Just Me, MA, MBA

What can be learned from 5 million books?

2011-09-20T20:01:00.001-04:00

E Patient Dave helps us save our own lives

2011-09-12T18:32:00.000-04:00

6 months later: Japan's nuclear disaster

2011-09-12T09:12:00.002-04:00

TOKYO – The scars of Japan’s March 11th disaster are both glaringly evident and deceptively hidden.

Six months after a tsunami turned Japan’s northeast into a tangled mess of metal, concrete, wood and dirt, legions of workers have made steady progress hauling away a good portion of the more than 20 million tonnes of debris covering ravaged coastal areas. The Environment Ministry says it expects to have it all removed by next March, and completely disposed of by 2014.

But a weightless by-product of this country’s March 11 disaster is expected to linger for much longer.

The Japanese learned a lot about the risks posed by radiation after the United States dropped atomic bombs on Hiroshima and Nagasaki in 1945. Now, once again, they are facing this invisible killer. This time, the mistake is of their own making.

'I think Tokyo Electric Power Company (TEPCO), as well as the Japanese government, made many mistakes.'—Shoji Sawada, theoretical particle physicist

"I’m afraid," says Shoji Sawada, a theoretical particle physicist who is opposed to the use of nuclear energy.

Sawada has been carefully monitoring the fallout from the accident at the Fukushima Daiichi power plant. “I think many people were exposed to radiation. I am afraid [they] will experience delayed effects, such as cancer and leukemia.”

Sawada dedicated his career to studying the impact radiation has on human health, particularly among the survivors of Japan’s atomic bombings. His interest is both professional and personal. When he was 13 years old, his mother urged him to flee their burning home in Hiroshima. She died, trapped beneath rubble.

“I think Tokyo Electric Power Company [TEPCO], as well as the Japanese government, made many mistakes,” he says.

Those mistakes have been clearly documented since the earthquake and tsunami triggered meltdowns and explosions at TEPCO’s Fukushima Daiichi, some 220 kilometres northeast of Tokyo. Warnings to build a higher tsunami wall were ignored; concerns about the safety of aging reactors covered up; and a toothless nuclear watchdog exposed as being more concerned with promoting atomic energy than protecting the public.

Evacuation zone

Japan's government maintains a 20-kilometre evacuation zone around the Fukushima Daiichi plant, with no unauthorized entry allowed.
The government has urged people within a 30-km radius of the plant to leave, but it's not mandatory.
Some people say the evacuation zone should include Fukushima City, which is 63 km away from the plant. At the moment, the roughly 100,000 local children are kept indoors, schools have banned soccer and outdoor sports, pools were closed this summer, and building windows are generally kept closed.
A handful of people argue the government should evacuate all of Fukushima prefecture, which has a population of about 2 million.

The result: a nuclear crisis with an international threat level rating on par with the 1986 disaster in Chernobyl.

No-entry zone

Tens of thousands of people have evacuated a 20 km no-entry zone around Fukushima Daiichi. In addition, the Japanese government has told residents living between 20 and 30 km away from the facility, and in so-called radiation “hot spots” beyond that, to leave their homes. Some may never return.

“The two-kilometre region is highly polluted, so I think it will be very difficult for people to go back,” Sawada says.

Then there are the concerns about the food supply. Unsafe levels of radioactive cesium, which has a half-life of about 30 years, have been detected in beef, milk, vegetables and tea leaves. Tokyo’s tap water was deemed dangerous for infants at one point. Sludge containing radioactive materials is building up at sewage facilities across Japan. And contaminants have been found in sandboxes at dozens of parks and school playgrounds in eastern Tokyo.

Government authorities insist they are taking precautions.

“We are doing our best, and counting and measuring the radiation level all the time,” says Maeko Nakabayashi, who holds a seat in Japan’s legislature for the ruling Democratic Party (DPJ). “We are extending that to every food product so that people can feel better [and] be assured that the food that they are eating is safe.”

But not everyone is convinced, especially parents.

“The Japanese government has a long history of lying or hiding the truth,” insists Gianni Simone, citing the cover-up of mercury poisoning in the 1950s and the HIV-tainted blood scandal of the 1980s. The freelance writer and Italian teacher lives just south of Tokyo with his wife, Hisako, and their eight and 10-year-old sons.

“We have started buying from food cooperatives whose products come from safe, or safer, prefectures located in the south,” says Simone. “My wife [and] her friends check suspect food by using instruments bought by local residents and stores, and directly calls the companies to make sure that the food she bought at the supermarket is safe.”

Simone and his wife are among a growing group of people in Japan who are carrying out independent tests on the food they eat and the air they breathe. They’d say they have good reason to be skeptical. The government and TEPCO dragged their heels for weeks before acknowledging three of Fukushima Daiichi’s reactors suffered meltdowns. In May, officials admitted they deliberately withheld forecasts on the spread of radiation.

“We did not provide the data to the public because we feared panic,” said Goshi Hosono, who is now Japan’s nuclear crisis minister. “We will make sure all data will be provided to the people without delay.”

Then last month, an investigation by the Associated Press suggested government authorities ignored their own computer forecasts and allowed thousands of people to stay for days in areas with high levels of radiation.

“In the initial stages, just after the hydrogen explosion, people needed to escape from the effect of radiation,” says Professor Sawada. “They deceived people when the level of radiation was very high.”

Decontamination

The Japanese government is now conducting extensive aerial surveys, from the northeast to the central part of the country, to track the spread of radiation from Fukushima Daiichi.

It’s also actively figuring out plans to decontaminate farmland, residential areas and public spaces around the nuclear plant, announcing it will power-wash buildings and scrape away topsoil from fields and playgrounds. It’s a mammoth job.

“The situation is more dire than most people would think,” says Lloyd Helferty of Biochar Ontario. The Canadian engineering technologist is trying to encourage Japanese officials to use a natural soil additive that would speed up the growth of plants, such as fungus, so they quickly absorb radiation.

'The whole world is waiting for Japan to bring the nuclear accident under control. The efforts of everyone here [at Fukushima Daiichi] will be the key to whether the nation can overcome the challenge.”—Japan’s new Prime Minister, Yoshihiko Noda

“The faster your plants grow, the faster you can take these things out of the ecosystem, essentially.”

No matter how this toxic mess is cleaned up, it will no doubt take years. Then there’s the long, complicated and costly process of controlling and then decommissioning Fukushima Daiichi.

