Wednesday 16 November 2011

NHS: Elderly care dossier shows 'shameful attitudes'


NHS: Elderly care dossier shows 'shameful attitudes'


By Nick TriggleHealth correspondent, BBC News
Nurse and patientAttitudes to elderly people in the NHS are shameful, says the Patients Association

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A dossier containing "shameful" stories about the care elderly patients receive in NHS hospitals in England has been published by campaigners.
The Patients Association said the 16 cases include people being denied pain relief, left to sit in their own faeces and going without food and drink.
It comes after criticism from other groups and the charity said it was highlighting the tip of the iceberg.
The government said it was determined to "root out poor performance".
A programme of unannounced inspections would continue, the Department of Health added.
Last month the Care Quality Commission attacked hospitals for what the regulator said were "alarming" levels of care.
The Health Service Ombudsman also raised concerns about the issue in February, reporting that nearly a fifth of complaints it got were related to the care of the elderly.
As well as highlighting the 16 cases, the Patients Association said the number of calls to its helpline regarding care on hospital wards had already hit 961 this year - a third more than the total made throughout the whole of 2010.

Left sitting in faeces

George Taylor was admitted to Chase Farm Hospital in London in August with a urinary tract infection and chest problem. His family said he received a shocking level of care while there.
On one day, he was told by a nurse to go to the toilet sitting in his chair because she did not have time to take him to a bathroom. He did and his family then found him sitting in his own faeces. His wife had to clean him up.
His family also said he was often not washed, and the smell became overpowering at times. He was also discharged too early and was soon admitted to another hospital, where doctors said he should not have been released at all.
Mr Taylor's daughter, Gaynor Marshall, said: "The nursing staff treated him as an object that they had to treat rather than a human being." A complaint has now been made about his care.
The Patients Association said the failings fell into four broad categories - communication, assistance going to the toilet, pain relief and nutrition.
And it called on NHS trusts to sign up to a pledge to ensure these four areas of care become top priorities.
It said responsibility for the problems lay with everyone from individual staff on the wards to senior managers on the board.
Among the cases highlighted are a patient who was left sitting in his own faeces for hours after a nurse told him he should empty his bowels in his chair because she did not have time to help him go to the toilet.
In another case, a family of a patient had to beg for pain relief for a dying woman before waiting for nearly two hours for help to arrive.
And one man had to wait for 15 minutes to have his call buzzer answered despite having to desperately struggle for breath.
It is the third time the Patients Association has published individual stories like this.
'Poor performance'
Katherine Murphy, the charity's chief executive, said: "We cannot ignore the fact that some trusts are not even paying lip service to the fundamentals of care.

Dying patient in 'terrible' pain

Sally Abbott-Sienkiewicz
Sally Abbott-Sienkiewicz was admitted to Glenfield Hospital in Leicester in November last year. She was terminally ill with cancer and had developed pneumonia. She died within two days.
But throughout her time there, her family had to battle to get her pain relief. They said she was left in terrible pain - sometimes for more than an hour - as they argued with staff to give her sedatives. The worst problems were experienced during the night.
Her daughter Samantha White said at times her pain was "horrendous and horrific", but staff were too slow to react.
Suzanne Hinchliffe, chief nurse at the trust which runs Glenfield, said: "It is clear that we completely failed Mrs Abbott-Sienkiewicz and her family, and for that we remain very sorry." She added that measures were being taken to improve practices.
"The issues we continue to highlight are human rights issues. They show a lack of compassion and care and a shameful attitude to treatment of the elderly."
Peter Carter, general secretary of the Royal College of Nursing, said the patients had been "clearly failed" in the cases highlighted.
"Each and every nurse is personally accountable for their own actions and must act promptly to raise concerns if staffing levels or other pressures get in the way of delivering good patient care."
But he also said managers must take responsibility, pointing out that job cuts were making it more difficult to provide good care.
The publication of the Patients Association report has also coincided with an announcement by the government that it is looking to improve standards for healthcare assistants, who are providing an increasing amount of care on wards.
These staff are currently unregulated, but the Department of Health is looking to introduce new rules by 2013 to ensure that they reach a minimum training levels before being allowed to work. However, indications are that this will be a voluntary requirement, which has disappointed some.
A spokesman for the Department of Health said: "The Patients Association is right to raise these examples and issues, and we will work with them and with the NHS to sort these problems out."

