standards in the NHS

The new framework will eventually cover most NHS work A consultation has begun on how standards in the NHS in England should be measured.

The government says it wants to move from national targets to a "set of national outcome goals".

So far it has taken a cautious response to dismantling the targets put in place by Labour.

Experts say gains made in cutting waiting times should not be lost in any changes.

In future, it has proposed the health service should be judged by measures which include how well it prevents people dying prematurely, how they recover and patients' experience of care.

Related stories
Commons clash over NHS shake-up
The first set of new standards is to be developed by April 2011. Under the planned shake up of the health service the new NHS commissioning board would use them to hold GP groups to account. Family doctors are due to take over NHS budgets for their local community by 2013.

The Health Secretary Andrew Lansley said: "I want to free doctors and nurses to focus on what really matters - better results for their patients - instead of them being stifled by top down targets."

So far the only target introduced by Labour to be removed outright is the obligation for GPs to offer an appointment within 48 hours to all patients.

Continue reading the main story
“
Start Quote
Much of what is proposed is already part of the performance management system for the NHS ”
End Quote
Kings Fund

Catherine Foot
Accident and Emergency departments have had the target to see patients within four hours relaxed slightly, but not removed. The promise of hospital treatment within 18 weeks of referral from a family doctor is no longer being monitored nationally but the health service has been told that long waits are not acceptable.

After angry exchanges in the Commons last week the government confirmed it would also be keeping the maximum two week wait for an appointment with a cancer specialist for urgent suspected cases.

The new outcome measures will include, wherever possible, information that can be compared internationally with standards in other major economies. This may help more accurate comparisons to be made. Andrew Lansley has said he wants to close the gap in cancer survival between the UK and other European countries.

Death rates from diseases which are treatable are one way of giving a rough idea of how well health systems are looking after their patients. Survival rates might also be important, as they take account of the number of patients suffering from any particular condition.

Performance management

The clinical watchdog for England, the National Institute for Health and Clinical Excellence (NICE), is being asked to develop 150 new outline standards for different areas of healthcare to support the new framework.

They are expected to be similar to the work it has already done in setting out what constitutes best care for groups of patients such as those suffering strokes, or dementia.

One common criticism of the targets developed by Labour was that they often had unintended consequences. Managers would focus all their efforts on improving areas where there were targets, sometimes at the cost of paying less attention to types of care which had few or no targets.

The Department of Health says the new outcomes framework should eventually cover most of the work of the health service.

Catherine Foot, senior policy fellow at the Kings Fund, said the ambition to develop such a comprehensive set of standards was welcome. But she added

"Much of what is proposed is already part of the performance management system for the NHS and it is positive to see this document building on what has been established before rather than reinventing things."

The independent health think tank says in order for the new outcomes to make a difference the NHS at a local level will probably still need to measure staffing levels and waiting times.

The beautifully-preserved remains

Cave yields marsupial fossil haul
Nimbadon may have travelled in herds, say the scientists
Fossil hunters in Australia have discovered a cave filled with the 15-million-year-old remains of prehistoric marsupials.

The rare haul of fossils includes 26 skulls from an extinct, sheep-sized marsupial with giant claws.

The finds come from the Riversleigh World Heritage fossil field in north-west Queensland.

Continue reading the main story
“
Start Quote
To find a complete specimen like that and so many from an age range is quite unique”
End Quote
Liz Reed

Flinders University
The beautifully-preserved remains have been described in the Journal of Vertebrate Paleontology.

"It's extraordinarily exciting for us," said University of New South Wales palaeontologist Mike Archer, co-author of the research.

"It's given us a window into the past of Australia that we simply didn't even have a pigeonhole into before.

"It's an extra insight into some of the strangest animals you could possibly imagine."

The giant-clawed, wombat-sized marsupial is named Nimbadon lavarackorum; researchers discovered the first of the Nimbadon skulls in 1993.

The palaeontologists have been stunned at how well preserved the fossils were - and by how many were found.

Discovering such a large assemblage suggests the animals may have travelled in herds - like modern-day kangaroos, said palaeontologist Karen Black, who led the research team.


The specimens offer an extra insight into the life of an extinct creature But how the animals all ended up in the cave remains a mystery. One theory is that they accidentally plunged into it through an opening obscured by vegetation and either died from the fall, or became trapped and later perished.

The Nimbadon skulls include those of babies still in their mothers' pouches, allowing the researchers to study how the animals developed.

The skulls reveal that bones at the front of the face developed quite quickly, which would have allowed the baby to suckle from its mother at an extremely young age.

Those findings suggest that Nimbadon newborns developed very similarly to modern kangaroos - likely being born after a month's gestation and crawling into their mother's pouch for the rest of their development, Black said.

Nimbadon also may have something in common with another marsupial. The fossils revealed the creatures had large claws, which may have been used to climb trees - as koalas do, Dr Black explained.

"To find a complete specimen like that and so many from an age range is quite unique," said Dr Liz Reed of Flinders University in South Australia, who was not affiliated with the study.

"It allows us to say something about behaviour and growth and a whole bunch of things that we wouldn't normally be able to do."

diagnosis of autism is based on a range of behavioural features, not just language development.

mengele-westof
Voice technology 'could help detect autism'

Children with autism have a very different vocal development pattern Young children with autism can be identified by listening to the noises they make, say US scientists.


Research suggests the babbling of infants with autism differs from that of children without it. The differences were spotted with 86% accuracy using automated vocal analysis technology.


Vocal characteristics are not currently used for diagnosing autism, even though the link has been suggested before.


The study is in the journal Proceedings of the National Academy of Sciences.


Autism is the name given to a group, or "spectrum", of lifelong developmental conditions characterised by an inability to communicate with or relate to others, a lack of social skills, obsessional traits, and repetitive behaviour.


Related stories
Many more genes linked to autism
Autism link with migrant parents
An estimated 500,000 people in the UK are believed to be affected by autism.


'Child utterances'


The US scientists analysed nearly 1,500 day-long vocal soundtracks from battery-powered recorders attached to the clothing of 232 children aged between 10 months and 4 years.


