Laser Surgery: What could Go Wrong With Minimally Invasive Techniques?

"In the course of cervical dilation in preparation for the hysteroscopy, the left fundal myometrium was perforated. The perforation was suspected by the surgeon based on the sudden absence of resistance on the dilator during cervical dilation. The perforation was subsequently confirmed with hysteroscopy. The perforation did not extend the time required to complete the surgery or prevent completion of the operative hysteroscopic portion of the surgery, which included resection of intrauterine adhesions and endometrial polypectomies. With release of the fluid pressure during the hysteroscopy, there was minimal bleeding from the perforation site, and there was no blood emanating from the cervix following the procedure. No interventions were required to treat the complication. Uterine perforation during cervical dilation is a known complication of this procedure that is of infrequent occurrence. In this case, the presence of intrauterine adhesions may have contributed to this event."
"The patient had a hysteroscopy done [at the beginning of the week] in the surgical center. The patient returned to the emergency room [the following day] and was sent to the OR that evening. Investigation showed she had a perforated uterus and small bowel perforation from the [hysteroscopy] to remove fibroids."
Commonwealth of Pennsylvania 

"It's a two-dimensional [keyhole incisions in minimally-invasive surgery] look at what's in three dimensions."
"We're training surgeons differently; there's much more simulation [in laparoscopic surgery]."
"Young surgeons have much more real, laparoscopic experience."
"The important point is that although safe, things do sometimes not go well. And we're trying to alert the profession as to what the issues are so they can further reduce any preventable harm."                                                                                                            Dr. Gordon Wallace, managing director, Canadian Patient Safety Institute

Getty Images   The laparoscopic procedures most frequently involved were hysterectomy and other gynecological procedures, cholecystectomy (gallbladder removal), appendectomy and nephrectomy (kidney removal).

In laparoscopic surgery there is a public understanding that because it is minimally invasive in nature, unlike 'open' surgery where large openings are made in a patient's body to permit more complicated surgical procedures, the less intrusive method translates to smaller scars, less bleeding, less pain, and swifter post-surgical recovery. All of which, generally speaking, is certainly true. Without taking into account complications like accidental perforations which are admittedly few in number.

But with "keyhole" incisions, their very size of entry and sightlines creates another type of complication where it becomes challenging for surgeons to visualize, rather than view the anatomy to see the placement of viscera and to protect internal organs during the small-incision surgical proceedings. Half of the most serious complications ensuing from small incisions, according to studies, relate to the insertion of a surgical tool called a trocar.

Insertion of the trocar is performed "blindly"; in essence with the surgeon judging where it should go and then proceeding with the hopeful assurance that all will go well. Sometimes it does not. The surgeon, after all, cannot actually see where the trocar he has inserted is going; if it becomes inserted too deeply, too swiftly with too much pressure, or off-angle, complications can and will raise their ugly heads. 

A 24-year-old man, for example, died during emergency appendix surgery at a Calgary hospital in 2010 when a surgeon blindly inserted into the patient's abdomen a sharp-bladed trocar, slicing a major artery and the patient could not be resuscitated. But according to Dr. Wallace of the Canadian Medical Protective Association, such accidents, rare as they are, are being minimized even further as surgeons gain more experience.

A review of such mishaps revealed instances of doctors who fail to respond to a "deteriorating" situation by changing tactics to immediately alter the surgery to an open type, giving the operating physician more control of the situation. Because complications develop and the surgeon is unable to see into the body what may be happening, the swift response required does not occur because the surgeon may be oblivious to the situation unfolding, since some injuries fail to be detected until the post-op period.

"Even then, surgeons sometimes failed to consider the possibility of a surgical injury", observed the Canadian Medical Protective Association's review of 423 closed cases where laparoscopic surgery was found to have occasioned injuries related to lacerated or damaged bowels, blood vessels, reproductive organs or nerves, as well as delays in recognizing and treating those injuries. The issue of surgeries performed on the wrong body part, or on the wrong patient also came under scrutiny.

Of the 423 cases reviewed, covering cases between 2011 and 2015, 45 people died of the complications that ensued from their minimally-invasive surgeries. Experts reviewing these cases found reason to be critical of care provided to patients in 74 percent of the surgeries under review.
Hysterectomy  and other gynecological procedures, cholecystectomy (gallbladder removal), appendectomy and nephrectomy (kidney removal) were the most frequently involved laparoscopic procedures.

In one perhaps typical case, a surgeon made an incision into a patient's navel, then inserted a sharp-bladed trocar to produce a portal into the abdominal cavity where instruments and cameras can be passed during surgery. The surgeon, finding resistance in inserting the trocar, pushed a little harder, accidentally puncturing the woman's abdominal aorta. The injury went undetected, and the blood pooled, causing significant nerve damage, leaving the woman with chronic, debilitating pain.

Many other injuries related to the puncturing or laceration of bile ducts during gallbladder surgery. Bile spilled into the abdominal cavity can cause potentially life-threatening infections. An inquiry resulting from a death placed the blame on improper use of a bladed trocar that was disposable, instead of a blunt, reusable trocar. Though the surgeon was highly skilled he had "experienced a momentary lapse in judgement that caused him to believe that he could use the bladed trocar safely", according to the judge.

"In open surgery, everything is done under direct visualization, so there’s much, much less chance of an inadvertent injury from a puncture or something. [However], there are certain techniques we call open techniques where you don’t use a sharp trocar though the skin. You make a small opening in the skin, you directly expose so you can see inside the abdominal cavity without putting anything in in a blind way."
"A lot of surgeons would consider these techniques in general to be safer than blind insertion techniques, where a sharp instrument is placed inside the abdominal cavity without clearly seeing the entire trajectory of the instrument."
"It’s not like these are totally new, that surgeons wouldn’t have any clue that it’s an issue and that you have to watch out for it. Surgeons who do minimally invasive surgery are by and large aware of these techniques for doing these types of manoeuvres, and getting access to surgical sites."
Dr. David Urbach, surgeon-in-chief, Women’s College Hospital, Toronto

Laparoscopic surgery appeals to people because it can mean less pain, smaller scars and quicker recovery time than traditional “open” surgery. Getty Images

CMA Calls for Age Increase for Youth Using Legalized Marijuana

"Simply put, cannabis should not be used by young people. It is toxic to their cortical neuronal networks, with both functional and structural changes seen in the brains of youth who use cannabis regularly."
"Most of us [doctors] know a young person whose life was derailed because of marijuana use."
"You can end up with a bright boy or girl with promise, who's ended up basically on the fringes of society. That is why I wrote this editorial. My worry is this legislation will increase the likelihood that kids who are vulnerable will have easier access to marijuana."
"There is a higher risk of having these mental-health disorders [among young people who smoke marijuana]."
Dr. Diane Kelsall, interim editor-in-chief, Canadian Medical Association Journal

In this April 20, 2016, file photo, people smoke marijuana during a 4/20 cannabis culture rally in Toronto. (Mark Blinch/The Canadian Press via AP, File)

It was a campaign promise that the current Prime Minister of Canada made to the electorate, one among many, most of which promises have not in fact been kept. But the promise to pass Bill C-45, to legalize marijuana use with certain provisions is one that appears to be on track for implementation. And if and when passed, this Bill would legalize marijuana use for adults over the age of 18, even though current research shows the human brain reaches maturity around age 25.

