Tuesday 25 October 2011

Zambia's growing population

Zambia's growing population

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You are going to hear a lot about population in the coming week. That's because on 31st October, the United Nations Population Fund will announce that the number of people on the planet has reached seven billion.
Of course no one knows exactly how many people there are - we may have already passed seven billion - but the UN has picked the day as the best estimate.
Catherine Phiri Catherine Phiri says she wants her children to become important people without suffering
I've been to Zambia because it has one of the world's fastest growing populations.
I have been to many maternity wards around the world but never one as busy at the United Teaching Hospital (UTH) in Lusaka.
They deliver at least 50 babies a day - sometimes 70 or more. The pressure on the maternity unit is significant according to Dr Lackson Kasonga.
"The population is expanding rapidly, especially in the capital where people are moving for jobs. The demand for maternity services is rising each year but that is not matched by the increase in space or resources."
Global fertility
Women in Zambia have, on average, six children. That number has barely shifted in recent decades. Contrast that with global fertility, which has fallen from five to two and a half children since 1950.
Catherine Phiri had just given birth to a daughter when I met her and husband Robert. They have two boys at home. A fourth child died in infancy. They live in poverty, like two-thirds of Zambia's population. The Phiris want more children and, like parents the world over, they are ambitious for their future.
Catherine Phiri told me: "I want my daughter and my sons to be important people in government so as they work they can extend help to us. We grew up suffering and I want it to be different for them."
Although basic education is free, there is often pressure to get older children to begin work so that they can help with the family finances. Robert Phiri said: "We'd like five or six children but I worry if we are going to be able to send them all to school. If we have more it might mean some going to school and some not - we will have to see what happens."
Potential burden
I visited the family home outside Lusaka. It is extremely basic. There is electricity but no running water. Mr Phiri earns below the minimum wage and the couple often don't have enough money to buy clothes.
I asked Anna Sampa from Unicef why so many poor couples in Africa choose to have large families. It's something that I have found on visits to Sierra Leone, Malawi and other developing nations.
She said: "They don't see the potential burden of having more mouths to feed. Rather they look on lots of children as a means of helping them in their old age." Aid agencies do not talk about population control - they fear it smacks of eugenics. Rather, they try to encourage family spacing and getting couples to have the number of children they can support.
At UTH I watched a demonstration on contraceptive methods given to a group of pregnant women. The majority of couples in Zambia still don't use modern methods such as condoms, the pill, implants and injections.
Myths

“Start Quote

This is a vast land, so we need more people. But it is the speed which is the cause for concern - we need to match population growth with resources.”
End Quote Dr Lackson Kasonga consultant obstetrician
Even though contraception is free, many women can't afford to travel to the health centres. There is also a good deal of ignorance about the methods available according to Ruth Bweupe, family planning officer at the Ministry of Health.
"The myth surrounding the implant is that it will go to the heart or the brain and do serious harm. The implant rods are inserted in the upper arm so they feel that it will travel around the body. For the pill they feel it will cause permanent infertility and they'll never be able to have children again."
The rising workload of UTH's maternity unit is a tangible sign of Zambia's growing population. It is 13 million now and projected to triple by 2050 according to the UN Population Division. Even its most cautious projection has the population at 100 million by 2100, with its medium (or best estimate) being 140 million.
Vast land
Does that matter? After all, Zambia is a big country, three times the size of the UK. It has fertile soil and rich mining reserves, so there is huge potential.
The economy is growing and the World Bank recently re-classified it as a "middle income" country. How this works given that two-thirds of families live in poverty is a little baffling, but it is an indicator that Zambia is improving economically.
Despite the heavy workload at the maternity unit, Dr Kasonga was upbeat about the future.
"We are happy to have more babies. This is a vast land, so we need more people. But it is the speed which is the cause for concern - we need to match population growth with resources."
Half of Zambia's population is aged 16 or under and it has a relatively smaller elderly population. Contrast that with most developed countries where the problem is that fewer and fewer people are supporting a growing cohort of elderly.
The potential problem for Zambia is that the population increase is so rapid that the government may struggle to keep pace. Those under 16 need education, healthcare and homes but they are not yet contributing to the economy. Zambia can barely feed 13 million people so how will it cope in the future?
Part of the answer will depend on how Zambia manages and encourages foreign investment - China is a huge player here. It also depends on the life chances given to the young, which starts with education.
Gender equality
 Norah Zulu Future generations hope to have smaller families. Norah Zulu says she only wants two children
Unicef supports education projects in Zambia and believes empowering women is vital if couples are to be lifted out of poverty and have the number of children they can support.
At Munali High School in Lusaka, most of the teenage girls I spoke to came from large families. But all wanted careers first and motherhood second. Their attitudes seem a world away from the older generation.
Norah Zulu, who is 16, told me things were very different from her parents' day: "They never learned about family spacing. We do. And they did not have gender equality - rights for girls and boys. I want two kids, no more."
Mercy Mushindu, who is 17 and one of eight children, said she also wants two kids "to reduce the population". Things are changing in Zambia and it will be the next generation who will have to ensure that population increase is a benefit rather than a burden

Monday 24 October 2011

Immune system defect may cause ME

Immune system defect may cause ME

Fatigued woman Chronic fatigue syndrome may be due to the immune system, researchers think.

