Wednesday, October 24, 2007

4 infants died - the police case against the mother collapses because of inadmissible evidence

Has Justice been served for this mother, who had 4 children and lost all of them for an unknown reason?

 

CAROL Matthey entered the Supreme Court yesterday charged with murdering her four small children, one by one, over five years.

Police said she deliberately suffocated them, partly in order to sustain her troubled relationship with her husband, Stephen Matthey, the children's father.

But yesterday, the criminal case against Mrs Matthey, who has always denied she harmed her children, collapsed.

Fifteen minutes after she arrived, Mrs Matthey left the court free, cheerfully accepting congratulations. In an extraordinary end to one of the most dramatic cases in Victorian legal history, prosecutors dropped the charges because much of the evidence gathered against her was ruled inadmissible.

A case that involved a three-year police investigation, thousands of pages of statements and 160 witnesses — and a case that dominated four years of Carol Matthey's life — was suddenly over before it reached trial.

After she left the court, Mrs Matthey walked along William Street smiling, declining to answer reporters' questions until this one: "Are you not guilty, Carol?"

"No," she said firmly.

The reporter pointed out the double negative and asked for clarification. Did she mean she was innocent? "Yes," she said, chuckling, amused at the misunderstanding. Then she walked off the public stage and into the rest of her life.

The Supreme Court case against Mrs Matthey ended as a result of pre-trial hearings before Justice John Coldrey. In a complex 94-page judgement on October 12, he found most of the proposed evidence inadmissible under the law.

In legal terms, this is not an acquittal. A defendant against whom charges are withdrawn is not protected by double jeopardy and, theoretically, faces the prospect of another trial if new evidence emerges.

Mrs Matthey, 27, of Geelong, lost four children between 1998 and 2003. Jacob was seven months old, Chloe nine weeks old, Joshua three months and Shania three years and four months. At her committal hearing in March 2006, Mrs Matthey's defence argued there was no physical evidence of harm done to any of the children. Her lawyers said it was possible the children shared an as-yet-undiscovered gene that caused a medical condition, such as a fatal cardiac arrhythmia, that led to their deaths.

Police yesterday declined to comment. The acting director of public prosecutions, Jeremy Rapke, QC, said the case was irreparably damaged when the judge deemed inadmissible much of the medical evidence.

Initially, Jacob and Chloe Matthey were found to have died from Sudden Infant Death Syndrome, and Joshua of klebsiella septicaemia. A police investigation began after the death of Shania, who was too old to have died of SIDS, and for whom no cause of death could be found. At the committal hearing, experts acknowledged SIDS was a "diagnosis of exclusion" — the cause of death used for babies when no other cause can be found. They said there were often no forensic clues that would differentiate natural SIDS from deliberate suffocation.

This left much of the expert medical evidence at the committal heated and contradictory. Four local forensic pathologists strongly argued the autopsies revealed no scientific evidence of harm to any of the children.

But a pediatrician from South Australia who specialized in SIDS, Dr Susan Beal, and a forensic pediatric pathologist from the US, Dr Janice Ophoven, were equally vehement homicide was the most likely explanation.

They argued that "scientific" evidence included the lack of risk factors for SIDS in some of the children; the rarity of four such deaths in one family; the troubled marriage; and the fact that the children had experienced "ALTEs" — apparent life-threatening episodes in which they stopped breathing or were found unconscious.

Dr Beal said: "ALTEs are not a predictor for SIDS; they're a predictor for (homicide)."

Justice Coldrey ruled out most of the evidence of these two witnesses.

The conflict between the experts meant the Crown case relied on other evidence, such as Mrs Matthey's relationship with her husband and children.

Justice Coldrey said the Crown had submitted that, particularly at times of ALTEs or deaths among the children, the marriage was under severe strain.

"Moreover, it is asserted that the relationship of Mrs Matthey to her children, evinced by unwanted and unplanned pregnancies, mediocre parenting and indifference to their deaths, would enable a jury to infer they were the unfortunate pawns in this strategy to bolster her marital situation," he wrote.

Justice Coldrey found there was no discernible link between the timing of marital crises and the ALTEs or the deaths: "There is no foundation for the contention that the killings were designed to win back Stephen Matthey's love and affection."

While there was evidence of poor mothering, the judge wrote, other reports painted a picture of a woman "who was a concerned, caring and loving mother during the children's lives, and a distressed and grieving one when they died".

Mrs Matthey's lawyer, Paul Lacava, SC, said there were no winners in the case. "Mrs Matthey and her husband have lost their children and their sadness is profound and ongoing.

 

I find it very strange that it used to be accepted if one baby died from SIDS then there was a chance that further babies could die from SIDS, yet these two women "experts" on a mission claim that it is impossible and that the deaths must be homicide. If this mother did in fact kill her children, then both of these "experts" have done a lot of harm to the prosecution case. The local pathologists, who had more than likely examined the bodies of the babies indicated that there was no scientific evidence of harm being done to the children. Why then should the Prosecution be allowed to build a case based upon the evidence of "experts" who had not performed any forensic pathology on the children. The Judge did the right thing striking down the charges. Carol Matthey does not walk away from the court as a totally free woman, because she could be charged again, but at least justice is seen to be done when a case that is not based upon fact, but upon "experts with a mission" has been struck down because of the lack of real evidence that would lead to a conviction.

Wednesday, October 17, 2007

Miraculous survival of Australia's smallest baby

Mario Xuereb
October 18, 2007

WHEN she was born, Elora De Bondi's arms barely spanned the length of her mother's finger.

The baby was born on January 29 weighing 319 grams, making her possibly the smallest baby born alive in Australia.

Before she was delivered 16 weeks' premature, doctors at the Royal Women's Hospital doubted she would live. But her mother, Adele, even after being told by doctors that they held no hope, never lost her own hope.