In total more than three million individual child utterances were used in the research, the study notes.


The study focused on 12 specific sound parameters associated with vocal development.


Continue reading the main story
“
Start Quote
The diagnosis of autism is based on a range of behavioural features, not just language development. The social aspects of communication must also be considered”
End Quote
Dr Gina Gomez de la Cuesta


The National Autistic Society
The most important were those involving "syllabification" - the ability of children to produce well-formed syllables with rapid movements of the jaw and tongue.


Experts believe these sounds form the foundation of words.


In autistic children up to four years old, there was a mismatch between the expected parameter values and age.


Professor Steven Warren, an expert in autism spectrum disorders at the University of Kansas, US, who took part in the study, said: "This technology could help paediatricians screen children for ASD (autism spectrum disorder) to determine if a referral to a specialist for a full diagnosis is required and get those children into earlier and more effective treatments."


The new system, called Lena (Language Environment Analysis) could make a big difference to the screening, assessment and treatment of autism, say researchers.


Speech patterns


They point out that since the analysis is based on sound patterns rather than words, it could be used to screen speakers of any language for signs of autism.


"The physics of human speech are the same in all people as far as we know," said Prof Warren.


Dr Gina Gomez de la Cuesta, action research leader at The National Autistic Society, said: "Any tools which could help to identify speech and language difficulties at a younger age have the potential to help families, when used with professional guidance.


"However, they are no substitute for proper assessment by experienced and well-trained professionals."


Dr de la Cuesta added: "The diagnosis of autism is based on a range of behavioural features, not just language development.


"The social aspects of communication must also be considered, and it should be remembered that every child is different and develops at their own pace."

malicious GP risk

Shipman's Hyde colleague warns of malicious GP risk
By Peter Marshall



Shipman killed at least 215 patients, an inquiry found A doctor who worked alongside serial killer Harold Shipman has told the BBC there is still scope for wrongdoing within the medical profession.

Dr Raj Patel, who still works in Hyde, believes that a malicious doctor could still exploit weaknesses in GP systems - 10 years after Shipman was jailed.

Dame Janet Smith, who chaired the Shipman inquiry, also said more still needed to be done to protect patients.

Shipman was jailed in January 2000 for murdering 15 of his patients.

A subsequent inquiry decided he had killed at least 215 people over a period of more than 20 years, making him the UK's most prolific serial killer.

Shipman exploited weaknesses in death certification and other systems used by GPs to avoid detection.

Ten years on from his imprisonment, Shipman's Market Street surgery in the Greater Manchester town is now a thriving business. Dr Patel works over the road in the Brooke Surgery.

Continue reading the main story
“
Start Quote
I certainly note that there could be potential for some wrongdoing by a healthcare professional or even a carer”
End Quote
Dr Raj Patel

Hyde GP

Shipman 'thought he was a god'
Are patients safer after Shipman?
Shipman response 'lacks progress'
As a young GP he occasionally stood in for Shipman as a locum and counter-signed many of his cremation forms - Shipman lied on those forms to avoid alerting the authorities to his crimes.

When the Shipman Inquiry highlighted weaknesses in that system, doctors at the Brooke Surgery say they tightened procedures almost overnight.

Anyone counter-signing a form would always speak to a relative or carer of the deceased and always examine medical records.

"We decided that we did not have to wait for the authorities to write legislation," said Dr Patel.

"We determined, as a group of doctors, if we decided we would behave differently around particularly cremation then we could effect that change very quickly."

But it was not until January 2009 that the government introduced a more stringent cremation form nationally. But new tighter checks before a body is cremated do not apply to burials.


Dr Raj Patel said his colleagues did not wait for legislation changes "The fact that the body is retrievable is an important factor for the process for burial to be more simple," Dr Patel added.

"However, I certainly note that there could be potential for some wrongdoing by a healthcare professional or even a carer."

It is a fear echoed by Dame Janet Smith, the senior judge who chaired the Shipman Inquiry.

In an exclusive BBC interview, she said the inquiry, which concluded its reports in 2005, had still not achieved as much as she had hoped.

"We haven't moved at all on basic death certification. It's exactly the same. There hasn't been any further work done since I moved off it in 2003," said Dame Janet.

Wholesale reform

For more than 20 years, Shipman used the drug diamorphine to kill patients both in their homes and at his surgery. He was jailed for life in January 2000 and committed suicide in prison in 2004.

In 2003, her inquiry recommended wholesale reform of death certification to make it less dependent on the honesty of a single doctor.

A single system covering burials and cremations, recommended by the inquiry, is yet to be implemented, although cremation forms have been made more stringent.

The government has said its new Coroners' and Justice Act, which includes plans for medical examiners to scrutinise death certificates, will help prevent a repeat of Shipman's killings.


Dame Janet Smith said Shipman's weapon was his syringe
"The act cannot function until secondary legislation in the form of rules have been prepared and brought into force," said Dame Janet.

"And that hasn't happened yet. That will take another year or two at least."

The Department of Health has insisted that the majority of recommendations from the Shipman Inquiry have been implemented with the aim of improving the quality and safety of patient care.

"Reforming the process of death certification requires changes to primary and secondary legislation - this takes time." said a spokesman.

"We've already made changes to primary legislation and decisions on priorities for this area will be made in the coming weeks."

Revalidation of doctors

The Shipman Inquiry was also highly critical of the General Medical Council's (GMC) approach to managing dangerous and incompetent doctors.

Dame Janet said the GMC's initial plans for revalidation - a process of assessing and re-licensing doctors - amounted to a "rubber stamp".

However, despite her recommendation for a robust evaluation of a doctor's fitness to practice, this has still not happened.

GMC chief executive Niall Dickson admitted that convincing the profession had been a slow process.

"I certainly think some older doctors found it a threatening process," he said.

"I know there will inevitably be frustration with how slowly the system moves and I can understand that. I think people who've seen system failure leading to the loss of a relative have genuine anger at how slowly things operate.

