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Krembil Discovery Tower: A new era in research

the Brain Campaign

Krembil Neuroscience Centre

Krembil Neuroscience Centre


An estimated six million Canadians suffer from progressive neurological conditions and debilitating brain injuries and disorders, which seriously impact quality of life. As Canada’s population ages, the incidence of neurological diseases, disorders and injuries will grow – one in three will suffer from Parkinson’s or Alzheimer’s disease within the next decade.

Every day, the care providers, researchers and educators at the Krembil Neuroscience Centre (KNC) are working to restore health and full function for those who rely on us, while leading discoveries that will one day become cures for the most devastating neurological diseases.
The Krembil Neuroscience Program

A dedicated team of interdisciplinary health professionals provides expert care in a collaborative environment. They integrate state-of-the-art technology, groundbreaking research and personalized care to prevent, treat and cure neural and sensory system disorders.

Providing comprehensive care across the continuum – from prevention, intervention, long-term management, outreach, and linkages to community providers – our program’s major areas of focus are:

Alzheimer’s Disease: Our researchers were the first in the world to identify two genes responsible for familial Alzheimer’s disease, and have pioneered treatments using deep brain stimulation.

Epilepsy: We evaluate more than 1,800 patients annually and pioneer the latest detection technologies such as multi-modality imaging that can diagnose epilepsy sooner.

Parkinson’s Disease: Morton and Gloria Shulman Movement Disorders Centre has earned international respect for its pro-active role in new drug trials and innovations in treatment.

Stroke: Designated as one of the first provincial Regional Stroke Centres, our world-renowned surgeons provide leadership to the province in best practices for stroke care, research and professional education.

Brain Tumours: KNC serves as a national and international referral centre, providing care for hundreds of new patients with brain tumours each year, and is home to the only Gamma Knife in Ontario.

Spinal Cord Injuries: KNC is among the top three spinal programs in the world, where a broad spectrum of scientists are dedicated to providing and advancing treatment strategies.
Research and Education

Researchers and scientists at the Krembil Neuroscience Centre explore the functions of the brain and nervous system as they discover treatments for spinal cord injuries, stroke, vascular malformations, brain tumors, neuro-ophthalmologic disorders and neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease.

Over 90 investigators are committed to scientific and clinical impact in these areas, and the proximity of basic researchers and clinician-scientists provides the full spectrum of expertise required to make discoveries in basic, translational and clinical research. Beginning in 2012, research activities will be based at the state-of-the-art $165 million Krembil Discovery Tower.

We are North America’s largest teaching centre to neurologists, neurosurgeons and ophthalmologists. Through our collaboration with the medical school at the University of Toronto, we are fostering the development of the best neural leaders of tomorrow.
Help us find the answers

Find out how you can help support the Brain Campaign and the leading-edge work of Krembil Neuroscience Centre. Click here for more information on how you can make a gift today.

MINOR STROKE CAPTURED ON VIDEO: WATCH AS IT HAPPENS.... On April 2, 2014, while driving home from work, Stacey Yepes sensed a stroke coming on. She pulled over, pulled out her smartphone and recorded what was happening so others could see.

MINOR STROKE CAPTURED ON VIDEO: WATCH AS IT HAPPENS


6/12/2014














On April 2, 2014, while driving home from work, Stacey Yepes sensed a stroke coming on. She pulled over, pulled out her smartphone and recorded what was happening so others could see. (UHNToronto/YouTube)​
​ UPDATE: Stacey Yepes' stroke 'selfie' video goes viral



Settled in for the evening on her couch watching TV, 49-year-old Stacey Yepes suddenly felt the left side of her body go numb.

Her face froze.


"Strokes can affect people of any age even if they have few risk factors, so it's very important to be aware and to know the signs of a stroke​."

-Dr. Cheryl Jaigobin


Then, the phone rang. She managed to answer, but slurred her words and couldn't speak properly.

The public service announcements for the signs of stroke flashed through Yepes' mind.

"Is this what's happening to me?" she thought.

Five minutes later, the symptoms subsided and Yepes felt normal again. Shaken by the experience, she went to her local emergency room and get checked out.

Tests run at the hospital were clear. She was told that the episode was most likely a result of stress and was given some tips on how to better manage the symptoms.

Yepes wasn't convinced.

"It's true that I hadn't slept well the last few days and that I have a stressful job," said Yepes, who works as a legal secretary. "But I was pretty sure that the symptoms I had experienced were due to a stroke."