Ms De Bondi, 29, learnt that her pregnancy was in trouble during an ultrasound scan. Her baby was too small and her pregnancy would most probably end within a month.

"Basically, I was 20 weeks pregnant but the baby was about 17 weeks in size," Ms De Bondi said yesterday.

Doctors gave her a course of steroids in the hope of stimulating Elora's growth. Her lungs had scarcely developed.

After two weeks, doctors told Ms De Bondi that her placenta was dying and, with it, Elora.

Undeterred by the prognosis, Ms De Bondi demanded a caesarean section despite the risks of losing not only her child but her fertility and her own life.

Elora was born after only 24 weeks in the womb. She spent seven months in intensive care attached to ventilators.

Ms De Bondi, from North Balwyn, says Elora came close to dying countless times: she battled infections, renal failure and the stress of her surroundings. Many times doctors advised Ms De Bondi to switch off Elora's life support. Her mother remained steadfast, trusting that her fragile daughter, who she had barely touched, would pull through.

After months in a critical condition, Elora grew to 4.4 kilograms. She left hospital on August 27, astounding doctors with her survival.

Elora's pediatrician said her story was "miraculous but the journey is long and uncertain for extremely tiny babies".

"Families, and the staff who care for such premature babies, have faced the most difficult decisions of survival and quality of life," said Sue Jacobs, director of the Royal Women's neonatal services.

Before Elora, the smallest surviving baby at the Royal Women's was Adriana Cassar, born 13 weeks premature, at 374 grams, eight years ago.

Elora faces many hurdles. She is fed through a gastronasal tube and her immune system is weak. While her lung disease is expected to clear in childhood, doctors will wait at least two years before giving the all-clear.

Elora de Bondi is possibly the smallest baby born alive in<br />Australia. She weighed 319 grams when she was delivered in January.

Elora de Bondi is possibly the smallest baby born alive in Australia.

Tuesday, October 16, 2007

Determining a brain-injured patient's prognosis

This is an article from the New Yorker about brain scans of persons in low conscious and/or vegetative states; that there may be quite a bit going on in there: 
http://www.newyorker.com/reporting/2007/10/15/071015fa_fact_groopman

Silent Minds

What scanning techniques are revealing about vegetative patients.

by Jerome Groopman October 15, 2007

Ten years ago, Adrian Owen, a young British neuroscientist, was working at a brain-imaging center at Addenbrooke’s Hospital, at the University of Cambridge. He had recently returned from the Montreal Neurological Institute, where he used advanced scanning technology to map areas of the brain, including those involved in recognizing human faces, and he was eager to continue his research. The imaging center was next to the hospital’s neurological intensive-care unit, and Owen heard about a patient there named Kate Bainbridge, a twenty-six-year-old schoolteacher who had become comatose after a flu-like illness, and was eventually diagnosed as being in what neurologists call a vegetative state. Owen decided to scan Bainbridge’s brain. “We were looking for interesting patients to study,” he told me. “She was the first vegetative patient I came across.”


For four months, Bainbridge had not spoken or responded to her family or her doctors, although her eyes were often open and roving. (A person in a coma appears to be asleep and is unaware of even painful stimulation; a person in a vegetative state has periods of wakefulness but shows no awareness of her environment and does not make purposeful movements.) Owen placed Bainbridge in a PET scanner, a machine that records changes in metabolism and blood flow in the brain, and, on a screen in front of her, projected photographs of faces belonging to members of her family, as well as digitally distorted images, in which the faces were unrecognizable. Whenever pictures of Bainbridge’s family flashed on the screen, an area of her brain called the fusiform gyrus, which neuroscientists had identified as playing a central role in face recognition, lit up on the scan. “We were stunned,” Owen told me. “The fusiform-gyrus activation in her brain was not simply similar to normal; it was exactly the same as normal volunteers’.”


Excited by this result, Owen resolved to try to conduct brain scans of other vegetative patients in the Cambridge area. Since 1997, he has studied several dozen people, though he decided to use speech sounds rather than photographs to stimulate their brains. (Owen was concerned that showing images of faces might not be a reliable way to test recognition, since the eyes of vegetative patients often wander. “We shifted to auditory responses because you can always put a pair of headphones on the person and know that you are transmitting sound,” he said.) Three years ago, he began using a functional MRI (fMRI) scanner, which is faster than a PET scanner, capturing changes in blood flow in the brain almost as they occur. The patients’ brains were scanned while they listened to a recording of simple sentences interspersed with meaningless “noise sounds.” The scans of some of the patients showed the same response to the sentences as scans of healthy volunteers, but Owen wasn’t sure that the patients had understood the words. “So we went the next step up the cognitive ladder, to look at comprehension,” he said.
Psycholinguists have shown that when we hear a noun at the beginning of a sentence we tend to associate the word with its most common meaning. For example, Owen said, most people hearing a sentence that begins, “The shell was . . .” think of an object typically found at the beach. But if the sentence is completed by the phrase “fired at the tank,” the listener quickly corrects himself, a process that is evident on a brain scan. “You can actually see it happening and image it on the scanner,” Owen said. “The beautiful thing about the psychological task is that we just do it automatically. When you play ambiguous sentences, areas in the inferior frontal lobe and in the posterior temporal lobe become activated, and these areas are very important for speech comprehension. They show that you understand the meaning of the word: it’s not just about perceiving speech; it’s about decoding. Your brain somehow appreciates that there are two meanings to a word like ‘shell.’ ”


