harassment ... that's not helpful. People need to understand they (sex offenders) have met their custodial obligation and are free members of society with the same rights as others ... they deserve not to be harassed and targeted by people."
RCMP officer Sgt.Dale Morgan

Police, social workers, much of the general public, criminal lawyers, have a perfect right to believe and support the theory that child-sex offenders having been charged for their crimes, judged and imprisoned, and thereafter have a perfect right to take their lawful place in society once they have discharged their obligation to justice by serving the time allotted to them as punishment for their crimes. Parents of vulnerable young children think differently; that their moral right to live alongside families with children will never be rehabilitated.

In July, after five years in prison, 35-year-old child-predator, sexual offender, and violent criminal Keith Constantin, convicted of sexually assaulting a seven-year-old boy, and a 45-year-old blind woman among other crimes, had his face and crimes placed on posters on every available space in the Gage Park area of Hamilton Ontario. Hamilton Police had warned that he represented a danger to reoffend.The backlash to his presence led by several hundred raging mothers unnerved this man to the extent that he broke his curfew and was taken back into police custody.

He was hounded out of the Gage Park area, then he settled into the nearby Hamilton suburb of Stoney Creek and the same reception met his presence. A mother of four young children set up a Facebook page, and residents printed and distributed posters along with an online petition that read: "Stop the government from allowing him to live in our city" that bore several thousand signatures. The man now faces a possibility of an additional two years in prison for breaching his curfew. Should he return to those communities afterward, he will face a similar reaction.

And then there is Terrance Leger, 54, who had been actively engaged in abusing young boys in the rural community of Collina, where locals held meetings, exchanged posters, drew up petitions and pressured the landlord who owned the house Mr. Leger was renting. Add to that Dave Mantin, director of the Sexual Abuse Network of Canada, living in Saint John, who managed and led the campaign. Mr. Mantin operates a support and advocacy network with cross-Canada reach.

Keith Minchin for National Post   Dave Mantin, Director with the Sexual Abuse Network of Canada, delivers flyers near his home in Saint John N.B.

He also maintains a public listing of sex offenders based on media reports, and uses private Facebook groups to keep tabs on convicted or suspected pedophiles, working entirely "within the law" to monitor and bring the concerns of neighbourhoods to the attention of police. Mr. Leger also was pressured out of Collina in a few months' time, leading him to move up to the road to Penobsquis, 20 kilometres away where Lynn Hutchinson is his neighbour.

She began driving by his house, beeping her horn to harass him after she had spotted him in her backyard one night. He threatened to call the police. Rosalind Prober of Beyond Borders ECPAT finds such tactics unuseful, but she knows the wellspring of fear and loathing from whence they arise, largely a feeling of powerlessness while a threat lurks in the community. Currently, the national sex offender registry available only to the RCMP, has 33,000 names, two-thirds of which represent people convicted of sex crimes against children.

That database will become public when the new legislation to establish a publicly accessible database of high-risk child sex offenders passes as it is expected to. In Penticton, British Columbia, Cpl. Martin Trudeau of the local police force is concerned of news of a new biker group promising to "work in conjunction" with authorities. The biker group explain they aren't vigilantes, but their promotion video's use of graphic images and threatening slogans leave an indelible impression that they are prepared to become just that.

Sexual violence against children represented one of the only violent crime categories to be on the rise when Police reported 4,232 such crimes against children in 2013, a notable increase from 2012 when there were 3,900 crimes reported. Yet Danielle Aubry at Calgary Communities Against Sexual abuse speaks of those figures as the tip of the iceberg, that such crimes are under-reported. Leaving society with quite a problem to be solved in some manner which at the present time escapes everyone, authorities and neighbourhoods alike.