Even as Yepes was exiting the hospital that day, she felt that strange numbing sensation return. It passed quickly. She went home and even went to work the next day.

Video: 'I don't know why this is happening to me'

Two days after her initial episode, while driving home from work, Yepes suddenly felt the left side of her body going numb again.

She pulled over as the symptoms returned full force. Then, she had the presence of mind to pull out her smartphone and film herself to show a doctor what she was experiencing.

"My tongue feels very numb," she said in the recording as the left side of her face starts to droop.

'Mini-stroke' confirmed

Yet again, the symptoms passed and Yepes felt normal. She had now experienced three of these events and was increasingly worried.

She went to another hospital for a second opinion. The symptoms she described and the video was enough for staff to suspect a minor stroke.

Yepes was referred to the stroke unit of the Krembil Neuroscience Centre (KNC) at Toronto Western Hospital (TWH) – the stroke centre of care of the west region of Toronto.

Because Yepes' episodes had been short and had passed each time, she had most likely experienced a transient ischemic attack (TIA) or what's known as a "mini-stroke."

Warning sign of more serious stroke

TIAs are caused by blood clots and the only difference between a TIA and a full blown stroke is that the TIA is usually temporary. However, they are no less serious as TIAs are considered a warning that a more serious stroke could happen.

TWH has Toronto's only day unit to treat TIAs and minor strokes. Called the Transient Ischemic Attack and Minor Stroke (TAMS) Unit, it is dedicated to assessing patients at high risk for stroke and providing them with the necessary interventions to prevent them.

Traditionally, patients suffering from a TIA or minor stroke who arrive at a hospital emergency room are either discharged and referred to a stroke prevention clinic or admitted to hospital – averaging a stay of up to three days.

The stroke team at the KNC identified a more effective way of treating these patients by creating a unit that rapidly assesses them in a single day.

KNC's TAMS Unit: Assessment, resources, treatment

Yepes' assessment showed she had suffered a small stroke due to a small blockage in one of the arteries supplying her brain.

Further tests confirmed that this was caused by atherosclerosis – or the build-up of plaque in the artery supplying the area of her brain injured in her stroke.

Although relieved to have confirmed the cause of her symptoms, Yepes thought she had been leading a relatively healthy lifestyle and was surprised to have suffered a stroke at such a young age.

But her neurologist, Dr. Cheryl Jaigobin, noted that it's not uncommon for young people to suffer a stroke.

"Strokes can affect people of any age even if they have few risk factors, so it's very important to be aware and to know thesigns of a stroke​," said Jaigobin.

"There are recent studies that indicate that the incidence of stroke in young patients is increasing. Risk factors such as hypertension, diabetes and elevated cholesterol are now seen in younger patients," she continued. "These findings are reflected in the patients we see in our stroke program. We treat many patients with stroke that occur at a young age."

Preventative measures

Jaigobin also recommends that people get their blood pressure and cholesterol levels checked and be screened for diabetes when they go for their annual check-up. ​
"My advice to others is, if you think you're having or had a stroke, don't wait. Go to the hospital and get checked out." –Stacey Yepes​


"Everyone should be proactive about their health and aware of any changes as they age, especially people with a family history of stroke or heart disease," she said.

During her assessment in the TAMS unit, Yepes was engaged in her own care and partnered with nurse practitioner Anne Cayley for ongoing education and to develop a treatment plan to prevent any more strokes.

Yepes was also referred to an outpatient rehabilitation program to regain strength and improve the function of her left arm. She is slowly but surely adjusting to this altered lifestyle and, like many stroke survivors, is expected to return to a normal life.

"I thought I was leading a healthy lifestyle, but since I work two jobs I had a lot of stress in my life, was often eating on the go and didn't have time to exercise regularly," she said. "The TAMS Unit has really taught me a new way of living and how to address these areas so I don't have another stroke."

Though she suffered three separate events, she is fortunate they only affected a small area of her brain and she wasn't left paralyzed or with impaired speech. But had she dismissed those initial symptoms, the outcome could have been much worse.

"I've since learned that a person's greatest chances to return to pre-stroke strength is within the first three months after their stroke, so my quick reaction to my symptoms to get treatment is contributing to my recovery," said Yepes. "My advice to others is, if you think you're having or had a stroke, don't wait. Go to the hospital and get checked out."