Owen eventually identified two vegetative patients whose brains showed the same activity in response to ambiguous sentences as the brains of healthy volunteers. He also took brain scans of healthy physicians, who were presented with the ambiguous sentences while under general anesthesia. Owen found that, as the effects of the anesthesia increased, the physicians showed less activity in the brain regions associated with comprehension. “That, of course, is in keeping with our personal experience of consciousness, which is that as you sort of drift into sleep you understand less and less of what is around you,” he said. (An article about this experiment appears this week in PNAS, the journal of the National Academy of Sciences.)
Owen’s final experiment was the most ambitious: a test to determine whether vegetative patients who seemed able to comprehend speech could also perform a complex mental task on command. He decided to ask them to imagine playing tennis. (“We chose sports, and tried to find one that involved a lot of upper-body movements and not too much running around,” he said.) First, he took brain scans of thirty-four healthy volunteers who were instructed to picture themselves playing the game for at least thirty seconds. Their brains showed activity in a region of the cerebrum that would be stimulated in an actual match. “This was an extremely robust activation, and it wasn’t difficult to tell whether somebody was imagining tennis or not,” Owen said. He then repeated the experiment using one of the vegetative patients, a woman who had been severely injured in a car accident. The woman had to be able to hear and understand Owen’s instructions, retrieve a memory of tennis including a conception of forehand and backhand and how the ball and the racquet meet and focus her attention for at least thirty seconds. To Owen’s astonishment, she passed the test. “Lo and behold, she produced a beautiful activation, indistinguishable from those of the group of normal volunteers,” he said. (Another vegetative patient, a man in his twenties, also passed the test, though Owen, having learned that the man was a soccer fan, asked him to imagine playing that sport instead of tennis.)
In September, 2006, Owen, along with Martin Coleman, a neuroscientist at Addenbrooke’s, and four other researchers, published an article about the tennis experiment in Science and ignited a vigorous debate. In letters to the journal, some neurologists argued that the woman must have been misdiagnosed a claim that Owen disputed. “She fulfilled all of the internationally agreed-upon criteria, and there wasn’t anything that she did that would lead anybody to say she wasn’t vegetative,” he told me. “Now, naturally, in hindsight she wasn’t vegetative; she was actually conscious. It’s a very interesting issue, because it means that she was in fact misdiagnosed, but not misdiagnosed in the sense that somebody made an error. Clearly, she is consciously aware of things around her. So something is missing in the diagnostic criteria.”
For decades, doctors assumed that patients who have been diagnosed as vegetative lack any capacity for conscious thought. Most are previously healthy people who suffered a traumatic brain injury, or oxygen deprivation after a heart attack or stroke, and have been regarded more or less as zombies: patients whose bodies continue to function sometimes for decades but whose minds are incapable of willed activity. (The term “vegetative” was proposed in 1972, by Bryan Jennett, a neurosurgeon, and Fred Plum, a neurologist, who chose it based on a definition in the O.E.D: “an organic body capable of growth and development but devoid of sensation and thought.”) In the occasional newspaper stories about someone who suddenly recovered consciousness after spending years in a vegetative state, the event was invariably described as a medically inexplicable “miracle.” The Mohonk Report, a paper prepared by a group of experts in brain injury and presented to Congress last year, cited estimates suggesting that there are approximately thirty-five thousand Americans in a vegetative state and another two hundred and eighty thousand in a minimally conscious state a less severe condition, in which patients show erratic evidence of deliberate behavior, such as responding to a simple command or focusing on a person or an object for a sustained period. Because insurers typically won’t pay for rehabilitation, on the assumption that such patients are unlikely to improve, most are given little in the way of therapy. “These people with brain trauma are out of our view,” Joseph Fins, an internist and medical ethicist at Weill Cornell Medical College, in Manhattan, and a member of the Mohonk group, told me. “We ignore them, and we sequester them in places where we can’t see them, usually in nursing homes.”
According to several American and British studies completed in the late nineties, patients suffering from what is known as “disorders of consciousness” are misdiagnosed between fifteen and forty-three per cent of the time. Physicians, who have traditionally relied on bedside evaluations to make diagnoses, sometimes misinterpret patients’ behavior, mistaking smiling, grunting, grimacing, crying, or moaning as evidence of consciousness.

 

Doctors can also miss signs of consciousness in vegetative patients, according to the British and American studies. Ten months after Owen and his colleagues completed the tennis experiment with the vegetative woman, she was brought back to the imaging center and placed in an MRI machine. “We were absolutely dismayed, because we scanned her and there was nothing,” Owen recalled. The team tested the woman again the next day. This time, in response to a command to play tennis, her brain showed normal activity in the regions that mediate arm movements. Owen now repeats scans for each patient, conducting them twice a day for three days. Patients with brain injuries have “seriously impaired attention capabilities and their levels of general arousal are likely to be shot,” he said. Recent research by Owen and other neuroscientists may eventually help make diagnoses more accurate, but it is not yet clear how the new brain-scan data will affect the medical understanding of consciousness.

As Owen put it, “The thought of coma, vegetative state, and other disorders of consciousness troubles us all, because it awakens the old terror of being buried alive. Can any of these patients think, feel, or understand those around them? And, if so, what does this tell us about the nature of consciousness itself?”


Owen’s article in Science was accompanied by an editorial by Lionel Naccache, a neurologist at the Hôpital Pitié-Salpêtrière, in Paris, who called the results of the tennis experiment “spectacular.” “Despite the patient’s very poor behavioral status, the fMRI findings indicate the existence of a rich mental life, including auditory language processing and the ability to perform mental imagery tasks,” Naccache wrote.

 

 Yet he cautioned against drawing general conclusions about vegetative patients from a single case, and asked, “If this patient is actually conscious, why wouldn’t she be able to engage in intentional motor acts, given that she had not suffered functional or structural lesion of the motor pathways?” Prompted by questions like this, Naccache and several of his colleagues are conducting brain-imaging experiments with the goal of identifying objective indicators of consciousness, and thus enabling doctors to better evaluate patients who are unable to communicate their awareness of themselves or their environment.


