Monday 29 August 2011

Bacteria stops dengue in tracks

The researchers infected the mosquito Aedes aegypti with bacteria

Australian scientists say they have discovered a cheap and effective method of preventing the transmission of dengue fever.

They infected mosquitoes that spread the disease with bacteria that block transmission of the dengue virus.
When the resistant insects were released, they successfully interbred with wild mosquitoes and halted their ability to transmit dengue.
Details of the work are published in the journal Nature.
The researchers are hopeful that this could be a viable control for a disease that affects more than 50 million people worldwide every year.
According to the World Health Organization around one third of the world's population is at risk from dengue fever. The incidence and severity of this untreatable, mosquito-borne illness are increasing in many parts of the world.
Pesticides that kill the specific type of mosquitoes that carry the virus have been the most effective method of control to date, but resistance is rising.
Now a team of Australian scientists say that a simple bacterium called Wolbachia that only infects insects could stop dengue in its tracks.
Natural agent
Professor Scott O'Neill from Monash University, Melbourne, is one of the authors of the research.
"The approach is to use a naturally occurring bacterial agent - An intracellular bacteria that only grows within insects, and it's extremely common in the environment, up to 70% of insects naturally carry it."
After a series of laboratory experiments that proved the power of Wolbachia to restrict the abilities of mosquitoes to transmit dengue, the scientists then released several hundred thousand of them in Queensland in northeastern Australia.
Scott O'Neill explained that a critical aspect was getting the consent of the community to the idea of releasing even more mosquitoes into the environment.
"We spent a considerable amount of time preparing the community before we did the open field tests. A key component was an independent risk analysis undertaken by the CSIRO (Commonwealth Scientific and Industrial Research Organisation - Australia's national science agency). It indicated that over a 30 year time frame any potential for a negative risk with these experiments was considered negligible," he said.
"The mosquitoes were placed in containers, we filled up a van with these containers and drove around early in the morning in the neighbourhood and simply lifted the cover off these containers and the mosquitoes would fly out."
Within months, a wave of infection by the bacterium had spread to almost all the wild mosquitoes rendering them incapable of passing on dengue.
The scientists are uncertain as to why Wolbachia blocks the ability to transmit dengue, but Professor O'Neill said they have two theories: "The first relates to the immune system. The data suggests that the presence of Wolbachia boosts the immune system and helps the mosquito fight off the effects of dengue.
"Other evidence suggests that Wolbachia is competing for key sub-cellular molecules that the virus needs to replicate such as fatty acids - the jury is still out, it might be a combination of both."
The researchers say that further field tests are needed in countries like Thailand, Vietnam, Brazil and Indonesia where the disease is endemic.

Thursday 25 August 2011

Designer vagina

Designer vagina NHS operations unwarranted

Women seek labial reduction surgery for cosmetic reasons

Published on 24/08/11

Women with normal sized labia minora still seek labial reduction surgery for cosmetic reasons finds new research published today in BJOG: An International Journal of Obstetrics and Gynaecology.

Women with normal sized labia minora still seek labial reduction surgery for cosmetic reasons finds new research published today (24 August) in BJOG: An International Journal of Obstetrics and Gynaecology.

Female cosmetic genital surgery is increasingly popular and the number of labial reduction procedures in the National Health Service has increased five fold in the past 10 years.

This is the first study looking specifically at the labial dimensions of women seeking cosmetic surgery. It looked at 33 women who had requested labial reduction surgery and who had been referred by their general practitioner. The average age of the group was 23.

All of the women were examined by a gynaecologist and the width and length of the labia minora were measured and compared with published normal values.

The study found that all women seeking surgery had normal sized labia minora, with an average width of 26.9 mm (right), and 24.8 mm (left).

Three women out of the total number were offered surgery to address a significant asymmetry. Of the women who were refused surgery, 12 (40%) of the women still remained keen to pursue surgery by another route, 11 women accepted a referral for psychology and one participant was referred to mental health services.

The women were asked what they would like to achieve with surgery and 20 women (60%) wished to make the labia smaller to improve appearance. Other reasons included reducing discomfort, improving confidence and wanting to improve sexual intercourse.

The study also looked at how old the women were when they first became dissatisfied with the labia minora. Twenty-seven women (81%) were able to pinpoint this. Of these, 5 women (15%) reported this to be under the age of 10, 10(30%) between the ages of 11 and 15, 5 (15%) between 16 and 20, 4 (12%) in their twenties, and 3 (9%) in their thirties.

