Thursday, December 18, 2008

A team of eight transplant surgeons in Cleveland Clinic in Ohio, USA, led by reconstructive surgeon Dr. Maria Siemionow, age 58, have successfully performed the first almost total face transplant in the US, and the fourth globally, on a woman so horribly disfigured due to trauma, that cost her an eye. Two weeks ago Dr. Siemionow, in a 23-hour marathon surgery, replaced 80 percent of her face, by transplanting or grafting bone, nerve, blood vessels, muscles and skin harvested from a female donor’s cadaver.

The Clinic surgeons, in Wednesday’s news conference, described the details of the transplant but upon request, the team did not publish her name, age and cause of injury nor the donor’s identity. The patient’s family desired the reason for her transplant to remain confidential. The Los Angeles Times reported that the patient “had no upper jaw, nose, cheeks or lower eyelids and was unable to eat, talk, smile, smell or breathe on her own.” The clinic’s dermatology and plastic surgery chair, Francis Papay, described the nine hours phase of the procedure: “We transferred the skin, all the facial muscles in the upper face and mid-face, the upper lip, all of the nose, most of the sinuses around the nose, the upper jaw including the teeth, the facial nerve.” Thereafter, another team spent three hours sewing the woman’s blood vessels to that of the donor’s face to restore blood circulation, making the graft a success.

The New York Times reported that “three partial face transplants have been performed since 2005, two in France and one in China, all using facial tissue from a dead donor with permission from their families.” “Only the forehead, upper eyelids, lower lip, lower teeth and jaw are hers, the rest of her face comes from a cadaver; she could not eat on her own or breathe without a hole in her windpipe. About 77 square inches of tissue were transplanted from the donor,” it further described the details of the medical marvel. The patient, however, must take lifetime immunosuppressive drugs, also called antirejection drugs, which do not guarantee success. The transplant team said that in case of failure, it would replace the part with a skin graft taken from her own body.

Dr. Bohdan Pomahac, a Brigham and Women’s Hospital surgeon praised the recent medical development. “There are patients who can benefit tremendously from this. It’s great that it happened,” he said.

Leading bioethicist Arthur Caplan of the University of Pennsylvania withheld judgment on the Cleveland transplant amid grave concerns on the post-operation results. “The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell. If your face is falling off and you can’t eat and you can’t breathe and you’re suffering in a terrible manner that can’t be reversed, you need to put on the table assistance in dying. There are patients who can benefit tremendously from this. It’s great that it happened,” he said.

Dr Alex Clarke, of the Royal Free Hospital had praised the Clinic for its contribution to medicine. “It is a real step forward for people who have severe disfigurement and this operation has been done by a team who have really prepared and worked towards this for a number of years. These transplants have proven that the technical difficulties can be overcome and psychologically the patients are doing well. They have all have reacted positively and have begun to do things they were not able to before. All the things people thought were barriers to this kind of operations have been overcome,” she said.

The first partial face transplant surgery on a living human was performed on Isabelle Dinoire on November 27 2005, when she was 38, by Professor Bernard Devauchelle, assisted by Professor Jean-Michel Dubernard in Amiens, France. Her Labrador dog mauled her in May 2005. A triangle of face tissue including the nose and mouth was taken from a brain-dead female donor and grafted onto the patient. Scientists elsewhere have performed scalp and ear transplants. However, the claim is the first for a mouth and nose transplant. Experts say the mouth and nose are the most difficult parts of the face to transplant.

In 2004, the same Cleveland Clinic, became the first institution to approve this surgery and test it on cadavers. In October 2006, surgeon Peter Butler at London‘s Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out a full face transplant. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six month intervals. In March 2008, the treatment of 30-year-old neurofibromatosis victim Pascal Coler of France ended after having received what his doctors call the worlds first successful full face transplant.

Ethical concerns, psychological impact, problems relating to immunosuppression and consequences of technical failure have prevented teams from performing face transplant operations in the past, even though it has been technically possible to carry out such procedures for years.

Mr Iain Hutchison, of Barts and the London Hospital, warned of several problems with face transplants, such as blood vessels in the donated tissue clotting and immunosuppressants failing or increasing the patient’s risk of cancer. He also pointed out ethical issues with the fact that the procedure requires a “beating heart donor”. The transplant is carried out while the donor is brain dead, but still alive by use of a ventilator.

According to Stephen Wigmore, chair of British Transplantation Society’s ethics committee, it is unknown to what extent facial expressions will function in the long term. He said that it is not certain whether a patient could be left worse off in the case of a face transplant failing.