"The only assurance I can give sitting where I am now is that our commitment to drive through a regular checking system for doctors is absolute and I will do everything I can both to see the system launched and delivered."

out-of-hours care

15 July 2010

Dr Stuart Gray, son of David: 'Not confident mistake won't happen again'
A company providing out-of-hours care in an area where a pensioner died after a painkiller overdose had "systematic" failings, the NHS regulator says.

David Gray, 70, from Manea, Cambridgeshire, was killed by Dr Daniel Ubani, a German medic working his first NHS shift for Take Care Now.

The now-defunct firm was criticised for failing to act on previous cases and warnings on standards.

The Care Quality Commission said the whole NHS should learn lessons too.

The death of Mr Gray in February 2008 after he was given 10 times the normal dose of diamorphine has focused national attention on weekend and night GP cover, which in many cases is provided by private firms.

Continue reading the main story
“
Start Quote
Take Care Now failed on many fronts. The lessons of its failure must resonate across the health service”
End Quote
Dame Jo Williams

CQC chairman
The CQC criticised Take Care Now (TCN) for failing to investigate and learn from two previous cases of diamorphine overdoses prior to Mr Gray's death.

Both were given by doctors from Germany, where the drug is not routinely used.

The firm was also warned prior to the case by one of its own doctors that it was "only a matter of time before a patient is killed".

But it did not take sufficient action, the Care Quality Commission (CQC) said.

Staffing levels were also said to be potentially unsafe.

'Stinging reminder'

The report also criticised the NHS trusts which used the firm, which is no longer in existence. As well as Cambridge, TCN had contracts in place with NHS Great Yarmouth and Waveney, NHS South West Essex, NHS Suffolk and NHS Worcestershire.

None of the trusts had robust arrangements to share information and out-of-hours care was judged to be a low priority - reflecting the national position.

Who Were Take Care Now?
Continue reading the main story The firm originated form Suffolk Doctors on Call (SDOC), a not-for-profit co-operative of GPs established in 1994
TCN was formed as the commercial wing of SDOC in 2005, following changes to out-of-hours care
The firm won contracts with five NHS trusts to provide weekend and night cover for GPs
Following the death of Mr Gray, the firm had its contract with the local NHS terminated
Its services were taken over by a larger company called Harmoni
The lack of attention from regional health authorities was also highlighted.

CQC chairman Dame Jo Williams said: "Take Care Now failed on many fronts. The lessons of its failure must resonate across the health service."

A spokeswoman for the Patients Association said the findings were a "stinging reminder".

Since the case, standards have been tightened. Guidance has been issued to local health managers stressing the importance of good monitoring and information sharing, while firms providing out-of-hours care must be registered with the CQC from 2012.

But Health Secretary Andrew Lansley said more action was needed.

He said the steps outlined in a White Paper on Monday to give GPs more responsibility for running services would lead to improvements.

"Out of hours care needs urgent reform," he said.

Meanwhile, German medical authorities have signalled an intention to bring Dr Ubani before disciplinary hearings.

He has been struck off the medical register in the UK, but is still free to work in Germany.

An inquest in February ruled Mr Gray had been unlawfully killed.
More on This Story
Related storiesVetting urged for foreign medics 28 JUNE 2010, HEALTH
GP struck off for fatal overdose 18 JUNE 2010, ENGLAND
German GP death family given £40K 24 MAY 2010, ENGLAND
Patient 'killed unlawfully' by GP 04 FEBRUARY 2010, HEALTH
GP out-of-hours variation fears 02 FEBRUARY 2010, HEALTH
Inquest hears of fatal injection 14 JANUARY 2010, HEALTH
Related Internet linksBritish Medical Association Department of Health Care Quality Commission Share this page

Exclusive I must lose my 38KKK boobs ...or I will die

By RHODRI PHILLIPS and CAROLINE GRANT

Published: 17 Jul 2010
Add a comment (50)
A MODEL with the world's biggest breasts last night told how she must have them removed - or die.
Sheyla Hershey was struck down by a potentially fatal infection during an op on her 38KKK implants.

The Brazilian beauty, 30, said: "Surgeons say there's an 80 per cent chance I can keep one, but if I lose one I don't want to keep the other.

"The chance of being able to keep both is 10 or 20 per cent."



Filmed ... Sheyla in a clinic last year
Splash
On Thursday we reported how Sheyla was undergoing corrective surgery in the US after her boobs became infected following an op in Brazil last month.




The model travelled there to have her breasts restored - her tenth op - after giving birth last year.

US doctors refused to boost the size of her breasts - as it is illegal there to place more than a GALLON of silicone in implants.


Advertisement

Yesterday Sheyla was due to meet docs again to see if there was any hope of saving them.

The bug has entered her bloodstream, leaving her struggling to breathe. She added: "I am in a lot of pain which I am trying to control with medication. The infection is like a cancer.

"The only way to get rid of it is to cut away breast tissue."

Sheyla is obsessed with plastic surgery and also had liposuction and a nose job. Her boobs were hailed as the world's largest by a Brazilian book of records.



Read more: http://www.thesun.co.uk/sol/homepage/news/3058163/I-must-lose-my-38KKK-record-boobs-or-die.html#ixzz0u0vTZ3pX

Low vitamin D levels 'linked to Parkinson's disease'

Low vitamin D levels 'linked to Parkinson's disease'
Sunlight on the skin helps generate vitamin D Having low vitamin D levels may increase a person's risk of developing Parkinson's disease later in life, say Finnish researchers.

Their study of 3,000 people, published in Archives of Neurology, found people with the lowest levels of the sunshine vitamin had a three-fold higher risk.

Vitamin D could be helping to protect the nerve cells gradually lost by people with the disease, experts say.

The charity Parkinson's UK said further research was required.

Parkinson's disease affects several parts of the brain, leading to symptoms like tremor and slow movements.

30-year study

The researchers from Finland's National Institute for Health and Welfare measured vitamin D levels from the study group between 1978 and 1980, using blood samples.

They then followed these people over 30 years to see whether they developed Parkinson's disease.

They found that people with the lowest levels of vitamin D were three times more likely to develop Parkinson's, compared with the group with the highest levels of vitamin D.