Reasons for this dissatisfaction included an increasing self awareness of the genital area, physical discomfort, comments from a partner and watching TV programmes on cosmetic genital surgery.

Sarah Creighton, UCL Elizabeth Garrett Anderson Institute of Women’s Health and lead author said:

“It is surprising that all of the study participants had normal sized labia minora and despite this nearly half were still keen to pursue surgery as an option.

“A particular concern is the age of some of the referred patients, one as young as 11 years old. Development of the external genitalia continues throughout adolescence and in particular the labia minora may develop asymmetrically initially and become more symmetrical in time.”

BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added:

“Many women who are worried may have normal sized labia minora. Clear guidance is needed for clinicians on how best to care for women seeking surgery.”

About 2,000 genital cosmetic operations are paid for by the NHS each year

GPs should not refer women who are well but worried for female genital cosmetic surgery on the NHS, say experts.

Specialists at a Central London teaching hospital say they received 30 such referrals, mainly from family doctors, over the past three years.

This included eight schoolgirls - one as young as 11 - the British Journal of Obstetrics and Gynaecology reports.

Experts say doctors need clear guidance on how best to care for women who mistakenly believe they need surgery.

The British Association of Aesthetic Plastic Surgeons says medics need to determine whether a problem exists or whether an alternative solution may be preferable, but offers no advice on how to judge the problem, say the researchers from University College London's Women's Health Institute.

“Start Quote

It's shocking, particularly because we are seeing girls who are really young”

End Quote Lead investigator Dr Sarah Creighton

They say it may be simpler to ban the procedure in the NHS altogether, leaving it to private practices. Some Primary Care Trusts do this.

And private provider Bupa says the procedure is purely cosmetic and does not offer financial cover for the procedure.

The NHS has no such restriction.

The experts who carried out the latest work said: "A private medical insurance company seems to be able to come to a conclusion when professional bodies are reluctant to act.

"National care standards are urgently needed."

Boom industry

Dr Sarah Creighton and colleagues believe the future demand for so-called "designer vagina" operations or labial reductions is potentially infinite and is driven by society's wider and growing desire for cosmetic surgery in general and changing expectations about what is a desirable appearance for women.

"It's shocking, particularly because we are seeing girls who are really young. They are asking for surgery that is irreversible and we do not know what the long-term risks of the procedure might be."

She said latest figures for England show about 2,000 of the procedures are paid for by the NHS each year.

"That's probably just the tip of the iceberg. It's a massive boom industry in the private sector."

For the study, they reviewed all 33 women referred to their clinic between 2007 and 2010 with requests for a labial reduction.

Most of the women were seeking help because they were concerned about appearance. Only a fifth wanted the surgery to reduce discomfort. One woman said she felt compelled to have the surgery after seeing a television programme on cosmetic genital surgery.

“Start Quote

If the concerns are aesthetic, that should probably be seen in the private sector”

End Quote Paul Banwell British Association of Aesthetic Plastic Surgeons

A third of the women said they had looked at advertisements about the surgery before seeing a doctor.

Upon examination, all of the women were deemed to have "normal" genitalia by the doctors. But three were offered surgery to address "a significant asymmetry". The remaining 30 were refused any procedure.

All of the women were offered the options of sessions with a clinical psychologist to explore issues leading to their request for surgery.

Twelve of the women said they would be seeking a second opinion and would consider going private to get the surgery if they still could not get it on the NHS.

Paul Banwell, of the British Association of Aesthetic Plastic Surgeons, said the operation was merited for some women, particularly those with functional concerns like discomfort.

"But if the concerns are aesthetic, that should probably be seen in the private sector."

He said he often dissuades patients from having the surgery and explains to them that there is a spectrum of 'normal' when it comes to female anatomy.

"We welcome the opportunity to be involved in suggesting guidelines and help for healthcare professionals seeing patients who are interested in labiaplasty."

Monday 22 August 2011

PFI projects 'poor value for money',

say MPs

PFI projects will generate an estimated £2.8bn in capital spending this year

The Private Finance Initiative (PFI) used by successive governments to pay for new schools and hospitals is poor value for money, MPs have said.