That's a problem, given the fact that a Canadian Paediatric Society position paper on cannabis points to its effects on children and youth making them vulnerable to serious potential effects such as increased mental illness, including depression, anxiety and psychosis. Lowered school performance and diminished lifetime achievement are linked to the use of marijuana by young people whose brains are still developing. Developing out of marijuana use is an increased risk of smoking tobacco; the risk of impaired neurological development and allied cognitive decline; and addiction risk.

Canadian youth were recognized to rank highest in use of cannabis among 43 countries in Europe and North America, according to a 2010 study. By the time Canadian youth reach age 15, one third had smoked marijuana at least once. Although the Liberal government states its bill is meant to prevent youth from acquiring cannabis, the bill permits up to four plants to be grown for personal use. "If it's a public health approach, why would you have that available in people's homes?" asks Dr. Kelsall.

"What is going to happen over time is you're going to have people with four very, very (potent) plants and there's no way that you would know that youth aren't accessing those plants." That, in the face of studies of MRI's show definite changes in people's brains who smoke marijuana is extremely worrying for its link to mental-health problems, particularly concerning young people. Bill C-45 would make it possible through changes to the Criminal Code, for anyone selling marijuana to youth to be sentenced up to 14 years in prison. Tougher punishments for driving under the influence are also contemplated.

The Canadian Medical Association has recommended that government raise the legal age for buying marijuana to 21, that the quantity and potency of marijuana those under 25 could access be restricted. These, adds Dr. Kelsall are "pragmatic recommendations" meant to balance the need to protect young people, in recognition that youth who cannot buy marijuana legally will manage to acquire it from illegal sources.

A pot smoker has a joint at the annual 4/20 day, which promotes the use of marijuana, in Vancouver. Cannabis shouldn't be used by young people, a medical journal editorial says. (David Horemans/CBC)

The Iceman: Ice in His Veins

High Existence

"Wim is internationally renowned for his countless ice endeavors that range from being up to his neck in a cylinder filled with ice cubes for over 90 minutes, swimming long distances under polar ice, running a marathon barefoot to climbing the Everest in nothing more than a pair of shorts. It gained him worldwide fame and his nickname: The Iceman. Wim has shown what the human body is capable of once you find the flow within your physical and mental state. Right now he especially sees his new challenge in passing on his method to others to give everyone the opportunity to reach out and do more than what they thought they were capable of. Through the right training and exercises, you can strengthen your inner nature and prevent disease."
Innerfire, Win Hof Academy, Workshops

High Existence

This 59-year-old Dutch man, father of five, has acquired quite the reputation. Known as the Iceman, he has demonstrated to an astonished world that humans are capable of restoring physical capabilities that nature bestowed on us to enable people to live within sometimes hostile environments where the atmosphere is extremely cold and seemingly forbidding to human endurance. However nature designed the human body to withstand extreme temperatures; she also designed the human brain to manipulate the environment to better suit humankind's idea of physical comfort.

And it is the latter inborn skill with which we were endowed that succeeded the primitive endowment enabling humans to acclimate their bodies to temperature extremes of icy-cold challenges to existence; the latter obviating the need for the initial design. Researchers at Maastricht University in Holland discovered that this extraordinary man had managed by the physical regimen he subjected himself to, to build up brown fat in his bodily reserves to enable him to produce five times the heat energy a typical 20-year-old can manage.

Brown body fat is rich in mitochondria whose purpose primarily is to enable the use of white fat taken from storage in the body, to burn; the energy consumed keeping the body warm, in exposure to freezing temperatures. Acclimating the human body to extremely cold temperatures in a systematic way has the effect of producing brown adipose tissue (brown fat). The more brown fat exists in the body, the more likely the body will remain lean since brown fat activates the burning of white fat, stored in body tissue.

When we're newborn, about five percent of body mass is brown fat, enabling us from infancy to resist freezing on exposure to cold temperatures. However, since humans have erected their environment of comfort where we're warm in the winter in our homes, and cool in the summer, we're protected from discomfort, with no need to manage our brown fat as a catalyst for the burning of stored white fat. The white fat remains, the brown fat disappears, and we become fat.

Wouter van Marken Lichtenbelt, professor of energetics and health at the Netherlands Maastricht University, gathered eight test subjects; overweight men of late 50s with Type 2 diabetes. The professor was interested in determining how short-term cold exposure might alter the bodies of his test subjects, so having the men dressed in shorts, and spending six hours daily in a 14C chamber for ten days with their insulin production and blood-sugar levels monitored, resulted in 43 percent more metabolized glucose in their blood levels.

Validating that experiencing cold has the capacity to spur the body to activate brown fat which in turn helps to burn white fat for energy. Wim Hof is able to control his body temperature during exposure to extreme cold conditions. In Poland he set up a training camp where he taught clients how they could remain warm in sub-zero temperatures without being clad against the cold. That exercise of consciously controlling the body's autoimmune system protects against sicknesses, improves mood, and increases energy.

In general agreement that human biology requires stress of the type spurred by environmental and physical oscillations to invigorate the nervous system which in turn sets up a cascade of physiological responses beyond the control of our brains, strictly autonomic, the scientific community studying the phenemenon that this man pioneered agrees with his contention. That exposure to icy temperatures triggers processes warming the body and also increases mental awareness, enhances insulin production and recalibrates the circulatory system.