We assimilate information unconsciously all the time; at any given moment, we process thousands of stimuli, of which we pay attention to only a few. As you read this sentence, you may not be aware of the birds singing in the back yard, but your brain has analyzed the sound and concluded that it poses no threat to you. In the past several decades, scientists have uncovered particularly dramatic examples of unconscious processing. In the early seventies, researchers at M.I.T. studied four patients who had experienced trauma to an area of the brain involved in vision and had been found to have a condition that was later called “blindsight.” These patients’ eyes functioned normally, but they did not perceive much of what was in their field of vision. When the researchers flashed a light at the patients and asked them to describe what they saw, the patients reported that they had seen nothing. Yet the researchers noticed that their eyes often located the source of the light. In a second experiment, a blindsight patient was shown pictures of faces displaying happiness, sadness, anger, and fear. The patient said that he could not see the faces, yet he was frequently able to correctly identify the emotions. The researchers concluded that, despite the patient’s injuries, pathways in his brain had been preserved which allowed him to process at least some visual data, even though he wasn’t consciously aware of doing so.


In the early nineteen-hundreds, the Austrian neurologist Hermann Zingerle described patients who, because of tumors or other abnormalities of the parietal lobe on the right side of the brain, ignored the left side of the body and objects in the left field of vision. (The right side of the brain controls awareness of the left side of the body.) For example, some of these patients would shave only the right side of their faces, since they were unaware of their left cheeks. In the nineteen-eighties, researchers determined that patients who had the syndrome ­now called “neglect”­ could process some objects in the left field of vision. In one experiment, a patient was shown two pictures of a house. The images were identical except that, in one, flames were emerging from a window on the left side of the façade. The patient said that she couldn’t see any difference between the images, but, when she was asked which house she would want to occupy, she almost always chose the one that was not on fire. “This is more complex than blindsight, because it means that the patient was unconsciously able to interpret and understand the symbolic meaning of the pictures,” Naccache said. “It is a powerful experiment to demonstrate that unconscious perception and unconscious cognition can reach upper levels of the brain.”


From these and other recent experiments, including his own, Naccache and his research team are developing a working medical definition of consciousness. “When we are conscious, the key property is our ability to report to ourselves or to others the content of the representations when I say, for example, ‘I am perceiving a flower,’ or the fact that I am conscious of speaking with you now on the telephone,” Naccache told me. “You have patients who are conscious, or who are able to make reports, but you can prove that some stimuli escaped their conscious reports, as in the case of blindsight or neglect. You can study the neural fate of these representations by showing that, even if the stimuli were not reported by the subject, they were still processed in the brain.” He added that, in the case of Owen’s vegetative patient who imagined playing tennis, it’s impossible to know whether she reported the event to herself which would suggest that she is capable of conscious thought or whether, as in the case of the blindsight and neglect patients, she had no subjective awareness of the experience. However, Naccache believes that consciousness also requires an ability to sustain a representation over time, which Owen’s patient clearly was able to do. “In assessing apparently vegetative patients who are unable to speak, and thus report, the direction of research should be to look for sustained representation,” he said. “If we can prove by neuro-imaging techniques that this person is able to actively maintain a given representation during tens of seconds, it provides strong evidence of conscious processing.”


Naccache has recently incorporated a third neurological feature into his definition of consciousness: broadcasting. In a person who is conscious, he explained, information entering the brain is processed in a few areas and then distributed or broadcast to many others. “It’s as though there is a kind of ignition in the brain, and then information is made available to a very rich number of regions,” Naccache told me. “And that makes sense, that the information is initially represented locally and then made available to a vast network, because the person has this ability to maintain the representation within the network for a long time.”


In 2005, Naccache conducted an experiment whose outcome suggested the importance of broadcasting as a marker of consciousness. First, he and his research team presented a series of words to three epileptic patients, who had had electrodes implanted temporarily in various brain regions, in an effort to locate the source of their seizures. The electrodes enabled doctors to record the activity in a given region. Some of the words, such as “blood” and “rape,” were chosen for their negative emotional connotations. The rest of the words, which included “chair” and “house,” were considered neutral. Each word was shown to the patients for twenty-nine milliseconds and then replaced with an image of a geometric figure, such as a rectangle. The patients reported seeing only the geometric figures. However, Naccache’s team discovered that in each patient the amygdala, a brain structure that is associated with strong negative emotions, such as fear, displayed much more activity in response to the negative words than to the neutral words.


“The picture we have now is that, unconsciously, many areas of the brain can process information, and that unconscious representation can be very abstract and very rich much more than neuroscientists thought some decades ago,” Naccache said. “But now we can begin to identify some limits of unconscious cognition. The activation picked up by the electrodes is not only evanescent but restricted to the amygdala and a few other regions, without broadcasting and amplification through the brain.”

 

 Owen’s tennis-playing patient may have been broadcasting information during the experiment, Naccache said, though he added that he is uncertain whether her diagnosis should be upgraded from vegetative to minimally conscious. Moreover, he said, brain-scan research cannot yet tell us much about such a patient’s prospects for improvement.


The J.F.K. Johnson Rehabilitation Institute, in Edison, New Jersey, is among the world’s largest centers for the treatment of brain injuries and one of the few places where patients suffering from disorders of consciousness participate in research studies and receive innovative therapy. In 2002, Joseph Giacino, a neuropsychologist at the institute, was the co-chair of the Aspen Work Group which was made up of experts in brain injury and helped formulate the criteria for diagnosing a minimally conscious state. “I think the rehabilitation field was ahead of the curve in understanding that there were subpopulations of patients who were not in a coma, were not in a vegetative state, but really were not conscious, at least in the way we think about normal consciousness,” Giacino told me. “In the medical literature, these patients were lumped together with everybody else.”


The techniques that Giacino uses to diagnose patients require no sophisticated technology. He recalled making rounds at the institute with two eminent neurologists and stopping at the bedside of a woman who had had a brain hemorrhage. The neurologists examined the woman, who lay with her eyes half closed and did not respond to the doctors’ commands. The neurologists concluded that she was in a vegetative state. “So I sort of sheepishly said, ‘Let me show you what happens when we stimulate her,’ ” Giacino recalled. He had been using a technique called “deep-pressure stimulation,” which involves squeezing a patient’s muscles with force and precision.