A Tragic Monstrosity

"While I'm professionally and personally against the capital punishment, this is indeed one of the rarest of the rare cases where the perpetrators deserve the death sentence."
"The sisters' modus operandi was using small children, often toddlers, as diversions to distract the public while one of them was engaged in stealing purses. When in danger of being caught, the other used to throw or bang the child to the ground or any hard surface."
"The object was to elicit sympathy by manipulating the public's emotions."
"In one of their particularly gruesome murders, they hung a two-year-old upside down, bashed his head against the wall and chopped him to pieces. They then went for a movie at a local theatre in Kolhapur, eating bhel puri [a savoury snack].
"All the while, the bag with the chopped remains remained under their feet."
Asim Sarode, human rights lawyer, activist, India

A police officer outside the high court in Mumbai, where the women have launched an appeal. Photograph: Punit Paranjpe/AFP/Getty Images

"Going into the details of the case, we find no mitigating circumstances against them apart from the fact they are women. Further, the nature of their crime and the systematic way in which each child was kidnapped and killed amply demonstrates the depravity of the mind of the appellants"
"They indulged in criminal activities for a very long period and continued till they were caught by the police. They very cleverly executed plans of kidnapping the children, and the moment they were no longer useful, killed them and threw the dead body at some deserted place."
Indian appeal court

HandoutSeema Mohan Gavit and Renuka Kiran Shinde, two sisters from Maharashtra may become the first to be executed in India. Both the sisters kidnapped children and pushed them into begging and killed them when they became troublesome.

The two sisters, Seema Gavit, and Renuka Shinde, are from Maharashtra state in India. Their crime-and-abduction-and-killing spree went on for five years -- beginning in 1991-- when they were thought to have kidnapped a total of thirteen children. Even the two women's mother was involved in the gruesome tale of depravity. And perhaps that she was involved gives a clue to the disposition of her daughters, where the lives they took seemed unimportant, the children disposable, used in their schemes of petty street crime.

The women's last victim was a choice that brought them finally to the attention of police when the mother of the abducted child suspected that her child had been taken by her husband's former wife. The former wife, mother of the two young women, held a virulent grudge against her former husband who had abandoned her and their two girls, the sisters Seema and Renuka. He remarried and then had other children with his new wife. His bitter wife planned her revenge and was aided by her daughters.

Shinde and Gavit helped their mother kidnap their father's nine-year-old daughter Kranti. The girl was then killed by their mother, the child's body left in a field. The little girl's mother suspected what had happened and spoke to police, informing them of her suspicions regarding her husband's ex-wife. They were all charged, arrested and placed on trial where in sentencing the sisters Judge G.L. Yedke spoke of the "most heinous" murders, observing that the women appeared to have enjoyed killing the children.

As far as the authorities were concerned, the sisters would remain a menace to society, unlikely to be reformed. They were charged with thirteen kidnappings and ten murders. Found guilty of five killings, they denied the charges against them. But they were convicted in 2001, and sentenced to death. Speaking on their behalf, their lawyer claimed they were wrongly convicted on the evidence of Shinde's husband. He had initially confessed to being involved, later changing his story and was permitted to give evidence against them in return for immunity.

Gavit was only 15 when she killed the first child; her older sister 17. Their mother Anjana, had introduced them to a life of crime. They were taught by their mother how to pick pockets in crowded marketplaces. During religious festivals in small towns throughout Maharashtra, western India, they would appear to take advantage of the festive distractions to take peoples' attention, and in those crowded atmospheres they plied their trade. 

Their first victim had been a one-year-old boy they took from a beggar woman. If, during their commissions of theft, the children were caught, one of them would slam the child who with them to the ground. After a number of these encounters, the child would be so battered, it would not stop crying. Anjana killed the boy by bashing his head against an iron rod. She herself died in prison before she could be tried, at age 50.

They had taught some of the older children they'd kidnapped to pick pockets. When they felt the children had become too much of a problem, they murdered the children who were at their mercy. The trouble was there was no mercy, no compassion in their sensibilities for the vulnerable children whose lives they took. Now, both women are to become the first in India to face execution, after the country's president rejected their final appeal for mercy.

Monrovia's Agony

Fifteen-year-old Shakie Kamara pleads "help me", as soldiers hold back a surging crowd with live rounds to drive back the young men hurling rocks, furious at being penned up by order of their president, in the slum known as West Point, home to over 75,000 indigent Liberians. Security forces, in line with President Sirleaf's orders erected a scrap wood and barbed wire fence to seal the residents of West Point into their crowded slum, sans sanitation, sans medical help, sans hope to survive Ebola set to ravage the community.

A Liberian soldier beats a local resident while enforcing a quarantine in Monrovia's West Point slum on Wednesday.     Photograph by John Moore, Getty

The boy, Shakie Kamara, had tried to scale that hastily-erected fence by which the government of Liberia was abandoning its most vulnerable population in Monrovia, Liberia. He lay there, beside the barricade that had rejected his attempts to mount it, shot in the right leg by soldiers doing their duty to the establishment in this time of crisis for Liberia. Following orders, they are enforcing a quarantine in a desperate effort to halt the Ebola virus spread.

