Amazing grace: Vancouver's supervised injection facility granted six-month lease on life

Addiction should be a matter, primarily, for the Chief of Medicine rather than the Chief of Police. While internationally renowned for its social kindness, Canada has not been without its share of disgraceful political mistakes in the not too distant past. Regrettably, there are many shameful events in Canada that have unfolded in the name of public policy including the banishment without medical treatment of Chinese Canadians living with leprosy to die on D'Arcy and Bentinck Islands in British Columbia while European Canadians stricken similarly enjoyed healthcare on the mainland as well as the eternally haunting treatment of people of aboriginal ancestry who were without full voting privileges in some parts of Canada until 1965 and abandoned to encampments, reserves, that paralleled South African apartheid. In due course, these public policies have come to be understood as horrific in retrospect. Many have all met with a remorseful fate where a future Prime Minister is held to public account for the sad excesses of an earlier generation. With respect to North America's only supervised injection facility (SIF), a medical program aimed at reducing fatal overdoses and infections (HIV, HCV) in injection drug users, Canada's Prime Minister Stephen Harper holds the ability to forestall a similarly heartrending fate in his political hands. The SIF currently has a temporary exemption from Canada's "Controlled Drugs and Substances Act" in order to operate until June of 2008. As such, the fate of the SIF is politically determined each time behind closed doors by the Prime Minister and his ministers. Sadly, the Prime Minister appears lost at present, content to ignore the scientific and medical evidence on the matter of population health. In light of the vast medical evidence accumulated on Vancouver's SIF, the fate of injection facilities needs to be taken out of the political realm entirely. I am hoping that the Prime Minister will be found, see the light of the scientific evidence, and lead the way towards to provision of a permanent medical exemption for injection facilities from Canada's Controlled Drugs and Substances Act (CDSA). In so doing, the Prime Minister would be on the brink of grace and would rescue a life saving health program from perpetual political interference

Patient, prisoner or person?

Case studies provide rich descriptions of significant vignettes that highlight atypical systemic or clinical problems and identify potentially important research questions. The case study presented by Venters, Razvi, Tobia and Drucker (2006) describes an unfortunate set of events pertaining to an individual's experience as they were failed by s several systems all at once and neglected for having had experience with an addiction. This commentary provides some remarks on the case study with respect to differing institutional narratives as they pertain to lived experience in the context of everyday life. It is suggested that, in the special case of addiction, the mistreatment of the subject of the case study, Mr. Ortiz, is not an exception to the norm, but the norm itself for people living with addictions and their families

Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment

A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear – and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify

Optimal Matching with Minimal Deviation from Fine Balance in a Study of Obesity and Surgical Outcomes

In multivariate matching, fine balance constrains the marginal distributions of a nominal variable in treated and matched control groups to be identical without constraining who is matched to whom. In this way, a fine balance constraint can balance a nominal variable with many levels while focusing efforts on other more important variables when pairing individuals to minimize the total covariate distance within pairs. Fine balance is not always possible; that is, it is a constraint on an optimization problem, but the constraint is not always feasible. We propose a new algorithm that returns a minimum distance finely balanced match when one is feasible, and otherwise minimizes the total distance among all matched samples that minimize the deviation from fine balance. Perhaps we can come very close to fine balance when fine balance is not attainable; moreover, in any event, because our algorithm is guaranteed to come as close as possible to fine balance, the investigator may perform one match, and on that basis judge whether the best attainable balance is adequate or not. We also show how to incorporate an additional constraint. The algorithm is implemented in two similar ways, first as an optimal assignment problem with an augmented distance matrix, second as a minimum cost flow problem in a network. The case of knee surgery in the Obesity and Surgical Outcomes Study motivated the development of this algorithm and is used as an illustration. In that example, 2 of 47 hospitals had too few nonobese patients to permit fine balance for the nominal variable with 47 levels representing the hospital, but our new algorithm came very close to fine balance. Moreover, in that example, there was a shortage of nonobese diabetic patients, and incorporation of an additional constraint forced the match to include all of these nonobese diabetic patients, thereby coming as close as possible to balance for this important but recalcitrant covariate

Defusing the History Wars: Finding Common Ground in Teaching Americas National Story

Our recent survey found that people have more in common than they think when it comes to their opinions on U.S. history. However, they incorrectly think members of the opposing party have views much different than they do - this is called a perception gap and it creates imagined enemies of their fellow Americans