Giacino started with the woman’s face and worked his way down to her toes, pinching her muscles between his fingers. As he explained, the nerve endings of the muscles send impulses to the brain stem, which relays them to other brain structures and rouses the patient to consciousness. “I did a cycle of deep-pressure stimulation, and within a minute or so she was talking to us,” Giacino said. “The neurologists were flabbergasted.” The woman was able to say her name and her husband’s name, and answer simple questions, such as “Is there a cup at your bedside?” After a few minutes, however, she became unresponsive again.


The woman had what Giacino calls a “drive disorder,” in which a patient is unable to speak, move, or, possibly, think unless physically stimulated by touch. Doctors believe that such disorders are caused by damage to the limbic lobes or to other parts of the brain that trigger and sustain behavioral responses. Some patients with drive disorders respond to drugs that increase brain levels of dopamine, a neurotransmitter that is associated with arousal.

 “Imagine if the woman were in a nursing home,” Giacino said. “Somebody would stop by for three minutes, check her bedpan, and present simple commands like ‘Squeeze my hand,’ ‘Close your eyes,’ and ‘Open your mouth.’ She is not going to do any of those things, but she clearly had a significant amount of preserved function. It had to be harnessed externally.”

At J.F.K. Johnson, patients with drive disorders receive behavioral and drug therapy. (Some patients improve, but prospects for recovery are largely determined by the extent and nature of the damage to the drive system.)


Since 2002, the institute has been experimenting with using brain scans to assist with diagnoses. Giacino cited the case of a male patient whose condition had been diagnosed as vegetative but who appeared to have strong emotional responses to people around him. “If a nurse came in to do his care, it looked like he was screaming silently,” Giacino recalled.

“His mouth would be wide open, and he had an agonized, contorted face, like the one in Edvard Munch’s painting ‘The Scream.’ The expression would occur if there was a lot of noise around him, or if he was being physically handled, but then his mother would come into the room, lower the lights, talk with him in a soothing voice, and it would just go away.”

When doctors scanned the man’s brain, they discovered that portions of the right hemisphere involved in emotional processing were intact. (Other parts of the right hemisphere were damaged.) “This shows you how treacherous diagnostic assessment can be,” Giacino said. “One can retain one piece of a network but be disconnected from other structures and other networks, so that there is almost no subjective awareness associated with this complex behavior. I’ve seen other patients with other behaviors that seem to be outside the scope of a vegetative state. Then you image them and you find out some circuits are still relatively preserved, while most of the rest of the brain is not.”


However, brain-scan technology has also helped doctors identify one patient at J.F.K. Johnson as a candidate for an experimental therapy. The patient, a thirty-eight-year-old man who suffered a head injury and had been living in a nursing home for six years, arrived at the institute in 2004. He appeared to be minimally conscious; he occasionally mouthed single words when prompted, but he was unable to respond reliably to simple questions, or to chew and swallow. (He had a feeding tube.) In 2001, PET and fMRI scans had been taken of the man’s brain, and, according to Giacino, one of many researchers involved in the case, “the findings were totally unexpected. The PET scan showed little metabolic activity, but the fMRI scan showed that the region of the cortex involved in processing language functioned in a fairly normal way.”

The researchers speculated that, because of damage to the man’s frontal lobe, thalamus, and brain stem areas involved in regulating arousal the nerve signals in his brain were muted. As Nicholas Schiff, a neurologist at Weill Cornell Medical College who led the study of the man’s brain, put it, “It’s as if a radio were turned to such a low volume that you couldn’t hear the music distinctly.” He added, “The scans confirmed our expectation that this patient had a greater capacity for language than he demonstrated.”


In August, Schiff, Giacino, Joseph Fins, and Ali Rezai, a neurosurgeon at the Cleveland Clinic, along with twelve other researchers, published an article about the case in Nature. The researchers described implanting electrodes in the man’s thalamus, which, by stimulating the brain tissue, had enabled him to regain considerable physical and mental function.

 “Deep brain stimulation can promote significant late functional recovery from severe traumatic brain injury,” they wrote. When the electrodes were turned on in the man’s thalamus, his speech improved, his movements became more fluid, and he was able to chew and swallow. When the researchers turned off the electrical stimulation, the man soon relapsed. He is now being given regular doses of electrical stimulation and is able to speak in short sentences and to chew and swallow. The researchers concluded that the case “challenges the existing practice of early treatment discontinuation” for minimally conscious patients who show some “interactive behaviors.”


Few vegetative or minimally conscious patients ever recover fully, and many are unlikely to improve. (Some neurologists estimate that an adult who has been vegetative for six months following a traumatic brain injury has only a twenty-per-cent chance of regaining consciousness.)

For the past three years, Schiff and Fins have been studying the brain of Terry Wallis, a forty-three-year-old man in rural Arkansas who had been the subject of national news stories in 2003, when it was reported that he had begun to speak after spending nineteen years in a nursing home, in a minimally conscious state. Schiff and Fins contacted Wallis’s family and offered to help him obtain medical care during his recovery, and to use brain scans to document his progress.

 In 1984, Wallis, a nineteen-year-old truck mechanic, had been in a car accident and sustained a severe brain injury; he was also paralyzed. Wallis’s father had asked the nursing home to arrange an evaluation of his son by a neurologist, but was told that such an assessment was too expensive and, in any case, would not be useful.

In 2003, when Wallis began to speak, he received twelve weeks of physical therapy, which was covered by Medicaid, but the Arkansas Department of Health and Human Services rejected his request for further treatment, concluding that he had not made sufficient progress.