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Code of conduct to be drafted for care workers







    A code of conduct and minimum standards of training is to be drawn up for health care assistants and care workers who look after the elderly in England.
    Care worker with resident
    The government said the new standards are likely to focus on communication, confidentiality, nutrition and hydration amongst other things.
    The announcement follows growing concerns about the training and quality of care provided by some care workers.They are often poorly paid whilst doing a difficult and demanding job.It is cases like that of Carol-Anne Norman that have caused concern.
    She and her sister set up a camera to monitor the care their 85-year-old father was being given. He has dementia.They say the closed-circuit television pictures showed a number of care workers who didn't appear to know what they were doing.

    “Start Quote

    It was just not care and, at times, I would call it abuse”
    Carol-Anne NormanDaughter of patient
    One worker was filmed wetting his flannel and toothbrush, wiping the basin with a towel to wet it then sprinkling talcum powder on the floor.In the notes it said their father had had a full wash, but their father was nowhere in sight. That worker has been suspended.Mrs Norman was shocked.She said: "It was just not care and, at times, I would call it abuse and they've done it because my father can't protect himself or speak for himself."
    'More safeguards'
    The local government ombudsman for England, Dr Jane Martin, is seeing a steady stream of cases that underline why a code of conduct is needed.Dr Martin can investigate what local authorities do, but believes there's a gap in the system when it comes to care workers.
    "It seems to me, if there were more safeguards around the qualification or perhaps the registration of care assistants, that would give me greater assurance that they were being properly vetted and employed to do a job that we had more confidence in."
    It is likely to be next September before details of the code and the training are published and a voluntary register of care workers is likely to be set up in 2013.Many will see it as a step in the right direction, but some will feel it doesn't go far enough.Nurses in particular have been pressing for a compulsory register for health care assistants. It is seen as a way to raise standards.In February, Health Secretary Andrew Lansley ruled out compulsory registration for care workers and scrapped the last government's plans for a register.Mr Lansley reportedly said that a compulsory system couldn't be justified in the current economic climate.He maintained voluntary registration could improve standards and quality of care without imposing the costs of mandatory regulation.Codes of practice have already been developed for health support workers in Scotland and Wales.

    Care worker with resident

    The government said the new standards are likely to focus on communication, confidentiality, nutrition and hydration amongst other things.    A code of conduct and minimum standards of training is to be drawn up for health care assistants and care workers who look after the elderly in England.
    The announcement follows growing concerns about the training and quality of care provided by some care workers.
    They are often poorly paid whilst doing a difficult and demanding job.
    It is cases like that of Carol-Anne Norman that have caused concern.
    She and her sister set up a camera to monitor the care their 85-year-old father was being given. He has dementia.
    They say the closed-circuit television pictures showed a number of care workers who didn't appear to know what they were doing.

    One worker was filmed wetting his flannel and toothbrush, wiping the basin with a towel to wet it then sprinkling talcum powder on the floor.
    In the notes it said their father had had a full wash, but their father was nowhere in sight. That worker has been suspended.
    Mrs Norman was shocked.She said: "It was just not care and, at times, I would call it abuse and they've done it because my father can't protect himself or speak for himself."
    'More safeguards'The local government ombudsman for England, Dr Jane Martin, is seeing a steady stream of cases that underline why a code of conduct is needed.
    Dr Martin can investigate what local authorities do, but believes there's a gap in the system when it comes to care workers.
    "It seems to me, if there were more safeguards around the qualification or perhaps the registration of care assistants, that would give me greater assurance that they were being properly vetted and employed to do a job that we had more confidence in."It is likely to be next September before details of the code and the training are published and a voluntary register of care workers is likely to be set up in 2013.Many will see it as a step in the right direction, but some will feel it doesn't go far enough.Nurses in particular have been pressing for a compulsory register for health care assistants. It is seen as a way to raise standards.In February, Health Secretary Andrew Lansley ruled out compulsory registration for care workers and scrapped the last government's plans for a register.Mr Lansley reportedly said that a compulsory system couldn't be justified in the current economic climate.He maintained voluntary registration could improve standards and quality of care without imposing the costs of mandatory regulation.Codes of practice have already been developed for health support workers in Scotland and Wales.