“The whole world is waiting for Japan to bring the nuclear accident under control,” said Japan’s new prime minister, Yoshihiko Noda, last Thursday when he visited the plant. “The efforts of everyone here will be the key to whether the nation can overcome the challenge.”

Monitoring the health of tens of thousands of citizens who lived around Fukushima Daiichi is another challenge facing the Noda administration. Already, small amounts of radioactive iodine have been detected in the thyroid glands of hundreds of children in Fukushima prefecture.

“People who were exposed to the radioactive matter should be taken care of by the government and checked once or twice a year,” insists Professor Sawada. “Early detection is very important.”

Rebuilding Japan’s northeast coast, which at first blush seemed a hopelessly overwhelming job, might prove to be the easy part of the recovery process. Dealing with the aftermath of its unprecedented nuclear accident will likely be much harder and take much longer.

Craig Dale is a senior producer with CBC's The National and is currently on loan to NHK, the Japanese public broadcaster, in Tokyo.

Quinn Stewart talks about rich media and education

2011-09-11T15:23:00.000-04:00

Study: Are Liberals Smarter Than Conservatives?

2011-06-03T13:44:00.000-04:00

The notion that liberals are smarter than conservatives is familiar to anyone who has spent time on a college campus. The College Democrats are said to be ugly, smug and intellectual; the College Republicans, pretty, belligerent and dumb. There's enough truth in both stereotypes that the vast majority of college students opt not to join either club.
But are liberals actually smarter? A libertarian (and, as such, nonpartisan) researcher, Satoshi Kanazawa of the London School of Economics and Political Science, has just written a paper that is set to be published in March by the journal Social Psychology Quarterly. The paper investigates not only whether conservatives are dumber than liberals but also why that might be so.

The short answer: Kanazawa's paper shows that more-intelligent people are more likely to say they are liberal. They are also less likely to say they go to religious services. These aren't entirely new findings; last year, for example, a British team found that kids with higher intelligence scores were more likely to grow into adults who vote for Liberal Democrats, even after the researchers controlled for socioeconomics. What's new in Kanazawa's paper is a provocative theory about why intelligence might correlate with liberalism. He argues that smarter people are more willing to espouse "evolutionarily novel" values — that is, values that did not exist in our ancestral environment, including weird ideas about, say, helping genetically unrelated strangers (liberalism, as Kanazawa defines it), which never would have occurred to us back when we had to hunt to feed our own clan and our only real technology was fire.

Kanazawa offers this view of how such novel values sprang up in our ancestors: Imagine you are a caveman (if it helps, you are wearing a loincloth and have never shaved). Lightning strikes a tree near your cave, and fire threatens. What do you do? Natural selection would have favored the smart specimen who could quickly conceive answers to such a problem (or other rare catastrophes like sudden drought or flood), even if — or maybe especially if — those answers were unusual ones that few others in your tribe could generate. So, the theory goes, genes for intelligence got wrapped up with genes for unnatural thinking.

It's an elegant theory, but based on Kanazawa's own evidence, I'm not sure he's right. In his paper, Kanazawa begins by noting, accurately, that psychologists don't have a good understanding of why people embrace the values they do. Many kids share their parents' values, but at the same time many adolescents define themselves in opposition to what their parents believe. We know that most people firm up their values when they are in their 20s, but some people experience conversions to new religions, new political parties, new artistic tastes and even new cuisines after middle age. As Kanazawa notes, this multiplicity of views — a multiplicity you find within both cultures and individuals — is one reason economists have largely abandoned the study of values with a single Latin phrase, De gustibus non est disputandum: there's no accounting for taste.

Kanazawa doesn't disagree, but he believes scientists can account for whether people like new tastes or old, radical tastes or Establishment ones. He points out that there's a strong correlation between liberalism and openness to new kinds of experiences. But openness to new experience isn't necessarily intelligent (cocaine is fun; accidental cocaine overdose is not).

So are liberals smarter? Kanazawa quotes from two surveys that support the hypothesis that liberals are more intelligent. One is the National Longitudinal Study of Adolescent Health, which is often called Add Health. The other is the General Social Survey (GSS). The Add Health study shows that the mean IQ of adolescents who identify themselves as "very liberal" is 106, compared with a mean IQ of 95 for those calling themselves "very conservative." The Add Health study is huge — more than 20,000 kids — and this difference is highly statistically significant.

(But self-identification is often misleading; do kids really know what it means to be liberal? The GSS data are instructive here: Kanazawa found that more-intelligent GSS respondents (as measured by a quick but highly reliable synonym test) were less likely to agree that the government has a responsibility to reduce income and wealth differences. In other words, intelligent people might like to portray themselves as liberal. But in the end, they know that it's good to be the king.

The jury may be out on whether conservatives are less intelligent than liberals, but there's evidence that they may be physically stronger. Last year, the Proceedings of the National Academy of Sciences published a fascinating paper by Aaron Sell, John Tooby and Leda Cosmides of the Center for Evolutionary Psychology at the University of California at Santa Barbara. The authors measured the strength of 343 students using weight-lifting machines at a gym. The participating students completed questionnaires designed to measure, among other things, their proneness to anger, their history of fighting and their fondness for aggression as a way to solve both individual and geopolitical problems.

Sell, Tooby and Cosmides found that men (but not women) with the most physical strength were the most likely to feel entitled to good treatment, anger easily, view themselves as successful in winning conflicts and believe in physical force as a tool for resolving interpersonal and international conflicts. Women who thought of themselves as pretty showed the same pattern of greater aggression. All of which means that if you are a liberal who believes you're smarter than conservatives, you probably shouldn't bring that up around them. You might not like them when they're angry.

Read more: http://www.time.com/time/health/article/0,8599,1968042,00.html#ixzz1OEh3fYpa

E. coli infections in Germany see significant rise

2011-06-01T15:37:00.000-04:00

There has been a significant rise in the number of people in Europe infected by a strain of E. coli which has led to the deaths of 17 people, officials say.More than 1,500 people in nine nations - though nearly all in Germany - have now been infected by enterohaemorrhagic E.coli (EHEC), which can cause the deadly haemolytic-uraemic syndrome (HUS).The death toll in Germany has risen to 16, with officials saying an 84-year-old woman with HUS had died on Sunday.
The outbreak's source is not yet known.