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Researchers in Norway believe Chronic Fatigue Syndrome (CFS), also known as ME, may be caused by a wayward immune system attacking the body.

The illness, the cause of which is uncertain and has no known cure, has attracted significant controversy.

A small study, reported in PLoS One, showed a cancer drug, which inhibited the immune system, relieved symptoms in some patients.

The ME Association said the findings were "very encouraging news".

Doctors in Norway stumbled across their first clue in 2004 when treating a patient with both Hodgkin's lymphoma, a cancer of the white blood cells, and CFS.

When she received cancer treatment, her fatigue symptoms improved for five months.

'Dramatic'

The latest study, carried out at the Haukeland University Hospital in Bergen, built on the previous discovery by testing 30 patients with CFS.

Start Quote

Their life was turned completely around very dramatically”

End Quote Øystein Fluge Consultant oncologist

Half were given two doses of Rituximab, a cancer drug which eliminates a type of white blood cell, while the other half were given a fake treatment.

In those patients receiving the drug, 67% reported an improvement in a score of their fatigue levels. Just 13% showed any improvement in the sham group.

Øystein Fluge, an oncology consultant at the hospital, told the BBC: "There was a varied response: none, moderate, dramatic relief of all symptoms.

"Two had no recurrence [of their symptoms], their life was turned completely around very dramatically."

Their theory is that a type of white blood cell, B lymphocytes, are producing an antibody which attacks the body.

The drug wipes out the lymphocytes which in some cases may "reset the immune system", however, in other patients the fatigue symptoms would return when more B lymphocytes were made.

Caution

Chronic Fatigue Syndrome

  • The disease is thought to affect some 250,000 people in the UK
  • Symptoms include extreme tiredness, problems with memory and concentration, sleep disturbances and mood swings
  • There is currently no accepted cure and no universally effective treatment
  • The cause is not clear either, with many doctors thinking the term CFS/ME is being used for several different diseases.
  • Some patients have sent death threats to researchers after disagreements over a cause or cure

Mr Fluge said: "I think the fact that patients responded to treatment, improved cognitive function, fatigue and pain makes us believe we're touching one of the central mechanisms.

"But we're scratching at the surface, I would not characterise this as a major breakthrough."

The researchers are now investigating the effect of giving more doses over a longer period of time.

If their hunch is right it will throw up more questions, such as what is the immune system actually attacking and whether or not an actual test for CFS/ME be developed.

Dr Charles Shepherd, the UK ME Association's medical adviser, said: "The results of this clinical trial are very encouraging news for people with ME.

"Firstly, they help to confirm that there is a significant abnormality in immune system function in this disease.

"Secondly, they indicate that altering the immune system response in ME could be an effective form of treatment for at least a subset of patients.

"We now need further clinical trials of such anti-cancer agents to see if other research groups can replicate these findings."

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can industrialised farming make Africa feed the world?


British-owned Chayton Atlas manages a 25,000 acre farm in Mkushi
The vision unfolding across the Mkushi plain in Zambia is at odds with the doleful imagery of modern Africa to which we have become accustomed.
Three hours from the capital Lusaka the wheat crop glows under the tropical sun. A combine harvester moves methodically across one portion of a vast field. Nearby a giant sprinkler irrigates the soya bean crop.
One might as easily be standing on the plains of the American Mid-West or among the grain fields of the Ukraine.
These are fields of plenty, a productive Africa that challenges the narrative of conflict and hunger that so dominates our idea of the continent.
"If we just increased the yields to 80% of world averages, Africa would become a net exporter of food. We believe that Africa can feed itself and the rest of the world too," Dabney Tonelli of Chayton Atlas, the British-owned company that manages the 25,000 acre farm at Mkushi, says.

Dabney Tonelli says Africa can become a net exporter of food
Chayton acquired a 14-year lease on the land from the Zambian government with the promise of hugely increasing yields, providing jobs for locals and passing on skills to the small farmers who live on subsistence plots nearby.
After years of misrule and corruption Zambia, which recently elected a new government, is seen as a beacon of stability on the continent.
"The political environment is stable, excellent conditions for agriculture in terms of climate and the quality of soil. For the agricultural investor Zambia is where you want to be," says Ms Tonelli.
Zimbabwean expertise
White farmers who were driven off their land in Zimbabwe have been hired to run the Chayton operation, bringing with them the intensive farming skills they have honed over decades.
The farm manager at Mkushi, Stuart Kearns, became a full-time farmer as a teenager after his father was killed in the Bush War in what was then Rhodesia. Despite his experiences in Zimbabwe he is optimistic about the future of farming in Zambia:
"There is huge potential here and I think the thing with Africa is that you have to keep trying again and again. That is something you learn when you grow up here."
Chayton promises to "create jobs, introduce sustainable farming methods… provide support and training to small-scale farmers".