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    'Pollination crisis' hitting India's

     vegetable farmers

    Vegetable market stall, India (Image: AP)Falling vegetable yields could have a detrimental impact on people's diets, Indian researchers warn

    Indian researchers said there was a "clear indication" that pollinator abundance was linked to productivity.    A decline in pollinating insects in India is resulting in reduced vegetable yields and could limit people's access to a nutritional diet, a study warns.
    They added that the loss of the natural service could have a long-term impact on the farming sector, which accounts for almost a fifth of the nation's GDP.
    Globally, pollination is estimated to be worth £141bn ($224bn) each year.
    The findings were presented at a recent British Ecological Society meeting, held at the University of Leeds.
    Each year, India produces about 7.5 million tonnes of vegetables. This accounts for about 14% of the global total, making the nation second only to China in the world's vegetable production league table.
    Lack of data
    Despite the concern, no study had been done to assess directly the scale of the decline in natural pollinators, explained Parthiba Basu, from the University of Calcutta's Ecology Research Unit.
    "The ideal situation would have been if we were able to compare the overall pollinator abundance over the years, but that kind of data was just not available," he told BBC News.
    Instead, his team compared the yields of pollinator-dependent crops with pollinator-independent crops.
    "Data shows that the yields of pollinator-independent crops have continued to increase," Dr Basu said. "On the other hand, pollinator-dependent crops have levelled off."
    He explained that certain crops did not depend on insects for pollination, including cereals. Instead, the plants used other mechanism - such as relying on the wind to carry the pollen.
    However, many vegetables - such as pumpkin, squash, cucumber and gherkin - were reliant on insects, such as bees.
    He added that the fall in yield per hectare was against the backdrop of a greater area being turned over to crop production each year.

    Bumblebee heading for a sunflower (Getty Images)
    The exact cause for the decline of pollinators, especially bees, still remains a mystery
    • Research money has beekeepers buzzing
    In an attempt to identify an underlying cause for the pollinator decline, the team is carrying out a series of field experiments, comparing conventional agriculture with "ecological farming".
    Defined as "a farming system that aims to develop an integrated, humane, environmentally and economically sustainable agricultural production system", ecological farming is almost a hybrid of conventional and organic farming, looking to capitalise on returns from modern farming methods as well as drawing on natural ecological services, such as pollination.
    Dr Basu said: "There is an obvious indication that within the ecological farming setting, there is pollinator abundance. This method typically provides the habitats for natural pollinators - this is the way forward."
    He added that if the team's findings were extrapolated, this would offer a "clear indication" that India was facing a decline in natural pollinators, as ecological farming was only practiced on about 10-20% of the country's arable land.
    Figures show that agriculture accounts for almost one-fifth of the nation's gross domestic product (GDP), compared with the global average of just 6%. The sector also provides livelihoods for more than half of India's 1.2 billion population.
    Troubling times
    The UN Food and Agriculture Organization (FAO) estimates that of the slightly more than 100 crop species that provide 90% of food supplies for 146 countries, 71 are bee-pollinated, primarily by wild bees, and a number of others are pollinated by other insects.