 One day, in 2005, Fins, who had contacted Wallis’s congressman to solicit his help in obtaining additional medical care for Wallis, asked Mrs. Wallis for her son’s Social Security number. “I was on the phone, and Mrs. Wallis said to Terry, ‘What’s your Social Security number?’ ” Fins recalled. “He gives his number, and I write it down. And I said, ‘Mrs. Wallis, was that Terry?’ And she said, ‘Yup. The first time he told us his Social Security, we thought he was wrong. But we looked it up, and he was right.’ ”


Fins was astonished. Not only has Wallis recovered memories from his life before the accident but, Fins said, “he is picking up American culture. He now knows the song ‘Bad boys, bad boys, what are you gonna do.’ Why is that important? It’s important because that song didn’t exist in 1984, so Terry is laying down new memories. It shows sustained improvement.”

 In 2006, Schiff arranged for Wallis to be taken to Weill Cornell Medical College, where he examined his brain using a sophisticated technique called diffusion tensor imaging, which assesses the number and health of axons, long fibres that transmit nerve impulses from one brain cell to another. The scans suggested that the axons in Wallis’s brain were growing and forming new connections a finding that contradicts the long-standing assumption that a damaged brain is incapable of healing after such a lengthy period.

 “We need to do longitudinal studies, to see if these kinds of changes are accruing over time, whether they happen frequently or infrequently, and what their association with the patient’s level of function is,” Schiff told me. In some cases, he speculated, the brain may sometimes be able to bypass an injured area and devise novel ways of connecting axons. Still, he went on, much about Wallis’s recovery and the neurological developments that are driving it - remains a mystery. “After nineteen years, Terry spoke a few words, but within seventy-two hours he recovered fluent, expressive, and receptive language,” Schiff said.


Kate Bainbridge, the first vegetative patient that Adrian Owen studied in Cambridge, has also made considerable progress, recovering the use of her arms, and much of her mental function, although she is unable to walk. She still has difficulty talking, and uses a letter board to communicate with people who are not used to her speech. “Most scans show what is wrong with your brain, which doctors need to know,” Bainbridge wrote to me in an e-mail. “But Adrian Owen’s scans show what is working. I say they found parts of my brain were working. It really scares me to think what might have happened to me if I had not had the scans. They show people it was worth carrying on even though my body was unresponsive.”

Sunday, October 14, 2007

The death of so Many patients could have been avoided

C.diff death scandal could have been avoided
By Rebecca Smith, Medical Editor

Last Updated: 3:06am BST 12/10/2007

Commentary

This is by far the worst single outbreak of a hospital infection and the fact at least 90 people probably died as a result is a scandal.

Clostridium difficile is a common hospital infection and poses a far greater threat to health services than the more notorious MRSA.

It is extremely infectious and the spores can live on surfaces, door handles, lavatory seats, bed rails and the like for days or weeks.

Hospital hygiene practices play an enormous role in preventing an outbreak emerging from a single infected person.

However, a clean hospital will still have problems with infections and gimmicks such as doctors wearing short sleeves and no ties can only go so far.

Good nursing care is essential so it is vital that hospitals have enough staff.There needs to be the time and space for cleaners to decontaminate beds between patients.

This is where Government targets are said to have hampered infection control measures because the pressure has been on to admit people from A&E before their four hour waiting time is up and to get patients in for surgery and off the waiting lists.

Doctors have also been too willing to prescribe broad spectrum antibiotics and at Maidstone and Tunbridge Wells NHS Trust patients at risk of C.diff were given unsuitable medication that made it easier for the bug to take hold.

Using antibiotics sparingly means it takes longer for the organism to become resistant to the drug which makes it more difficult to treat.

Some degree of resistance is inevitable and hospitals will never be completely clear of infections.

What makes this case so horrifying is the sheer scale of it and the lack of action by mangers despite repeated warnings from staff and patients.

The fact some people came into the hospital with entirely curable conditions, only to contract C.diff and die is utterly tragic and should never be repeated.

A Scandal erupts in UK hospitals - hundreds of patients die from Clostridium Difficile bug

The UK government has released a report concerning the deaths of hundreds of people who have died in hospital as a result of contracting what is known as the super bug Clostridium Difficile. These deaths are the direct result of some extraordinarily poor health practices on the wards of hospitals in the U.K. Is it a matter of staff being stressed out because of too much work, or is it a matter of poor training in the first place? Certainly there should be no excuse for the discovery of dirty sinks in a ward:

 

Case studies: Wretched death of C.diff victims


By Gordon Rayner, Stephen Adams, Lucy Cockcroft and Laura Clout

Last Updated: 3:07am BST 12/10/2007

Families of some of the 331 patients whose deaths have been linked to Clostridium Difficile in Britain's worst hospital superbug outbreak welcomed the findings of yesterday's Healthcare Commission report which disclosed the scale of the scandal.

A sink in a cleaning room at Maidstone Hospital

A sink in a cleaning room at Maidstone Hospital

Several of the relatives spoke to The Daily Telegraph to share their experiences of the shocking conditions, to expose the chronic understaffing which many say is to blame, and to express the devastation of seeing a loved one die in such circumstances.

FLORRIE FIELD

A healthy 86-year-old who worked part-time in a clothes shop, Florrie Field contracted C.diff at the end of March this year after being admitted to Maidstone Hospital with an eye infection.

Doctors told her family that the chronic diarrhoea she suffered after being given anti-biotics was just a reaction to the drugs. She was sent home after two weeks.

It was only when she collapsed at home and a GP visited her that C.diff was diagnosed. She was taken to the Kent and Sussex Hospital for treatment but died on May 27.

Her daughter, Brenda Charlton, said she saw staff at Maidstone Hospital failing to wash their hands or change aprons as they went from patient to patient. Three times they told Mrs Field to wet her bed, saying they didn't have time to take her to the bathroom or bring a bedpan.

