AIDS leaves 9 mln African children without mothers Yahoo! NEWS
Some 9 million children in Africa have lost a mother to AIDS, British charity Save the Children said Monday, calling on donors to sharply increase aid to meet their needs. "Incredibly, the impact of HIV and AIDS on children is still being ignored," Save the Children Chief Executive Jasmine Whitbread said in a statement. The charity said in a report that a lack of testing facilities meant that many mothers, especially in the poorest countries, did not know their HIV status until they were ill and unable to fight off even the simplest infections. "The AIDS pandemic robs millions of children of their childhoods as well as their mothers," Whitbread said. "Children are caring for their mothers, missing school, and having to work because their mothers are too sick to look after them." The charity called for a focus on children orphaned by AIDS as well as sick parents, adding red tape was slowing aid flows. "Donors must spend 12 percent of their AIDS funding on proper support for children," it said, adding this would amount to $6.4 billion over a three-year period. In 2006, if Britain, the United States and Ireland met all their pledges, there would be $412 million committed for children -- or about one quarter of the $2.1 billion needed per year. "This is best case scenario and it's not yet clear whether all of the donors will meet their commitments," a spokeswoman for Save the Children told Reuters by telephone from London. The charity addressed its appeal to the G8 wealthy nations, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank and the European Commission. Sub-Saharan Africa has about 10 percent of the world's population but 60 percent of the people living with HIV/AIDS. More than 3 million Africans were infected with HIV in 2005, representing 64 percent of all new infections globally and more than in any previous year for the impoverished continent, according to UNAIDS, the lead U.N. agency against AIDS. Across sub-Saharan Africa, an estimated 4.6 percent of young women aged 15 to 24 are infected with HIV, compared to 1.7 percent of young men, according to U.N. data. Save the Children said most of the 19.2 million women living with HIV around the globe were already mothers. "To truly make a difference we must also support children whose mothers are HIV positive," it said. "In sub-Saharan Africa alone, more than 12 million children under the age of 15 have lost one or both parents to AIDS. By 2010, at current rates of HIV infection, this number is likely to increase to 18 million," Save the Children said.
By Manoah Esipisu

To head off allergies, expose your kids to pets and dirt early Yahoo! NEWS
Here's the conventional wisdom: Pets promote allergy, kids shouldn't eat peanuts until they're at least 3, and intestinal worms are nothing more than an icky reminder of life before flush toilets. Here's the new wisdom: Early exposure to pets, peanuts and intestinal worms might actually be good for you, because they program the developing immune system to know the difference between real threats, such as germs, and Aunt Millie's cat. (Graphic: Short-circuiting a cat allergy) Evidence to support this view has been mounting for more than a decade. But now, for the first time, researchers are beginning to test remedies based on these theories in patients. Other doctors are trying to make use of novel approaches to retrain the immune system once it's too late and allergies set in. "What we've learned is that it may, in fact, be important to be exposed early on to a sufficient quantity of allergy-causing substances to train the immune system that they are not a threat," says Andy Saxon of the University of California-Los Angeles. "And, in people who already have allergies, we see for the first time where the problems lie, and we have new opportunities to tweak the system." Scientists base this radical new thinking about human allergies on a deeper understanding of how the immune system works. They have begun to exploit fresh insights to attack allergies and other immune diseases in unexpected ways. No longer content just to treat allergy symptoms, they hope to outwit the immune system and stop allergic responses before they start. "When you're born, Day Zero, your immune system is like a new computer. It's not programmed. You have to add software," says Joel Weinstock of Tufts New England Medical Center. "Between the ages of zero and 12, you're learning to read, you're learning to write, and your immune system is learning to react to things. Part of that is learning to limit reactivity." If the new approaches work, millions might benefit. More than 50 million people have allergic diseases, which are the sixth-leading cause of chronic illness in the USA, according to the National Institute of Allergy and Infectious Diseases (NIAID), costing the health system $18 billion a year. Asthma alone accounts for 500,000 hospitalizations a year, including 2 million admissions to the emergency room, says a study in the May 2005 Journal of Allergy and Clinical Immunology. Since 1980, adult asthma cases have risen by 75% and childhood asthma by 160%, the Centers for Disease Control and Prevention reports. (Related: Asthmatic kids under a cloud) To test whether high-dose exposure breeds tolerance, researchers led by Gideon Lack at Imperial College in London are preparing to launch a counterintuitive - and some would say risky - seven-year, U.S.-financed study that will expose infants to peanuts. It's based on research showing that children who eat peanuts at an early age are less likely to develop peanut allergies. The study is risky because children with unrecognized peanut allergies might suffer anaphylactic shock, a deadly drop in blood pressure often combined with asthma, if they're exposed to peanuts. A second team of researchers, led by Patrick Holt of the University of Western Australia in Perth, will conduct a similar study in which children who are already allergic to other substances will be exposed to airborne allergens such as ragweed to see whether it will block the development of other allergies. Other studies suggest that short-lived infections with a benign parasite might relieve allergies and possibly autoimmune illnesses such as Crohn's disease and Type I diabetes by restoring the immune system's natural balance. Major human trials in the USA and Europe are set to begin this year. Although trying to link allergies to autoimmune diseases such as Crohn's might seem like a stretch, scientists say both types of ailments result from an immune system run amok. In allergies, the immune system goes on alert when ragweed or some other allergy-causing protein wafts through the air, settles on the skin or tickles the tongue. In autoimmune diseases, the immune system can no longer distinguish between the self and foreign proteins. Mistaking the self for those proteins, the immune system attacks the bowel in Crohn's disease or insulin-producing cells in Type 1 diabetes.