Zambia's vice-president Dr Guy Scott voiced concern about job losses
But there are considerable obstacles - poor infrastructure and bureaucracy stand in the way of Zambia becoming a major exporter of food to the continent. At the moment Chayton is only producing for the local market.
And in an interview with Newsnight, the country's new vice-president, Dr Guy Scott, a farmer himself, was sceptical of some of the claims made by the company:
"I am very sceptical because I've been around a lot and I know what proposals look like and what justifications look like in the investment game and I would say that 90% of what is promised turns out not to be true… not necessarily because of any venality or any deliberate fraud.
"I mean people hope for the best. They hope it is going to work. And the government hopes it is going to work. And we all get each others hopes up. And then you find 'oh dear we didn't actually succeed in having the social impact or economic impact we'd hoped for'."
Displacement fears
Dr Scott worries about the social impact of job losses due to more intensive farming where machines take the place of people:

Local small-scale farmers complain about problems securing capital
"I think the main problem is that the population for Zambia is that the population is about four times too big for the economy. And I think that is the danger with large scale intensive farming; it tends to be capital intensive, it tends not to create jobs and at the same time tends to displace people who are unemployed from their fallback position which is to be subsistence farmers."
Chayton acknowledge that their modernised farming methods have already led to job losses, but insist that as the business grows it will create employment in spin-off businesses:
"Yes, over time some of the less skilled work goes as a result of mechanisation, but we are building a large scale business so over time we are creating other jobs," Ms Tonelli says.
"What we are able to do is train people to do highly skilled jobs which they can continue to use in a career in agriculture of transfer to other sectors as well."
Local feeling
The local subsistence farmers I meet say they welcome the principle of commercial farming, but have yet to see it bring any benefit to them.
Chayton has only been operating in the area for a year but Brighton Marcokatebe, a farmer in the nearby village of Asa, says other commercial farmers have failed to help their smaller neighbours.

Most of Zambia's farmers are small-scale subsistence farmers
"If they come with help then I will accept it, but so far they don't help," he says.
The villagers also complain that they cannot access capital. Most land in Zambia is owned by the state and administered by village chiefs. Without any legal title to the land small farmers cannot get bank loans to buy machinery and expand their production.
But according to Dr Guy Scott, Zambia's small farmers can look forward to a better deal:
"We're elected by Zambians and their interests have to come first. If their interests can be made to coincide with those of the international markets or whatever then great, but at the end of the day we are responsible for their protection, their social protection."
Matching that commitment with the agreements already made with foreign investors will require considerable political skill.

Sunday 23 October 2011

Henry David Thoreau



"Christianity, on the other hand, is humane, practical, and, in a large sense, radical. So many years and ages of the gods those Eastern sages sat contemplating Brahm, uttering in silence the mystic "Om," being absorbed into the essence of the Supreme Being, never going out of themselves, but subsiding farther and deeper within; so infinitely wise, yet infinitely stagnant; until, at last, in that same Asia, but in the western part of it, appeared a youth, wholly unforetold by them,—not being absorbed into Brahm, but bringing Brahm down to earth and to mankind; in whom Brahm had awakened from his long sleep, and exerted himself, and the day began,—a new avatar. The Brahman had never thought to be a brother of mankind as well as a child of God."

Dutch court convicts five for Tamil Tiger fundraising

Dutch court convicts five for Tamil Tiger fundraising

Tamil Tiger flag Tamil Tiger rebels fought for a separate homeland in Sri Lanka for decades
A Dutch court has convicted five Dutch ethnic Tamil men for raising funds for the banned Tamil Tiger rebels.
The men got sentences of up to six years for their activities on behalf of rebels who fought for an independent homeland for Tamils in Sri Lanka.
Prosecutors said the men extorted millions of euros from the Tamil diaspora through blackmail and threats.
But the defence counsel for the five men argued that they were freedom fighters.
In a complex ruling, the judge said the men were not convicted of supporting terror but that he found them guilty of involvement in a criminal organisation.
The Liberation Tigers of Tamil Eelam [LTTE] was outlawed by the European Union in 2006.
They fought a decades-long and bloody war against Sri Lankan authorities for a separate Tamil homeland in the north and east of the country, but were defeated by the Sri Lankan army in 2009.
Prosecutors also accused the men of "brainwashing" children by teaching them to make pictures of bombs and grenades.
This case is one of a number of prosecutions concerning both sides of the Sri Lankan conflict that are currently being considered in foreign courts.