The Treasury select committee said PFI was no more efficient than other forms of borrowing and it was "illusory" that it shielded the taxpayer from risk.
Government had become "addicted" to PFI, the committee's Tory chair said.
A government source said it had already acted to make PFI more transparent and rigorous and cut the cost of projects.
Following criticism that the true costs of PFI were being hidden "off balance sheet" and excluded from government debt calculations, the coalition published details of total PFI liabilities for the first time last year alongside the national accounts.
PFI was introduced by John Major's Conservative government in 1992 as a way of bringing in private funding to pay for major public infrastructure projects.
'Addicted'
It was widely used by Labour between 1997 and 2010 but faced growing criticism for the costs involved and the ultimate liabilities for the taxpayer in the event of projects going wrong - such as the collapse of London Underground maintenance firm Metronet in 2008.
In a critical report, the cross-party Treasury select committee said the long-term expense of PFI deals - where the private sector shoulders the upfront cost and is typically repaid by the taxpayer over a 30-year period - were now much higher than more conventional forms of borrowing.
Due to the financing costs involved, it said paying off a £1bn debt incurred through PFI cost the taxpayer equivalent to a direct government debt of £1.7bn.
PFI had become the default option for many public bodies as initial procurement costs were comparatively low, the MPs said, but too often the size of the financial commitments undertaken and their impact on future budgets was not taken into account at the time.
"We believe that a financial model that routinely finds in favour of the PFI route, after the significant increases in finance costs in the wake of the financial crisis is unlikely to be fundamentally sound," the report concluded.
"We do not believe that PFI can be relied upon to provide good value for money without substantial reform."

“Start Quote

PFI means getting something now and paying later”

End Quote Andrew Tyrie Treasury committee chairman

The report found little evidence that PFI-funded buildings were of higher quality or more innovative in their design than those procured by other means or that contractors were incentivised to maintain finished buildings to a higher standard.

"PFI means getting something now and paying later," Andrew Tyrie, the Tory MP who chairs the committee, said.
"Any Whitehall department could be excused for becoming addicted to that. We cannot carry on as were are, expecting the next generation of taxpayers to pick up the tab. PFI should only be used where we can show clear benefits for the taxpayer."
''Much-needed'
An aide to the chancellor said the government had already taken action to ensure a "level playing field" between PFI and other public procurement methods and to address some of the "perverse incentives" surrounding PFI identified by the committee.
"We have been saying for a long time that the PFI system we inherited was completely discredited," he said. "That's why we are reforming it so it is genuinely transparent and only used when it provides value for money for the taxpayer.
"So far we have announced plans to save £1.5bn off existing projects, abolished PFI credits so PFI doesn't have an advantage over other forms of public procurement and strengthened the approval process for approving projects."
Labour defended its use of the PFI system when it was in government, saying it had been used to deliver hundreds of new public facilities and the biggest ever hospital building programme.
Kerry McCarthy, Labour's shadow treasury minister, said clear guidelines were in place to ensure it was only used if it was deemed value for money compared with public sector routes.
"The Tory-led government has continued to use the PFI scheme, the Treasury has reportedly signed off on more than 60 projects so far totalling close to £7bn," she said.
"This suggests that they believe it can be a value for money means of generating investment in our public services."
The CBI said the government needed to decide how PFI would develop in the future as investors needed certainty and the economy badly needed private investment.
"With the state of the public finances, it is absolutely essential we attract the billions of pounds of private finance needed to upgrade our national infrastructure and boost jobs and growth," said its deputy director general Neil Bentley.
"It is worth remembering that without PFI we would not have seen hundreds of much-needed hospitals, schools and homes delivered on time and within budget."

how the body stops C. diff from being toxic

Gut's hospital bug defence found

Researchers show how the body stops C. diff from being toxic

The way cells in the gut fight off toxins produced by a hospital bug has been discovered by US researchers.

Writing in Nature Medicine, they showed how a chemical - GSNO - deactivated a toxin from Clostridium difficile which causes inflammation and diarrhoea.

They hope to use their findings to develop a treatment for C. difficile.

A specialist in the bacterium said the discovery was "exciting", but any treatment was still a long way off.

C. difficile is one of many bacteria which can live in the human gut without causing health problems.

No competition

“Start Quote

Understanding how this mechanism deactivates toxins provides a basis for developing new therapies that can target toxins directly”

End Quote Dr Jonathan Stamler Case Western Reserve University

A course of antibiotics, which wipes out other bacteria in the gut, can allow C. difficile to multiply and run rampant in the bowels.

They produce large numbers of toxins which enter the cells lining the bowel. This damages the cells resulting in inflammation, cramps, fever, diarrhoea and blood-stained stools.

It is particularly a problem in hospitals as the bacteria can spread, and many patients could be taking antibiotics or have a weakened immune system.

In hospitals in England there were 10,414 C. difficile infections during the financial year 2010-11, down from 33,442 in 2007-08.

Access denied

The whole toxin is unable to penetrate cells so it needs to cleave off a smaller chunk.