Mrs Charlton's husband Tony, 63, said: "You would have thought someone at the hospital would have recognised the symptoms, but there was a failure of procedure and it wasn't noted."

RANJIT GOSAL

John Gosal is planning to sue Maidstone Hospital for a catalogue of errors which he says led to the death of his mother from C.diff.

Ranjit Gosal, 71, who was being treated for ovarian cancer, caught the bug in May last year and died the following June after what her son describes as "shambolic" treatment, including doctors prescribing antibiotics that made her condition worse.

Mr Gosal said: "The conditions in Maidstone Hospital were appalling. There was dust everywhere and it smelled. One patient who had diarrhoea was on the ward with just a curtain separating her from the other patients.

"Though the hospital was in the middle of the outbreak, they didn't check my mother had C.diff and it was only diagnosed after she died."

JOSEPH NIXON

The 87-year-old Dunkirk veteran died a wretched death last July after catching C.diff at Maidstone Hospital.

His daughter Jackie said the former officer with the Metropolitan Police was appalled by the conditions at the hospital where "hour by hour his soul was being stripped".

Mr Nixon, who caught the superbug after a bowel operation, asked his daughter: "What have I done to deserve being trapped in this awful place?"

Mrs Nixon, who took her father home to die, said there was little the nurses could do because the wards were so chronically understaffed.

"I ended up having to change my father's bed for him the whole time because otherwise he would be left lying in his own soiled sheets for three to four hours at a time," she said. "Keeping hospitals clean is basic. But there aren't enough nurses to do it properly."

DOREEN FORD

After being given chemotherapy at Maidstone Hospital for a tumour under her arm, Doreen Ford, 77, a retired civil servant, was told she did not have to go back to the hospital for six months.

But Mrs Ford had been given a blood transfusion as part of her treatment, during which she contracted C.diff. She died five weeks later, in October last year. Her family was unaware she had the superbug until they saw it on her death certificate.

Her stepson Steve Stroud, 55, said: "When we asked the hospital about the C.diff she had contracted there was a bit of a silence there.

"They didn't seem to want to talk about it. We had to have our house fumigated to kill off the C.diff spores which can last for six months, but we were told the disinfectant which was used in our house is 100 per cent effective, so we wanted to know why the hospital wasn't using the same chemicals. They wouldn't answer."

Mr Stroud's wife, the former Bucks Fizz singer, Cheryl Baker, later called for Maidstone Hospital to stop admitting patients likely to be vulnerable to the C.diff bug.

MARY HIRST

Having broken her hip in a fall, Mary Hirst, 83, was told by doctors at Maidstone Hospital that she would be home in a week.

But shortly before she was due to be discharged she began suffering from diarrhoea, and seven weeks later, on May 24 last year, she died, having contracted C.diff and MRSA.

Her daughter, Jackie Stewart, said: "She used to be fighting fit. She looked after a three-bedroom semi, did the gardening and hadn't seen a doctor in years.

"Everything was going well, the hip was fixing, then four days after her operation to mend her hip we were told she had diarrhoea. As far as we knew that's all she had. We were not told that she had C.diff.

"She was left in her own soiled sheets and was sobbing because nobody had cleaned her up. Her treatment was appalling. She was not being fed properly, not being cleaned, and there was only one commode between six patients. She didn't die of a broken hip, she died of hospital neglect."

Mrs Stewart said she was considering suing Maidstone and Tunbridge Wells NHS Trust. She said she was "not surprised" by the Healthcare Commission's revelation of so many deaths from C.diff.

"They seemed to be taking bodies away every five minutes," she said.

Every single case that has been highlighted in this story involves an elderly patient, and it is almost as if the staff at these hospitals were deliberately not caring for these elderly patients. I would not like to think that this was true, but it seems that there is a pattern to this neglect. Leaving patients in soiled sheets is downright disgusting. Refusing to take them to the toilet is an abuse of the elderly patient. The staff at these hospitals have been behaving in a very abusive way towards elderly patients. They try to hide behind the mask of not having enough staff to cope on the wards. Does the buck stop with the hospital? Does it go further and implicate a lack of proper government funding? Or is it pointing to the flaw of having a totally public hospital system that relies upon government funding, where there is not enough funds being allocated in the right way so that elderly patients receive the correct form of care? Or is it a case of hiring third world staff who do not know enough about personal hygiene, thus risking the lives of patients who are being admitted to hospital wards that are being kept in third world conditions?

Tuesday, October 09, 2007

Qian Xun Xue returns to China with mum's ashes

Qian Xun Xue returns to China with mum's ashes | NEWS.com.au

Little Qian Xun Xue has returned to China with her grandmother and her mother's ashes. The grandmother is grateful for the help that has been offered by the New Zealand government that allowed her to gain custody of Pumpkin within a short period of time. Pumpkin's half-sister is allowed full access through emails and visits to either China or Pumpkin travelling to New Zealand. The little girl will probably return to either New Zealand or Australia for a part of her education.

I am happy for little Qian, that she has been placed with family and that she will receive good care provided by her grandmother. It is a blessing that she will be allowed to see her half-sister, Grace, and I hope that they will forge a good relationship with each other in the future.

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Monday, October 08, 2007

Now the Portuguese police say Madeleine died in a fall on a staircase

Now the Portuguese police say Madeleine died in a fall on a staircase | the Daily Mail

It seems that I missed blogging about this particular allegation from the Portuguese police, for not only has it been claimed that Madeleine was over-sedated by her mother, but now it is claimed that the child died after a fall down some stairs at the apartment where the McCann family was staying:


Now the Portuguese police say Madeleine died in a fall on a staircase

From VANESSA ALLEN in Praia da Luz - More by this author » Last updated at 15:29pm on 1st October 2007

Comments Comments (6)

kate mccann rotheley

Accused: Kate McCann leaves church in Rotheley, Leicestershire yesterday - still clutching Madeleine's favourite toy Cuddle Cat

Madeleine McCann died in a fall down a flight of stairs at her parents' holiday apartment, Portuguese police claimed yesterday in the latest leak from inside the investigation.