Early intervention
If educating the immune system is tough, re-educating it after allergies set in appears to be tougher. Allergy shots work, but they're costly and often must be continued for years, and the protection fades over time. Higher-tech approaches rely heavily on 21st-century molecular medicine to engineer proteins that block allergies. One strategy, pioneered by researchers at Dynavax Technologies in Berkeley, Calif., involves disguising a key ragweed protein with DNA from a bacterium. The goal: to create a new short course of allergy shots that tricks the immune system into permanently thinking that ragweed is a bacterium, so it will attack it like a germ and not mount an allergic response. The approach has appeared to work in early trials at Johns Hopkins University. A second strategy, now being developed by Saxon and his colleagues at UCLA and licensed to the biotech firm Biogen Idec, involves fusing a cat allergen with a snippet of a powerful antibody called IgG. This IgG snippet turns off cells that make histamine, the chemical responsible for scratchy throats, watery eyes, runny noses and asthma. Researchers hope the combo will lock histamine-producing cells in the off position, and, in time, retrain the immune system to accept that Aunt Millie's cat is harmless.

Hypothetically speaking
The new approach to allergy prevention and treatment arises from a paradox. Known as the hygiene hypothesis, it suggests that growing up in cities and suburbs, away from fields and farm animals, leaves people more susceptible to a host of immune disorders, including allergies and asthma. Weinstock says the divide between developed and undeveloped countries is still evident today. "Hay fever is the most common allergy in the developed world," he says. "Yet, there are some countries in the world where doctors don't know what hay fever is." What about urban life is triggering a rash of allergies and autoimmune diseases? It's a good question, and not an easy one to answer. The immune system isn't palpable as are the heart and lungs; you can't listen to it or feel its pulse. Yet the immune system is our most sensitive link to the environment, on alert for threats of all kinds, most of the time running in the background like computer anti-virus software. To accelerate the research, the National Institutes of Health and the Juvenile Diabetes Research Foundation in 1999 set up a seven-year, $144 million international consortium called the Immune Tolerance Network, says Marshall Plaut of NIAID. Already, research is turning up surprising results. Dennis Ownby of the Medical College of Georgia followed 474 infants in the Detroit area from birth to age 7, hoping to identify clues about why some would pick up allergies and others would not. Ownby, then at Henry Ford Hospital, says he was unprepared for what he found. Ownby's team compared 184 children who were exposed to two or more dogs or cats in their first year of life with 220 who didn't have pets. To their surprise, the scientists found that children raised with pets were 45% less likely to test positive for allergies than other kids. The study appeared in the Aug. 28, 2002 Journal of the American Medical Association. "We've been taught for at least a couple of decades that early exposure to an allergen increases the risk of becoming allergic later in life," Ownby says. "So when we first examined our data, we were very afraid that something had gone wrong. It's the opposite of what we would have predicted." The challenge now, Ownby says, is to figure out what's happening. One possible explanation is that dogs and cats shed a substance called endotoxin, from bacteria. A study by Andy Liu of National Jewish Medical and Research Center in Denver reported in 2000 that infants with the most endotoxin exposure were the least likely to have allergies, indicating that what researchers call the Pigpen Effect, the invisible cloud of dust and dirt surrounding us all, might not be a bad thing. Or consider the peanut paradox. In the past 10 years, peanut allergies have doubled in the USA, United Kingdom and other countries that advise against exposing unborn children to peanuts (through their mothers' diet) and during infancy, Imperial College's Lack says. He believes children become allergic to peanuts not by eating them but by coming into contact with peanut