Mr Michael Earley, a member of the Royal College of Surgeon‘s facial transplantation working party, commented that if successful, the transplant would be “a major breakthrough in facial reconstruction” and “a major step forward for the facially disfigured.”

In Wednesday’s conference, Siemionow said “we know that there are so many patients there in their homes where they are hiding from society because they are afraid to walk to the grocery stores, they are afraid to go the the street.” “Our patient was called names and was humiliated. We very much hope that for this very special group of patients there is a hope that someday they will be able to go comfortably from their houses and enjoy the things we take for granted,” she added.

In response to the medical breakthrough, a British medical group led by Royal Free Hospital’s lead surgeon Dr Peter Butler, said they will finish the world’s first full face transplant within a year. “We hope to make an announcement about a full-face operation in the next 12 months. This latest operation shows how facial transplantation can help a particular group of the most severely facially injured people. These are people who would otherwise live a terrible twilight life, shut away from public gaze,” he said.

Friday, January 19, 2007

In the United States, a stabbing at the Lincoln-Sudbury Regional High School in Sudbury, Massachusetts has left a 15-year old student dead.

The stabbing happened around 7:20 am EST, before classes had started. A fight broke out in a boys’ bathroom between the 15-year old victim, James Alenson and 16-year-old suspect John Odgren, the fight spilled out in the hallway, where the stabbing occurred.

The school was sent into a “lockdown” and students were ushered into the gym, cafeteria and various classrooms. Alenson was rushed to Emerson Hospital where he was pronounced dead at 8:15 am EST. Odgren admitted to the stabbing and was in the principal’s office saying “I did it, I did it,” to police. However, Odgren also reportedly said “Is he OK? I don’t want him to die,” according to a police report.All students were released at 10:20 am EST.

Odgren was diagnosed with severe Asperger’s syndrome, an autistic spectrum disorder has been on medication for years, was a special education student at the school and had no history of violence according to his lawyer, Jonathan Shapiro. He is being charged with “murder, assault and battery with a dangerous weapon, and carrying a knife onto school property” and was arraigned in Framingham District Court where he pleaded not guilty to the charges.

Shapiro also asked if his client could go to secure facility at Children’s Hospital in Boston. Judge Paul Healy denied the request saying he did not have “enough assurance that Children’s Hospital would be secure.” Instead, he will be held at Middlesex Jail in Cambridge outside of the general population.

According to the school’s website, there will be a community meeting tonight in the school’s auditorium at 7pm EST.

Thursday, December 20, 2007

Wikinews reporter David Shankbone is currently, courtesy of the Israeli government and friends, visiting Israel. This is a first-hand account of his experiences and may — as a result — not fully comply with Wikinews’ neutrality policy. Please note this is a journalism experiment for Wikinews and put constructive criticism on the collaboration page.

Dr. Yossi Vardi is known as Israel’s ‘Father of the Entrepreneur’, and he has many children in the form of technology companies he has helped to incubate in Tel Aviv‘s booming Internet sector. At the offices of Superna, one such company, he introduced a whirlwind of presentations from his baby incubators to a group of journalists. What stuck most in my head was when Vardi said, “What is important is not the technology, but the talent.” Perhaps because he repeated this after each young Internet entrepreneur showed us his or her latest creation under Vardi’s tutelage. I had a sense of déjà vu from this mantra. A casual reader of the newspapers during the Dot.com boom will remember a glut of stories that could be called “The Rise of the Failure”; people whose technology companies had collapsed were suddenly hot commodities to start up new companies. This seemingly paradoxical thinking was talked about as new back then; but even Thomas Edison—the Father of Invention—is oft-quoted for saying, “I have not failed. I have just found ten thousand ways that won’t work.”

Vardi’s focus on encouraging his brood of talent regardless of the practicalities stuck out to me because of a recent pair of “dueling studies” The New York Times has printed. These are the sort of studies that confuse parents on how to raise their kids. The first, by Carol Dweck at Stanford University, came to the conclusion that children who are not praised for their efforts, regardless of the outcome’s success, rarely attempt more challenging and complex pursuits. According to Dweck’s study, when a child knows that they will receive praise for being right instead of for tackling difficult problems, even if they fail, they will simply elect to take on easy tasks in which they are assured of finding the solution.