Scientists have identified the chemical GSNO - S-nitrosoglutathione - which is produced by the bowels in response to inflammation. It can bind to the toxin, preventing cleavage, so the toxin cannot enter cells.

One of the researchers Dr Jonathan Stamler, from the Case Western Reserve University, said: "Understanding how this mechanism deactivates toxins provides a basis for developing new therapies that can target toxins directly and thereby keep bacterial infections, like C. diff, from spreading."

In experiments on mice, the study showed giving the chemical orally increased survival. Researchers now want to begin clinical trials.

The report's lead author Prof Tor Savidge, from the University of Texas, believes the technique could be used on other infections.

"Along with its potential to provide a much-needed new approach to treating Clostridium difficile infection, the discovery could be applied to developing new treatments for other forms of diarrhoea, as well as non-diarrheal diseases caused by bacteria," he said.

Prof Nigel Minton, from the Clostridia Research Group at the University of Nottingham, said: "This is an exciting discovery.

"Anything that can add to our scant arsenal of available treatments for combating this devastating disease is an important step forward.

"Having said that, one imagines that an actual therapeutic based on this discovery is some way off, either from being developed, and more importantly, from entering the clinic."

light on autism

New support for autistic people falling victim to crime

The card provides details for a personal contact police and care staff can approach

A new card will be available to people with autism to help them if they fall victim to crime or are involved in an accident.

The Autism Alert card carries contact details for a person who can help police, firefighters and medical and council staff give the best support.
The National Autistic Society (NAS) Scotland has urged teenagers and adults with autism to apply for it.
Northern Constabulary is among public bodies welcoming the card.
NAS Scotland director Dr Robert Moffat said it was vital that emergency and care services had the right information to support people with autism.
He said: "Being a victim of a crime or accident can be a stressful experience for anyone.
"But for someone with autism, it can be particularly disorientating and frightening."
Dr Moffat added: "People with autism often have difficulty understanding facial expressions, can be very literal in their understanding of questions and easily misinterpret others' intentions.
"In an environment of serious crime or medical emergency these types of misunderstandings can have serious consequences."
Highland Council, Highlands and Islands Fire and Rescue Service and NHS Highland have also offered their support to the initiative.

Saturday 20 August 2011

Single-sex wards in the NHS 'now the norm'

Eliminating mixed-sex wards has been a long-held goal

Further falls in the number of patients kept on mixed-sex wards has prompted ministers to suggest single-sex accommodation is now the norm in the NHS in England.

In July there were 1,126 breaches - a drop of 90% since December 2010.

More than two thirds of hospitals reported zero breaches with the north east becoming the first region to report no breaches at all.

Ministers said the NHS had done a "fantastic job".

A new system of fines was introduced in April in an attempt to eradicate what has been a long-running problem for the NHS.

Single-sex accommodation means patients share sleeping, bathroom and toilet facilities only with people of the same sex.

Hospitals have to pay £250 for each day a patient is kept in mixed-sex accommodation. Previously, the levels of fines varied considerably depending on the treatment and were inconsistently levied.

'Getting to grips'

The government's drive on mixed-sex accommodation follows attempts by the previous administration to tackle the issue.

Health Secretary Andrew Lansley said: "The NHS has done a fantastic job getting to grips with this. Single-sex accommodation is what people can now expect."

He added as part of the push all hospital refurbishments and new builds should look to ensure half of their beds are in single en-suite rooms.

The rules do allow wards to be segregated into distinct bays as long as they have separate facilities.

They apply to all trusts from acute hospitals to mental health units. Only intensive care and A&E are excused.

Friday 19 August 2011

(H1N1) virus

Putative amino acid determinants of the emergence of the 2009 influenza A (H1N1) virus in the human population

+ Author Affiliations

^aDepartment of Biochemistry and Molecular Biology, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel-Aviv, Israel 69978;
^bDepartment of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN 38105; and
^cVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109

Edited by Barry Honig, Columbia University Howard Hughes Medical Institute, New York, NY, and approved July 8, 2011 (received for review October 6, 2010)

