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Predicting Suicide: The EDOR® Enigma (Part 3)

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This time last year I wrote(1,2) about a Swedish company called Emotra. Emotra make a device that is supposed to measure suicide risk in people with mental illness. The test is called EDOR® and according to Emotra’s website and materials, it has been shown to be highly effective. Last year, I explained why I disagree with that assessment.

edor_box_emotra

Now, a year later, I’m revisting the EDOR® story, because there have been a number of developments that I find quite disturbing. It seems that EDOR® has now found users and is, or soon will be, in actual commercial use in a number of hospitals.

The use of EDOR® began in March with an unnamed psychiatric clinic in Warsaw, Poland, who agreed to “borrow the instrument and pay Emotra for test analyses”. In October, a German psychiatric hospital signed up to a similar agreement. Then, a month ago, EDOR® came right to my own doorstep with the announcement that a hospital in London will be trialling the device:

As Emotra announced in a press release on November 16, a letter of intent has been signed with a London-based psychiatric hospital. The agreement will allow the hospital to evaluate EDOR® in clinical practice for a limited period of time. This evaluation was commenced in the past few days with the training of the physicians and test leaders involved.

Last Wednesday, EDOR was also presented to the board of directors of the company that owns this London hospital. The evaluation that is now in the starting blocks could potentially open the door to other hospitals owned and run by this company.

Overall, while Emotra don’t seem to have actually sold any EDOR® hardware to anyone yet, the technology seems to be on the threshold of entering clinical practice.

This worries me because I don’t think the evidence base is strong enough yet to justify using this method clinically. For instance, in 2013 a large study, carried out by EDOR® inventor and Emotra head of research Lars-Håkan Thorell, was published with unimpressive results.

The 2013 paper showed that electrodermal hyporeactivity testing, the technique behind EDOR®, is not much better than chance at predicting suicide or violent suicide attempt. In particular, the method produced a large number of false positives i.e. it had low specificity. (Thorell et al. tried to redefine the word ‘specificity’ to deal with these results, something Emotra is still doing to this day on their website.)

Thorell recently published a new paper claiming much better performance for electrodermal hyporeactivity tests: “The relationship between electrodermal hyporeactivity and suicide was highly statistically significant (p = 0.00058) and the risk of suicide was 25 times higher among hyporeactive than reactive depressed patients.” This sounds like an impressive set of results, but the study was very small: the total number of suicides was only 10. It’s also not reassuring that this paper was published by notorious predatory publishers ECronicon.

This isn’t to say that EDOR® is a bogus technology. There is quite a lot of research on electrodermal hyporeactivity and I wouldn’t be surprised if it can predict suicide to some extent. The problem is that we don’t know that extent. I don’t think we know the accuracy of EDOR® well enough to be confident that it is safe or cost-effective.

Predicting suicide is not an academic exercise. Even if a test is (say) 80% accurate, what happens to the 20% of patients who are incorrectly assessed? What about the patient, actually not suicidal, who is treated as if they are? What happens to the suicidal patient who is wrongly classed at being of low risk? Disturbing scenarios suggest themselves.

Emotra’s CEO says in a statement that:

In our opinion, EDOR® is a mature product that has proven itself amply in clinical practice and, therefore, the time is ripe for a commercial launch of the method.

In my opinion, this is highly optimistic.

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Ecology

Yukon and Northern BC First Nations tackle climate change using Indigenous knowledge and science

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YUKON, June 18, 2021 /CNW/ – The Government of Canada is working together in partnership with Indigenous and Northern communities in finding solutions to adapt to the impacts of climate change in the North.

Today, Minister of Northern Affairs, Daniel Vandal, along with Parliamentary Secretary to the Minister of Economic Development and Official Languages (Canadian Northern Economic Development Agency), Larry Bagnell, highlighted progress on three unique, Indigenous-led projects that are helping communities in Yukon and Northern British Columbia adapt to the challenges posed by climate change.

The Minister and Parliamentary Secretary met virtually with Carcross/Tagish First Nation (C/TFN) to learn about their community-led climate change monitoring program. C/TFN has partnered with Tsay Keh Dene Nation (TKDN) and Chu Cho Environmental of Prince George, British Columbia, to build a community-led monitoring project that examines environmental data and Indigenous knowledge to create a holistic picture of how the climate is changing across C/TFN and TKDN traditional territories. The project combines tracking of current and historical climate trends with knowledge shared by Elders while also providing opportunities for youth mentorship and climate change awareness.