Earlier, the Spanish government said it was considering legal action against the authorities in Hamburg for wrongly blaming its produce. "We do not rule out taking action against the authorities who called into question the quality of our products," Deputy Prime Minister Alfredo Perez Rubalcaba told radio Cadena Ser.Spain's fruit and vegetable exporters estimate they have been losing more than 200m euros ($290m; £174m) since the outbreak emerged.

"I live in a province in Spain where a lot of farmers grow their vegetables... They feel what has happened is unjustified” Leon Cohen Castell de Ferro, Spain

Germany has admitted the bacteria did not come from Spain as initially reported, but said the decision to issue the warning had been correct as a different strain of E.coli was present in Spanish cucumbers.
"Hundreds of tests have been done and the responsible agencies... have determined that most of the patients who have been sickened ate cucumbers, tomatoes and leaf lettuce and primarily in northern Germany," German Agriculture Minister Ilse Aigner said."The states that have conducted the tests must now follow back the delivery path to see how the cucumbers or tomatoes or lettuce got here."

'Unprecedented'

The Robert Koch Institute, the German federal institution responsible for disease control, said on Wednesday afternoon that 1,534 people in the country had been infected by EHEC. EHEC is a deadly strain of E. coli bacteria, which is found in the digestive systems of cows, humans and other mammals.On Tuesday, the RKI reported 1169 cases of EHEC, and said 470 people were suffering from HUS, up from 373 on Monday.

HUS cases and deaths, by country

Germany: 470 cases, 16 deaths

Sweden: 15 cases, one death

Denmark: Seven cases

The Netherlands: Three cases

UK: Two cases

Spain: One case

Sources: European Centre for Disease Prevention and Control, and the Robert Koch Institute

Experts said the number was unprecedented in modern medical history because HUS normally occurred in 10% of EHEC infections. They warned that the strain could be more dangerous than anything previously seen."There may well be a great number of asymptomatic cases out there that we're missing," Paul Hunter, a professor of health protection at the University of East Anglia, told the Associated Press.

"This could be a much bigger outbreak than we realise right now."

"There might also be something genetically different about this particular strain of E. coli that makes it more virulent."

But the European Commissioner for Health and Consumer Policy, John Dalli, ruled out any need for a ban on cucumbers, or for a warning against travelling to northern Germany.

"The outbreak is limited geographically to an area surrounding the city of Hamburg," he told reporters.
"It appears the outbreak is on the decline."

Epileptic fits

About half of the HUS patients in Hamburg clinics have suffered neural disorders three to five days after falling ill, such as epileptic fits and slurred speech, according to the German newspaper, Die Welt.
Germany typically sees a maximum of 50 to 60 annual cases of HUS, which has a fatality rate of up to 5%, according to the World Health Organization (WHO).

Unusually, more than 60% of the EHEC cases in Germany have been women - 88% over the age of 20 - and nearly 90% of the HUS cases have been women over the age of 20, officials have said. Experts have said this may be because women were the ones most likely to be eating fresh produce or handling food in the kitchen.

Hundreds of tests have been carried out by laboratories across Germany In addition to Germany, cases of EHEC have also been reported in eight other European countries - Austria, Denmark, the Netherlands, Norway, Spain, Sweden, Switzerland and the UK, the WHO said. All but two of those infected either live in Germany or recently travelled to Germany. Fifteen cases of HUS and one related death have also been reported in Sweden, seven cases in Denmark, three in the Netherlands, two in the UK, and one in Spain, according to the European Center for Disease Prevention and Control.

Several countries have taken steps to curtail the outbreak, such as banning cucumber imports and removing the vegetables from sale.Health authorities have also advised people to wash fruit and vegetables thoroughly, to do the same with all cutlery and plates, and to wash their hands before meals.

the Selfish way to save the world

2011-05-28T21:04:00.000-04:00

Sleep-deprived doctor problem needs strategy

2011-05-25T11:26:00.000-04:00

Sleepy surgeons a problem: medical journal

Last year, researchers reported higher rates of surgical complications if a surgeon had less than six hours of sleep the night before."The problem may only be getting worse," Drs. Noni MacDonald, Paul Hébert, Ken Flegel and Matthew Stanbrook wrote in an editorial in Tuesday's issue of the Canadian Medical Association Journal. Doctors themselves are part of the problem of sleep deprivation in medicine, a medical journal editorial says. iStock

Medical care is more complex, as patients with life-threatening conditions now survive thanks to medical innovations, drugs and technologies that weren't an option in past decades, the editorial noted.The greater complexity at both the bedside and in the operating room not only affects surgeons but also doctors who stay up all night assisting at a birth or dealing with a patient in crisis, they said.
"We doctors ourselves are part of this problem," the editorial said. "We need to shift our professional culture. Long periods on call should not be accepted as routine or a source of pride. Instead, we must admit that working while impaired from sleep deprivation is neither normal nor acceptable."
A previous study suggested that sleep deprivation from an overnight call can cause a similar degree of impairment in judgment and motor performance as having a blood alcohol level above 0.05 per cent. But solving the problem could be costly. A U.S. study in 2009 estimated it would take a 71 per cent increase in the physician workforce and a 174 per cent jump in the number of residents to apply the aviation industry's strategy of restricting work hours to ease fatigue in the medical system.

Some hospitals, departments and practices have used innovative strategies such as:
Adopting strict policies on going home after call.

Refraining from booking procedures or clinics the day after call.

Reorganizing schedules to allow for more coverage by doctors.

Moving to shift work.

Ultimately, licensing, accreditation, insurance and governments need to establish standards on minimum uninterrupted sleep hours and best practices, they concluded.

When do blood clots become a problem?

2011-05-19T16:46:00.000-04:00

The simple answer is, when they form in the bloodstream not in response to a wound. Then it's called thrombosis. Deep-vein thrombosis (DVT) usually occurs in the leg. DVT clots can block the flow of blood through the veins. It's a problem that occurs most often in the legs because it is harder to maintain blood flow in the lower parts of the body.When a clot breaks away and travels through the body, it causes a pulmonary embolism (PE) if it blocks an artery. Venous thrombosis (VTE) is simply the umbrella term for DVT and PE.When a clot forms in the arteries supplying the heart, and blood flow is blocked, it may result in a heart attack. If a clot forms in the arteries supplying the brain, blocking blood flow, it may cause a stroke.
What are the risk factors?