Most people live primarily in the comfort of indoors environments, spurning the outdoor environment when the atmosphere becomes intemperate, and in the process this critical system of challenging the body's own capability of responding to the challenge of extreme cold never occurs. The result is that weak circulatory systems result, and circulatory diseases are responsible for close to 30 percent of mortality in the world. Obesity and diabetes represent common outcomes of human bodies accustomed to comfort int he avoidance of physical challenges linked to the circulatory system.

In his training camp, Mr. Hof teaches first and foremost his unique breathing routine, alternating between controlled hyperventilation and breath-holds. That training results in people being able to hold their breath for longer periods, reprogramming the nervous system's stress response and aiding in withstanding environmental stressors with the capacity to remain warm despite exposure to extremely cold temperatures.

High Existence

After having mastered Wim Hof's breathing technique, what is left is simple enough; becoming accustomed to suffering cold exposure and training yourself not to shiver; that autonomic body response to cold exposure to produce energy to warm the body. Relaxing, taking calm breaths aids in stilling the impulse to shiver, forcing the body to generate brown fat and burn white fat for energy rather than using muscle movement to produce heat.

Unsustainably Exploiting the Oceans

"Chinese fleets are all over the world now, and without these subsidies, the industry just wouldn't be sustainable."
"For Senegal and other countries of West Africa, the impact has been devastating."
Li Shuo, global policy adviser, Greenpeace East Asia

"Foreigners complain about Africa migrants coming to their countries, but they have no problem coming to our waters and stealing all our fish."
Moustapha Balde, 22, Senegal

"We always thought that sea life was boundless. [Now], we are facing a catastrophe."
"I understand why [local fishermen in Joal, Senegal] they hate me [for his campaign targeting Chinese boats and Senegalese boats alike against overfishing]. They are just trying to survive from day to day."
Abdou Karmim Sall, 50, president, Joal fishermen's association

"Sometimes the Chinese pay bribes [to local African authorities] to get access [along the African seacoast, for fishing], and that money doesn't trickle down, so the population is hit by a double whammy."
Rashid Sumaila, director, Fisheries Economics Research Unit, University of British Columbia Fisheries Center

A Chinese fisherman and three local e local sailors clean recently caught shark. (Greenpeace/Liu Yuyang)

Senegal has close to a 500 kilometer coastline along the Atlantic, and for the country the ocean represents their economic lifeblood, with seafood their main export. Fishing-linked industries give employment to close to 20 percent of the Senegalese work force. Declining fish stocks and drought linked to climate change has led millions of rural Senegalese to migrate to the coast, placing a further burden on sea dependency.

In the small fishing village of Joal, the population has swelled to 55,000 souls and as a result 4,900 pirogues fish from Joal, a substantial increase from the few dozen that were part of the local scene when Abdou Karim Sall was still in his teens. More latterly at age 50, he became a local celebrity
when he personally detained captains of two Chinese fishing boats fishing close by his village illegally.

Large, foreign-owners trawlers capriciously trawl the seacoast; at last estimate, over 100 of the boats representing European, Asian and locally flagged vessels. Apart from those fishing vessels, there are other boats flying Senegalese flags despite their ownership by Chinese companies. Chinese boats are flagged as among the worst offenders, stealing 40,000 tons of fish yearly from Senegalese waters, representing about $28-million the nation might have profited by.

What has been happening in Senegal is repeated throughout West Africa where countries like Guinea-Bissau, and Sierra Leone have few boats to police their national waters. "We used to have big grouper and tuna, but now we are fighting over a few sardinella" buyer Sente Camara, 68, complained. "The future is dark", she added.

In the nation of 14-million, impoverished Senegal has seen its fishing stocks plummet, and local fishermen with their hand-hewn canoes have a difficult time competing with the megatrawlers whose nets scoop every living thing out of the seas. The fish are sent abroad, much of it becoming fishmeal for chickens and pigs in the United States and Europe.

Local fishermen in Senegal cast their nets. Other than a motor and GPS, their boat lacks any modern equipment. (Greenpeace/Liu Yuyang)

Fewer returns from the sea translates to far less income for fishermen, itself ensuring high food prices for all Senegalese citizens traditionally dependent for protein on fish. China is the world's largest seafood exporter, its population accounting for over a third of all fish being consumed globally, with China's fishing industry giving employment to over 14-million people, another 30 million relying for their livelihood on the fish industry.

Indonesia has responded to the presence of Chinese trawlers caught poaching by impounding scores of them. A Chinese vessel was sunk by Argentina when it attempted to ram an Argentinian coast guard ship. Chinese fishermen and South Korean authorities have clashed with deadly results. Beijing, however, views its fishing vessels as a forerunner of its territorial ambitions in the South China Sea where in Hainan Province the government motivates boat owners to fish around the Spratly archipelago and the Paracel Islands claimed by the Philippines and Vietnam respectively.

Chinese fishing boats are not entirely on their own; they have naval power back-up, and Chinese naval frigates have driven off thousands of Filipino fishermen dependent on the rich fishing areas around the Spratly Islands.  China's distant-water fishing fleet has expanded to include close to 2,600 vesselsm most of them so large they scoop up as much fish in a week as Senegalese boats bring in throughout the space of a year.

The journal Frontiers in Marine Science estimates that China's fishing predation costs West African economies $2-billion yearly in lost income, while Chinese government subsidies valued at close to $22-billion-worth between 2011 and 2015, has created a dependency among Chinese boat owners.

Local fishermen beat the sides of their boat and sing traditional songs as they pull their nets in. (Greenpeace/Liu Yuyang)

Investing in Brain Cancer Research

"We're incredibly excited and humbled by the opportunity [to advance with Farmington trials to respond to glioblastoma; brain cancer]. But to be honest, it's now a bit scary because we have to get the job done."
"We know there's a need for something drastically better [than current treatment], and we think this particular technology -- Farmington -- checks many of the boxes in terms of what we've been searching for."
"For us, that was an exciting proposition [search for viruses in fight against cancer]. We were really looking for viruses that were able to exist in the brain but do so in a safe way. We wanted something that would not damage normal brain cells."
Dr. David Stojdl, professor, University of Ottawa

Farmington is a virus which in 1969 was isolated from a wild bird captured in Connecticut at a time that scientists were on the search for evidence of the existence of an entirely different virus involved in outbreaks of encephalitis. Viruses are infectious agents capable of colonizing and destroying human cells. The properties of these highly involved infections are believed by scientists to make them suited to attacking malignant tumour cells whose genetic mutations make them susceptible to viruses.