A police report has pinpointed a set of ten stairs leading up to the McCann family apartment's patio doors, it was claimed.

The report was based on the findings of two British sniffer dogs which allegedly found the "scent of death" and microscopic traces of blood inside the apartment and on Kate McCann's clothes.

Detectives have also been looking at another theory - that a former maid at the resort where the family were staying abducted Madeleine.

Portuguese and British police have been told that the woman was sacked from the Mark Warner resort in Praia da Luz a few days before Madeleine went missing on May 3.

They are working on the theory that the woman - whose name they have been given - may have taken Madeleine as a form of revenge against her former employers.

The tip-off was passed to British and Portuguese police this week, after it was initially sent by email to the Prince of Wales's website.

Detectives think the informant was impressed by Prince Charles' public support for the McCanns.

A source revealed: "It appears that the email came from somewhere in the Iberian peninsular. The information does appear to check out.

"Whoever sent this email might not have wanted to trust it in the hands of the Portuguese police. They may well have thought that in order for people to take notice, they should sent it to Prince Charles.

Claims that Madeleine fell down the stairs at the McCann's apartment were made by allegedly highranking police sources to the Portuguese newspaper 24 Horas.

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madeleine stairs

Portuguese police reportedly believe Madeleine died after falling down this flight of stairs at the holiday apartment in Praia da Luz

The sources were reported as saying there were "strong suspicions" the girl smashed the back of her head against tiles on the steps.

"The only thing to investigate is how the body disappeared," said one.

Mrs McCann has already faced accusations that she and her husband Gerry covered up their daughter's accidental death after they sedated her so she would sleep while they went out for dinner.

Fearing a post-mortem would lead to accusations that they drugged their children, they hid the body and later moved it in their hire car and dumped it, it has been claimed.

Madeleine

Madeleine has been missing for 150 days

The Policia Judiciaria also believe Mr and Mrs McCann, a GP, may have been helped by their holiday friends, the so-called Tapas Nine.

Detectives want to re-interview all of the Tapas Nine and the newspaper 24 Horas said it was "highly possible" that some of them could be made official suspects, or arguidos.

Friends of the couple accused police of inventing theories. One said: "How can you tell what anyone died of without a body? There appears to be leak after leak to smear the name of the McCanns."

The McCanns' spokesman Clarence Mitchell added: "Some of the leaks that appear on a daily basis are hurtful, surely it is time to stop."

The couple are increasingly frustrated that they cannot campaign on Madeleine's behalf or defend their reputations because their arguido status means they are banned from speaking out.

Mrs McCann was reported to have said she was willing to risk a 12-month jail sentence under Portuguese judicial laws if it kept people looking for her daughter.

She told close friends: "What does any of it matter if it helps find Madeleine?"

The McCanns, both 39, marked the 150th day since Madeleine vanished by going to church in their home village of Rothley, Leicestershire.

Sir Richard Branson, defended the couple against the barrage of slurs from Portuguese police.

Speaking for the first time since it emerged he had donated £100,000 to their legal costs, the Virgin billionaire said: "The Portuguese press have behaved abysmally, fed inaccurate stories by the Portuguese police, which all turned out to be a load of garbage."

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Madeleine: New DNA evidence 'provides fresh link to parents'

Madeleine: New DNA evidence 'provides fresh link to parents' | the Daily Mail

Yet another report claiming that DNA evidence points the finger at the McCanns in the disappearance of their daughter. To be honest the Portuguese police have been relying upon methods that can only be considered the gathering of circumstantial evidence. It is now claimed that they can tell the difference between Madelaine's DNA and that of her siblings and parents. I thought that the sample would only be reliable if it was 100 per cent accurate, and so far I have seen nothing about a sample that is such a perfect match.

The case that is being built up is still full of holes, and certainly I think that Madelaine's disappearance should be investigated as part of a new investigation into the disappearance of another child (whose mother was beaten into admitting that she killed her daughter by the same Portuguese police). If there is a link between the disappearance of these children then that link needs to be established.

This case has always reminded me of the nightmare endured by Lindy Chamberlain, but now I am reminded of some other cases that have not as yet been fully resolved. The first one is the disappearance of the Beaumont children at an Adelaide beach. Their bodies have not been found, yet it is possible that the man most likely to have committed the crime of abduction and murder of the children is behind bars. The second case is that of Linda Stillwell from St. Kilda (or was that Elwood) beach, and again her body has not been found. There is a third case, that of Eloise Worledge, who disappeared from her bedroom in Beaumaris. I have never heard whether or not this disappearance was ever solved (there is no link established to the same man who could be responsible for the disappearance of the Beaumont children and Linda Stilwell). There are parents here who have not had the mystery surrounding the disappearance of their children resolved. They faced the same nightmare that the McCanns are facing now, but the difference here is that the parents were not blamed when the children disappeared, except for Azaria Chamberlain, where Lindy was charged with a murder she did not commit. There is one more case in WA, Australia that has not been resolved, that of an 11 year old boy, who had been with his brother before he disappeared, and then his body was found - he had been abducted and raped. That abduction and murder has not been resolved, and that child was once my next door neighbour. I still feel for his parents and siblings and yes I still remember when they lived next door to us in Canberra, and how they had played with my own sons after school.

Is Madelaine alive? Is she dead? I do not know, but I do wish that everyone would stop trying to blame the parents unless someone comes up with a body of a child and it was proved that she died according to what is still being claimed. The scenario that has been built up is very flimsy because the police have been claiming that the child's body was hidden in a freezer somewhere and then removed several weeks later. Really?  The smell of death coming from the freezer or refrigerator would have been so strong that the evidence would be a lot more than circumstantial by now.


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