Some people have a genetic predisposition to blood clots, just as other people are at risk of their blood not clotting properly when necessary (hemophiliacs, for example).
Immobility, especially during flights of six hours or more, is a risk factor for venous thrombosis.

There is also a long list of things that increase the probability of VTEs:

Hospitalization: the risk of VTE is 10 times higher when hospitalized, a result of the combination of risk factors listed below. One in five VTEs occurs in hospital, according to the National Blood Clot Alliance (NBCA) in the U.S. In England, VTEs in hospital result in more than 25,000 deaths per year.

Age: risk increases as individuals get older.

Obesity or being overweight: doubles the risk.

Infections and disease: these raise the levels of clotting factors in the blood.

Immobility: especially after air flights of six hours or longer.

Injury and/or trauma.

Surgery, intravenous catheters or any treatment that damages blood vessels. (Hip replacement patients have a 60 per cent chance of DVT.)

Pregnancy.

Varicose veins.

How would taking a drug lead to a VTE?

Some drugs may add to the risk of unwanted blood clots. "A cascade of factors leads to a lower threshold" for blood clots, according to Dr. Karl Kabasele, a public health physician

For example, oral contraceptives (and other hormone-based treatments) increase the risk of blood clots, some brands significantly more than others.

What happens when you get a blood clot?

If it's DVT, the symptoms can include:

Pain, tenderness and swelling of the leg (usually the calf, but if the clot occurs in the thigh, the swelling may affect the whole leg).

Discoloration, with the leg appearing a pale, blue or reddish purple colour.

Leg feels warm when touched.

People with DVT can also be asymptomatic.

If it is PE, symptoms can include:

Shortness of breath, either severe and sudden or gradual onset.

Sharp, stabbing chest pain, which may be worse when breathing deeply.

Sudden collapse.

Rapid heart rate.

Unexplained cough, sometimes with bloody mucus.

DVT symptoms (see above).

PE is a medical emergency.

How is thrombosis treated?

The most common treatment is blood thinners (anticoagulants). These drugs block the action by the clotting factors rather than literally thinning blood. The most extensively used blood thinner, warfarin, was first used as a rat poison. It was introduced in 1948, but after a 1955 suicide attempt using warfarin, researchers began looking at other possible uses. U.S. President Dwight Eisenhower was one of the first people to be treated with warfarin.

Age and poor fitness increase the risk of blood clots, but even young athletes are vulnerable. Tennis star Serena Williams, pictured at Wimbledon on July 3, 2010, received emergency treatment for a blood clot in her lungs in February.

In the U.S. today, warfarin is No. 20 on the list of most-prescribed drugs, with about 20 million prescriptions per year. Newer blood thinners include low-molecular-weight heparin, made from animal sources and injected once or twice a day, and fondaparinux (arixtra), a synthetic drug that is also injected but lasts longer than heparin.

How can VTEs be prevented?

When travelling by plane, train or bus, get up and move around at least every hour, especially on trips over four hours. If you cannot move around, exercise and stretch your legs and feet.

Stop every two hours when driving to get out and move around.

Drink lots of water and wear loose-fitting clothing when travelling.

Lose weight if overweight, stay active, exercise and avoid long periods of immobility.

Discuss the risks of blood clots with your doctor if taking hormones, going into hospital or planning a long trip. For people at higher risk, doctors may recommend wearing elastic compression stockings or taking a single dose of a blood thinner.
Kabasele recommends against taking aspirin to prevent blood clots unless recommended by a doctor.
Hospitals especially need to take preventive measures with their patients.

Investigations in Chronic Pain Resolutions

2011-05-18T12:29:00.002-04:00

Obstetric cholestasis

2011-05-15T09:47:00.000-04:00

Twenty-three years ago I was a week away from delivering huge twins when my body erupted in the worst itching of my life. I never knew what caused it until I discovered this article on the BBC website. As a side note: I did have previoius and a subsequent pregnancy of a single baby and had no reoccurance of this problem. My impression was that the condition was caused by the compression of my liver by twins that in combination weighed more than 17 lbs.

Who gets obstetric cholestasis?

Obstetric cholestasis occurs in about 1 in 100 pregnancies in the UK. It is more common in women carrying twins, triplets, or more. Mothers, daughters and sisters of affected women have a higher than average risk of also being affected when pregnant. It is more common in certain parts of the world. For example, in some countries in South America, especially Chile and Bolivia, up to 1 in 20 or more pregnant women develop this condition. (These facts support the theory that there is a strong genetic factor involved - see below.) If you have obstetric cholestasis in one pregnancy, you have a high chance that it will occur in future pregnancies..

What causes obstetric cholestasis?

The exact cause is not clear. Hormonal and genetic factors may be responsible..

•Hormone factors. Pregnancy causes an increase in oestrogen and progestogen hormones. These can affect the liver in a way which slows down the rate of bile passing out along the tiny bile ducts. Some pregnant women may be more sensitive to these hormone effects.

•Genetic factors. Obstetric cholestasis seems to run in some families (although it may skip some generations). One theory is that women who develop obstetric cholestasis may inherit a slight problem with the way bile is made and passes down the bile ducts. This does not matter when not pregnant. However, the high level of hormones made during pregnancy may 'tip the balance' to cause a much reduced flow of bile.

There may be other environmental factors which contribute. However, whatever the underlying cause, the pregnancy 'triggers' the problem. Within a week or so after giving birth the symptoms clear and there is no long term problem with the liver..

What are the symptoms of obstetric cholestasis?

Typically, symptoms occur in the last third of pregnancy when the hormone levels are at their highest. However, it sometimes develops earlier in pregnancy.

Itch

This is the most common and typical symptom. The itch can be 'all over', but it is often worst on the hands and feet. Commonly, itch is the only symptom. It tends to get worse until you have the baby. The itch can become severe and affect sleep, concentration, mood, and can become distressing.
Note: mild itching from time to time is normal in pregnancy. However, if you develop a constant itch that gets worse, tell your doctor. A blood test can confirm if you have obstetric cholestasis..

Other less common symptoms include:

•Tiredness.

•Poor appetite and feeling sick.

•Mild jaundice. You may go 'yellow' and have dark urine and pale faeces (stools). This is uncommon and due to an increased level of bilirubin (a constituent of bile) leaking from the bile ducts into the bloodstream.

How is obstetric cholestasis diagnosed?