Dr. Stojdl, a senior scientist with Children's Hospital of Eastern Ontario Research Institute, has been working with the Farmington virus for years. In that work he has custom-designed the virus, enabling it to search for and destroy brain-cancer cells, alongside triggering an immune response to fight the same type of tumour it has isolated and destroyed. Additionally, researchers anticipate the virus might also become a vaccine, offering patients relapse protection.

Brain tissue is sensitive and not amenable to regeneration. Dr. Stojdl sought a virus that could only infect and destroy cancer cells, without becoming a threat to the rest of the central nervous system. And Farmington just happened to be the outstanding mechanism that he recognized would fit his equation, with the properties to attack malignant cells, leaving normal ones intact.

Close to three thousand Canadians each year are diagnosed with brain cancer. Those tumours in the brain represent some of the most difficult of cancers to treat. The average survival rate for an adult diagnosed with glioblastoma is roughly a year, according to the Ontario Institute for Cancer Research. Conventional treatment consists of surgery, chemotherapy and radiation.

This image shows an oncolytic virus infecting and killing tumour cells. When the tumour cells become infected with virus, they glow green. When the tumour cells die, they glow red. Where you have a virus infecting (green) and killing (red) in the same tumour cell, these green and red colours merge into yellow.

Since glioblastomas can lodge themselves in sensitive brain areas, with swiftly-multiplying cells, they become extremely difficult to eliminate completely. Many drugs furthermore, are incapable of crossing the blood-brain barrier to act on a tumour. Additionally, there is a requirement to control inflammation as the brain has little room to swell, and each patient's brain tumour is genetically distinct.

With all of these complicating factors, it is hardly surprising that there are currently no effective long-term treatments. Dr. Stojdl and his research team are hoping to change all of this in the most treatment-positive way imaginable. The Farmington virus held Dr. Stojdl's confidence, since it exists in the brains of healthy birds.

Now, a clinical trial meant to test the efficaciousness and safety of the Farmington virus is set to launch in a year-and-half at Toronto's St. Michael's Hospital, with Dr. Stojdl in possession of a $2.2-million grant to manufacture and test his virus against the aggressive brain cancer. Clinical trial funding was made available through the Ontario Institute for Cancer Research.

No Boundaries, No Hostilities in Collaborative Science

"Today sees the fulfillment of many hopes and dreams. The hope that a group of initially inexperienced young people could build SESAME and make it work - they have: three weeks ago SESAME reached its full design energy. The hope that, nurtured by SESAME’s training program, large numbers of scientists in the region would become interested in using SESAME – they have: 55 proposals to use the first two beamlines have already been submitted. And the hope that the diverse Members could work together harmoniously."
"As well as being a day for celebration, the opening is an occasion to look forward to the science that SESAME will produce, using photons provided by what will soon be the world’s first accelerator powered solely by renewable energy."
President of the SESAME Council, Professor Sir Chris Llewellyn Smith

"We call it the light at the end of the tunnel."
"Jordan was the site [the Jordanian desert]. It was where everybody could come."
"I actually got to live in a universe where Arabs, Israelis, Iranians, Pakistanis work together for the same cause for their own people, for humanity. And that definitely feels good."
Eliezer Rabinovici, theoretical physicist, Hebrew University, Jerusalem

The Synchrotron-Light for Experimental Science and Applications centre (known as Sesame) in Jordan. Photograph: http://www.sesame.org.jo/

Dr. Rabinovici has had the rare good fortune to see his efforts of twenty years bearing fruit. It is for that length of time that he has been involved in hoping to create a Middle Eastern Science Committee. In 1993 he had been working at CERN, on the Large Hadron Collider, of the European Organization for Nuclear Research near Geneva, where five years ago the Higgs boson was finally found.

A colleague from Italy, Sergio Fubini, planted the seed of an idea in Dr. Rabinovici's head by telling him it was time he placed his "naive idealism" to the test. With that prodding Drs. Rabinovici and Fubini set out to create the Middle Eastern Science Committee, leading to a meeting in November 1995 in Egypt where scientists from around the Middle East were assembled.

German scientists offered the group an old accelerator nicknamed Bessy. Bessy had once served in Berlin as a light source and at that juncture she was being replaced. The accelerator was dismantled and then shipped in boxes to the site in the Jordanian desert where the group was preparing to set itself up to fully engage in the serious business of scientific investigation into the energy of light.

The group had named itself SESAME, the name derived from an acronym for Synchrotron-light for Experimental Science and Applications in the Middle East. May 16 was its official opening. SESAME is comprised of physicists from Cyprus, Egypt, Iran, Israel, Jordan, Turkey and Pakistan, and including the Palestinian Authority; a membership whose scientists are dedicated to collaboration in the name of science.

His Majesty King Abdullah II following the opening of SESAME, flanked by Heads of the delegations of the SESAME Members and Directors of International Organisations that have supported SESAME**. (Image: Noemi Caraban Gonzalez/CERN)

The institute has been established with the particle accelerator known as a synchrotron, to study the phenomenon of speeding electrons. These scientists are invested in harnessing the electrons in a 'dance' which would emit powerful beams of radiation, called synchrotron light, and that light made use of, to study properties of materials, from semiconductors to viruses.

Throughout the world about sixty such light sources exist and are studied for their increasing value as tools in medicine and engineering. Scientists in California using X-rays from a light source, discovered recently new details in the structure of proteins regulating blood pressure. That insight raises the possibility of improved treatment for hypertension.

CERN, viewed by SESAME as a guide toward their own potential for success came about when UNESCO conceived of reviving science in Europe post World War II, and at the same time fostering the Continent's capacity to cooperate in a time of peace, as a means of keeping the peace and furthering science at the very same time.

Dr. Christopher Llewellyn Smith, Oxford University physics professor, and now president of the SESAME Council, observes that the major difference lies in the fact that hostilities in Europe have long since passed, whereas in the Middle East they are alive and thriving. Synchrotron light sources' study is meant to transform wasted energy into a scientific tool.

In machines like the Large Hadron Collider, as charged particles accelerate around an electromagnetic racetrack, they radiate energy, called synchrotron radiation. Arrays of magnets called wigglers and undulators can be inserted to induce the electrons to dance, producing powerful pencil-beams of light types. The manner in which these beams of light are absorbed by target materials, or reflected, can reveal molecular arrangements and shapes in the manner in which the double helix of DNA had been revealed by X-ray photographs in the 1950s.

