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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

Globe Climate: Canada’s resource reckoning is coming

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Good afternoon, and welcome to Globe Climate, a newsletter about climate change, environment and resources in Canada.

This afternoon, the Alberta government announced that it is restoring a coal mining policy it revoked last spring. At the time, the move provoked a widespread public backlash detailed by The Globe. The original decision, which opened up more than 1.4 million hectares to exploration, was made without public consultation. Premier Jason Kenney previously defended the changes.

Lots more on coal and Canada’s resources industry in this week’s newsletter edition.

Now, let’s catch you up on other news.

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Ecology

‘Incredibly destructive’: Canada’s Prairies to see devastating impact of climate change

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As the climate continues to warm at an alarming rate, experts warn if dramatic steps to mitigate global warming are not taken, the effects in Canada’s Prairie region will be devastating to the country’s agriculture sector.

According to Environment and Climate Change Canada, the country is warming, on average, about double the global rate.

Scientists with the National Oceanic and Atmospheric Administration in the U.S. recently found 2020 was earth’s second-hottest year on record, with the average land and ocean surface temperature across the globe at 0.98 of a degree C above the 20th-century average.

However, the agency found the northern hemisphere saw its hottest year on record, at 1.28 degrees C above the average.

“(In Canada) we are looking at about 6.4C degrees of warming this century, which isn’t much less than one degree per decade, which is just a terrifying rate of warming,” Darrin Qualman, the director of climate crisis policy and action at the National Farmer’s Union said.

Qualman said there is “massive change coming” to Canada’s Prairies, which will be “incredibly destructive.”

“It’s not going too far to say that if we made that happen, parts of the Prairies wouldn’t be farmable anymore,” he said.

According to the federal government, in 2018 Canada’s agriculture and agri-food system generated $143 billion, accounting for 7.4 per cent of the country’s GDP.

The sector employed 2.3 million people in 2018. The majority of the 64.2 million hectares of farmland in Canada is concentrated in the Prairies and in southern Ontario.

The effects of climate change are already being felt on the ground in the Prairies, Qualman said, adding that the NFU has already heard from farmers complaining of “challenging weather.”

“People are sharing pictures of flattened crops and buildings, et cetera, that have been damaged,” he said. “And we’re still at the beginning of this.”

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Insect-based dog food aims to cut your pet’s carbon pawprint

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Meat has an enormous carbon footprint, with livestock liable for about 15 per cent of worldwide emissions, as we have beforehand mentioned on this e-newsletter. That is prompted specialists to suggest consuming much less meat for sustainability (and well being) causes.

However what about your pet? One research discovered that the methane and nitrous oxide emissions generated by canine and cat meals within the U.S. alone had been equal to about 64 million tonnes of CO2, or roughly the quantity produced by 13.6 million automobiles. And it might be getting worse, with a development towards feeding pets “human-grade” meat.

That is prompted some pet meals makers to look to lower-carbon protein sources — together with bugs.

Research present that producing insect-based meals requires far much less feed, land and water and generates far fewer greenhouse fuel emissions per kilogram than meats comparable to beef, pork or rooster.

That is one of many causes increasingly more pet meals containing insect protein are hitting the market. Purina, a model owned by multinational Nestlé, launched a line of canine and cat meals containing black soldier fly larvae in Switzerland in November.

In Canada, Montreal-based Wilder Harrier began promoting canine treats made with cricket protein in 2015 and pet food made with black soldier fly larvae in 2019. It plans to broaden to launch a line of insect-based cat treats later this yr and cat meals in 2022 due to “a ton of demand,” mentioned firm co-founder Philippe Poirier.

Wilder Harrier initially labored with animal nutritionists on insect-based merchandise to unravel a unique downside — specifically, the founders’ canines had allergy symptoms to frequent meats utilized in canine meals. Poirier mentioned now about half its prospects hunt down the product due to their pets’ allergy symptoms and about half for environmental causes.

Dr. Cailin Heinze, a U.S.-based veterinary nutritionist licensed by the American School of Veterinary Vitamin, has written concerning the environmental influence of pet meals. She mentioned we’re typically “not as involved as we probably ought to [be]” concerning the environmental footprint of pets.

Alternatively, she famous that the longer-term influence of newer diets, comparable to vegan meals and people containing bugs, hasn’t been nicely examined in comparison with conventional pet meals.

Maria Cattai de Godoy, an assistant professor of animal sciences on the College of Illinois who research novel proteins for pet meals (together with bugs, yeast and plant-based substances), mentioned such substances are rigorously examined to find out their security and diet earlier than being added to pet meals. 

“This can be a very extremely regulated trade,” she mentioned, however admitted it is also evolving.

Relating to bugs, she mentioned constructive information “reveals promise in direction of utilizing them increasingly more in pet meals.” Insect-based proteins have additionally earned the endorsement of the British Veterinary Affiliation, which says some insect-based meals could also be higher for pets than prime steak.

However Godoy famous that there isn’t any one-size-fits-all resolution, and pet homeowners ought to take into consideration the wants of their very own particular person pet and analysis whether or not a specific weight loss plan can be appropriate.

She mentioned that other than the kind of protein, issues like packaging and manufacturing strategies may also make a distinction. For instance, utilizing meat byproducts that may in any other case turn into waste would not drive elevated meat manufacturing the identical approach as utilizing human-grade meat.

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