The diagnosis is suspected if you develop itch during pregnancy. A blood test can detect the raised level of bile acids and liver enzymes (chemicals) in the blood. Other blood tests may be taken to measure other liver functions and to rule out other causes of liver problems such as viral hepatitis. In some cases the itch develops a week or more before the blood test becomes abnormal. Therefore, if the first blood test is normal then another may be done a week or so later if the itch continues.

The diagnosis is confirmed if you have:.

•Itch that is not due to any other known cause (such as a skin disorder), and

•High levels of liver enzymes and/or bile salts in your blood that cannot be explained by any other liver disease such as viral hepatitis.

Both the itch and high level of liver enzymes and bile salts go away after the birth of the baby. A blood test done sometime after the baby is born can confirm this. This sometimes helps to confirm that the diagnosis was, in fact, obstetric cholestasis if there had been any doubt..

What is the treatment for obstetric cholestasis?

There is no cure for obstetric cholestasis. As mentioned, the condition is not usually serious but can be distressing. Symptoms go once you have the baby. The following may be advised by your specialist which may help..

General measures

Some women have found that keeping cool helps to ease the itch. Tips to do this include: lowering the thermostat in your house, keep your body uncovered at night, take cool showers and baths, soak your feet or hands in ice water. These measures may give some temporary relief, particularly before going to bed when the itch may ease enough to allow you to fall asleep. A bland moisturiser cream may also give some temporary relief from itch..

Ursodeoxycholic acid

This is a naturally occurring bile acid and is used as a medication. Strictly speaking, it is not licensed for pregnant women, but has often been prescribed. The logic is that taking this drug may help to improve the function of the liver and help to reduce the bile acid level in the bloodstream. This may then ease symptoms (and may possibly reduce any possible increased risk of pregnancy complications).
However, the research evidence to support the use of this drug is not strong. Whilst some doctors believe it helps, some small studies have concluded that it does not help. A current national guideline on obstetric cholestasis states ... "there are insufficient data to support the widespread use of ursodeoxycholic acid (UDCA) outside of clinical trials." So, it is a treatment that is being studied and may be used, but more research is needed to clarify if it is helpful or not..

Vitamin K supplements

These are commonly prescribed. Vitamin K is essential for the blood clotting mechanism to work. Sometimes the level is reduced in people with liver and bile problems. So, it seems sensible to make sure that you do not lack this vitamin. This is why supplements are often advised..

Regular ante-natal checks

You may be advised to have ante-natal checks more often than usual to monitor the progress of your baby carefully..

Deciding about early delivery of the baby

Until recently it was thought that there was an increased risk of stillbirth with obstetric cholestasis. Because of this, many specialists advised to induce labour so that you would give birth early - at 37 weeks of pregnancy. However, as discussed above, the concern about an increased risk of stillbirth is debatable. So, the practice of early delivery is under review and may be revised. Your specialist can advise about the most up to date thinking and practice about this..

Further sources of information and help
Obstetric Cholestasis Support Website
Web: www.ocsupport.org.uk

Provides support and information to mothers who have, or who may have, the condition. Keeps abreast of the most recent research into the condition..

References

•Obstetric Cholestasis, Royal College of Obstetricians and Gynaecologists (2006)

•Milkiewicz P, Elias E, Williamson C, et al; Obstetric cholestasis. BMJ. 2002 Jan 19;324(7330):123-4.

Speach Patters and Persuasion

2011-05-15T09:28:00.000-04:00

How speech patterns sway opinions

The best way to persuade someone to do as you wish is to speak moderately quickly, pause frequently and not be too animated, US researchers suggest.The study analysed just under 1,400 calls trying to persuade people to take part in phone surveys.Those who spoke very fast, did not pause or were too animated were least successful.

A UK language expert said it showed "it's not about what you say, but how you say it".The University of Michigan Institute of Social Research study used recordings of introductory calls made by 100 male and female telephone interviewers at the institute.They looked at the interviewers' speech rates, fluency, and pitch, and then at how successful they were in convincing people to participate in the survey.

Those who spoke at a rate of around 3.5 words per second (moderately fast) were much more successful at convincing people to take part than those who spoke very fast or very slowly.
'Too scripted'
The researchers, led by Jose Benki, an expert in the psychology of language, said people who speak too quickly are often seen as "out to pull the wool over our eyes", while those who talk very slow are seen as "not too bright or overly pedantic/ We have all experienced situations where someone's words could have been taken a number of different ways, but their tone has offended us” Dr Rachael-Anne Knight, City University, London

The study, funded by the US National Science Foundation and presented to the American Association for Public Opinion Research, also found people thought too much variation in pitch "sounds artificial" and "like people are trying too hard". Finally, the team found interviewers who paused frequently - around four or five times a minute - were more successful than those who were fluent. The team suggest they sounded "too scripted".
Dr Rachael-Anne Knight, senior lecturer in phonetics at London's City University, said prosody - the rhythm, stress, and intonation of speech - was key to how what people say is received.

"These features can give us a great deal of information, including how the speaker is feeling at the time and how they feel towards us, the listener. "For example, we have all experienced situations where someone's words could have been taken a number of different ways, but their tone has offended us, hence when people remark 'it's not what he said, it's the way that he said it'. "Speakers aren't always aware of the different ways in which their prosody can affect their message, so this research is useful in that it identifies some practical ways in which people trying to get others to participate in telephone surveys might improve their success rates.
"It might also have applications to the service industries, and potentially to all kinds of real-life situations".

The good results from a single smile

2011-05-13T14:22:00.001-04:00

Selenium 'does not prevent cancer'

2011-05-12T08:40:00.000-04:00

By Michelle Roberts-Health reporter, BBC News

Taking a daily supplement of selenium will not ward off cancer, say experts who have reviewed the available evidence.The Cochrane group looked at 55 studies that included over a million people.Despite anecdotal reports of selenium's cancer powers, the investigators found no proof of a protective effect against skin cancer or prostate cancer. And taking selenium over a long period of time could have toxic effects, they found.