UN finds polio among Madagascar's children

UN finds polio among Madagascar's children

Archive photo of a child receiving an oral polio vaccine in Ivory Coast Vaccination programmes have to reach 80-90% of the population to be effective

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An outbreak of polio in three children from the south of Madagascar has raised concerns over a possible resurgence of this crippling disease.

The UN children's fund (Unicef) has called for urgent action to prevent its spread.

Unicef spokesman Daniel Timme says three cases of polio without symptoms have been identified.

The disease was discovered during Unicef's Mother and Child Health week following tests and urine samples.

Mr Timme said that the symptoms could emerge in these children at any time.

Polio vaccination programmes must reach at least 80 to 90% of the population of the region to be effective.

Otherwise there is a risk that non-vaccinated children could produce a mutation of the polio disease.

Vaccination campaigns disrupted

Unicef experts believe this may be the case in Madagascar, as has been seen elsewhere in Africa, including Nigeria.

The political crisis in Madagascar since 2009 has interrupted vaccination programmes across the country.

Shortages of fuel for refrigerators to store the vaccines, and the closure of 250 clinics, have reduced vaccination rates to less than 40% in the south.

Two further vaccination campaigns are now required to ensure 90% of the 700,000 children are vaccinated to curb a potential epidemic.

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NHS reforms: Audit areas to be extended

NHS reforms: Audit areas to be extended, Lansley says

Andrew Lansley Andrew Lansley said offering patients more choice did not amount to privatisation

Monitoring of NHS healthcare is to be extended to 11 extra areas of medicine, the health secretary has announced.

Andrew Lansley told GPs in Liverpool that auditing would be extended to areas including HIV and breast cancer.

He said publishing better data would allow patients to make more informed choices and specialists to "compare themselves with the best".

Mr Lansley also defended plans to give GPs more commissioning responsibility under the government's NHS reforms.

In his speech to the Royal College of GPs' conference, Mr Lansley said the government's Health and Social Care Bill would encourage competition and that GPs wanted more say in the running of the service.

"For years, GPs have been telling me, 'if only they would listen to us, we could do it so much better'," he said.

"Well as I say, I am now 'they'. I am listening to you. And I do want you to do it better.

"At the heart, then and now, of doing it better for patients is for clinicians to be at the heart of commissioning."

Speaking to BBC News before Saturday's conference, Mr Lansley said that offering more choice for patients did not mean privatisation.

"We're not looking to turn the NHS into some kind of private industry, far from it.

"It's a public service and it has to be integrated around the needs of patients.

"But there is a role, a big role, for patients in being able to exercise choice and therefore by extension where patients exercise choice, you have to have a choice amongst providers."

Mr Lansley told the conference outcomes for patients in areas of medicine including breast cancer, prostate cancer and chronic obstructive pulmonary disease would be "audited, monitored and regularly published in the future".

"From December we will pilot the publication of clinical audit data to detail the performance of clinical teams. This will then be rolled out across England from April next year," he said.

"Better data means better quality in the NHS - for patients, for their specialist clinicians, and crucially for you - both as their GPs and as the future commissioners of those services," he said.

Controversy over policy

The NHS reforms in the Health and Social Care Bill would increase competition and put GP-led groups in control of buying care in their areas.

Ministers say the changes are vital to help the NHS cope with the demands of an ageing population, the costs of new drugs and treatments and the impact of lifestyle factors, such as obesity.

The reforms have been one of the most controversial areas of government policy over the past year and had to be put on hold in the spring amid mounting criticisms from the medical profession, academics and MPs.

It led to ministers making a number of concessions, including giving health professionals other than GPs more power over how NHS funds are spent as well as watering down the role of competition.

Earlier this month, the House of Lords rejected a proposed amendment that would have referred parts of the bill to a special select committee.

It will now proceed to a normal committee stage in the Lords.

However, Labour's shadow health secretary Andy Burnham has said his party will continue to fight for "substantial and drastic changes" to the bill.

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When did potatoes become unpopular?


Saturday, 22 October 2011


When did potatoes become

When did potatoes become unpopular?