Most vitamin D is made by the body when the skin is exposed to sunlight, although some comes from foods like oily fish, milk or cereals.

As people age, however, their skin becomes less able to produce vitamin D.

Doctors have known for many years that vitamin D helps calcium uptake and bone formation.

But research is now showing that it also plays a role in regulating the immune system, as well as in the development of the nervous system.

Vitamin target

Writing in an editorial in the US journal Archives of Neurology, Marian Evatt, assistant professor of neurology at Emory University School of Medicine, says that health authorities should consider raising the target vitamin D level.

"At this point, 30 nanograms per millilitre of blood or more appears optimal for bone health in humans.

"However, researchers don't yet know what level is optimal for brain health or at what point vitamin D becomes toxic for humans, and this is a topic that deserves close examination."

Dr Kieran Breen, director of research at Parkinson's UK, said: "The study provides further clues about the potential environmental factors that may influence or protect against the progression of Parkinson's.

"A balanced healthy diet should provide the recommended levels of vitamin D.

"Further research is required to find out whether taking a dietary supplement, or increased exposure to sunlight, may have an effect on Parkinson's, and at what stage these would be most beneficial."Vitamin D
From Wikipedia, the free encyclopedia
Jump to: navigation, search
For other uses, see Vitamin D (disambiguation).

Cholecalciferol (D3)
Calcium regulation in the human body.[1] The role of vitamin D is shown in orange.Vitamin D is a group of fat-soluble secosteroids, the two major physiologically relevant forms of which are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D without a subscript refers to either D2 or D3 or both. Vitamin D3 is produced in the skin of vertebrates after exposure to ultraviolet B light from the sun or artificial sources, and occurs naturally in a small range of foods. In some countries staples such as milk, flour and margarine are artificially fortified with vitamin D, and it is also available as a supplement in pill form.[2]

Vitamin D is carried in the bloodstream to the liver, where it is converted into the prohormone calcidiol. Circulating calcidiol may then be converted into calcitriol, the biologically active form of vitamin D, either in the kidneys or by monocyte-macrophages in the immune system. When synthesized by monocyte-macrophages, calcitriol acts locally as a cytokine, defending the body against microbial invaders.[3]

When synthesized in the kidneys, calcitriol circulates as a hormone, regulating, among other things, the concentration of calcium and phosphate in the bloodstream, promoting the healthy mineralization, growth and remodeling of bone, and the prevention of hypocalcemic tetany. Vitamin D insufficiency can result in thin, brittle, or misshapen bones, while sufficiency prevents rickets in children and osteomalacia in adults, and, together with calcium, helps to protect older adults from osteoporosis. Vitamin D also modulates neuromuscular function, reduces inflammation, and influences the action of many genes that regulate the proliferation, differentiation and apoptosis of cells.[4]

Link between inactivity and obesity queried

Link between inactivity and obesity queried

Child obesity levels have been rising for decades Researchers have challenged the assumption that a lack of exercise causes children to put on weight.

An 11-year study of more than 200 children in Plymouth suggests the effect is the other way around - that getting fatter makes them inactive.

The paper, published in the Archives of Disease in Childhood, concludes that programmes to tackle obesity may need to focus more on food than exercise.

However, some other experts have questioned the findings.

The paper says there is no disputing the association between physical activity and body fat. And there is no suggestion that exercise is not good for children. But it does question its value as a way of tackling obesity.

Continue reading the main story What we shouldn't do is take the paper at face value and allow lean children to be as lazy as they please
Dr David Haslam
National Obesity Forum
The researchers at the EarlyBird Diabetes Study, based at the Peninsula Medical School in Plymouth, has been following a group of more than 200 city school children for the past 11 years.

As part of the long-term study, they monitored body fat and exercise at regular intervals over three years.

They found no indication that doing more physical activity had any effect on weight, but they did find that children who put on weight did relatively less exercise.

The findings indicate that 10% more body fat in a seven-year-old leads to four minutes less moderate or vigorous exercise each day. The lead author, Professor Terry Wilkin, says this may not sound a lot, but it adds up over time.

"Moderate and physical activity only occupies in boys a little less than an hour a day and in girls about 45 minutes.

"So it's a not insubstantial amount of activity that is gained by having the lower body mass.

"And that of course is energy expenditure day in day out, week in week out, month in month out so the balance is changed substantially."

The paper suggests that overweight children may perceive their body image negatively, and as a result choose not to join in sports and exercise. It also argues that children who put on too much weight may suffer discomfort and pain during exercise more quickly.

Professor Wilkin says the policy implications are far-reaching, indicating that nutrition, rather than ever-increasing doses of physical activity, is the key to tackling childhood obesity.

However many experts believe that exercise does have a role to play in helping children to lose weight. Professor Andy Ness from Bristol University, who has also examined activity and obesity in children, says the EarlyBird findings are "partly right".

Academic debate

"In our study we can see evidence that physical activity is predictive of a change in fatness," he said. "But that doesn't mean there's not something going on the other way. We think it's a combination."

Dr David Haslam from the National Obesity Forum says the wider health benefits of exercise for children must not be overlooked.

"The EarlyBird team really force us to question our comfortable assumptions regarding childhood obesity.

"What we, as clinicians must do, is nod reverently at their work, learn lessons from it, and re-appraise our own practices accordingly.

"What we shouldn't do is take the paper at face value and allow lean children to be as lazy as they please, as that would be a catastrophic mistake!"

In a statement the Department of Health in England said the EarlyBird study provided some "useful messages".

A spokesperson said: "We will consider this evidence alongside other research which has different findings on the link between physical activity and weight when we are developing our policy to produce better public health outcomes."

westof: Brain clue may explain autism 'hug avoidance'

westof: Brain clue may explain autism 'hug avoidance'

'Cookie-shaped' fossils point to multicellular life Page last updated at 10:07 GMT, Thursday, 1 July 2010 11:07 UK E-mail this to a friend Printable v

'Cookie-shaped' fossils point to multicellular life
Page last updated at 10:07 GMT, Thursday, 1 July 2010 11:07 UK
E-mail this to a friend Printable version A virtual reconstruction of the inner and outer form of one of the fossils Relics of some of the first stirrings of modern life may have been uncovered.