Lead author Dr Gabriele Dennert, of the Institute for Transdisciplinary Health Research in Germany, said: "We could find no evidence to recommend regular intake of selenium supplements for cancer prevention in people whether or not they already have enough selenium."Small amounts of selenium are essential for health and help build a strong immune system to fight off infections and diseases.
Many foods, including brazil nuts, tuna and pasta, contain selenium.
"We know from many large studies that vitamin and mineral supplements far from being potent cancer-fighters are mostly ineffective in protecting against cancer, and can even increase the risk of cancer in some cases”

And there have been numerous trials to see if it might reduce cancer risk. Some of these have found a benefit, while others have not. But now experts say that there is enough evidence to confidently rule out selenium as a cancer preventative therapy. Yinka Ebo, senior health information officer at Cancer Research UK, said: "We know from many large studies that vitamin and mineral supplements far from being potent cancer-fighters are mostly ineffective in protecting against cancer, and can even increase the risk of cancer in some cases.
"This review on selenium adds to this body of evidence and should give people good reason to think twice before relying on selenium supplements.

"The best way to get your full range of vitamins and minerals is to eat a healthy, balanced diet with a wide variety of fruit and vegetables, and this can help protect against cancer."
He said that for most healthy people there should be no need to take supplements. "Some people are advised to take supplements under medical guidance and should talk to their doctor if they are worried," he added.

Smile- it could prolong your life

2011-05-11T17:08:00.000-04:00

Specific jusices good for heart

2011-05-10T08:26:00.000-04:00

Five portions a day 'saves lives'

A blend of fruit juices, including grape, cranberry and blackcurrant, may have benefits for the heart, research suggests.French scientists tested the blend on pig arteries in the lab, and found it caused artery walls to relax.It remains to be seen whether fruit juices can improve vascular health, they report in a scientific journal.The study adds weight to evidence fruit and veg reduces heart disease risk, says the British Heart Foundation.

The researchers looked for a chemical called polyphenol in fruit and berries.They found the most active fruits included blackcurrant, blueberry, aronia (choke berries), cranberry, lingonberry and grape.
"This research adds more weight to evidence that eating fruit and vegetables is good for us in terms of reducing our risk for heart disease."However, we still don't fully understand why, or whether certain fruits and vegetables are better than others. Even this study acknowledges that scientists can't yet explain any link."What we do know is that we should all eat a wide range of fruit and veg as part of a balanced diet, and fruit juice is a tasty and handy way of doing this. "Don't forget though, juice contains less fibre and more sugar than the original fruit so it only counts as one of our five-a-day."

The research was published in the Royal Society of Chemistry journal, Food and Function.

Noam Chomsky on changes in Healthcare

2011-05-09T18:23:00.001-04:00

Bereavement and its effects

2011-05-09T11:51:00.000-04:00

Bereavement is an immensely stressful event that can take a huge toll on the body, potentially causing all sorts of physical problems, including physical exhaustion, uncontrollable crying, sleep disruption, palpitations, shortness of breath, headaches, recurrent infections, high blood pressure, loss of appetite, stomach upsets, hair loss, disruption of the menstrual cycle, irritability, worsening of any chronic condition such as eczema or asthma, and visual and auditory hallucinations.

Effects on the nervous system

Lethargy and tiredness are common physical symptoms of bereavement. The loss of a loved one sets off a powerful stress response in the body, with release of high levels of natural steroids and a heightened state of awareness in the nervous system, especially the autonomic nervous system (the 'flight or fight' system) which controls the body's readiness for action. The heart responds to this greater nervous drive with an increase in pulse and blood pressure. Even if the person seems slow and down, inside they're in turmoil.

Decreased immunity

The stress response also affects the immune system. Bereavement causes a fall in activity of the T-lymphocytes, cells that are very important in fighting infection. So colds and other minor infections are common. Pre-existing painful problems such as arthritis may get worse and other chronic health conditions often flare up too. It's common for conditions that need careful control such as diabetes and high blood pressure to go awry. This partly explains why people who experience personal loss are at higher risk of dying during the first year. Men are at greater risk than women, perhaps because they have fewer support systems among family and friends.

Physical and mental

Psychological problems are also common during intense grief and, as mind and body are interlinked, these can also cause physical problems. Depression can disrupt sleep and appetite, and cause the body to slow down.

Anxiety is also common during grieving, and can cause a racing pulse, hot sweats, poor sleep and loss of appetite. The bereaved may turn to alcohol, recreational drugs or prescription drugs at this stressful time, compounding their problems.

It's not unusual for people who have lost a partner to clearly see or hear the person about the house, and sometimes even converse with them at length. These visual and auditory hallucinations are part of the normal grief reaction and a very real physical occurrence to those who experience them. Sometimes these grief reactions are mistaken for signs of dementia or severe psychiatric illness. The end result can be that the surviving partner is given unnecessary medication or even put in a home when what they actually need is help with grieving.

The effect on children

Children are just as likely to show physical effects during bereavement, particularly complaining of tummy pains, headaches, bed-wetting and insomnia.They may also show behavioural problems, becoming wild and unruly or withdrawn and sulky because of difficulties expressing their grief while at the same time coping with all the normal struggles of growing up.What grieving children and adults need most of all is quiet support and understanding, a chance to share feelings and worries as well as time to work through their emotions.

Appropriate treatment for physical symptoms is important, so do seek medical advice. But while this may mean medication, many symptoms, such as sleep and appetite problems, get better with simple therapies or even on their own as the person works through the stages of bereavement.

Dan Ariel on Self Control

2011-05-07T14:14:00.000-04:00

500th Post- Turning Bad fat into good?

2011-05-03T18:11:00.000-04:00

Scientists turn 'bad fat' into 'good fat'By Michelle Roberts-Health reporter, BBC News

Scientists say they have found a way to turn body fat into a better type of fat that burns off calories and weight.The US Johns Hopkins team made the breakthrough in rats but believe the same could be done in humans, offering the hope of a new way to treat obesity.Modifying the expression of a protein linked to appetite not only reduced the animals' calorie intake and weight, but also transformed their fat composition.

"Bad" white fat became "good" brown fat, Cell Metabolism journal reports. Brown fat is abundant in babies, which they use as a power source to generate body heat, expending calories at the same time.
But as we age our brown fat largely disappears and gets replaced by "bad" white fat, which typically sits as a spare tyre around the waist. "We will need a lot more work to tease this out, but it could offer a feasible way to develop new treatments for obesity” UK obesity expert Dr Jeremy Tomlinson

Experts have reasoned that stimulating the body to make more brown fat rather than white fat could be a helpful way to control weight and prevent obesity and its related health problems like type 2 diabetes.