Hands holding some potatoes US senators easily approved a measure to forbid restrictions on potatoes served at school
Potatoes have gone from nation-building superfoods to national pariahs. Why?
This week, the US Congress foiled plans to limit the amount of potatoes served in school lunches. Rules proposed by the United States Department of Agriculture (USDA) stated that potatoes, along with other starchy vegetables like corn, peas, and lima beans, could be served in school cafeterias only twice a week.
A Senate amendment passed on Tuesday, however, forbade the USDA from imposing such restrictions.
It was a small victory in an era when the potato is often under attack.
"Carbohydrate-rich foods in general have been vilified unfairly, and potatoes are the latest target," says dietician Elisa Zied, author of Nutrition at Your Fingertips.
In 2007, Americans ate 20% fewer potatoes than they did in 1997, according to a report from the United States Potato Board. In the UK, potato consumption decreased by 7.8% between 2005 and 2008.
It was not always this way. The potato used to be considered something of a wonder food. Grown originally in South America, its introduction to Europe literally transformed agriculture.
Fertile food
Before the introduction of the potato, those in Ireland, England and continental Europe lived mostly off grain, which grew inconsistently in regions with a wet, cold climate or rocky soil. Potatoes grew in some conditions where grain could not, and the effect on the population was overwhelming.
"In Switzerland, for instance, the potato arrived in the early 18th Century and you can see over and over again as people started growing potatoes, the population grew," says John Reader, author of The Potato: A History of the Propitious Esculent.
"Birth rates rose, infant mortality improved, women became more fecund and all of that can be absolutely attributed to the potato."
For decades, potatoes were one of the most reliable sources of energy. They grew when other grains and vegetables could not, they required little processing once grown, and they packed a healthy dose of nutrients.
"For a 5.3-ounce, medium baked potato, you're looking at over 100 calories, very little fat, and one of the richest sources of potassium of any single food in the entire food chain," says nutritionist David Grotto, author of 101 Optimal Life foods. It is also a good source of vitamin C and fibre.
Defamed by diets
Recently, potatoes have suffered from poor PR. Diets like Atkins and South Beach forbid potatoes because of their carbohydrate content. Starchy, carb-heavy food became synonymous with empty calories and low nutritional value, and the battle against potatoes became another front in America's relentless war on fat.

The amazing potato

Potatoes
  • Potatoes were the first food to be grown in space
  • There are more than 10,000 different kinds of potatoes, 5,000 of which are regularly grown and eaten
  • Potato crystals were used to develop the first colour photography
  • Biodegradable plastics can be created from potato starch
  • Like humans, potatoes are 80% water
Source: Meredith Hughes, managing director of the Potato Museum
The facts do not bear that out, says Mr Grotto. "Our potato consumption has been on a decline, and I'd love to say that our obesity rate has declined as well, but that's not the case," he says.
One of the latest trends in nutrition, the Glycemic Index, has not been kind to the potato, either.
The index measures how foods affect blood sugar (glucose) levels, and is used to help people with diabetes control their blood sugar levels. Recent diet books have also proposed the GI as a good way to prevent weight gain and monitor health.
Carbs rank high on GI, and potatoes are a main source of carbs. But fears about their effect on health and weight are unfounded, says Mr Grotto, because potatoes are not eaten in isolation.
"We don't eat carbs, we eat food," he says. "The effect of protein and fibre with potatoes, how the potatoes are cooked, whether they are served as a reheated leftover can all have an effect on the glycemic index."
Deep-fried dilemma
When it comes to its maligned reputation, a bigger problem is that the potato has started spending too much time with the wrong crowd.
"It's been demonised for its association with the deep fat fryer," says Grotto.
Not without reason. According to the Institute of Medicine (IOM) children eat less than half the vegetables they should - and of the vegetables they do eat, over 20% come in the form of potato chips, or crisps as they are known in the UK.
The regulations supported by the USDA - based of recommendations from the IOM - were in part to help promote different types of vegetables instead of the starchy standbys so often served with added fat and salt.
For Ms Zied, there needs to be a better approach. "The message to consumers should not be avoidance of foods that are naturally nutrient-rich, low in fat and relatively low in calories," she says. "The message should include finding ways to have potatoes and other healthful foods," prepared without an excess of sugar, solid fats, or calories.
But the truth of the matter is that school children love their chips. That is why Meredith Hughes, managing director of the Potato Museum, is not worried about pockets of anti-potato sentiment. "I don't agree that the potato is vilified," she says. "I think the potato is just taking off."
Ms Hughes and her family have built up the largest private collection of potato artefacts, currently located in New Mexico, but in search a permanent home. Both she and the museum are unaffiliated with the potato industry.
"The potato is an incredibly influential food," she says. "It has changed the course of history, it has influenced popular culture. It has saved people from starvation."
And at least for now, potatoes will continue to be plentiful in school lunches.

Saturday 22 October 2011

An ancient bone with a projectile point lodged within it appears to up-end - once and for all - a long-held idea of how the Americas were first popula

Old American theory is 'speared'

Bone It would have taken a lot of force to drive the point into the mastodon bone