Abstract

The emergence of the unique H1N1 influenza A virus in 2009 resulted in a pandemic that has spread to over 200 countries. The constellation of molecular factors leading to the emergence of this strain is still unclear. Using a computational approach, we identified molecular determinants that may discriminate the hemagglutinin protein of the 2009 human pandemic H1N1 (pH1N1) strain from that of other H1N1 strains. As expected, positions discriminating the pH1N1 from seasonal human strains were located in or near known H1N1 antigenic sites, thus camouflaging the pH1N1 strain from immune recognition. For example, the alteration S145K (an antigenic position) was found as a characteristic of the pH1N1 strain. We also detected positions in the hemagglutinin protein differentiating classical swine viruses from pH1N1. These positions were mostly located in and around the receptor-binding pocket, possibly influencing binding affinity to the human cell. Such alterations may be liable in part for the virus’s efficient infection and adaptation to humans. For instance, 133_A and 149 were identified as discriminative positions. Significantly, we showed that the substitutions R133_AK and R149K, predicted to be pH1N1 characteristics, each altered virus binding to erythrocytes and conferred virulence to A/swine/NC/18161/02 in mice, reinforcing the computational findings. Our findings provide a structural explanation for the deficient immunity of humans to the pH1N1 strain. Moreover, our analysis points to unique molecular factors that may have facilitated the emergence of this swine variant in humans, in contrast to other swine variants that failed.

Vitamin D mum test 'could protect babies from rickets'

By Adam Brimelow Health Correspondent, BBC News

The weakened bones and bowed legs of a child with rickets

The NHS should consider checking pregnant women's vitamin D levels to protect babies from the "Victorian" bone disease rickets, an expert says.

A Journal of Medical Screening article suggests rickets was returning, with many women not getting enough vitamin D, which comes mainly from sunlight.

People with dark skin, and women who cover up for cultural or religious reasons, are at particular risk.

The Department of Health is reviewing the evidence on vitamin D screening.

The editorial was by Dr James Haddow, a US expert in pre-natal screening.

Breastfeeding mothers

His article described cases of seizures, heart failure and rickets in children whose mothers were vitamin D deficient.

Dr Haddow said it was time to look at screening pregnant women with a blood test, focusing initially on those most at risk.

"Any strategy aimed at avoiding symptomatic vitamin D deficiency in offspring would logically include assuring adequacy of maternal vitamin D during pregnancy.

"Attending to this aspect of maternal and child health has added significance for mothers who breastfeed."

A recent study in inner-city Birmingham found that almost one in two Asian women were vitamin D deficient.

“Start Quote

Screening in selected populations is currently the way forward”

End Quote Dr Jonathan Berg City Hospital, Birmingham

The level was one in three in the wider Asian community, one in four in the black population and one in eight among Caucasians.

One of the authors, Dr Jonathan Berg, director of pathology at City Hospital, Birmingham, says some local GPs are already screening pregnant women from the Asian community, although there is no formal protocol.

The trust also offers a vitamin D blood-test for those who are not in at-risk groups, for £20. Dr Berg says a lot of people were having the check.

"Screening in selected populations is currently the way forward, but clearly it is very difficult for the NHS to test everyone. We are seeing a big increase in demand from the 'worried well'."

Free supplements

A consultant paediatrician at Ealing's hospital, Dr Colin Michie, says the increased use of high-factor sun-cream means a lot of women who are not in at-risk groups are also vitamin D deficient.

He says the idea of screening is interesting, but he argues that providing free vitamin D supplements for all pregnant women would be cheaper and easier.

He believes this would lead to healthier babies and would save the NHS money.

A spokesman for the Department of Health in England said: "All pregnant women are advised to take vitamin D supplements.

"Our priority is to ensure health professionals provide consistent advice and implement the current recommendations."

The department has asked the scientific advisory committee to review the evidence on vitamin D requirements for different population groups.

Thursday 18 August 2011

Trainee doctor changeover 'impacts on patient safety'

The survey looked at the month when trainee doctors take up their posts

The vast majority of doctors believe patient safety is compromised by the August intake of medical trainees, a survey has suggested.

The latest intake of medical trainee doctors start their training posts in the NHS at the beginning of the month.

The figures come in a study from the Society of Acute Medicine and the Royal College of Physicians of Edinburgh.

It found that 90% of doctors who responded said the changeover had a negative impact on patient safety.

The report authors called for an urgent reform to the system to be examined by the UK and Scottish governments.

On the same day trainees start doctors already in training rotate into other positions.

An estimated 50,000 doctors in the UK change over on the first Wednesday in August.

“Start Quote

August is always a nightmare”

End Quote Survey respondent

The RCPE said evidence in recent years had also suggested that there may be a higher early death rate for patients admitted at this time than at other times.

The survey of just under 750 doctors throughout the UK, published in the journal Clinical Medicine, found:

93% believed the August changeover had a negative impact on patient care

90% believed the changeover had a negative impact on patient safety

58% believed the changeover had a negative impact on doctors' training

The effects of the changeover on care and training were perceived to last for up to one month.