Related Links
Stacey Yepes' stroke 'selfie' video goes viral
KNC drug could revolutionize stroke treatment
Stroke prevention clinic
Transient Ischemic Attack and Minor Stroke Unit (TAMS)
Stroke history: What we now know – and what we didn’t
Stroke Month: Fellow to conduct cutting-edge research​
​

NTSB Finds Mismanagement of Approach and Inadequate Monitoring of Airspeed Led to Crash of Asiana flight 214Multiple contributing factors also identified June 24

NTSB Finds Mismanagement of Approach and Inadequate Monitoring of Airspeed Led to Crash of Asiana flight 214Multiple contributing factors also identified
June 24


WASHINGTON - In a Board meeting held today, the National Transportation Safety Board determined that Asiana flight 214 crashed when the airplane descended below the visual glidepath due to the flight crew's mismanagement of the approach and inadequate monitoring of airspeed. The Board also found that the complexities of the autothrottle and autopilot flight director systems, and the crew's misunderstanding of those systems, contributed to the accident.


On July 6, 2013, about 11:28 a.m. (PDT), the Boeing 777 was on approach to runway 28L at San Francisco International Airport in San Francisco, California when it struck the seawall at the end of the runway. Three of the 291 passengers died; 40 passengers, eight of the 12 flight attendants, and one of the four flight crewmembers received serious injuries. The other 248 passengers, four flight attendants, and three flight crewmembers received minor injuries or were not injured. The impact forces and a postcrash fire destroyed the airplane.


The NTSB determined that the flight crew mismanaged the initial approach and that the airplane was well above the desired glidepath as it neared the runway. In response to the excessive altitude, the captain selected an inappropriate autopilot mode and took other actions that, unbeknownst to him, resulted in the autothrottle no longer controlling airspeed.


As the airplane descended below the desired glidepath, the crew did not notice the decreasing airspeed nor did they respond to the unstable approach. The flight crew began a go-around maneuver when the airplane was below 100 feet, but it was too late and the airplane struck the seawall.


"In this accident, the flight crew over-relied on automated systems without fully understanding how they interacted," said NTSB Acting Chairman Christopher A. Hart. "Automation has made aviation safer. But even in highly automated aircraft, the human must be the boss."


As a result of this accident investigation, the NTSB made recommendations to the Federal Aviation Administration, Asiana Airlines, The Boeing Company, the Aircraft Rescue and Firefighting Working Group, and the City of San Francisco.


These recommendations address the safety issues identified in the investigation, including the need for reinforced adherence to Asiana flight crew standard operating procedures, more opportunities for manual flying for Asiana pilots, a context-dependent low energy alerting system, and both certification design review and enhanced training on the Boeing 777 autoflight system.


The recommendations also address the need for improved emergency communications, and staffing requirements and training for aircraft rescue and firefighting personnel.


"Today, good piloting includes being on the lookout for surprises in how the automation works, and taking control when needed," Hart said. "Good design means not only maximizing reliability, but also minimizing surprises and uncertainties."


A synopsis of the NTSB report, including the probable cause, findings, and a complete list of the 27 safety recommendations, is available athttp://www.ntsb.gov/news/events/2014/asiana214/abstract.html. The full report will be available on the website in several weeks.

The Conservative government has agreed to accept new helicopters to replace Canada's 50-year-old fleet of Sea Kings even though they don't meet a key requirement recommended for marine helicopters by Canada's air safety investigator,

The Conservative government has agreed to accept new helicopters to replace Canada's 50-year-old fleet of Sea Kings even though they don't meet a key requirement recommended for marine helicopters by Canada's air safety investigator, CBC News has learned.
How the Cyclone helicopter compares to the Sea King
$1.7B already spent on troubled Cyclone helicopters
Report on 2009 fatal chopper crash calls for new rules

The government announced Wednesday it had finally signed a renegotiated contract with helicopter-maker Sikorsky for 28 new CH-148 Cyclone helicopters at a cost of $7.6 billion.

Now, CBC News has learned the details of what the government has agreed to forego in order to conclude a long-awaited new deal with Sikorsky, and it includes a formerly mandatory safety measure: a 30-minute run-dry standard for its main gear box.

The importance of the ability to fly for 30 minutes after a loss of lubrication in the main gear box was reinforced by an investigation into a deadly 2009 crash of a Sikorsky-built helicopter.

The gearbox is a kind of linkage between the helicopters engines and its rotor system. It's packed with lubricating oil that cools the gears and keeps power flowing to the rotors. If a helicopter loses oil in its main gearbox, the system will get too hot and either seize up or otherwise fail. That would lead to a loss of power in the rotor, forcing a helicopter from the sky.