    “Start Quote

    We - not only in India, but in other parts of the world - do not really know what is happening to natural pollinator populations”
    Dr Parthiba BasuUniversity of Calcutta
    In order to gain a clear insight into the scale of the global problem, the FAO has established the International Pollinators Initiative, which includes a project involving seven nations (India is among them) with the aim of identifying practices and building capacity in the management of pollination services.
    In a 2007 assessment of the scientific data on the issue, the UN Environment Programme observed: "Any loss in biodiversity is a matter of public concern, but losses of pollinating insects may be particularly troublesome because of the potential effects on plant reproduction and hence on food supply security."
    Dr Basu said food security was unlikely to be the main consequence facing India.
    "There has been a debate within India about this, but most of the cereal crops are not pollinator dependent, so if there is a pollination crisis it is not going to affect food security as such.
    "What is going to be affected is nutritional security."
    The concept of food security was first established by a FAO committee in 1983. Nutritional security was soon added as a key pillar to ensure "access by all people at all times to enough food for an active and healthy life".
    Dr Basu said that vegetables such as pumpkins, squash, cucumber, and gherkins were "quite substantial" in terms of delivering necessary nutrients to the population.
    "But there are many other vegetable crops that are eaten by people who are around the poverty level, so-called minor vegetable crops like eggplant, for which is there is no or very little data," he explained.
    About a quarter of India's population is believed to live below the poverty level, which - under the UN's Millennium Development Goals - refers to people who live on less than US$1 a day.
    Uncertain times
    In industrialised nations, such as the US and in Europe, many farms employ the services of commercial hives to pollinate fruit trees and food crops, and ensure they harvest adequate yields.
    But Dr Basu said the use of domesticated bees in this context was not widespread in South Asia.
    "There are honey farmers, but using hives in the field to pollinate crops is not at all common in India," he said.
    "That is why a lot of the political noise about a global pollination crisis came from the US and Europe, because their managed/domesticated bee population was declining."
    In 2007, about one third of the US domesticated bee population was wiped out as a result of a phenomenon known as Colony Collapse Disorder (CCD), with some commercial hive owners losing up to 90% of their bees.
    The exact cause remains a mystery, and last year a number of UK agencies - including the Biotechnology and Biological Sciences Research Council (BBSRC) - began a £10m project to help identify the main threat to bees and other insect pollinators.
    A number of possible causes have been suggested, including the misuse of pesticides, habitat loss and fragmentation, and the spread of parasites and diseases.
    Dr Basu said that as a result of his team's field experiments, it was clear that India too was experiencing a decline.
    However, he cautioned: "There are many kinds of natural pollinators. As a result, we - not only in India, but in other parts of the world - do not really know what is happening to natural pollinator populations."

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    embryonic stem cells



    The world's first official trial using human embryonic stem cells in patients has been halted.
    Geron, based in California, made the sudden announcement that it was halting further work in this field.
    In a statement the company said in the "current environment of capital scarcity and uncertain economic conditions" it had decided to concentrate instead on developing cancer treatments.
    Geron said it was seeking partners to enable further development of its stem cell programmes. The press statement implies the decision is purely a financial one - by stopping its stem cell programme it will cut its workforce by more than a third and save millions of dollars.
    But the company has already invested tens of millions in the stem cell therapy over the past decade. Its submission to the US Food and Drug Administration to conduct the first trial in patients of human embryonic stem cells was the largest and most complex ever submitted.
    Geron had injected stem cells into the spine of a small number of spinal patients to test safety. In its statement the company said the treatment had been "well tolerated with no serious adverse events".
    The decision does seem to be extraordinary given the huge investment of time and resources. When I visited Geron nearly three years ago, the then chief executive Dr Tom Okarma claimed the technology had an incredible future (Green light for US stem cell work):
    "What stem cells promise for a heart attack or spinal cord injury or diabetes is that you go to the hospital, you receive these cells and you go home with a repaired organ, that has been repaired by new heart cells or new new nerve cells or new islet cells that have been made from embryonic stem cells."
    If that future exists, it won't be Geron that will now lead the way.
    Ben Sykes, Executive Director of the UK National Stem Cell Network, said:
    "Stem cell research continues to show great promise in helping many people currently suffering from incurable conditions and injuries. It is disappointing that Geron has taken the decision to stop its spinal cord injury trial but we hope that the company is able to find new partners who can take on the work and provide the necessary finance."
    Joanna Knott, Co-Founder and Chair of SpinalCure Australia said: "This is incredibly sad and frustrating news for people with spinal injuries and their families. It is devastating for those people who will have a spinal injury and may as a result of this research been cured.
    Daniel Heumann, who is on the board of the Christopher and Dana Reeve Foundation, was more forthright in The Washington Post online which reported him as saying: "I'm disgusted. It makes me sick. To get people's hopes up and then do this for financial reasons is despicable. They're treating us like lab rats."
    John Martin, Professor of Cardiovascular Medicine at University College London said: "The Geron trial had no real chance of success because of the design and the disease targeted. It was an intrinsically flawed study. And for that reasons we should not be describing this as a set back.
    "The first trials of stem cell that will give an answer are our own in the heart. The heart is an organ that can give quantitative data of quality."
    Josephine Quintavalle from the group Comment on Reproductive Ethics said: "At long last after 10 years of unremitting hype, reality has caught up with embryonic stem cell claims. If Geron is abandoning this project it is because it is simply not working, despite the millions of dollars and hot air that has been invested in the promotion of this research."
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    Tuesday 15 November 2011