Only one month earlier the Times produced another story for parents to agonize over, this time based on a study from the Brookings Institution, entitled “Are Kids Getting Too Much Praise?” Unlike Dweck’s clinical study, Brookings drew conclusions from statistical data that could be influenced by a variety of factors (since there was no clinical control). The study found American kids are far more confident that they have done well than their Korean counterparts, even when the inverse is true. The Times adds in the words of a Harvard faculty psychologist who intoned, “Self-esteem is based on real accomplishments. It’s all about letting kids shine in a realistic way.” But this is not the first time the self-esteem generation’s proponents have been criticized.

Vardi clearly would find himself encouraged by Dweck’s study, though, based upon how often he seemed to ask us to keep our eyes on the people more than the products. That’s not to say he has not found his latest ICQ, though only time—and consumers—will tell.

For a Web 2.User like myself, I was most fascinated by Fixya, a site that, like Wikipedia, exists on the free work of people with knowledge. Fixya is a tech support site where people who are having problems with equipment ask a question and it is answered by registered “experts.” These experts are the equivalent of Wikipedia’s editors: they are self-ordained purveyors of solutions. But instead of solving a mystery of knowledge a reader has in their head, these experts solve a problem related to something you have bought and do not understand. From baby cribs to cellular phones, over 500,000 products are “supported” on Fixya’s website. The Fixya business model relies upon the good will of its experts to want to help other people through the ever-expanding world of consumer appliances. But it is different from Wikipedia in two important ways. First, Fixya is for-profit. The altruistic exchange of information is somewhat dampened by the knowledge that somebody, somewhere, is profiting from whatever you give. Second, with Wikipedia it is very easy for a person to type in a few sentences about a subject on an article about the Toshiba Satellite laptop, but to answer technical problems a person is experiencing seems like a different realm. But is it? “It’s a beautiful thing. People really want to help other people,” said the presenter, who marveled at the community that has already developed on Fixya. “Another difference from Wikipedia is that we have a premium content version of the site.” Their premium site is where they envision making their money. Customers with a problem will assign a dollar amount based upon how badly they need an answer to a question, and the expert-editors of Fixya will share in the payment for the resolved issue. Like Wikipedia, reputation is paramount to Fixya’s experts. Whereas Wikipedia editors are judged by how they are perceived in the Wiki community, the amount of barnstars they receive and by the value of their contributions, Fixya’s customers rate its experts based upon the usefulness of their advice. The site is currently working on offering extended warranties with some manufacturers, although it was not clear how that would work on a site that functioned on the work of any expert.

Another collaborative effort product presented to us was YouFig, which is software designed to allow a group of people to collaborate on work product. This is not a new idea, although may web-based products have generally fallen flat. The idea is that people who are working on a multi-media project can combine efforts to create a final product. They envision their initial market to be academia, but one could see the product stretching to fields such as law, where large litigation projects with high-level of collaboration on both document creation and media presentation; in business, where software aimed at product development has generally not lived up to its promises; and in the science and engineering fields, where multi-media collaboration is quickly becoming not only the norm, but a necessity.

For the popular consumer market, Superna, whose offices hosted our meeting, demonstrated their cost-saving vision for the Smart Home (SH). Current SH systems require a large, expensive server in order to coordinate all the electronic appliances in today’s air-conditioned, lit and entertainment-saturated house. Such coordinating servers can cost upwards of US$5,000, whereas Superna’s software can turn a US$1,000 hand-held tablet PC into household remote control.

There were a few start-ups where Vardi’s fatherly mentoring seemed more at play than long-term practical business modeling. In the hot market of WiFi products, WeFi is software that will allow groups of users, such as friends, share knowledge about the location of free Internet WiFi access, and also provide codes and keys for certain hot spots, with access provided only to the trusted users within a group. The mock-up that was shown to us had a Google Maps-esque city block that had green points to the known hot spots that are available either for free (such as those owned by good Samaritans who do not secure their WiFi access) or for pay, with access information provided for that location. I saw two long-term problems: first, WiMAX, which is able to provide Internet access to people for miles within its range. There is already discussion all over the Internet as to whether this technology will eventually make WiFi obsolete, negating the need to find “hot spots” for a group of friends. Taiwan is already testing an island-wide WiMAX project. The second problem is if good Samaritans are more easily located, instead of just happened-upon, how many will keep their WiFi access free? It has already become more difficult to find people willing to contribute to free Internet. Even in Tel Aviv, and elsewhere, I have come across several secure wireless users who named their network “Fuck Off” in an in-your-face message to freeloaders.