"This is messed up. They injured one of my police officers. That's not cool. It's a group of criminals that did this. Look at this child. God in heaven help us."
Lt. Col. Abraham, Kromah, national police, head of operations

"We have been unable to control the spread [of Ebola]."
"There will be no movements in and out of those areas."
Liberian President Ellen Johnson Sirleaf

This, after hundreds of people from the slum had stormed the neighbourhood school turned into an Ebola isolation ward, where people from outside West Point had been brought in for isolation due to their symptoms of the dread virus. Their presence had enraged the slum occupants who allowed those suspected Ebola patients to flee from the holding facility, a situation that increased fears the disease would spread throughout the city. The isolation unit was looted, medical supplies and linens full of blood, vomit and feces of the isolated patients taken by the enraged protesters.

That was Saturday. Wednesday the residents of West Point awakened to the fact that their immediate environment was now completely under quarantine. Police and military personnel in riot gear had blocked roads leading in and out of their neighbourhood. A seaside neighbourhood, where coast guard officers too halted residents attempting to set out in canoes from West Point. That West Point just happens to be the area with the highest number of confirmed and suspected Ebola cases in the capital means, effectively that the poverty-stricken neighbourhood has been abandoned to its fate.

Riot police enforce the quarantine in West Point, home to 75,000 impoverished people.  Photograph by John Moore, Getty

 

While outbreaks of the disease have affected Guinea (where it is believed the viral contagion began), Nigeria and Sierra Leone, there the cases have been concentrated for the most part in rural areas. But in Liberia, the disease has spread to its major city of Monrovia, the country's capital. President Sirleaf blamed the high number of cases on denial, defiance of authorities and cultural burial practices where bodies are handled by the bereaved, transmitting the virus. Monrovians, on the other hand, believe the government has been inept, leaving bodies to rot in the streets, sometimes for days.

"It's out of control; the numbers keep rising. It's very difficult and complex in Monrovia. We've never had a large outbreak like this in an urban setting."
Lindis Hurum, co-ordinator, Doctors without Borders,

Rush Right Over, Y'All!

"All it did was make this gator mad."
"Fear had taken hold at this point."
"When I pulled the trigger this time, water just exploded on all of us."
Mandy Stokes, 'gator-hunter, Alabama River

"We give all the glory to God. Ten men couldn't have done what we did."
John Stokes, Mandy's husband and co-'gator-hunter

• 

  In this Saturday, Aug 16, 2014 photo, A monster alligator weighing 1011.5 pounds measuring 15-feet long is pictured in Thomaston, Ala. The alligator was caught in the Alabama River near Camden, Ala., by Mandy Stokes at right, along with her husband John Stokes, at her right, and her brother-in-law Kevin Jenkins, left, and his two teenage children, Savannah Jenkins, 16, and Parker Jenkins, 14, all of Thomaston, Ala. (AP Photo/Al.com, Sharon Steinmann)The Associated Press

"Most nights on the rivers between the Millers Ferry Dam and the Mobile Bay Causeway, you can find stretches of bank that light up like holiday displays, there are so many gator eyes reflecting red in a spotlight's beam."
Jeff Duet, Alabama, U.S.A.

That was one venerable alligator indeed. At 4.5-metres in length, and 450-kilograms it was a granddaddy, to be sure. Living out its life-span in the dignity that nature accords all its creatures in their natural environment. Likely never suspecting that its end lurked in the dedicated 'gator-hunting hands of a doughty family fortunate enough to have drawn one of 150 permits to hunt alligators this year.

A mere 25 kilometres west of Montgomery, the state capital, an extended family of father, daughter and son, 16 and 14 respectively, along with the father's sister-in-law and her husband, set off, permit in hand to do a day's hunting of those beasts who unreasonably in their reptile brains feel secure in their natural environment, for little do they know that they are viewed as prospects for a hunting expedition on the part of other creatures entering their natural preserve for that very purpose.

When the family scoped out their prospects they came across one formidable beast whose size awakened a challenge in their hunting spirits. Mind, were the situation to have been reversed and say for example, the 14-year old, Parker Jenkins, had fallen into the river and been scooped up by an enterprising grip-jawed alligator to submerge with his prey, the horror of an alligator consuming a human child would have gripped the nation.