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An ancient bone with a projectile point lodged within it appears to up-end - once and for all - a long-held idea of how the Americas were first populated.
The rib, from a tusked beast known as a mastodon, has been dated precisely to 13,800 years ago.
This places it before the so-called Clovis hunters, who many academics had argued were the North American continent's original inhabitants.
News of the dating results is reported in Science magazine.
In truth, the "Clovis first" model, which holds to the idea that America's original human population swept across a land-bridge from Siberia some 13,000 years ago, has looked untenable for some time.
A succession of archaeological finds right across the United States and northern Mexico have indicated there was human activity much earlier than this - perhaps as early as 15-16,000 years ago.
The mastodon rib, however, really leaves the once cherished model with nowhere to go.
The specimen has actually been known about for more than 30 years. It is plainly from an old male animal that had been attacked with some kind of weaponry.
It was found in the late 1970s at the Manis site near Sequim, north-west of Seattle, in Washington State.
Although scientists at the time correctly identified the specimen's antiquity, adherents to the Clovis-first model questioned the dating and interpretation of the site.
To try to settle any lingering uncertainty, Prof Michael Waters of Texas A&M University and colleagues called upon a range of up-to-date analytical tools and revisited the specimen.
These investigations included new radio carbon tests using atomic accelerators.
"The beauty of atomic accelerators is that you can date very small samples and also very chemically pure samples," Prof Waters told BBC News.
"We extracted specific amino acids from the collagen in the bone and dated those, and yielded dates 13,800 years ago, plus or minus 20 years. That's very precise." It is 800 years or so before Clovis evidence is seen in the historical record.
Computed tomography, which creates exquisite 3D X-ray images of objects, was used to study the embedded point. The visualisation reveals how the projectile end had been deliberately sharpened to give a needle-like quality. And it also enabled the scientists to estimate the projectile end's likely original size - at least 27cm long, they believe.
"The other thing that's really interesting is that as it went in, the very tip broke and rotated off to the side," said the Texas A&M researcher.
Bone The CT imagery reveals the extent of the wound and the shape of the buried point's end
"That's a very common breakage pattern when any kind of projectile hits bone. You see it even in stone projectiles that are embedded in, say, bison bones."
DNA investigation also threw up a remarkable irony - the point itself was made from mastodon bone, proving that the people who fashioned it were systematically hunting or scavenging animal bones to make their tools.
The timing of humanity's presence in North America is important because it plays into the debate over why so many great beasts from the end of the last Ice Age in that quarter of the globe went extinct.
Not just mastodons, but woolly mammoths, sabre-toothed cats, giant sloths, camels, and teratorns (predatory birds with a nearly four-metre wingspan) - all disappeared in short order a little over 12,700 years ago.
A rapidly changing climate in North America is assumed to have played a key role - as is the sophisticated stone-tool weaponry used by the Clovis hunters. But the fact that there are also humans with effective bone and antler killing technologies present in North America deeper in time suggests the hunting pressure on these animals may have been even greater than previously thought.
"Humans clearly had a role in these extinctions and by the time the Clovis technology turns up at 13,000 years ago - that's the end. They finished them off," said Prof Waters.
"You know, the Clovis-first model has been dying for some time," he finished. "But there's nothing harder to change than a paradigm, than long-standing thinking. When Clovis-First was first proposed, it was a very elegant model but it's time to move on, and most of the archaeological community is doing just that."
Mastodon Now extinct, the mastodon was a large elephant-like animal


Thursday 20 October 2011

Patients' taxis cost NHS millions

Patients' taxis cost NHS millions


Patient transport service Patient transport services are mainly run by ambulance trusts
More than £30m has been spent on taxis for NHS patients since 2008 because of a shortage of official non-emergency transport, the BBC has learned.
The figures cover the transfer of patients who are too ill to travel by themselves, such as those with broken limbs or receiving chemotherapy.
Ambulance trusts in England, Wales and Northern Ireland responded to a BBC Freedom of Information request.
Health chiefs insisted the practice was not putting patients at risk.
But they admitted they were aiming to reduce the use of taxis amid concerns that their use was not providing value for money.
The North West Ambulance Service has spent the most on taxis - £9.9m since April 2008, on more than 500,000 journeys. However, like many trusts it said it was in the process of reducing its reliance on them.
Some trusts also provided information on the most costly taxi journeys they had paid for.
These included two fares in excess of £700. One was for a 184-mile journey from Cambridgeshire to Bristol when a patient was discharged from Papworth Hospital, while the second was for a 151-mile trip from Chase Farm Hospital in north London to Shrewsbury, Shropshire.
Regular use
Patient transport services - provided free to those who are too ill or unable to travel to and from hospitals - are mainly run by ambulance trusts, although private firms are used in some places.

Costly taxi journeys

  • East of England Ambulance Trust paid £777.45 for a 184-mile journey from Cambridge to Bristol when a patient was discharged from Papworth Hospital
  • The service in London paid £747 for a 151-mile journey from London's Chase Farm Hospital in north London to Shrewsbury in Shropshire
  • £670.86 was handed over for a 290-mile journey from St Cross General Hospital in Rugby to a nursing home in Falmouth by West Midlands ambulance bosses
  • About £600 was paid for a 262-mile journey from Queen Elizabeth Hospital in Greenwich to Hartlepool by London's ambulance service
The services rely on specially adapted vehicles - normally minibuses equipped with basic medical supplies such as oxygen - staffed by trained crews to ferry patients around.
For those who do not need any medical assistance, official ambulance trust cars can be used to drive them.
But when neither of these options are available, they have to turn to private taxi companies.
Only the South East Coast Ambulance Trust has avoided paying anything out to taxis in the past three years, while London has reduced its reliance on them to under 100 journeys a year.
The figures show that all other ambulance trusts use taxis on a regular basis.
Value for money
Sara Gorton, from Unison, expressed concern about taxi use.
"There may be occasions where it is unavoidable, but while these are not patients who have dialled 999, there will be times when they will need someone with more skills and training than just how to drive.