Another child of Vardi’s that the Brookings Institution might say was over-praised for self-esteem but lacking real accomplishment is AtlasCT, although reportedly Nokia offered to pay US$8.1 million for the software, which they turned down. It is again a map-based software that allows user-generated photographs to be uploaded to personalized street maps that they can share with friends, students, colleagues or whomever else wants to view a person’s slideshow from their vacation to Paris (“Dude, go to the icon over Boulevard Montmartre and you’ll see this girl I thought was hot outside the Hard Rock Cafe!”) Aside from the idea that many people probably have little interest in looking at the photo journey of someone they know (“You can see how I traced the steps of Jesus in the Galilee“), it is also easy to imagine Google coming out with its own freeware that would instantly trump this program. Although one can see an e-classroom in architecture employing such software to allow students to take a walking tour through Rome, its desirability may be limited.

Whether Vardi is a smart parent for his encouragement, or in fact propping up laggards, is something only time will tell him as he attempts to bring these products of his children to market. The look of awe that came across each company’s representative whenever he entered the room provided the answer to the question of Who’s your daddy?

Tuesday, June 9, 2009

Indonesian state-owned flag carrier Garuda Indonesia has been expanding, with the airline set to add nine new jets to its fleet and double its flights between Jakarta and Kuala Lumpur. Garuda is also considering a bid for defunct rival Linus Airways.

Garuda is expecting the imminent arrival of four new Airbus jets and five new Boeings. The Airbuses, A330-200s, are earmarked to fly international routes to Seoul and Shanghai starting in July. All four have Internet and telephone access for passengers. The Boeings, B737-800 Next Generation aircraft, are due to be in service by the 2010.

Also planned before the year’s end is the increase in flights on the Jakarta-Kuala Lumpur route from one to two per week. “We saw our current load factor[s] have reached 75 percent and even more during school breaks like June and July,” Said the company’s Vice President for Network Oversight, Risnandi. “This is very promising.”

Garuda is now reported to be considering a bid for Linus, who stopped operating on April 27 and have recently been stripped of the rights to fly their former routes as legally required for airlines that do not operate for more than thrity days. Linus still holds some documents of worth to Garuda for transfer to their subisidiary Citilink.

“I heard that Garuda intends to buy Linus who already hold an aviation business license (SIUP) and an air operators certificate (AOC) for the scheduled air services,” said Indonesian Director General of Civil aviation Herry Bakti S. Gumay to reporters for Bisnis Indonesia. He said that his office was in favour of a takeover by Garuda because foreign bids are limited to holding a maximum total of 49% of the shares in Linus.

Linus Airways’ President Directer Indra said that “we are flexible to acquisition, depending on the investor. If someone wants to buy 100% of the shares we can release our shares, but if someone wants take only a majority shareholding with us as a partner – we are also open.” Indra commented that he has had an informal meeting with Garuda CEO Emirsyah Satar but says that they never discussed acquisition by Garuda and that Linus is already in talks with another ‘strategic investor’ with a view to resuming operations.

Two airlines, Riau Airlines and Kartika Airlines, have both launched bids for the ten routes formally operated by Linus, which include four from Jakarta and three from Batam.

Garuda Indonesia’s Financial Direcotr Eddy Purwanto has anounced that US$650 million worth of loans from Bank Mandiri have been restructured. Garuda, who has apointed Rothschild’s as their international financial advisors, will now pay US$450 million by 2015.

Thursday, June 9, 2005

Canada’s top court has struck down Quebec’s bans on private health care insurance, citing an increased risk to the life and health of Canadians. [1]

The Supreme Court of Canada ruling looked into a patient’s right to pay for faster service in a system that currently treats patients on the basis of equal access to medical care, regardless of income. [2]

Quebec patient George Zeliotis, a chemical salesman who waited in pain for more than a year in 1997 to have his hip replaced, said he should have had the right to pay for surgery.

Under public health care, it’s forbidden to pay for services covered under the system.

Despite free medical treatment, there are often long waiting lists for operations and services with current public health care.[3]

Together with physician, Dr. Jacques Chaoulli, Mr. Zeliotis launched a challenge to the Supreme Court of Canada, after losing their fight in Quebec’s lower courts, arguing that having to wait for surgery violates a patient’s constitutional right to life, liberty, and security of the person. [4]

Mr. Zeliotis and Dr. Chaoulli argued that being able to pay for private medical services wouldn’t be detrimental to the public health care system.

The Quebec Superior Court and the Quebec Court of Appeal had dismissed the case, ruling that the provincial law’s intent was not to discriminate among patients and to provide health care based on need rather than a patient’s ability to pay.

The Canadian Medical Association said the Superior Court of Canada ruling could “fundamentally change the health-care system in Canada as we now know it” but declined to comment any further until it had time to study the decision. [5]