A helicopter that meets the run-dry standard can continue flying for 30 minutes even if there's no oil in the main gear box — a critical feature for helicopters flying hundreds of kilometres out to sea.

"I am shocked, this is a very dangerous thing," said Jack Harris, the NDP's defence critic.

"This is a major safety requirement ... necessary for the safety of the aircraft operating in the maritime environment.

"This is a significant safety issue."
Mandatory requirement in original bids

Sikorsky has struggled for years against the allegation its main gearbox could not meet that 30-minute standard.

It was a mandatory requirement in the 2004 competition held to determine which helicopter would best serve Canada's interests.

Sikorsky won that competition, besting the AW 101, a helicopter that meets the 30-minute standard and flies search and rescue for the Canadian military today.

Critics suggest if Sikorsky could not meet that requirement, it ought not to have won the competition to replace Canada's Sea Kings in the first place.

"There are other helicopters that can meet that standard," Jack Harris said. "These guys signed a contract with this as a requirement. They said they could do it."

In an e-mail, Defence Department spokeswoman Ashley Lemire said the main gearbox on Canada's new Cyclones is designed to ensure the total loss of oil lubrication is "very remote."

"The Cyclone gear box lubrication system has many safety features, including a bypass valve than can be used to isolate the gearbox case from the oil cooler in the unlikely event of an external leak, to prevent further loss of transmission oil," Lemire said.

Since Canada first signed with Sikorsky in 2004, the American company has been over budget and years behind schedule.

Last year, the government even took the unprecedented step of announcing it might drop Sikorsky and began looking at other choppers. But a consultant's report suggested the government recognize Sikorsky was essentially developing a military helicopter for Canada and accept it might have to let some promised items slip.

The government accepted that advice and the announcement last week was the conclusion of a process that saw the government reveal its bottom line on its requirements and Sikorsky lay out realistic capabilities and timelines.

In the end, the Cyclone helicopters Canada will get will feature several trade-offs when compared to the helicopter the government ordered a decade ago.
Government makes concessions

The 30-minute run-dry capability is just one of seven concessions the government has made.

The others include:
The ability to secure the helicopter's ramp in various positions during flight.
Crew comfort systems during extreme temperature operations.
Unobstructed hand and foot holds for technicians to conduct maintenance.
The ability to self start in very cold weather.
Cockpit ergonomics factors.
A system to automatically deploy personnel life rafts in emergency situations.

Lemire said the air force accepted those concessions because "there is no impact to overall operational capabilities and will not risk crew safety."

But it's hard to see how that's the case.

Sikorsky refers to Canada's Cyclone helicopters as H-92s. The H is used to identify the helicopter as a military aircraft. The H-92s are militarized and upgraded versions of Sikorsky's civilian S-92s.

When that lineage is understood, the lack of run-dry becomes more of a concern.
17 died in crash of Cougar S-92

In 2009, a Sikorsky-built Cougar Helicopter S-92 on the way from St. John's, N.L., to an offshore oil platform crashed into the sea when two titanium studs securing the main gearbox failed, causing a total loss of lubrication. All but one of the 18 people aboard died.

The Canadian Transportation Safety Board investigation made several recommendationsbut it also highlighted the problem with the helicopter's failure to meet that 30-minute run-dry certification.

"We recommend that all Category A helicopters, including the S-92, should be able to fly for at least 30 minutes following a massive loss of main gearbox oil," TSB chair Wendy Tadros told reporters in 2011.

Military helicopters are subject to different operating standards than civilian choppers, but in this case the government says Canada's upgraded and militarized versions of the S-92 will meet civilian airworthiness regulations.

That American standard, called FAR Part 29, allows for Sikorsky's design to fly, as it provides for an alternative to a run-dry requirement, provided the manufacturer can establish the total loss of lubrication is "extremely remote."

Qualification under that FAA regulation is what both the government of Canada and Sikorsky are relying on in order to get their deal done.

"Sikorsky and the Canadian government have agreed on all technical requirements for the CH-148 Cyclone helicopter," says Sikorsky spokesman Paul Jackson. "The gearbox meets all FAR Part 29 requirements by the FAA, including those related to loss of primary lubrication."

Following Tadros' investigation of the Cougar crash, the TSB chair said that extremely remote standard was not good enough.

"The 30-minute requirement is negated by the 'extremely remote' provision. Therefore, (the provision) needs to go. It's as simple as that."