Scientists report in the journal Nature the discovery of centimetre-sized fossils they suggest are the earliest known examples of multicellular life.

The specimens, from Gabon, are 2.1 billion years old - 200 million years older than for any previous claim.

Abderrazak El Albani and colleagues describe the fossils' distinctive appearance as resembling irregularly shaped "wrinkly cookies".

The step from single-celled to multicellular organisation was a key step in the evolution of life on Earth and set the scene for the eventual emergence of all complex organisms, including animals and plants.

The big question is whether the new West African specimens truly represent large organisms growing in a co-ordinated manner, or are merely a record of the remains of aggregations of unicellular bacteria.

The team tells Nature that its analysis of the fossils' three-dimensional structure using X-ray microtomography leans it towards the former explanation.

The fossils would have existed during a period in Earth history that came shortly after the so-called Great Oxidation Event, when free oxygen concentrations in the atmosphere rose rapidly.

Another oxygen surge that occurred about half a billion years ago co-incided with the Cambrian Explosion - the huge spurt in evolution that established all the major animal groupings.

"The evolution of the Gabon macrofossils, representing an early step toward large-sized multicellularity, may have become possible by the first boost in oxygen," Dr El Albani and colleagues said in a statement, "whereas the Cambrian Explosion could have been fuelled by the second.

"Why it took 1.5 billion years for the multicellular organisms to take over is currently one of the great unsolved mysteries in the history of the biosphere."

The Gabonese fossils were laid down in shales

Hay fever season is well under way

Why do adults suddenly develop hay fever?



WHO, WHAT, WHY?
The Magazine answers...


Hay fever season is well under way, meaning misery for millions of people across Britain. But why are some people suddenly struck by the condition after years of experiencing no symptoms?

With pollen counts soaring, hay fever sufferers are in the midst of their annual bout of summer misery.

But although the condition is generally assumed to begin in childhood, some adults will be getting a nasty shock as they experience unpleasant symptoms such as sneezing and itching for the first time.

THE ANSWER
Despite plenty of research, no-one really knows
It could be that something in the environment of those with a genetic predisposition to allergies that sets it off
Alternatively, sufferers possibly experience very mild symptoms that they do not notice as children


Can you make your garden hay fever-proof?
Unfortunately, there is no way to predict when people who are atopic - that is, genetically predisposed towards allergies - begin to show signs that they are sufferers, says Beverly Adams Groom, chief palynologist at the National Pollen and Aerobiology Unit at the University of Worcester.

But broader theories about whether pollution or, conversely, a more sanitised environment could be causing a rise in hay fever symptoms could offer a clue.

"Lots of people assume that everyone with hay fever develops it in childhood, but we've had people coming to us in their 70s who've just been diagnosed," says Ms Adams Groom.

"People who have a genetic disposition are going to develop it, but as to what triggers it we don't know."


The bee may love pollen... but hay fever sufferers certainly don't
Hay fever is an allergy to pollens - the male reproductive parts of plants - from grasses and trees.

When these come into contact with the tissue inside the nose, they trigger an immune reaction that can cause congestion, sneezing, itching, and a runny nose.

Between 15 and 20% of people in the UK are thought to be affected, with the numbers being even higher among teenagers and symptoms typically peaking in people's 20s.

However, not all follow this pattern, and Ms Adams Groom suggests this could be linked with whatever is driving the general rise in hay fever cases.

Allergy specialist Prof Stephen Durham has calculated that the number of sufferers has doubled over a 20-year period.

"There's some evidence that pollution exacerbates it," he says. "And you've also got the hygiene hypothesis - that our bodies aren't as strong because we aren't exposed to infections when we are small children that our systems rebel against."

Oddly, researchers in Austria have also found that young children in regular contact with farm animals are less likely to develop allergies later in life.

WHO, WHAT, WHY?

A regular part of the BBC News Magazine, Who, What, Why? aims to answer some of the questions behind the headlines
Children living on farms were found to be three times less sensitive to hay fever and nearly four times less likely to suffer from asthma than those living in a non-rural environment.

This all may suggest that something about modern lifestyles may be responsible.

But, as Brian Lipworth, professor of allergy and respiratory medicine at the University of Dundee says, not enough work has been done to be sure either way.

However, he suggests that it could just be that many supposed adult-onset cases were in fact sufferers all along - just that their symptoms started off as too minor to notice.

"The data sets just aren't there to establish anything," he says.

"I'm suspecting that teenagers may not report symptoms because they are so mild, and it's not until they get to a certain level that they are any the wiser - but we just don't know."

It will, of course, be of little comfort to those currently plagued by itchy eyeballs and streaming noses. But the subject is surely a doctoral thesis waiting to happen

Swine flu vaccine

Swine flu vaccine contracts "lacked get out clauses"
Page last updated at 10:26 GMT, Thursday, 1 July 2010 11:26 UK

The government sent leaflets about swine flu to every UK household The contracts negotiated by the UK government for a swine flu vaccine should have had get-out clauses to protect taxpayers' money, experts say.

An independent review, led by Dame Deirdre Hine, a former chief medical officer for Wales, said that was just one of the lessons that should be learned.

Some of the communications about the pandemic were confusing, it added.

But the review praised the overall approach taken.

The review said the four devolved administrations worked well together.

And it said the spending - more than £1.2 billion in total on preparing and responding - was justified.

The review said without such a thorough approach the consequences could have been disastrous if the pandemic had proven to be more severe.

But the review team acknowledged the UK government should have cut a deal over vaccines.

'Threat remains'

More than 30m doses are thought to be left over after one of the manufacturers, GlaxoSmithKline (GSK) refused requests for the contract to be torn up.

Dame Hine: 'the only predicable thing is its unpredictability.'
The other manufacturer, Baxter, agreed to a "break clause" allowing the government to cancel its order.