Case study

The North West Ambulance Service is one of the largest providers of patient transport services in the NHS so in many ways it is not surprising that it spends the most on taxis.
Since April 2008 it has paid out nearly £10m on more than 500,000 journeys.
But in recent years its reliance on taxis has been falling. Latest figures show 6% of transfers were done by taxi - down from 10% in previous years.
This has been achieved through an overhaul of the way the service works.
Patient transport was given its own dedicated management structure two years ago. Before that there was a joint structure with the emergency side of the trust.
Working hours have also been altered to move the service from what was a largely 8am to 6pm operation to one more geared towards round-the-clock working.
"But our concerns about [patient transport services] go wider than use of taxis. There are big differences in the way that patient transport is provided and what standards are kept to in different areas.
"Increasingly, services are being outsourced to private firms which means that competition is based on costs, and standards are being driven down. This also means it's harder to find out what is happening."
But Delwyn Wray, the director of patient transport services at North West Ambulance Trust and vice-chairman of the National Patient Transport Service Group, said while there was concern about taxi use, it was on value-for-money grounds rather than safety.
"Anyone needing medical help in any way would not go by taxis."
But he added: "I think there will always be a need for them at times, but each service needs to look at how they are using them and whether there is a more efficient and better way of transporting patients. That is what we are gearing up to in the North West."
The Department of Health said it was up to local NHS chiefs to decide about who transported patients.
Data for how much was spent on taxis in Scotland was not available.


Wednesday 19 October 2011

babies

Monday October 17 2011


Most children with autism have a normal birthweight
“Babies born weighing less than 4lb (1.8kg) could be more prone to developing autism than children born at normal weight,” BBC News has reported.
This finding comes from a study that found about 5% of infants whose birthweight was less than 2000g (about 4lbs and 6oz) had autistic spectrum disorders (ASDs) at the age of 21. This was higher than previous estimates that suggested that 0.9% of US eight year olds of any birthweight have been diagnosed with some form of ASDs.
The main limitation to this study is that it did not include a control group of children with normal birthweight to compare against those with low birthweight. Instead, it relied on general population estimates to examine the relationship. This makes understanding the issue more complex as the children in this study were all given specific assessments for detecting ASDs that would not be routinely given to children in the general population.
This means we cannot be certain to what extent children with low birthweight truly do have higher rates of ASDs or if the methods used simply detected cases that would go undiagnosed in everyday life. This is supported by the fact that some of the cases identified had not previously been diagnosed by a doctor.
It is also worth noting that a large proportion of those eligible to participate did not complete the study and this may have influenced results. Overall, the findings of this study need to be confirmed by more robust studies with a control group of infants of normal birthweight.

Where did the story come from?

The study was carried out by researchers from the University of Pennsylvania and other research institutes in the US. It was funded by US National Institutes of Health and published in the peer reviewed medical journal Pediatrics.
BBC News generally placed the study into context well, noting that the findings need to be confirmed in other studies and including quotes such as those from Dorothy Bishop, professor of developmental neuropsychology at the University of Oxford. She is quoted as saying, 'the association looks real, but nevertheless, most low birthweight children don't have autism, and most children with autism don't have low birthweight'.

What kind of research was this?

This was a prospective longitudinal study that looked at what proportion of infants with low birthweight went on to develop autistic spectrum disorders (ASDs) in adolescence or early adulthood.
ASDs, including autism and Asperger’s syndrome, and are a group of related disorders that begin in childhood and persist into adulthood. They are diagnosed by the presence of three broad categories of symptoms:
  • difficulties with social interaction
  • impaired language development and communication skills
  • unusual patterns of thought and physical behaviour
In over 90% of cases no underlying medical condition can be found to explain the symptoms of ASD, though causes continue to be investigated.
The researchers say that low birthweight is an established risk factor for cognitive and movement problems, and some studies have suggested that low birthweight may also be a risk factor for ASDs. However, they also point out that most prospective studies examining this possible association have not made firm diagnoses of ASDs using standard diagnostic methods.
This study followed only a group of low birthweight individuals, and then made comparisons with how common autism is in the population as a whole, based on the figures reported in another study. This may give some idea of whether autism is more common in low birthweight infants but there are some limitations. For example, the children in this study were given assessments to specifically test whether they had autism, which means that more cases might be picked up than would be found than in the general population, which is not routinely screened for autism.
Ideally, the study would have included groups of babies with different birthweights all born in the same period, and followed and assessed them in the same way. This could help establish whether the results seen would be genuinely due to increased prevalence or due to increased diagnosis. It would also allow them to take into account any other differences between babies of low and normal birthweights.