The Taku River Tlingit First Nation (TRTFN) is also leading a unique project to assess the impacts of climate change within their traditional territory. Climate change is causing many of the culturally significant ice patches to melt, exposing organic artifacts to oxygen and leading to rapid deterioration. The TRTFN ice patch mapping project will involve performing archaeological assessments to prevent the degradation of artifacts. Research will be guided by traditional knowledge, Elders and oral histories, when available, and heavily involve community, Elders, youth and Knowledge Keepers.

The Pelly Crossing Selkirk Development Corporation is leading the Selkirk Wind Resource Assessment project through the installation of a Sonic Detection and Ranging (SODAR) system. The initiative includes a feasibility study leading up to the construction of a renewable energy facility, including wind, solar and battery energy storage. Expanding clean energy within the region will have direct benefits for communities, including reduced reliance on diesel, job creation and revenue generation for Selkirk First Nation. 

These projects are delivering important environmental, social and economic benefits that lead to healthier, more sustainable and resilient communities across Yukon and Northern British Columbia. They also build community clean energy capacity and help to avoid the impacts of climate change.

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Ecology

Atlantic Provinces Ready For Aquaculture Growth

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Aquaculture is an important economic driver for rural, coastal and Indigenous communities, and Atlantic Canada is well positioned to increase aquaculture production as global demand for sustainably sourced seafood grows.

That is why the ministers responsible for aquaculture in the Atlantic provinces have agreed to the ongoing development and management of their industries based on common principles. A new memorandum of understanding has been signed by the four ministers, which extends the previous agreement signed in 2008.

“In a time when food security is especially important, it is good to see our aquaculture industry has grown steadily and is poised for continued growth in 2021 based on environmentally responsible, science-based policies and practices,” said Keith Colwell, Minister of Fisheries and Aquaculture for Nova Scotia. “Our Atlantic partnership continues to help the industry grow sustainably.”

Cooperation between the provinces and the aquaculture industry has led to improvements in pest management, environmentally sustainable aquaculture methods, aquatic animal health and policies to support the shared use of marine and freshwater resources. It also aims to align regulation and policy between the provinces to make the regulatory requirements easier to understand by industry and the public.

Each province has a comprehensive and robust legislative and regulatory framework to ensure environmental sustainability, economic prosperity and public accountability. The provinces update their legislation and regulations regularly. Nova Scotia revamped its regulatory framework in 2015; New Brunswick received Royal Assent for a new Aquaculture Act in 2019 and is working on the supporting regulations; Newfoundland and Labrador completely revised its aquaculture policy in 2019; and Prince Edward Island has recently drafted a new Aquaculture Act.

The ministers have agreed to continue to use science-based evidence for management decisions, thereby increasing public and investor confidence in the Atlantic Canadian aquaculture industry.

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Ecology

COMING SOON: A Healthy Environment and a Healthy Economy 2.0

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We all want the same thing: a clean and responsible energy future for our children and future generations while continuing to enjoy a high standard of living.

On December 11, 2020, the Prime Minister announced a new climate plan which he claimed will help achieve Canada’s economic and environmental goals.

The proposed plan by Environment and Climate Change Canada (ECCC) entitled “A Healthy Environment and a Healthy Economy” will have an initial investment of $15 billion of taxpayer’s money. It is built on 5 pillars of action:

  1) Making the Places Canadians Live and Gather More Affordable by Cutting Energy Waste

2) Making Clean, Affordable Transportation and Power Available in Every Community

3) Continuing to Ensure Pollution isn’t Free and Households Get More Money Back

4) Building Canada’s Clean Industrial Advantage

5) Embracing the Power of Nature to Support Healthier Families and More Resilient Communities  

In my paper, “A Healthy Environment and a Healthy Economy 2.0” I will objectively critique each pillar in the government’s new climate plan and provide alternative solutions to the same issues.

  This is an alternative plan that supports workers, protects lower income earners and creates economic growth while respecting the environment and focusing on the dignity of work.

  This plan abandons virtue-signaling projects and relies on Canadian ingenuity to build our economy and restore Canada’s role of responsible leadership in the world.

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