Novel approach

Various teams have been searching for a way to do this, and Dr Sheng Bi and colleagues at the Johns Hopkins University School of Medicine believe they may have cracked it.They designed an experiment to see if suppressing an appetite-stimulating protein called NPY would decrease body weight in rats.
When they silenced NPY in the brains of the rodents they found their appetite and food intake decreased.
Even when the rats were fed a very rich, high-fat diet they still managed to keep more weight off than rats who had fully functioning NPY.The scientists then checked the fat composition of the rats and found interesting change had occurred. In the rats with silenced NPY expression, some of the bad white fat had been replaced with good brown fat.The researchers are hopeful that it may be possible to achieve the same effect in people by injecting brown fat stem cells under the skin to burn white fat and stimulate weight loss.Dr Bi said: "If we could get the human body to turn bad fat into good fat that burns calories instead of storing them, we could add a serious new tool to tackle the obesity epidemic. "Only future research will tell us if that is possible."
Dr Jeremy Tomlinson, an expert at the University of Birmingham's Centre for Obesity Research, said: "This is exciting, novel and interesting. "We will need a lot more work to tease this out, but it could offer a feasible way to develop new treatments for obesity."

Healthy Brain Aging

2011-05-01T19:54:00.002-04:00

Why do some people preserve their memory into old age while others do not? Much research is being done to answer this question. While science has yet to find a way to stop the aging process and prevent degenerative disorders such as Alzheimer’s disease and dementia, neuroscientists are actively researching this area and have already found several strategies that may help maintain or improve brain health as we age.

Reaching a better understanding of aging and disease prevention strategies is critically important for maintaining brain health. About 500 million people worldwide were at least 65 years old by 2006, according to the National Institute on Aging. That is 12 percent of the world’s population. By 2030, that figure is expected to climb to 20 percent. As health conditions improve in developing countries, life expectancies will rise, and the number of people with cognitive problems due to age-related disorders is set to skyrocket.

Word puzzles and nighttime classical music are often misguidedly touted as cure-alls to preserving brain health into old age. However, brain myths such as these have now largely been debunked. In fact, human and animal studies have established that simple habits can lead to sharper memory in our later years. Basic science research indicates that many lifestyle choices are linked to brain health. These findings are showing:

•How exercise enhances nerve cell formation and survival in parts of the brain associated with learning and memory.

•Why diets high in fat and sugar increase the formation of a protein implicated in Alzheimer’s disease.

•How chronic stress can damage the hippocampus — a brain region linked with learning, memory, and emotion.

Regular exercise is one of the most important recommendations for healthy bodies and brains. Research indicates that aerobic fitness enhances learning and memory in older animals. In aged mice, exercise improved memory retention and the speed of learning. Their time on a running wheel also encouraged the development of new brain cells — a process called neurogenesis — in the hippocampus. Alzheimer’s disease and other forms of dementia are characterized by a decreased number of neurons in this brain region.

The same improvements have been seen in people. Research suggests that physical fitness prevents the atrophy of brain regions, including the hippocampus. One study showed inactive older adults who begin to walk three times a week have improved efficiency in the neural networks involved in cognition. Other results show that physical activity affects executive control functions, such as multi-tasking, scheduling, and planning. Overall, aerobic exercise continues to show positive effects at all levels, from cellular to behavioral.

A balanced diet is important for weight management, which turns out to be another key factor in maintaining brain fitness. Clinical research shows that older men with the most body fat tend to do worse on cognitive tests than their slimmer counterparts. Women show similar effects. Older women with a group of risk factors known as “metabolic syndrome” — excess fat around the waist, high cholesterol, and high blood pressure — had increased rates of cognitive impairment.

Another reason to eat right: blood sugar levels affect brain health. The blood sugar glucose, which the hormone insulin shuttles through the blood stream into cells, provides the brain with fuel. Too much glucose overwhelms the body’s ability to use and regulate sugars effectively. Abnormally low levels of glucose, a state known as hypoglycemia, impair the delivery of nutrients to the brain and injure cells.

In people with insulin resistance, cells don’t respond to glucose normally, so the body releases greater amounts of insulin to compensate. But this can backfire, as elevated levels of insulin often lead to diabetes. One study reported that older adults with diabetes or insulin resistance had abnormalities in the way their brains metabolize glucose and showed impaired performance on a word memorization task. Other research indicates that diets high in fat and sugar increase the formation of amyloid beta, a protein involved in Alzheimer’s disease.

Research shows that avoiding undue stress also is important for promoting healthy aging. Chronic stress can strain the entire body, and physicians have long noted that severe stress weakens the immune system and promotes weight gain. Scientists have found the brain also suffers from long-term psychological stress. Steroid hormones known as glucocoticoids, which are released in response to stress, can have lasting effects on the brain regions that regulate their release. Regions of the aging brain that are most susceptible to decline are especially vulnerable to stress hormones.

Research also suggests that extremely stressful lifestyles could damage the brain’s memory machinery. Prolonged social stress in rodents, tree shrews, and vervet monkeys has been shown to damage the hippocampus. Research in these animals reveals that chronic stress increases cell death, reduces the development of new cells, and decreases connections between cells in the hippocampus.

Fortunately, all this evidence indicates that behaviors that make you feel good — regular exercise, diet and weight management, and low stress — also support your cognitive abilities in the long term.

T-cells trained to recognize and then attack cancer cells

2011-05-01T10:06:00.000-04:00

Memory cells to fight cancer

By Helen Briggs- Health reporter, BBC News

They take some blood, extract the white blood cells, then coax them in the laboratory to memorise the cells that cause cancer.When injected back into the body, the memory T-cells go on to hunt and destroy tumour cells for more than a year. For a handful of patients around the world - such a treatment has already become a reality. The hope is that in five to ten years' time, this highly experimental therapy could make the leap to approved drug.
This week, US scientists reported their results on nine patients with one of the deadliest forms of cancer.
All had advanced melanoma that had spread from the skin to other parts of the body. "The dream would be that we could make a library of killer T-cells that we could generate quickly for patients” Dr Marcus Butler
Dana-Farber Cancer Institute

Melanoma can usually be cured if detected and removed early.But once they have spread around the body, most patients survive for less than a year.The experimental therapy using "killer" T-cells did not stop the cancer progressing in most of the nine patients studied.But in one, his cancers shrank and after two years they cannot be seen on scans.