The state would have entered the picture, dispatching its Wildlife & Freshwater Fisheries biologists to use explosives to blast the creatures out of the water, dispatching them all to oblivion, making the river safe for the recreational transport of city folk enjoying their summer afternoon out in the wilds of Alabama. On this occasion, after four hours of tempting alligators to take bait with lines and snatch hooks, they had their prize.

Wait: not so soon. The three adults and two young 'uns grappled with the beast for the better part of five tireless, exciting hours as the alligator in its existential fight for survival, stretched and flattened the three-pronged snatch hooks, until there were a mere few left. As the alligator began to submerge the family worked frantically to wrap the lines attached to it to the cleats on the boats, so the strength of the beast hauled their boat with its passengers along with its frantic efforts to free itself.

Ms. Stokes made her first attempt with her 20-gauge shotgun to bring the contest to an end, aiming it directly between its eyes, a technique she had been taught in 'gator training' classes. Her shot went awry and as the animal surged and high-speed-towed the six-metre boat across the river the boat finally crashed into a tree stump looming out of the water, rather unsettling the five people within. But another opportunity presented itself and the woman shot the alligator square between the eyes.

Such exhilaration, such an excess of pride and superiority! Their hunt was a magnificent effort and their prize -- after weighing in where a winch assembly in use to hoist average gators was destroyed, requiring the use of a backhoe to lift the carcass to be weighed -- was a dandy. Next on the agenda: a taxidermy shop.

• 

  In this Saturday, Aug 16, 2014 photo, a large alligator weighing 1011.5 pounds measuring 15-feet long is pictured in Thomaston, Ala. The alligator was caught in the Alabama River near Camden, Ala., by Mandy Stokes and family, according to AL.COM. (AP Photo/Al.com, Sharon Steinmann)The Associated Press

For those in awe and feeling slightly jealous of this virtuous effort and its stupendous catch, the proud hunters gave hope; plenty more where this one came from, including a three-metre specimen spotted before they hooked this gargantuan one. Go to it, folks!

Physician, Heal Thyself....

"It's still a taboo topic to some degree. Sometimes people are afraid: 'Is this going to affect my licence? Is this going to affect my reputation?' It's a stigma, for sure."
Francoise Mathieu, expert, compassion fatigue Ottawa address, Canadian Medical Foundation

Françoise is director of Compassion Fatigue Solutions inc., whose aim is to offer consulting and training to helpers on topics related to self care, wellness, burnout and compassion fatigue. She is a Certified Mental Health Counsellor and a Compassion Fatigue specialist.

"One of the reasons why I came [annual meeting, Canadian Medical Association] is I'd like some advice with how to deal with it. We're all trying to balance trying to take care of ourselves. I think it's an issue that affects all physicians."
"Sometimes we feel like we need to be stronger than we actually are. You let things go on and on without reaching for help."
Alika Lafontaine, anesthesiologist, Grande Prairie, Alberta

A University of Ottawa medical school teacher, director of physician health at the Canadian Medical Association spoke of the experiences that doctors are often exposed to in their medical practise in empathy with their patients as being "quite horrific". He recalls his feelings when he himself worked in pediatric oncology, twenty years earlier, as a resident. That experience convinced him his medical career would be better spent elsewhere.

'Elsewhere' happened to be in psychiatry where now he treats many other physicians for issues relating to their mental health, namely compassion fatigue and psychological burnout. If left unaddressed, said Dr. Derek Puddester, these issues are capable of turning many doctors' thoughts to suicide. Many physicians are so preoccupied with their professional requirement to care for their patients, they remain in denial about the state of their own health.

"That huge red flag isn't seen until the symptoms are very severe", he explained. Many health professionals, on the other hand, faced with severe burnout or compassion fatigue decide to turn their attention to other types of work. They may take extended sabbaticals, resulting in up to hundreds of millions of dollars in cost for the universal health care system, according to Lee Gould, president of the Canadian Medical Foundation.

Compassion fatigue is characterized as an erosion of the capacity to tolerate emphatic emotions and difficult patient situations which can manifest itself as a seeming desensitization to patient issues and difficulties in adjusting and coping with the emotional strain, at work and at home. Those emotional depressions tend to accumulate over time and successive experience, until they resemble post-traumatic stress disorder.