What did the research involve?

The researchers enrolled 1,105 low birthweight infants who weighed less than 2000g when they were born. Babies born between October 1, 1984 and July 3, 1989, at three New Jersey hospitals were eligible. Of these infants, 862 (78% of those enrolled) were eligible for follow-up at age 16, and 623 (56%) were screened to identify those that might have ASDs. At age 21, the researchers used standard diagnostic interviews for ASDs to reassess 60% of those who screened positive for autism at age 16, and 24% of those who tested negative. This confirmed which individuals had a diagnosis of ASDs. They used the figures to estimate how common autism was in the entire group of low birthweight babies.
The infants in this study were part of the Neonatal Brain Hemorrhage Study (NBHS), which included all infants admitted to three hospitals in New Jersey, which cared for 85% of low birthweight babies born in the area. The children were assessed at ages 2, 6, 9, 16, and 21 years. At age 16, this included questionnaires that the parents completed about autism symptoms and social communication. The questionnaires asked parents if their child had ever been diagnosed with ASDs by a healthcare professional.
The ASDs the researchers tested for included autism, Asperger’s syndrome, or a pervasive developmental disorder (not otherwise specified). Those scoring over set thresholds on the questionnaires or those with a professional ASD diagnosis were considered to be ‘screen positives’, and assessed again for a ASDs diagnosis at age 21.
The researchers also tested a proportion of adolescents who had screened negative at 16 to identify whether the initial screening had missed any cases. The diagnostic interviews at age 21 were conducted with the parents and with the young adult themselves, and were performed by researchers who did not know whether the participants had screened positive or negative for ASDs at age 16.

What were the basic results?

In the first ASDs screen at age 16 years, 117 low birthweight adolescents (18.8% of those tested) screened positive for ASDs. Of these 117 adolescents, 47 (40.2%) were lost to follow-up or did not complete the ASD questionnaires at age 21. Of the 70 who were assessed at age 21 years, 11 (15.7%) were confirmed as having ASD at age 21.
In the first ASD screen at age 16 years, 506 (81.2%) low birthweight adolescents had screened negative for ASDs. Of these 506 adolescents, 119 (23.5%) were selected for assessment at age 21. Of these 119 screen negatives, three (2.5%) were found to have ASD at their later assessment.
Most of the participants identified with ASDs (9 out of 14) were reported to have relatively high levels of functioning, spoken language, and with IQs of 70 or over.
Based on these figures, and the proportion of screen positives and screen negatives at age 16, the researchers calculated that about 5% of the entire low birthweight cohort assessed at age 16 had ASD. Just over half of these young adults (8 out of 14) had not been diagnosed prior to this study.
There were some differences between the individuals who could be followed up and those who could not. For example, those who were not followed up at age 21 were more likely to have had suboptimal neurodevelopmental outcomes at age 16 (for example, cognitive or movement disabilities).

How did the researchers interpret the results?

The researchers conclude that ASDs in this group of low birthweight individuals was 5%. They say that this was higher than the prevalence of 0.9% reported by the US Centers for Disease Control and Prevention for eight year olds in the general US population (all birthweights) in 2006.

Conclusion

This study has suggested that about 5% of children of low birthweight (<2000g) in the US may go on to develop autistic spectrum disorders (ASDs). This is higher than previous estimates for the general population of children in the US (estimated at 0.9% among eight year olds). When considering these results there are both strengths, such as the prospective nature of the study, and limitations that must be taken into account:
  • The children in this study were specifically assessed to see if they had autism, which means that more cases might be picked up than would be found than in the general population, who are not all assessed for autism. Ultimately, this raises the question of whether the results reflect greater prevalence among underweight babies or greater rates of diagnosis. Ideally, the study would have included a group of babies of different birthweights all born in the same period, and followed them all up and assessed them in the same way. This would also allow them to take into account any other differences between low birthweight and normal birthweight babies that could influence rates of ASDs.
  • The general population prevalence figures were based on children aged eight, and these figures may differ from those found among adolescents and young adults such as those in this study.
  • A high proportion (40%) of those assessed at age 16 could not be assessed again at age 21, and this could have influenced the results.
  • Not all participants received all parts of the screening and diagnostic assessments.
The results of this study need to be confirmed by more robust studies with a control group of infants with normal birthweight. It is also worth bearing in mind the quote from Dorothy Bishop, professor of developmental neuropsychology at the University of Oxford, in the BBC News: 'The association looks real, but nevertheless, most low birthweight children don't have autism, and most children with autism don't have low birthweight.'

Links to the headlines

Low birthweight 'linked to autism', says US study. BBC News, October 17 2011

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