These are very early days. As the researchers - led by Dr Marcus Butler of the Dana-Farber Cancer Institute - point out, this is a phase I trial, and will need to be investigated in far larger numbers of patients.
But it offers a glimpse of what experimental treatments like these might one day offer cancer patients.
Dr Butler told the BBC: "Cancer-killing T-cells trained in the lab can induce long-lasting anti-cancer effects.
"The dream would be that we could make a library of killer T-cells that we could generate quickly for patients."

Immunotherapy

The approach - known as adoptive T-cell therapy - has only been studied in a few hundred patients around the world.

MELANOMA

The most serious form of skin cancer

Sun exposure is the main - and most preventable - risk factor, causing genetic damage to the skin

Around one third of melanomas develop from normal moles

The rest develop on areas of previously normal skin

Warning signs include:

Two halves of a mole do not look the same

The edges of the mole are irregular, blurred or jagged

Colour is uneven, with more than one shade

Mole is wider than 6mm

One obstacle is that the cells tend to disappear quickly when injected into cancer patients.

But the Dana-Farber research, published in the journal Science Translational Medicine , shows that the cells' life can be extended by priming them in the lab with an artificial version of cells found naturally in the immune system.
These cells inform the body's immune system that cancer is present and needs to be destroyed.Co-author, Dr Naoto Hirano, says the next step is to study this technique in conjunction with other therapies that can boost the numbers and effectiveness of the T-cells.

He added: "We will be beginning a series of clinical trials to learn which combinations work best in which patients."Dr Laura Bell, senior science information officer at Cancer Research UK, said the work is one of a large number of immunotherapy treatments now entering clinical trials. "Immunotherapy is an exciting area of cancer research, designed to harness the power of the body's own immune system to fight cancer," she said."The results of laboratory research in this area are now starting to feed through into the clinic and we'll be following the progress of these trials with interest."

Why we love the foods we love- 5 influences

2011-04-29T11:41:00.000-04:00

We are all born with a love of sweet foods and a dislike of bitter flavors, but beyond that, the foods we love and the foods we hate can vary wildly. A recent article in the Washington Post laid out the five influences on how people taste food.

1. Genetics: People experience bitter flavors differently, as the combination of bitter receptor genes varies for each person. And almost everyone lacks the ability to detect at least one scent, meaning that the chemical that gives truffles their distinctive odor might strike you as either offensive or earthy. Or you might be among the 25% who can't smell it at all.

2. Experience: Did you know babies are predisposed to liking the foods their mothers ate while they were pregnant and later while breastfeeding? Exposing children to a wide range of foods can start even before they're born.
3. Culture: Not many people like extremely bitter or spicy foods the first time tasting them, but they can come to tolerate and even crave them with repeated exposure and by being around people who enjoy these foods.

4. Gender: Women are more likely to crave sweets and men are more likely to crave salty foods. This should come as no surprise if you've ever seen an advertisement for chocolate.
5. Texture: Although science cannot yet fully explain why, some people simply hate gritty, slimy or creamy foods, no matter their flavor. Case in point: natto, the slippery fermented soybeans pictured above.

Status 'determines brain's reactions to others

2011-04-29T11:17:00.000-04:00

Our brains react differently to others depending on how we view their social status, researchers say.
The Current Biology study found those who see themselves as being of a high status display more brain activity with those they think are equally elevated.The researchers said behaviour was determined by how people saw those around them. A British expert said first evaluations were crucial in determining how individuals related to each other.

It was already known from other studies that monkeys behave this way; changing behaviour dependent on how they perceived the other animal's position in the troop.The 23 participants, who had varying levels of social status, were shown information about someone of higher status and information about someone of lower status.
The team used functional magnetic resonance imaging (fMRI) to measure activity in the ventral striatum, part of the brain's reward system. People who viewed themselves as having a higher subjective socioeconomic status displayed greater brain activity in response to other high-ranked individuals, while those with lower status have a greater response to other low-status individuals.

First evaluations

Dr Caroline Zink, of the US National Institute of Mental Health, who led the study, said: "The way we interact with and behave around other people is often determined by their social status relative to our own, and therefore information regarding social status is very valuable to us."Interestingly, the value we assign to information about someone's particular status seems to depend on our own.She added that socioeconomic status is not based solely on money, but can also include factors such as accomplishments and habits.

Dr Jane McCartney, a London-based chartered psychologist and a member of the British Psychological Society, said: "First evaluations are terribly important to everyone, whether it's to do with status, looks or money. "It's about deciding if this person is of the same status, and what one needs to do ensure they know you are of an equal status and evaluating what role they may play in your life."

Morning heart attacks the worst

2011-04-28T11:35:00.000-04:00

People who have a heart attack in the morning tend to fare worse than those who have one at other times of the day and night, experts have discovered. Heart attacks occurring between 0600 and noon are more likely to create a larger area of damaged heart tissue.The findings in Heart journal come from a study of over 800 patients in Spain. Experts say the body's natural sleep-awake cycle could explain the differences seen, but advise more research to confirm the findings.

It is well established that a person's 24-hour body clock can influence heart attack risk. For example, doctors know that people are more likely to have a heart attack around the time when they are waking up from sleep than at other times, but what is less known is the extent of damage that this leads to. "Regardless of the time of day, the quicker someone having a heart attack is treated, the less the damage they will have”
Judy O'Sullivan

British Heart Foundation

To investigate, Dr Borja Ibanez and colleagues analysed data on 811 patients at their hospital who had suffered a type of heart attack known as an ST elevation myocardial infarction, which occurs when there is a prolonged period of blocked blood supply to the heart muscle. The researchers split the patients into four groups based on what time segment of the 24-hour clock the heart attack occurred. They found that one group in particular - the 0600 to midday or "morning" heart attack group - had the most severe heart attacks.
This morning group had much higher levels of an enzyme in their blood that is a marker of dying heart tissue than patients whose heart attack had occurred in the evening (between 6pm and midnight).

Judging by the blood enzyme levels, the researchers estimate that the area of the heart damaged in the morning group was, on average, a fifth larger in comparison.Judy O'Sullivan, senior cardiac nurse at the British Heart Foundation, said: "This study provides some interesting observations on the association between the time of day a heart attack occurs and the degree of subsequent damage to the heart muscle. "However further research is needed before we can draw firm conclusions.
"Regardless of the time of day, the quicker someone having a heart attack is treated, the less the damage they will have, which is why it is essential that anyone who experiences heart attack symptoms should call 911 immediately."