Unsupervised Prediction Aggregation

Consider the scenario where votes from multiple experts utilizing different data modalities or modeling assumptions are available for a given prediction task. The task of combining these signals with the goal of obtaining a better prediction is ubiquitous in Information Retrieval (IR), Natural Language Processing (NLP) and many other areas. In IR, for instance, meta-search aims to combine the outputs of multiple search engines to produce a better ranking. In NLP, aggregation of the outputs of computer systems generating natural language translations [7], syntactic dependency parses [8], identifying intended meanings of words [1], and others has received considerable recent attention. Most existing learning approaches to aggregation address the supervised setting. However, for complex prediction tasks such as these, data annotation is a very labor intensive and time consuming process. In this line of work, we first derive a mathematical and algorithmic framework for learning to combine predictions from multiple signals without supervision. In particular, we use the extended Mallows formalism (e.g. [5, 4]) for modeling aggregation, and derive an unsupervised learning procedure for estimating the model parameters [2]. While direct application of the learning framework can be computationally expensive in general, we propose alternatives to keep learning and inferenc

Skunk River Review September 1993, vol 5

https://openspace.dmacc.edu/skunkriver/1008/thumbnail.jp

Spectral and Conformational Analysis of Deoxyadenosine Adducts Derived from syn-and anti-Dibenzo[a,l]pyrene Diol Epoxides: Fluorescence Studies

Low-temperature fluorescence spectra and results of conformational studies with trans- syn-, cis-syn-, trans-anti-, and cis-anti-dibenzo[a,l]pyrene diol epoxide (DB[a,l]PDE)-derived deoxyadenosine (dA) adducts are presented and compared with those previously obtained for the stereoisomeric DB[a,l]P tetrols [Jankowiak, R., et al. (1997) Chem. Res. Toxicol. 10, 677-686]. In contrast to DB[a,l]P tetrols, for which only trans isomers exhibited two conformers, all stereoisomeric dA adducts adopt two different conformations with either half-chair or halfboat structures for the cyclohexenyl ring, and an "open"-or "folded"-type configuration between dA and the DB[a,l]P moiety. The major conformations observed for trans-syn-, cis-syn-, and cis-anti-DB [a,l]PDE-14-N 6 dA could be assigned on the basis of the previous calculations for the DB[a,l]P tetrols. The major conformers of the trans-syn-and cis-syn-DB [a,l]PDE-14-N 6 -dA adducts exist in conformations I and II, with their fluorescence origin bands at ∼382 and ∼389 nm, respectively. In conformation I, the cyclohexenyl ring adopts a half-boat structure with dA in a pseudoaxial position (an open configuration), whereas the cyclohexenyl ring in conformation II adopts a half-chair structure with dA in pseudoequatorial position (a folded configuration). The major conformation of cis-anti-DB[a,l]PDE-14-N 6 dA, with its origin band at ∼389 nm, was also assigned as a folded-type configuration with a half-chair structure in the cyclohexenyl ring. Molecular mechanics and dynamical simulations were performed for interpretation of the low-temperature fluorescence spectra and 1 H NMR coupling constants observed for the trans-anti-DB[a,l]PDE-14-N 6 dA adduct. The major conformer of this adduct has a half-chair structure in the cyclohexenyl ring, but a deviation from planarity in the fjord region different from that of conformer II of cis-anti-DB [a,l]PDE-N 6 dA. This new structure is labeled as conformer II′. Its (0,0) fluorescence band is at 388.1 and 388.3 nm in ethanol and glycerol/water glasses, respectively, consistent with the folded-type configuration revealed by the calculations. The fluorescence line-narrowed spectra reveal that the trans- dA adducts can be distinguished. Thus, their spectra should prove useful for identification of DB[a,l]P-DNA adducts formed at low levels in biological samples

Synaptic Scaling Balances Learning in a Spiking Model of Neocortex

Learning in the brain requires complementary mechanisms: potentiation and activity-dependent homeostatic scaling. We introduce synaptic scaling to a biologically-realistic spiking model of neocortex which can learn changes in oscillatory rhythms using STDP, and show that scaling is necessary to balance both positive and negative changes in input from potentiation and atrophy. We discuss some of the issues that arise when considering synaptic scaling in such a model, and show that scaling regulates activity whilst allowing learning to remain unaltered.Comment: 10 page