A grant from the European Union enabled CERN to assist in building the magnets and to supervise construction of the SESAME machine, part of the $90-million raised to date to make the project possible. Jordan offered another $7 million for a solar power plant to result in Sesame presenting as the first accelerator worldwide to be powered through renewable energy.

A worker looks at research data at the Sesame facility. Photograph: Kareem Shaheen

Inexorable Climate Shift in Antarctica

"People will think of Antarctica quite rightly as a very icy place, but our work shows that parts of it are green, and are likely to be getting greener."
"Even those relatively remote ecosystems, that people might think are relatively untouched by humankind, are showing the effects of human-induced climate change."
"We're starting back on a journey toward that sort of environment [a different landscape]. Certainly, Antarctica has not always been the ice place it has been now on very long time-scales."
Matthew Amesbury, researcher, University of Exeter, Britain

Credit: University of Exeter Flickr 

"This is another indicator that Antarctica is moving backward in geologic time -- which makes sense, considering atmospheric C02 levels have already risen to levels that the planet hasn't seen since the Pliocene, 3 million years ago, when the Antarctic ice sheet was smaller, and sea-levels were higher."
"If greenhouse gas emissions continue unchecked, Antarctica will head even further back in geologic time ... perhaps the peninsula will even become forested again some day, like it was during the greenhouse climates of the Cretaceous and Eocene, when the continent was ice-free."
Rob DeConto, glaciologist, University of Massachusetts, Amherst

Credit: NASA

"These changes combined with increased ice-free land areas from glacier retreat, will drive large-scale alteration to the biological functioning, appearance, and landscape of the [Antarctic Peninsula] over the rest of the 21st Century and beyond."
Antarctica research study, Current Biology 

In the Arctic a greening trend on a very large scale has been captured by satellite photography where so much plant growth has appeared now that among some scientists there is hope that its presence might partially offset the loss of carbon from thawing permafrost under those plants. What has happened in the Arctic is also being reflected in its polar opposite geology, but on  an infinitely slower time-scale.

Antarctica researchers have discovered the presence of growing banks of mosses on the northern peninsula whose presence is validation to their scientific minds of climate change impacting the iciest, most remote areas of Planet Earth. Throughout the last fifty years the gradual warming of the atmosphere has resulted in the presence of two varied species of mosses appearing in spurts of growth. Mosses which at one time grew at a rate of under a millimetre annually, now grow at a rate of over 3 millimetres on average, yearly.

The study by Professor Amesbury and his colleagues with Cambridge University, the British Antarctic Survey and the University of Durham just saw publication in Current Biology. The study has shown that in parts of the Antarctic Peninsula, mosses now grow on frozen ground, partially thawing in the summer months to the first foot of permafrost depth. The Antarctica is a unique place on this Earth upon which plant life grows on less than one percent of its icescape.

In the summer months when the ground becomes partially thawed, surface mosses build into a thin surface layer which then freezes in winter. Layer upon layer builds up with older mosses sinking below the frozen ground to be well preserved as a result of the temperatures, representing "a record of changes over time", like geological fossil records. Dramatic changes in growth patterns back to 150 years earlier were identified through an examination of soil samples from a 644-kilometre area on the northern portion of the Peninsula.

Latterly, the Antarctic Peninsula has seen relatively rapid warming with increasing numbers of days annually where above-freezing temperatures are recognized. According to the study, a four- to five-fold increase in the amount of moss growth has materialized as a consequence of that warming, reflected in the more recent portion of the climate record.

The researchers took cores of the moss bank to examine 150 years of data to discover "changepoints" that occurred in the final 50 years, demonstrating moss cover increase which Professor Amesbury spoke of as a signifier of change in the region. That plant life exists on an admittedly minuscule portion of Antarctica of roughly 0.3 percent of the continent, but researchers feel the likelihood of increase is assured as the region continues to warm.

An ecosystem shift appears inevitable, reflecting the situation that researchers have discovered in the Arctic, as land cover increases with ice and snow withdrawal and more heat absorbed in the area. "It’s a clear sign that the biological response to climate warming is pervasive around the globe. The Antarctic Peninsula is often thought of as a very remote and possibly even untouched region, but this clearly shows that the effects of climate change are felt here", stated Professor Amesbury.

Antarctica, Petermann Island, Icicles hang from melting iceberg near Lemaire Channel Paul Souders_Getty Images

Consumer Caution Advised in Energy Drinks

"The energy drink industry claims that their products are safe because they have no more caffeine than a premium coffee-house coffee."
"However, energy drinks also contain a proprietary 'energy blend', which typically consists of stimulants and other additives. Some of these ingredients [including taurine and guarana] have not been FDA-approved as safe in the food supply, and few studies have tested the effects of caffeine consumption together with these 'novelty' ingredients."
"On top of that, energy drinks are highly marketed to adolescent boys in ways that encourage risky behaviour, including rapid and excessive consumption. As a result, emergency room visits by young people in connection with energy drinks are rising."
Dr. Jennifer L. Harris, Rudd Center for Food Policy and Obesity, University of Connecticut

The multiple ingredients in different brands of energy drinks need more scrutiny, researchers say. (Canadian Press)

Over 500 energy drink products are now on the market; their popularity is manifest by the extent of their sales, and in lock-step with their popularity is the allied phenomenon of increasing visits to hospital emergency centres, and even deaths attributed to their consumption. A 32-ounce container of an energy drink is now being linked with potentially harmful blood pressure and heart function changes beyond alarming and owing not only to the caffeine in those drinks but other key ingredients present in them.

Consumers like energy drinks. And people who convince themselves that anything that is freely available on the market and that suits their lifestyle cannot be a threat to their health, simply will not believe that these drinks indeed can very well pose a threat best avoided. The manufacturers of the energy drinks, after all, attest to their perfect safety, in itself persuading consumers there is no threat to their health in their consumption. But the growing body of evidence appears to firmly point in the opposite direction.

Caffeine up to 400 mg, reflected in the consumption of up to five cups of coffee is considered to be a safe daily dose by the U.S. Food and Drug Administration. Energy drinks mostly contain caffeine, and plenty of it, but it is the other ingredients in those drinks about which the level of safety is largely unknown, concluded a study team whose results were published in the Journal of the American Heart Association.

A research team led by Sachin A. Shah of David Grant Medical Center on Travis Air Force Base along with the University of the Pacific in Stockton, California, set out to compare physical alterations resulting in a group of 18 healthy men and women after they had consumed an energy drink and after another drink with a similar dose of caffeine, lacking any other ingredients had alternately been consumed.