The review makes 28 recommendations aimed at ensuring a better response to any future pandemic.

Dame Deirdre said: "It is important that the experience of 2009 does not lead to complacency.

"The threat of a flu pandemic remains and the next one could be very serious."

Hundreds of thousands of people were infected with the virus, although most only had relatively mild symptoms.

However, more than 400 people still died in the UK.

Pregnant women and young children tended to be the worst affected.

The UK had been planning for a pandemic for years.

Originally it was thought it would be caused by bird flu, which would probably have meant a much more severe pandemic.

Containment

When swine flu emerged in April last year the government already had stockpiles of anti-flu drugs to lessen the symptoms and pre-contract agreements in place for vaccines.

This level of planning was praised by the review.

When infections started occurring in the UK, the authorities initiated a containment approach. This involved giving anti-flu drugs to anyone who had come into contact with an infected person.

The review said there was no definitive proof this had worked in slowing the spread.

The use of the phrase containment was also criticised along with others for confusing the public. It said there was a perception the approach was designed to stop the pandemic spreading completely instead of just disrupting it.

There was also criticism of the projections given for deaths.

In England, officials released the worst-case scenario figures which at one point were saying there could be more than 60,000 deaths.

This caused confusion, the report says, as some interpreted it as a straight prediction.

westof: 'junk food'

westof: 'junk food'

westof: bubonic plague

westof: bubonic plague

Fin to limb evolution clue found

Fin to limb evolution clue found
Page last updated at 01:58 GMT, Thursday, 24 June 2010 02:58 UK
E-mail this to a friend Printable version By Victoria Gill

Science reporter, BBC News

The researchers discovered genes involved in fin but not limb development A study has shed light on a key genetic step in the evolution of animals' limbs from the fins of fish, scientists say.

A team of researchers identified two new genes that are important in fin development.

They report in the journal Nature that the loss of these genes could have been an "important step" in the evolutionary transformation of fins into limbs.

Marie-Andree Akimenko, from the University of Ottawa in Canada, led the research.

She and her colleagues began their study by looking at the development of zebrafish embryos. They discovered two genes that coded for proteins that were important in the structure of fins.

These proteins were components of the thread-like fibres known as "actinotrichia". These are found in fish larvae and they eventually develop into the bony fin rays of mature fish.

"We found there were no [equivalent genes] in limbs, so this suggested these may have been lost in evolution," explained Dr Akimenko.

To confirm this, they looked for - and found - the same family of genes in the genomes of elephant sharks, which are a very basal (or ancient) fish species.

This suggested that the "ancient family of genes persisted in [bony fish] and was lost when they evolved" into four-footed animals, Dr Akimenko said.

Recreating evolution

Embryo development can provide important genetic and molecular clues about evolution; many early developmental changes are believed to mirror evolutionary changes.

The embryonic fin (right) has ray-forming fibres, which are absent in the embryonic mouse limb The scientists were able to manipulate zebrafish development, to study these changes in more detail. They inactivated the newly discovered genes in a developing zebrafish embryo. When they did this, they found that it developed shorter "truncated" fins with no bony rays.

The loss of these fin rays, the scientists say, was a key step in fin-to-limb evolution.

The team then compared the development of normal zebrafish embryos with that of mouse embryos.

"When we compared fin development and limb development, the early steps are very similar," Dr Akimenko said.

"But at one point there is a divergence, and that correlates with the beginning of the expression of these genes."

Professor Jonathan Bard, a retired developmental biologist now working with the department of physiology, anatomy and genetics at Oxford University, said the findings were only a very small part of the evolutionary story.

He said that this still did not tell us about digit formation - "how the broad, multi-ray fins of fishes became transformed into the eight digits of the hand or foot plate of the first tetrapods".

"More generally," he said, "hundreds of millions of years of separate evolution divide [bony fish] and mice."

He added: "It is an interesting paper... and it will be be interesting to see what the [researchers] do next."

Study examines scientists' 'climate credibility'

Study examines scientists' 'climate credibility'
Page last updated at 08:47 GMT, Tuesday, 22 June 2010 09:47 UK

Most experts agreed human activity was affecting the climate system Some 98% of climate scientists that publish research on the subject support the view that human activities are warming the planet, a study suggests.

It added there was little disagreement among the most experienced scientists.

But climate sceptics questioned the findings, saying that publication in scientific journals was not a fair test of expertise.

The findings have been published in the journal Proceedings of the National Academy of Sciences.

The study's authors said they found "immense" differences in both the expertise and scientific prominence of those who supported the "primary tenets" of latest assessments made by the Intergovernmental Panel on Climate Change (IPCC) and those who were sceptical of the IPCC's findings.

In general, they added, the researchers who were convinced of the human impact on climate change had published twice as many papers as their sceptical counterparts, and were cited in other people's research two to three times more often.

Continue reading the main story It's typical of this broad-brush study to make such wide ranging claims similar to the infamous 'the debate is over'
Professor Hans von Storch

University of Hamburg
Lead author William Anderegg, from Stanford University in California, US, said the findings suggested that not all experts were equal in what they claimed.

"The researchers who are convinced (by the IPCC's assessment reports) have a lot more experience in climate research and have published a lot more papers in the scientific literature and are generally well respected in their field," he said.

"And it also demonstrates the converse that those who are sceptical of the IPCC's claims, in general, know a lot less about the climate system."

Mr Anderegg and his colleagues drew from a list of 908 researchers who had contributed to research used by the IPCC and have signed statements broadly in support of the UN body's assessments.

On the sceptical side, they chose 475 scientists from a list of 11 major sceptical declarations and open letters.

The researchers said they felt the need to carry out the survey because of the growing public perception that scientific opinion was divided on the issue following recent scandals, such as "climategate" at the UK's University of East Anglia and the use of non-peer reviewed literature in the IPCC findings.

"We really felt that the state of the scientific debate was so far removed from the state of the public discourse and we felt that a good quantitative, rigorous comparison of this would put to rest the notion that the scientists 'disagree' about global warming," Mr Anderegg told BBC News.