“Start Quote

Consideration must be given to making the changeover in training safer”

End Quote Dr Neil Dewhurst RCPE

Most doctors believed a staggered transition by grade, over a period of over a month, could mitigate the impact. One respondent reported: "August is always a nightmare."

Dr Louella Vaughan, honorary consultant physician in acute medicine, and lead author of the study, said: "The results of this survey add to the emerging evidence base which indicates that the current August changeover system increases a number of risks for patients, including an increased early death rate for patients admitted to hospital at this time."

She called for "urgent reform" to the current system.

Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, added: "Formal evidence in support of our concerns has, however, been limited, but is now increasing and has reached the level where it should not be ignored.

"Other changes to established systems within healthcare have been shown to deliver real improvements for patients and similar consideration must be given to making the changeover in training safer.

"We would urge the Scottish and UK governments to review this matter as a matter of urgency."

Monday 15 August 2011

theories over methane puzzle

Fertilisers enhance the ability of some bacteria to consume methane

Scientists say that there has been a mysterious decline in the growth of methane in the atmosphere in the last decades of the 20th Century.

Researchers writing in the journal Nature have come up with two widely differing theories as to the cause.
One suggests the decline was caused by greater commercial use of natural gas, the other that increased use in Asia of artificial fertiliser was responsible.
Both studies agree that human activities are the key element.
And there are suggestions that methane levels are now on the rise again.
Methane is regarded as one of the most potent greenhouse gases, trapping over 20 times more atmospheric heat than carbon dioxide.
Since the start of the industrial revolution, levels of methane in the atmosphere have more than doubled from a wide variety of sources, including energy production, the burning of forests, and increased numbers of cattle and sheep.
But between 1980 and the turn of the millennium, the growth rate reduced substantially, leaving scientists puzzled as to the cause.
Now, two teams of researchers have arrived at two very different conclusions for the decline. The first study was led by Dr Murat Aydin from the University of California, Irvine.
"We went after ethane - it's another hydrocarbon similar to methane, it has common sources, but is easier to trace. We determined what ethane did during the second half of the 20th century using ancient air that we collected at polar ice sheets.
"We think the trend we see in methane is best explained by dramatic changes in emissions linked to fossil fuel production and use which seem to have declined in the 1980s and 1990s.
Efficiency drive
Dr Murat is at pains to emphasise that economic efficiency played a critical part.
"Methane became economically valuable only during the second half of the 20th Century. We think this had a role in it. We're not suggesting we used less fossil fuel, but because we were more careful about capturing the natural gas and using it as an energy resource, emissions of these gases into the atmosphere declined at the end of the 20th Century."
However another team of researchers from the same department in the same university came to different conclusions using a different method of measuring methane.
The second team looked at different chemical signals of methane from both fossil fuels and from microbes active in wetlands and rice paddies.
Traditionally rice farmers have used organic manure which contains high levels of methane. By using artificial fertilisers, the farmers have considerably reduced this amount.
"Approximately half of the decrease in methane can be explained by reduced emissions from rice agriculture in Asia associated with increases in fertiliser application and reductions in water use," says the lead author Dr Fuu Ming Kai.
Fertilisers are believed to enhance the ability of some bacteria to consume methane that originates in the soils.
One or the other?
However, the second team found no evidence that the decline was caused by more efficient use of fossil fuels.
This has puzzled Dr Paul Fraser, an expert in methane emissions with the Centre for Australian Weather and Climate Research. He says both papers are plausible. But he is concerned that the second team may have been too quick to dismiss the idea that increased use of natural gas may have played a part.
"The authors may be correct but from the data shown it is not unequivocal that there could not also be a fossil methane contribution to the declining methane sources," he said.
However he says he would not be surprised if in the long term both explanations are significant in explaining the decline.
Climate sceptics who think that natural factors and not human activities play a more important role in temperature rise might take comfort from the lack of certainty in these papers - but according to Dr Murat Aydin this would be a mistake.
"I think both studies are actually suggesting that human activities are playing a very important role in determining the methane levels in the atmosphere," he explained.
As we use more and more fossil fuels, you can be sure it will start creeping up again slowly, I think it demonstrates pretty clearly that human activities have direct and pretty profound impacts on the levels of these gases in the atmosphere."

Fat 'disrupts sugar'

Fat 'disrupts sugar sensors causing type 2 diabetes'

US researchers say they have identified how a high-fat diet can trigger type 2 diabetes, in experiments on mice and human tissue.