The energy drink given the test subjects contained four ounces of sugar, several B vitamins, and a proprietary 'energy blend' of taurine and other ingredients most often linked to drinks like Monster Energy, Red Bull, and 5-hour Energy. And that energy drink also contained the obligatory 320 mg of caffeine, analogous to what would be contained in four cups of coffee. Alternately another drink was given the participants which held only the 320 mg of caffeine, nothing additional.

The research team then measured the study participants' blood pressure along with measuring heart electrical activity for 24 hours following the consumption of the drinks. Using an electrocardiogram (EKG) for the heart measurement activity, it was discovered that a change identified as QTc prolongation, a condition associated with life-threatening irregularities in the heartbeat, was present post-energy drink consumption, but not after consuming the caffeine beverage.

Blood pressure was seen to increase by about five points after the energy drink was consumed, and in comparison less than a one point increase was noted after the test subjects drank the beverage containing caffeine only. In addition, blood pressure remained in that elevated state for the following six hours. The study points out that healthy individuals are not threatened by these changes, but people with particular heart conditions would do well to exercise caution with these energy drinks.

Just as adolescents are taught to drink alcohol responsibly, they could receive a similar message about energy drinks, pediatricians say. (Jack Dempsey/Associated Press)

"The energy drink amount tested by the U.S. researchers in this study was equal to twice the amount that is permitted to be labelled in Canada for maximum recommended servings per day."
"Health Canada's recommended maximum amounts are based on all of the ingredients of energy drinks, not just the caffeine."
Canadian Beverage Association

Preventing Cancer

"To see Sandra age and then quickly lose her cognitive ability, her speech, her memory, her ability to walk and care for herself ... It was all gone very quickly."
"To me, it's ass-backwards. You have all these millions of dollars of cancer treatment stuff, and then you have a dinky little cupboard [tiny, understaffed office], basically, for [cancer] prevention."
Alan Huggett, Prince George, British Columbia

"It's why the cancer problem is as big today as it was when [President] Nixon declared the war on cancer."
"We haven't won that war because we have been fighting on the wrong front, or at least we haven't been fighting on the front where we could have a major impact."
"Curing cancer gets votes. There are no grateful people saying, 'Thank you for preventing my bladder cancer'."
Jack Siemiatycki, cancer epidemiologist, University of Montreal

Sandra Huggett and her daughter Lia in 2014: Photo provided by Alan Huggett

Mr. Huggett of Prince George, B.C. is mourning his wife, stricken with lung cancer, diagnosed at stage-four at a point where the malignancy had already spread to her kidneys and bones. A year after her diagnosis the cancer had invaded her brain and she was in palliative care. She lingered for another few months and died before her 56th birthday, leaving behind her husband and their two young daughters. Sandra Huggett had never been a smoker.

After her shocking diagnosis a test for radon was conducted on their family house. That test revealed that she had been exposed to radon gas, a colourless, odourless gas found naturally throughout Canada. Her home was revealed to have three and a half times the level of radon considered to be safe. Radon, though considered to be the second greatest cause of lung cancer after tobacco, is not on most people's radar; most have never heard of it, have no idea what its exposure can cause.

And its presence and what it can cause is considered to be an avoidable source of cancer. Sandra Huggett's husband Alan and their daughters Lia and Kimberly still live in the family home in Prince George. But it no longer presents a dire health threat. The presence of radon has been for all practical purposes eliminated, and at a fairly modest cost. Retrofits that ensured the radon could no longer penetrate the house and affect the lungs of the remaining three of the Huggett family cost less than $1,500.

Research into cancer and treatments for cancer is a multi-billion dollar industry. Yet work hindering the disease from invading vulnerable humans to begin with appears to be treated as a casual afterthought, with barely five percent of the total expenditure on research and treatment going toward prevention.  According to a 2015 federal survey less than three percent of homes have been tested for the presence of the deadly gas.

As well, according to Dr. Siemiatycki, holder of the Guzzo Cancer Research Society chair in environment and cancer, Canadian scientists researching the causes of cancer have dwindled to half of their number involved in that work in 1985. Dr. Siemiatycki points out that the Canadian Institute for Health Research, the major federal medical-science body providing funding, is complacent over providing one to two percent of its cancer budget to prevention.

One day, he believes, scientists will have succeeded in identifying preventable risk factors for all cancers, once the tide turns and sufficient resources are allocated to ensure that outcome. Some experts feel that 40 to 50 percent of malignant cancers are now avoidable, as the result of lifestyle or environmental influence, ranging from sun exposure to obesity.

Dr. Siemiatycki feels that most cancers in all likelihood have both a non-preventable, genetic aspect along with an aspect relating to the individual's behaviour or environmental exposure. Tobacco, recognized as the most powerful carcinogen, relates to behaviour as well as exposure. Yet roughly ten percent of heavy smokers will end up with lung cancer, pointing to a hard-wired genetic propensity for acquiring cancer, working alongside the habit of exposure.

But science must repeatedly prove the theories that arise to convince doubters. In 2015 the journal Science published a paper written by Cristian Tomasetti and Bert Vogelstein, two Johns Hopkins University researchers who hypothesized that the lung is 11 times likelier than the brain to be affected by cancer, related to the frequency at which stem cells divide, leading to resulting DNA mutations. Their conclusion was that a random process is involved relating to the development of tumours adduced to stem-cell divisions.

Two thirds of cancer risks, according to these two researchers, can be attributed to "bad luck". Dr. Tomasetti, a bio-statistician, recommends a sharper focus on early detection to allow patients diagnosed with cancer an enhanced opportunity for survival. Inherited, environmental and random triggers represent the trifecta he and his research partner identified in their study. "This really is a paradigm shift and it has strong implications for research direction", he said.

The wholesale plummeting of smoking rates from the 1960s forward has saved 800,000 lives in the United States alone on an annual basis, accounting for most of the drop in  cancer mortality, according to a 2012 U.S. study. A new study involving 300,000 Canadians is currently underway where subjects are to be closely followed over time, with blood tests and questionnaires, in an effort to obtain data on why some people contract cancer and others don't.

Estimates by Cancer Research U.K. suggest that societal obesity reduction has the potential of preventing up to 187,000 cancer cases a year in Britain; that eating more fruit and vegetables would reduce cancer numbers by 15,000 annually; consuming less alcohol 13,000 fewer cancer cases; and more conscientious sun protection would result in 11,000 fewer cases yearly of skin cancers.