The TSB urged U.S. regulators to amend the standard, pointing out other helicopter-makers were designing aircraft that could meet the 30-minute standard.

Defence spokeswoman Ashley Lemire says the military will make sure Canada's Cyclones meet American civilian regulations.

"Through extensive testing, proper operating procedures will be established to satisfy the required airworthiness regulations, including the civil run-dry requirement, to ensure the safety of the crew and aircraft," Lemire said.





Clarifications

Earlier versions of this story placed the values of the Cyclone helicopter contract between the Canadian government and Sikorsky at $5.7 billion. In fact, the total budget is $7.6 billion - $5.7 billion for in-service support, including the amendments to the contract, and $1.9 billion for the acquisition of the helicopters.
Jun 23, 2014 11:50 AM ET

New citizenship law will be challenged on constitutional grounds, if passed, say rights groups CARL and BCCLA,

New citizenship law will be challenged on constitutional grounds, if passed, say rights groups


TORONTO (June 19, 2014) – The Canadian Association of Refugee Lawyers (CARL), supported by the British Columbia Civil Liberties Association (BCCLA), announced today that it plans to launch a legal challenge to the proposed new citizenship amendments – Bill C-24 – if the bill is passed by the Senate.

Bill C-24, introducing sweeping changes to Canada’s citizenship laws that make citizenship harder to get and easier to lose, has passed through the House of Commons and is now being considered by the Senate. CARL, BCCLA and Amnesty International take the position that this proposed law has dramatically negative effects on Canadian citizenship, eliminating equal citizenship rights for all, and violates the Charter of Rights and Freedoms as well as international human rights. According to the organizations, the new law will take away rights from countless Canadians, creating a two-tier citizenship regime that discriminates against dual nationals and naturalized citizens.

“This proposed law would allow certain Canadians to be stripped of citizenship that was validly obtained by birth or by naturalization. We think that is unconstitutional, and we intend to challenge this law if it is passed,” said Lorne Waldman, President of the Canadian Association of Refugee Lawyers. “We have presented our arguments to the House of Commons and to the Senate, in an attempt to get them to change or stop this Bill. But the government hasn’t listened, it refuses to amend the bill, and we feel we will have little choice but to challenge it in the courts.”

Over 41,000 people have signed a petition on Change.org asking for the bill to be stopped. The petition was jointly launched by CARL and BCCLA, and was delivered to the citizenship minister earlier in June.

“The ‘Strengthening Canadian Citizenship Act’ does exactly the opposite of what the title proclaims. It makes citizenship less secure,” said Josh Paterson, Executive Director of the BC Civil Liberties Association. “In Canada, lawfully-obtained citizenship has always been permanent – once a Canadian, always a Canadian – and all Canadians have always had equal citizenship rights. This bill turns the whole idea of being Canadian upside-down, so that the Canadian citizenship of some people will be worth less than the Canadian citizenship of others. That is wrong, and it must be challenged.” While the BCCLA was not prepared to announce litigation today, it did not rule out joining in litigation with CARL on this issue as the case goes forward.

Last week, Amnesty International released its own legal analysis of Bill C-24, concluding that the new law fails to live up to Canada’s international human rights obligations to guarantee non-discrimination and to ensure fair hearings for the determination of such a critical status as citizenship. Amnesty International is not a part of the proposed litigation.

Alex Neve, Secretary General of Amnesty International Canada’s English-speaking branch, added: “A government decision to revoke citizenship could negatively affect a person’s life, liberty or security. Such a decision must only take place in accordance with the principles of fundamental justice, and this bill’s citizenship revocation provisions completely fail to meet this standard,” said Alex Neve, Secretary General, Amnesty International Canada, English speaking branch. “The revocation provisions also put Canadians at risk of discrimination based on their dual nationality, or their family origin. The bill cuts against Canada’s duty not to discriminate and to protect people from discrimination. Amnesty International calls for the revocation provisions to be withdrawn from the bill.”

Read the Canadian Association of Refugee Lawyers’ Backgrounder on Bill C-24 in English,French, Spanish, Farsi, Urdu, Hindi, Arabic, Chinese – traditional, Chinese – simplified and Filipino.

Read the Canadian Association of Refugee Lawyers’ submission to the House of Commons and Senate committees considering bill C-24.

Read Amnesty International’s brief on concerns regarding Bill C-24.

View the petition on Change.org/secondclasscitizens