    Is oral contraceptive pill fuelling prostate cancer?



    oral contraceptive pillThe Pill became publicly available in the 1960s and remains a popular choice of contraceptive

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    Scientists say research is needed to ascertain if oral contraceptive pill use could be fuelling rising prostate cancer rates.
    Canadian investigators told the BMJ that they have found a possible link.
    But experts stress this is not proof that one causes the other and it might be a fluke finding.
    The researchers believe oestrogen by-products excreted in the urine of pill-users may have contaminated the food chain and drinking water.
    The hormone is known to feed the growth of certain cancers.
    The latest investigation looked at data from 2007 for individual nations and continents worldwide to see if there was any link.
    The researchers found a significant association between contraceptive pill use in the population as a whole with both the number of new cases of, and deaths from, prostate cancer.
    This link was irrespective of the nation's wealth, suggesting it might not be down to better disease detection in more affluent countries that also tend to have higher rates of oral contraceptive use.
    And it was strongest in Europe.
    Additionally, they found no link between prostate cancer and other forms of contraception, like the coil, suggesting it is not something that is sexually transmitted or associated with intercourse itself.
    'Thought-provoking'
    Drs David Margel and Neil Fleshner, from Toronto University, fear that contamination of the food chain with hormones originating from the pill are the likely culprit.

    “Start Quote

    Comparing the rates of two apparently unrelated issues across countries is a notoriously unreliable way of establishing whether they are truly linked”
    Jessica HarrisCancer Research UK
    They stress that their work merely suggests a link and is not proof.
    "It must be considered hypothesis generating and thought-provoking," they say in their BMJ Open report.
    They said more investigations are needed and recommend close monitoring of environmental levels of oral contraceptive by-products or endocrine disruptive compounds (EDCs).
    Dr Kate Holmes, of The Prostate Cancer Charity, agreed that more research was warranted.
    "While this study raises some interesting questions about the presence of EDCs in the environment, it does not contribute to our overall understanding of the development of prostate cancer."
    Jessica Harris, of Cancer Research UK, said uncertainty about the disease remained.
    "Comparing the rates of two apparently unrelated issues across countries is a notoriously unreliable way of establishing whether they are truly linked, because so many things vary between different countries that it's impossible to say whether one thing is causing the other.
    "It has been difficult to identify factors that affect the risk of prostate cancer, but we know that men are at higher risk as they get older, or if they have a strong family history of breast or prostate cancer. The disease is also more common in black men than white or Asian men."

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    United Nations Framework Convention on Climate Change



    United Nations Framework Convention on Climate Change

    From Wikipedia, the free encyclopedia

    The United Nations Framework Convention on Climate Change (UNFCCC or FCCC) is an international
     environmental treaty produced at the United Nations Conference on Environment and Development (UNCED),
     informally known as the Earth Summit, held in Rio de Janeiro from June 3 to 14, 1992. The objective of the treaty
     is to stabilize greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous
     anthropogenic interference with the climate system.[1]
    The treaty itself set no mandatory limits on greenhouse gas emissions for individual countries and contains no
     enforcement mechanisms. In that sense, the treaty is considered legally non-binding. Instead, the treaty provides
     for updates (called "protocols") that would set mandatory emission limits. The principal update is the Kyoto Protocol,
     which has become much better known than the UNFCCC itself.
    The UNFCCC was opened for signature on May 9, 1992, after an Intergovernmental Negotiating Committee produced
     the text of the Framework Convention as a report following its meeting in New York from April 30 to May 9, 1992
    . It entered into force on March 21, 1994. As of May 2011, UNFCCC has 194 parties.
    One of its first tasks was to establish national greenhouse gas inventories of greenhouse gas (GHG) emissions
     and removals, which were used to create the 1990 benchmark levels for accession of Annex I countries to the
     Kyoto Protocol and for the commitment of those countries to GHG reductions. Updated inventories must be
     regularly submitted by Annex I countries.
    The UNFCCC is also the name of the United Nations Secretariat charged with supporting the operation of the
     Convention, with offices in Haus Carstanjen, Bonn, Germany. From 2006 to 2010 the head of the secretariat was
     Yvo de Boer; on May 17, 2010 his successor, Christiana Figueres from Costa Rica has been named.
     The Secretariat, augmented through the parallel efforts of the Intergovernmental Panel on Climate Change (IPCC),
     aims to gain consensus through meetings and the discussion of various strategies.
    The parties to the convention have met annually from 1995 in Conferences of the Parties (COP) to assess
     progress in dealing with climate change. In 1997, the Kyoto Protocol was concluded and established legally 
    binding obligations for developed countries to reduce their greenhouse gas emissions.[2]