Writing in the journal Nature Medicine, they say that fat interferes with the body's sugar sensors.

The authors argue that a deeper understanding of the processes involved could help them develop a cure.

Diabetes UK said the study was interesting and a "theory worth investigating further".

One of the main risk factors for type 2 diabetes is being overweight - rising obesity levels have contributed to a doubling of diabetes cases in the last 30 years.

Fat and sugar

Sugar in the blood is monitored by pancreatic beta cells. If sugar levels are too high then the cells release the hormone insulin, which tells the body to bring the levels back down.

Key to this is the enzyme GnT-4a. It allows the cells to absorb glucose and therefore know how much is in the blood.

“Start Quote

The identification of the molecular players in this pathway to diabetes suggests new therapeutic targets and approaches towards developing an effective preventative or perhaps curative treatment”

End Quote Dr Jamey Marth Lead researcher

Researchers at the University of California and the Sanford-Burnham Medical Research Institute say they have shown how fat disrupts the enzyme's production.

Experiments on mice showed that those on a high-fat diet had elevated levels of free fatty acids in the blood.

These fatty acids interfered with two proteins - FOXA2 and HNF1A - involved in the production of GnT-4a.

The result: fat effectively blinded cells to sugar levels in the blood and the mice showed several symptoms of type 2 diabetes.

The same process also took place in samples of human pancreatic cells.

Lead researcher Dr Jamey Marth said: "The observation that beta cell malfunction significantly contributes to multiple disease signs, including insulin resistance, was unexpected."

He suggested that boosting GnT-4a levels could prevent the onset of type 2 diabetes: "The identification of the molecular players in this pathway to diabetes suggests new therapeutic targets and approaches towards developing an effective preventative or perhaps curative treatment.

"This may be accomplished by beta cell gene therapy or by drugs that interfere with this pathway in order to maintain normal beta cell function."

Dr Iain Frame, Director of Research at Diabetes UK, said: "This is a well-executed study into possible factors responsible for the events that lead to type 2 diabetes.

"The researchers have linked their results in mice to the same pathways in humans and although they did not show they could prevent or cure type 2 diabetes they have shown it is a theory worth investigating further.

"We will watch this with great interest and hope this early work will eventually lead to some benefit to people with type 2 diabetes."

Wednesday 10 August 2011

Elderly care bill

Elderly care bill 'should be capped at £35,000'

Click to play

An official inquiry will recommend that the bill elderly people in England have to pay for care should be capped at £35,000, the BBC understands.

The proposal could stop thousands of people having to sell their house or lose all their savings, says the BBC's political editor Nick Robinson.

The details will come in the report of the Commission on Funding of Care and Support in England on Monday.

Commission chairman Andrew Dilnot said a cap "would take away the fear".

He told the BBC: "If a cap were put in place we could take away the fear that people would lose everything that they had built up and in particular people seem reasonably anxious that they might lose all the value of their house.

"They still have to pay something but much less than if they end up with high care needs as it is at the moment."

Lord Sutherland, who chaired a Royal Commission into long-term care for the elderly in the 1990s, told BBC Radio 4's Today programme a cap would provide a degree of certainty.

"People could begin to plan, and what's more you could get the insurance market involved. They weren't interested 12 years ago."

Our political editor understands Monday's report will say that the bill for caring for the elderly is soaring.

Cost of £2bn-£3bn

A quarter of people aged over 65 can expect a bill of more than £50,000. One in 10 pays more than £100,000.

The cap could cost the Treasury between £2bn and £3bn - the same as the cuts to public sector pensions.

Woman helping an elderly man to his door

Ministers are looking to revamp the social care system in England

Nick Robinson says ministers will welcome the report but question where the money would come from to fund it.

At the moment, the support provided by councils is means-tested so that anyone with assets of more than £23,250 has to pay for all the cost of their care.

It means thousands of people a year are forced to sell their homes when they go into a care home.

In 1999, Lord Sutherland's Royal Commission recommended the state should pick up all of the bill for personal care, as happens in Scotland, but the government ignored the report.

Lord Sutherland told Today the government was unlikely to follow that recommendation "in our current situation", but that Scottish governments had shown "it is expensive but it is affordable" to provide free care for the elderly.

"They have a mature understanding that this is not an add on extra, this has to do with the reality of the shape of the population for the future, whereas it is being treated in Westminster largely as an extra you might afford or not - you cannot avoid doing something," he said.

'Broken' system

Earlier Mr Dilnot said the system was "broken" after being left largely untouched for 70 years.