Statistical Bias and Perceptions on Religious Devotion

"Caring for others versus personal fulfillment, those are two very different value constructs. And the relationship between them and religiosity is really significant."
"What this survey proves is that having a faith, being part of a faith community, seems to propel people in the direction of developing higher levels of compassion or caring."
"I find it noteworthy that we have significant divisions in this country on some moral issues, and those divisions seem to be heavily correlated with religious belief and membership in faith communities."
"We like to sometimes paint ourselves as this country where, unlike the United States, which has deep value differences, we are all sort of linked arm-to-arm on all issues. Actually, that's not true."
Angus Reid, founder/chairman, Angus Reid Institute

"On the one hand, in contrast to the prevalent public narrative that religion is private and it doesn't mater, it's quite clear that for the vast majority of Canadians, it does. Over half say, 'Religion is actually shaping my identity and my decisions'."
"On the other hand, that engagement is a relatively thin engagement."
Ray Pennings, executive vice-president, Christian think-tank Cardus

While some Canadians might not attend religious institutions like church regularly, many of them have religious views and personal faith. (Chris Corday/CBC) 

 

On Mr. Reid's part, the recent survey his firm conducted allied with Faith in Canada 150, appears to validate for him a foregone conclusion -- that religious faith makes us better people, more aware of the needs of others, willing to inconvenience ourselves for the sake of aiding others, and being more receptive to the need to be charitable and generous and caring. On Mr. Penning's part, that validation has a bitter core; that not enough members of the broader public have committed to religious adherence and those that have do so in a tepid manner. Religion or not people who live fulfilled lives themselves tend to be more generous with others; it's called simple human decency.



This project took a year to gauge the beliefs of Canadians who took part in the poll to arrive at a consensus on their religious practices. People responding to the questions were divided into four distinct categories identifying them  as a) non-believers on to b) religiously committed devotees regularly attending places of worship. Responding to the choice of two alternatives representing their idea of "the best way to live life", 53 percent chose "achieving our own dreams and happiness" rather than "being concerned about helping others".

When religion was brought into the equation, it was found that 67 percent of those committed to religion chose helping others, while 65 percent of non-believers selected the personal pursuit of happiness. Something seems to be missing here, and that is the common-sense understanding that people who are happy and satisfied are more likely and able to extend themselves to helping others, while those who are miserable are usually so caught up in their situation they are  most often incapable of giving aid to others.

Across different regions of Canada the question elicited different responses, with the Province of Quebec scoring the highest proportion of people selecting for self-fulfillment at 65 percent, while Alberta was second at 54 percent and British Columbia came next at 43 percent. Elsewhere in Canada, a majority of respondents selected giving aid to others; Saskatchewan proving the most generous at 59 percent.

Oddly enough, Quebecers were traditionally the most bound to Catholicism before undergoing a sweeping change where the Catholic Church stepped back during the Quiet Revolution as formerly devout parishioners rebelled against the stranglehold on life of the Church. And Quebec is the province whose administration is the most broadly social-welfare inclined, so Quebecers are accustomed to having things done for them, not to doing for others. Religious devotion still plays a private, not a public role in the province, despite which Quebecers are parsimonious when it comes to funding charities.



A total of 2,006 Canadian adults took part in the survey and responded to a series of questions with clear moral overtones. Pollsters concluded that the two groups representing the religious spectrum, both privately faithful and religiously committed were likelier to agree that:

• Canada should accept fewer immigrants and refugees;
• They would be uncomfortable if a child planned to marry someone from a different cultural or religious background;
• There should not be a greater social acceptance of people who are LGBTQ (lesbian, gay, bisexual, transgender, queer);
• Preserving life is more important than people's freedom to choose on issues like abortion and doctor-assisted death;

Which hardly shines a socially g enerous light on religious adherents; rather their socially conservative attitude bespeaks issues of intolerance and a lack of openly generous impulse. Another question was where the poll led participants to select the statement they felt reflected their personal views:

• People are fundamentally sinners and in need of salvation; or
• People are essentially good and sin has been invented to control people.

The essential goodness of people was selected by two thirds of those pooled while the religiously committed, providing roughly one-fifth of the survey group, felt by 73 percent that people are fundamentally sinners. The concept of right and wrong in absolute terms or a vacillating conception was posed as well with a large majority of 68 percent finding that right or wrong "depends on the circumstances", while close to 66 percent outright rejected that moral questions' outcome differ for different cultures.



Religiously committed were the most likely to claim universal rights apply to the entire human race, at 74 percent. And they represented people stating their faith to be of primary importance to their personal identity at 54 percent, and to their day-to-day lives at 55 percent. Of course religion, as does culture and heritage, shapes an individual's values and colours the way others are viewed; human beings are programmed by nature to cleave to those who share like commitments and values. Which should not deter them from viewing those outside their groups as worthy, but that too reflects basic human nature.

Living With Cancer

"If you're surrounded by people who are telling you, 'you've got to fight', you think, 'How about I rest today and fight tomorrow? How about, 'I'm scared and I don't want to battle'?"
"And some people talk about just feeling ready to let go. They've battled it for too long. But that's unacceptable. That's seen as failure. That's seen as losing."
"I always get these looks, deep in my eyes -- 'how are  you doing'?"
"It's the people who get kind of stuck there, and I find that difficult. ...I'm not there any more, and I guess that's part of the chronic thing. People who have had cancer for a long time, I'm sure they don't want to live as if their identity is, 'I'm a cancer person'."
United Church Minister David Giuliano, 20-year cancer patient

"Who wants to go to war with themselves? How is it ever helpful to think of oneself as a victim who was randomly attacked and now you're trying to kill your assailant in order to survive?"
"Some cancer patients may perceive themselves as a soldier going to war. But surely not all do."
Radiation oncologist Edward Halperin, New York Medical College

"Battle language is everywhere in my profession. [The message conveyed is] that there's a choice to fight or give up."
Dr. Seema Marwaha, internal medicine specialist, Toronto

"But cancer isn't an enemy -- it doesn't have an ideology, it doesn't have a political agenda."
"It comes from within us; it's part of the history of humanity. We rarely cure cancer unless we can cut it out. But things like long-term remission and disease control -- these are the goals."
"We're getting better at controlling cancer for longer periods of time."
Dr. James Downar, critical care and palliative care physician, University Health Network, Toronto 

"There are periods where the cancer needs treatment and periods where no treatment is given."
"Part of the challenge also is doing enough, doing sufficient visits and scans so that you have a good handle on what's happening so that you can adjust and adapt and intervene, but not overburden somebody with scans."
"This is all quite new, this whole notion of kind of being in-between [treatments]. It's a bit of a limbo state, sometimes."
Dr. Jonathan Sussman, radiation oncologist, McMaster University

At the present time, an estimated 800,000 cancer "survivors" exist in Canada, some living with cancers which never quite recede on a permanent basis, like lymphomas of a certain type, leukemia, and sometimes invasive beast cancers. This is cancer hovering, always in the background, seeming to recede, then returning years later. Low-grade lymphomas, for example, cancers of the lymphatic system, are among those which arrive, depart, return.