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    The hockey stick controversy


    The term "hockey stick graph" has been used of numerous reconstructions of Northern Hemisphere temperatures for the last 600 or 1,000 years: by December 2005 more than a dozen reconstructions showed the basic finding that late 20th century temperatures significantly exceeded previous 
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    Hockey stick controversy

    Hockey stick controversy

    The hockey stick controversy refers to debates over the technical correctness and implications for
     global warming of graphs showing reconstructed estimates of thetemperature record of the past 1000 years;
     at a political level, the debate is about the use of these graphs to convey complex science to the public, and
     the question of the 
    robustness of the assessment presented by the Intergovernmental Panel on Climate Change (IPCC).
    By the late 1990s a number of competing teams were using proxy indicators to estimate the temperature record 
    of past centuries, and finding suggestions that recent warming was exceptional.[1] In 1998
     Michael E. Mann, Raymond S. Bradley and Malcolm K. Hughes produced the first quantitative
     hemispheric-scale reconstruction, from an analysis of a variety of measures, which they summarised
     in a graph going back to 1400 showing recent measured temperatures increasing sharply.
     Their 1999 paper extended this study back to 1000, and included a graph which was featured prominently in the
     2001 United Nations Intergovernmental Panel on Climate Change (IPCC) Third Assessment Report(TAR) as 
    supporting the mainstream view of climate scientists that there had been a relatively sharp rise in temperatures
     during the second half of the 20th century. It became a focus of dispute for those opposed to this
     strengthening scientific consensus.[2] The term hockey stick was coined by the climatologist Jerry Mahlman, to
     describe the pattern, envisaging a graph that is relatively flat to 1900 as forming the hockey stick's "shaft", followed
     by a sharp increase corresponding to the "blade".[3]
    In 2003, Willie Soon and Sallie Baliunas argued against this pattern in a paper which was quickly dismissed as faulty
     in the Soon and Baliunas controversy.[1] In the United States there was already a hot political dispute over action on
     global warming following lobbying regarding the 1997 Kyoto Protocol, and on July 28, Republican Jim Inhofe made
     a Senate speech citing Soon and Baliunas to support his view "that man-made global warming is the greatest hoax
     ever perpetrated on the American people".[4] Also in 2003,Stephen McIntyre and Ross McKitrick published a paper
     questioning the statistical methods used in the Mann et al. paper, and there was continued debate on these issues
    .Hans von Storch regards that paper as of little consequence, and believes his paper of 2004 to be the first significant
     criticism.[5] At the request of Congress, a panel of scientists convened by the National Research Council was set up
    , which reported in 2006 supporting Mann's findings with some qualifications, including agreeing that there were some
     statistical failings but these had little effect on the result.[6] U.S. Rep. Joe Barton and U.S. Rep. Ed Whitfield
     requested Edward Wegman to set up a team of statisticians to investigate, and they supported the view that
     there were statistical failings, although their report has itself been criticized on several grounds.
    More than twelve subsequent scientific papers, using various statistical methods and combinations of proxy records
    , produced reconstructions broadly similar to the original MBH hockey-stick graph, with variations in how flat the
     pre-20th century "shaft" appears. Almost all of them supported the IPCC conclusion that the warmest decade in
     1000 years was probably that at the end of the 20th century
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    More patients in Scotland given antidepressants

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