He said: "This is the only major risk people face where there is no sharing of risks.

“Start Quote

There is no doubt to make this system better we are going to have to pay more. It does need more resource, but at the moment the amount we spend on this is rather small”

End Quote Andrew Dilnot Commission on Funding of Care and Support

"Our health care needs, the consequences of having a car crash, the consequences of having your house burn down - all of those are covered either by the state or private sector.

"Here the state doesn't cover you and the private sector won't cover you so people are exposed to a very large risk with nothing they can do about it."

"There is no doubt to make this system better we are going to have to pay more. It does need more resource, but at the moment the amount we spend on this is rather small," added Mr Dilnot.

Earlier this week care services minister Paul Burstow suggested the reaction to the recommendations could be "lukewarm" - the Treasury is thought to have some misgivings about more funding.

A spokeswoman for the Treasury said no decisions had been taken.

She added: "Once we have received the report, we will consider its findings and welcome continued constructive engagement from all stakeholders."

Over 2,000 care homes in England have no registered manager

8 August 2011 Last updated at 17:13TakatsukiBBC Radio 4 You and Yours

Fewer inspections have taken place this year

Over 2,000 care homes in England have no registered manager, according to figures from the regulator.

The Care Quality Commission data showed 2,200 of the 24,000 homes in England had no-one named as being in charge.

Homes should have registered managers who are legally responsible and accountable for the running the home.

The charity Action on Elder Abuse, which last month found 3,000 homes without managers, said the situation was "appalling".

Administration problems

It had obtained data under the Freedom of Information Act.

Gary Fitzgerald, chief executive of Action on Elder Abuse, told BBC Radio 4's You and Yours the numbers of homes without a manager demonstrated a "frightening picture of the state of residential care in England".

He added: "The registered manager holds a crucial role in establishing and maintaining standards of quality and to have so many homes with requirements of this type is appalling".

And he said he had never before heard such concern from care home providers about the CQC's speed in registering managers.

“Start Quote

"It is the provider's responsibility to have a registered manager”

Amanda SherlockCare Quality Commission

"I'm hearing too many care providers now questioning whether the CQC is fit for purpose.

"There is no doubt that there is a percentage of cases where home managers aren't being registered because of the slow process within the CQC."

Indeed, care providers claim the high number of unregistered managers is down to slow administration on the part of the CQC, after it implemented a new registration process last October.

Oliver Thomas, director of Bupa Care Homes UK, which has around 265 care homes in England said: "The CQC system can be slow to register managers who have been in post for a while.

"I am still seeing registrations being returned to me from October last year."

Care home provider Barchester told You and Yours that in some instances it had taken the CQC more than five months to register a manager. It currently has 29 posts awaiting registration.

All the care providers contacted were keen to stress that there were managers in place, even if they were not registered.

Inspections

Sarah Ramamurthy from Four Seasons Health Care said: "Not having a manager registered with CQC certainly does not mean the home is - or was ever - without a suitably qualified and experienced manager in place.

"It merely means the documentation had not been completed and processed at that time."

But the CQC's Director of Operations Amanda Sherlock told You and Yours she did not accept delays on their part were the reason for so many unregistered managers.

"It is the provider's responsibility to have a registered manager. It is the CQC's responsibility to make sure registration is timely and robust.

"Last October, at the point of transition into the new process, there were some backlogs. We have worked very hard to clear them and are now processing the vast majority of applications within eight weeks."

"Our performance in terms of registration is as strong as any predecessor registration authority."

However, she admitted there were still 2,200 homes today without a registered manager.

And it appears the new registration process has had other unintended consequences.

The research by Action on Elder Abuse also revealed that the number of inspections of care homes by the Care Quality Commission has fallen significantly.

The CQC confirmed there were 10,856 inspections of care homes in England between the 1st April 2009 and 31st March 2010. In the same period the following year there were just 3,806 inspections - a fall of 65%.

Gary FitzGerald, of Action on Elder Abuse, said the CQC had been warned that reducing the number of inspections would put residents at risk.

"Their inspectors told them the process was placing people at risk; we told them, and care providers told them."

"They continued along this process and what worries me is they didn't tell the public they were doing that and they gave the impression all was OK with inspections."

Amanda Sherlock said it had been left with no other choice but to divert resources into what she described as the "very challenging" re-registration process.

But she said face to face inspections of care homes are now increasing.

"We're now seeing our inspection numbers go up month on month by a third and I'm absolutely committed to achieving a figure of a 1,000 a month by the end of this financial year."

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