At one time melanomas were always lethal when they spread, having an average survival rate of a year, two years. At the present time, immunotherapies succeed in placing a robust proportion of patients with metastatic melanoma in a state that is controlled "where the thing is quiet, it's not really advancing", explained Dr. Sussman. But cancer is not an invited and a valued guest, and when it does decide to invade, the psychological burden is a heavy one when people are plagued by fears of a returning or progressing cancer.

The language of cancer, the nomenclature used, is an understandable one; after all this dread disease has decided to invade someone's body, threatening anguish, pain and death. And when people are constantly encouraged to put a positive spin on their fears  of what that cancer is doing to them, by 'fighting' it, an insidious state of mind can creep into the situation, where patients accede to brutal treatments or "maximum tolerated doses" of chemotherapy, despite the hope of survival being so dim.

If patients become so committed to 'fighting' when it's long past time to struggle with the disease, that they refuse palliative care to ease symptoms and alleviate the mind which in and of itself is capable of slightly prolonging life, the demand for aggressive treatment among others whose type of cancer would in all probability never threaten their existence, but leaves them subjected to pain and trauma represents two polarized states and outcomes, both linked to 'fighting' and 'defeating' cancer.

People who are encouraged to 'fight' and to remain 'positive' are likelier to succumb to emotional distress while putting on that proverbial brave face. Over one thousand Canadian women with breast cancer, part of a research program out of the University of Manitoba, revealed that those who considered their disease in 'enemy' terms and 'punishment' suffered higher levels of depression and anxiety three years later.

According to some experts the future holds out the promise that it may be possible to conceptualize a time when cancer, Ike controlled diabetes or HIV, becomes a chronic, manageable disease. Some medical scientists feel that if total destruction of cancer remains elusive, an alternative arises where tumour cells are contained, when it becomes possible to "box-in tumour cells with a discrete-focused strategy of containment."

Meanwhile, the drive to destroy cancer cells unremittingly leads, according to those experts, to survival of the fittest in the sense that the "moderate" cells, sensitive to chemotherapy are destroyed at the same time that the "extremist" cells are left intact, preparing to morph into even more deadly tumours. Whereas a middle ground between "appeasement and Armagedden is containment".

Survival of at least five years after diagnosis represents the reality for about 60 percent of cancer patients overall. That, in comparison to the 1950s, when fewer than 25 percent of cancer patients would survive their bout with cancer. As for most women going through breast cancer diagnosis and treatment, "the breast cancer is not going to be their length-of-life-defining illness", Dr. Sussman emphasizes.

A Living Surgical Nightmare

"Someone was inside me, ripping ripping me apart."
"It was excruciating. It was burning and burning and burning."
Lynn Hillis, 54, Cancer patient, Toronto

"She described trying to move, open her eyes and scream but being unable to get the attention of the doctors."
Judge Kendra Coats, Toronto

"The impact was just profound. It started with the nightmares."
"It's been nine years [since her own 'awakening' during surgery] and I still have nightmares. I still wake up screaming."
Donna Penner, Winnipeg, former surgical patient

SunMedia    In the first ruling of its kind in Canada, a judge says an anesthetist was at fault for a Toronto woman's nightmare experience of waking up in the midst of surgery

 

Surgeons and anesthesiologists are increasingly aware that on occasion a patient under sedation in preparation for surgery can 'awaken' and be entirely aware of what is happening as an operation proceeds. Because of anesthetic immobilizing them physically and breathing tubes inserted through their mouths since the autonomic breathing is interfered with when anesthetic is infused into a human body, the newly-awakened patient, while aware of what is transpiring and feeling horrible pain, cannot communicate with the surgeons. It is only after the surgery that the surgical patients can describe the horrors they experienced.

 

New research appears to have concluded that this 'awakening' phenomenon almost exclusively impacts on morbidly obese patients resulting from the difficulties anesthesiologists experience in calculating how much anesthetic to administer; just enough to keep them sedated; not too much so that there is danger blood flow may be restricted to the heart and brain. Most anesthesiologists end up calculating the amount of anesthetic required by body weight, and with obese patients those calculations tend to discount body fat, just weight minus the fat out of concern of administering too much.

 

In Lynn Hillis's experience the accidental surgical 'awareness' left her vulnerable to physical helplessness, and being forced to be aware of everything taking place during her surgery, including the incalculable pain she experienced. Suddenly, halfway through her operation resulting from her diagnosis of endometrial cancer where laparoscopic surgery to remove her uterus, ovaries and fallopian tubes was taking place at Toronto General Hospital, she awoke.

 

What she experienced during that 2008 operation forever changed her life; she was diagnosed with severe trauma; post-traumatic stress disorder. Her experience of being frozen by paralytic drugs leaving her unable to communicate with the surgeons focusing on her surgery was the stuff of nightmares. And it is calculated that roughly one thousand patients annually in Canada undergo some version of being 'awake' during surgery when anesthetic fails; sometimes fleetingly, sometimes throughout the surgery.

While waking during surgery is not common, professor of anesthesiology Dr. Eric Jacobsohn says it needs to be taken seriously. (Jean-Sebastien EvrardAFP/Getty Images)

Ms. Hills decided to sue the two anesthetists who took part in her surgery; one a staff doctor who handed over her care halfway through the surgery to a "fellow"; an advanced trainee, present for the entire surgical procedure. Ms. Hillis was able to recount the entire proceedings of the surgery, including what the surgeons transmitted to one another as they spoke and how the surgery proceeded. And while the doctors' lawyers insisted that anesthetic was properly administered, the judge hearing the case concluded that Dr. Reza Ghaffai had erred in failing to increase the intravenous Propofol sufficiently.