Compassion fatigue strikes more often those in the health care field working in oncology, child welfare and palliative care, unsurprisingly. Ms. Mathieu, expert in the symptoms and stresses of compassion fatigue, pointed out that people who focus on working with animals also experience similar symptoms of compassion fatigue, much of it caused by the evidence of trauma and abuse of vulnerable animals.

Burnout, prolonged stress, frustration leading to physical and emotional exhaustion are all hallmarks of compassion fatigue. Doctors are particularly vulnerable not only through exposure to the pain and heartache of their patients, but as a result of overwork on their part. A few additional hours of work weekly can increase significantly opportunities of burnout.

Ms. Mathieu pointed out that the five medical groups most affected by burnout tended to be emergency room doctors, internal medicine specialists, general practitioners, neurologists and oncologists.

According to statistics quoted by Ms. Mathieu, about 40 percent of oncologists (cancer specialists) experience profound emotional exhaustion with their work in some form, and about 50 percent of Ontario oncologists specifically reported being overcome with feelings of low personal accomplishment.

Moderate to severe burnout affects roughly 46% of all doctors in Canada. A Canadian Physician Health survey found a third of physicians reported feelings of depression. Canada is hardly alone in recognition of this medical-personal phenomenon.

A recent Australian study found about 54 percent of medical residents exhibited symptoms of compassion fatigue, while 69 percent suffered from burnout, and 71 percent expressed lower-than-average job satisfaction. And a U.S. study resulted in identifying that close to 7 percent of surgeons reported having had suicidal thoughts in the last year. At the same time, 60 percent of those individuals claimed they would not seek help because they feared repercussions at work.

In 2013, the Canadian Medical Foundation and the Canadian Medical Association founded the Canadian Physician Health Institute. It stands as the only institute of its kind in the world, according to Dr. Puddester. "Canada is a global leader in physician health. I think we should be very proud of that." Moreover, the problem is so acute that medical schools now pay attention to physician health, offering increased training to aid doctors to cope with potential emotional stresses.

Coping mechanisms to ward off compassion fatigue and burnout include reducing workload, reducing exposure to trauma, increasing workplace training and engaging in positive habits such as mindfulness-based meditation. All common sense self-help techniques, but for a physician, perhaps difficult to achieve. And according to Ms. Mathieu newer medical school graduates representing the "millennial" generation are aware of and attempting to achieve better work-life balance.

That's one problem afflicting the health community, and here's another, not spoken of too frequently, but equally devastating to those in the professional medical-health field: drug and alcohol abuse. And this is what the US National Library of Medicine

National Institutes of Health has to say about this issue:

The pathways toward development of substance abuse and dependence problems in healthcare professionals (HPs) vary by group. For example, though professionally discouraged, self-diagnosing physicians have reported prescribing controlled substances for themselves [1]. Due to drug access, a significant number of pharmacists tend to self-medicate and have the opportunity to titrate their drug use [2], a practice that can perpetuate the fallacy that pharmacological knowledge of drug action is an effective strategy to prevent addiction. In addition to drug access and a social environment promoting drug use [3] people who choose nursing as a profession may report a higher rate of family history of alcoholism and drug abuse than other HP groups [4]. Finally, perhaps more so than any other group of HPs, the greatest threat in dentistry may be alcohol consumption not controlled substance use [5]. Given the increasingly stressful environment due to manpower shortages in the healthcare system in general, substance induced impairment among some healthcare professions is anticipated to grow [6]. While a number of studies provide some foundation for our understanding of the epidemiologic and etiologic processes contributing to substance use by HPs, rarely have recent studies sought to examine the relative importance of risk factors on alcohol and drug (AOD) use across a sample of major groups of HPs. The major aim of this study therefore was to investigate the risk factors contributing to AOD use by HPs within the context of self-reported past year alcohol and drug use at different levels of use: any alcohol and drug use and a substantial level of alcohol and drug use. Early identification is essential as patient and provider well-being may be at risk [7]. Just like evidence for alcohol [8], cocaine [9], and illicit drugs [10], drug dependent HPs represent a specific subtype of drug abuser who have access to licit drugs. Knowing those HPs who may be at greatest risk for substance abuse, may facilitate the development of more tailored and effective educational and intervention strategies for this subtype of addict