'Broad-brush study'

Sceptical groups, however, argued that publication in scientific journals was not a fair test of expertise.

They said that those who choose which papers to publish favoured research that supported the IPCC's view, and suggested that the new study was tautologous.

Professor Hans von Storch, from the Meteorological Institute of the University of Hamburg, said: "You have to ask yourself - which are the the tenets of (the human induced climate change) outlined by the IPCC the '"convinced" groups of scientists agree with.

"There is a core of assertions, dealing with the effect of greenhouse gases on temperature and sea level, which enjoy general agreement," Professor von Storch told BBC News.

"While others, for instance, related to the Himalaya glaciers, the changing tropical storms and their damages or the fate of Greenland, are heavy contested.

"It's typical of this broad-brush study to make such wide ranging claims similar to the infamous 'the debate is over'."

Dr Sonja Boehmer-Christiansen, from the University of Hull, UK, added: "Who judges expertise and prominence? It looks to me that the authors belong to an IPCC supporting group that must count as believers and belong to the beneficiaries of the man-made warming scare."

annual summer solstice.

Solstice sunrise at Stonehenge


STONEHENGE: The sun rises behind the Stonehenge monument in England, during the summer solstice shortly after 4.52am.
STONEHENGE: Revellers attend the annual summer solstice.
LONGEST DAY: Sun rises over the ancient stones at Stonehenge in Wiltshire.
SUMMER SOLSTICE: A Druid walks past the ancient standing stones at Stonehenge.

STONEHENGE: People raise their hands meditating during the summer solstice shortly after 4.52am at the Stonehenge monument in England.
SUMMER SOLSTICE: The sun rises over the ancient stones of Stonehenge.
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EuropePostcard arrives after 95 years EU to import solar power from Sahara Princess weds gym instructor Britain readies for austere budget Komorowski leads Polish election UK doctor admits he helped patients die Northern Irish police uncover large bomb in van Laura Dekker's solo sail delayed by court ruling Is BP headed for a cash crunch? French floods death toll hits 25 Thousands of New Agers and neo-pagans danced and whooped in delight as the sun rose above the ancient stone circle of Stonehenge, marking the summer solstice.


About 20,000 people crowded the prehistoric site on Salisbury Plain, Wiltshire, southern England, to see the sunrise at 4.52am following an annual all-night party.

The annual pilgrimage marks the northern hemisphere's longest day of the year.


The Heel Stone, just outside the main circle, aligns with the rising sun.


Police described the event as one of the safest in years, although 34 people were arrested for minor drug offences.


Peter Carson from English Heritage told the BBC said: "It has been quieter this year but it's been a great solstice.


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staff escape NHS hygiene rule

Muslim staff escape NHS hygiene rule
Muslim doctors and nurses are to be allowed to opt out of strict hygiene rules introduced by the NHS to restrict the spread of hospital superbugs.

Published: 12:30AM BST 11 Apr 2010

Muslim doctors and nurses are to be allowed to opt out of strict hygiene rules introduced by the NHS to restrict teh spread of hospital superbugs. Photo: MARTIN POPE
Female staff who follow the Islamic faith will be allowed to cover their arms to preserve their modesty despite earlier guidance that all staff should be "bare below the elbow".

The Department of Health has also relaxed rules prohibiting jewellery so that Sikh members of staff can wear bangles linked with their faith, providing they are pushed up the arm while the medic treats a patient.


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Fight against superbugs hampered by doctors failing to wash their handsThe Mail on Sunday reported the change had been made after female Muslims objected to being required to expose their arm below the elbow under guidance introduced by Alan Johnson when he was health secretary in 2007.

The rules were drawn up to reduce the number of patients who were falling ill, and even dying, from superbugs such as MRSA and Clostridium difficile.

Revised guidance which relaxed the requirements for some religions was published last month.

Some Muslim staff and those from other groups may be allowed to use disposable plastic over-sleeves which cover their clothes below the elbow and allow the skin to remain covered up.

Derek Butler, chairman of MRSA Action UK, said: "My worry is that allowing some medics to use disposable sleeves you compromise patient safety because unless you change the sleeves between each patient, you spread bacteria.

"Scrubbing bare arms is far more effective."

A Department of Health spokesman said: "The guidance is intended to provide direction to services in how they can balance infection control measures with cultural beliefs without compromising patient safety."

40,000 deaths a year due to junk food, says health watchdog Nice

40,000 deaths a year due to junk food, says health watchdog Nice
More than 40,000 Britons are dying unnecessarily every year because of high levels of salt and fat in their diets, the Government’s public health watchdog Nice has warned.

By Rebecca Smith, Medical Editor

Foods high in salt and fat are behind 40,000 unnecessary deaths in Britain every year, says the health watchdog Nice. Photo: JONATHAN LODGE
The National Institute for Health and Clinical Excellence (Nice) says that unhealthy foods have wreaked a “terrible toll of ill health” on the nation and placed a “substantial” strain on the economy.

For the first time, the organisation publishes landmark guidance on how to prevent the “huge number of unnecessary deaths” from conditions such as heart disease that are linked to the consumption of ready meals and processed food.


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Salt levels must be cut further 'to reduce premature deaths', says FSA
Sandwiches with salt content 'equivalent to nine bags of crisps'It calls for sweeping changes to food production and government policy to encourage lifestyle changes, and to reduce significantly the amount of salt and saturated fat the nation consumes.

It says “toxic” artificial fats known as trans fats, which have no nutritional value and are linked to heart disease, should be banned. The organisation says that ministers should consider introducing legislation if food manufacturers failed to make their products healthier.

Nice says it has brought together all the available evidence to illustrate the link between unhealthy food and public health, partly in response to increasing concern about obesity in Britain, particularly among children.

It says there are about five million people in the country suffering the effects of cardiovascular disease — a “largely avoidable” condition that includes heart attacks, heart disease and stroke — and that it causes 150,000 deaths annually. Nice says 40,000 of these deaths could be prevented, and hundreds of millions of pounds saved, if its measures were introduced.

The guidance, which was commissioned by the Department of Health, also recommends that:

• Low-salt and low-fat foods should be sold more cheaply than their unhealthy counterparts, through the use of subsidies if necessary;

• Advertising of unhealthy foods should be banned until after 9pm and planning laws should be used to restrict the number of fast food outlets, especially near schools;

• The Common Agricultural Policy should focus more on public health, ensuring farmers are paid to produce healthier foods;

• Action should also be taken to introduce a “traffic light” food labelling system, even though the European Parliament recently voted against this;

• Local authorities must act to encourage walking and cycling and public sector caterers must provide healthier meals;

• All lobbying of the Government and its agencies by the food and drink industry should be fully disclosed.

Prof Klim McPherson, the Chairman of the Nice Guidance Development Group and professor of epidemiology at Oxford University, said: “Where food is concerned, we want the healthy choice to be the easy choice. Going even further, we want the healthy choice to be the less expensive, more attractive choice.

“Put simply, this guidance can help the Government and the food industry to take action to prevent huge numbers of unnecessary deaths and illnesses caused by heart disease and stroke.” The average person in Britain consumes more than eight grams of salt a day. The body only requires one gram to function. Targets are already in place to reduce salt consumption to six grams by 2015 and this should be extended to three grams by 2050, the guidance says.

Nice says children should consume considerably less salt than adults and that, because the bulk of salt in their diets comes from prepared food such as bread, cereal, soups, meat and cheese products, manufacturers have a significant role to play in reducing it.

The organisation says that most consumers did not even notice a difference in taste if salt levels were reduced by

5-10 per cent a year because their taste buds adjusted.

Prof Mike Kelly, the public health director at Nice, added: “This isn’t about telling individuals to choose salad instead of chips — it’s about making sure that the chips we all enjoy occasionally are as healthy as possible.

“That means making further reductions in the salt, trans fats and saturated fats in the food we eat every day.”

Betty McBride, the director of policy and communications at the British Heart Foundation, said: “Creating an environment that makes healthy choices easy is vital. Government, the health service, industry and individuals must all play their part. We must see industry making major efforts now to reformulate products with less saturated fat.

“Cutting our 'sat fat’ intake would have a major impact on heart disease.”

Prof Sir Ian Gilmore, president of the Royal College of Physicians, added: “The Nice guidance demonstrates conclusively why we need to change radically our approach to this vast and silent killer.

“Many of the diet-related recommendations made by Nice have the added benefit of costing the public purse little to nothing, while creating an opportunity to reduce the tens of billions of pounds of associated costs the UK loses every year to heart disease.”

While the guidance was welcomed by health experts, representatives of the food and drink industry said significant progress on salt and fat had already been taken.

The Food and Drink Federation accused Nice of being “out of touch with the reality”. Julian Hunt, its director of communications, said: “We are surprised that Nice has found the time and the money to develop guidance that seems to be out of touch with the reality of what has been happening for many years.

“The food industry is leading the world when it comes to voluntarily changing the recipes of popular food brands so that they are lower in salt, fat or sugar; introducing better-for-you choices at the same price as standard lines; and improving the quality of nutrition information available on packs.”

Ape hunters pick up new viruses

Ape hunters pick up new viruses

Chimpanzees carry viruses which can jump to humans
Two new viruses from the same family as HIV have been discovered in central Africans who hunt nonhuman primates.
Researchers say their work proves it is not unusual for potentially dangerous viruses to jump from primates to man.

They say it is important to monitor disease in bushmeat hunters closely, as any virus they contract from animals may spread to the community at large.

The study, led by the US Johns Hopkins University, is published in Proceedings of the National Academy of Sciences.

Far from being rare events, retroviruses are actively crossing into human populations

Dr Nathan Wolfe
The new viruses identified in the latest study come from a group known as the retroviruses, which are known to cause serious illnesses in humans.

They have been named Human T-lymphotropic Virus types 3 and 4 (HTLV-3 and HTLV-4).

Humans have previously been infected by HTLV-1 and HTLV-2. In most cases, infection does not produce symptoms, but it can trigger neurological problems, and even leukaemia.

Lead researcher Dr Nathan Wolfe said: "The emergence of HIV from primate origins has cost millions of lives.

"The discoveries of HTLV-3 and HTLV-4 show that, far from being rare events, retroviruses are actively crossing into human populations."

Blood samples

The research team collected and examined blood samples from more than 900 people living throughout Cameroon.

All the individuals studied reported some exposure to blood and body fluids of nonhuman primates, contact mostly due to hunting and butchering of bushmeat, and in some cases to keeping primates as pets.

Analysis of the blood samples showed that various simian (ape) viruses had infected the participants.

The two previously unknown viruses were found in two bushmeat hunters.

HTLV-3 is similar to a simian virus called STLV-3, and was most likely contracted through direct contact with a primate during hunting.

HTLV-4 does not have a known primate counterpart, making its origin less clear. The researchers believe it could have arisen through cross-species transmission from an animal carrying an unknown form of STLV.

The same team discovered another primate retrovirus - the simian foamy virus (SFV) - in bushmeat hunters last year.

Threat unclear

At this stage it is unclear whether either of the two newly discovered viruses or SFV are harmful to humans, or can be transferred from person to person.

However, the researchers say their work clearly shows that hunting provides the opportunity for viruses to jump the species barrier.

Dr Wolfe said: "Ongoing collaboration with hunters in central Africa gives us the potential to predict and prevent disease emergence.

"Given the incredible potential costs of a new human retrovirus spreading into the general population, the development of sentinel systems for forecasting disease emergence - such as long-term surveillance of hunters - should be seen as a human health imperative."

Dr Deenan Pillay, an expert in virology at University College London, UK, told the BBC News website that it had been thought few viruses jumped the species barrier.

"This research suggests that there seems to be far more transmission of a whole range of primate viruses into humans than was previously thought," he said.

"But that is not alarming in its own right. If the virus fails to replicate, or to be passed on to others, then it does not pose a threat.

"However, if cross-species transmission is such a frequent event, then all it takes is for one virus to really take hold in somebody, and be passed on to others for it to take off in humans."