oil in their mothers' skin lotions, according to a study published in the March 2003 New England Journal of Medicine. Studies of rodents suggest eating peanuts conditions the immune system to tolerate them. Infants in regions of Africa and Asia who are exposed to peanuts rarely develop the allergy, Lack says, in contrast to countries such as the USA and UK, where the prevalence of peanut allergies might be more than 10 times higher. To test whether eating peanut products can protect children from peanut allergies, Lack plans to launch a dramatic seven-year study in which parents will regularly feed high doses of peanuts to about 200 children who have egg allergies or eczema, conditions that put them at high risk of developing other allergies. Parents of another 200 children will follow the government's advice and try to completely avoid peanuts. One key message, Lack says, is don't try this at home, without the safeguards of a carefully controlled trial. "Feeding babies peanuts can be extremely dangerous," he says. As high-risk as the trial is, it might be extremely rewarding, doctors say. Each year in the USA, about 15,000 people suffer severe allergic reactions from eating peanuts, and about 100 die. "It's the first large-scale trial of what we consider a very dangerous allergic food," Ownby says. To the squeamish, it might not matter that intestinal worms are less risky than foods that promote allergy. But some doctors say worms might do something that allergy-causing substances won't do - broadly reset the immune system so that it no longer reacts to allergy-causing substances or attacks the body's tissues, as it does in Crohn's disease and Type I diabetes. "This is an exciting new area with potential for opening new therapeutic avenues for diseases that are hard to control and treat," says Weinstock of Tufts New England Medical Center. Worms captured Weinstock's imagination and that of his collaborator, David Elliott of the University of Iowa, because worm infections appear to regulate the immune system so that it functions normally. The allergic response - itchy, watery eyes, a runny nose and constriction of smooth muscles - evolved to flush out intestinal worms. "The immune system didn't evolve for allergy," Weinstock says. "Why in a hundred billion years of evolution would we evolve a response for allergy?" In fact, says Robert Coffman, vice president of the biotech firm Dynavax Technologies, the immune system developed two sets of responses: one for bacteria and viruses and one for worms. Called Th1 for germs and Th2 for worms, they work in opposition. When Th1 is active, Th2 takes a break. When Th2 is active, it's Th1's turn. All of the symptoms people link with allergy are part of the Th2 response.

The worm turns
Weinstock, Elliott and other researchers believe that a low-grade infection with intestinal worms - pig whipworms because they can't reproduce in people - can restore the immune system's natural balance. A small-scale study in which 29 people with Crohn's disease drank whipworm eggs in Gatorade found that 23 responded to treatment and 21 of the 23 experienced complete remission. Although worms haven't been directly tested in allergic patients, researchers point to a study by Maria Yazdanbakhsh of Leiden University in the Netherlands, which found that treating schoolchildren in Gabon for worms, so that the worms were expelled from their bodies, doubled their risk of becoming allergic to house dust mites, a common allergen. Weinstock argues that it is exposure to the worms in the environment that confers protection against allergies. "That's one possibility," he says. "Whether it's due to worms, endotoxin, lifestyle, smoking or other factors that we haven't identified - that's the fun of it. But environment clearly plays a part."
By Steve Sternberg, USA TODAY

Health Tip: Heart Attack or Indigestion? Yahoo! NEWS
As with a heart attack, indigestion can cause burning in the chest. But according to the U.S. Department of Health and Human Services, it's unlikely that pain from indigestion would spread to other parts of the body, as a typical heart attack does. Indigestion, frequently accompanied by nausea, often stems from eating too much, too quickly, or the wrong kinds of foods. If you have any of these symptoms, they could indicate something more serious than simple indigestion:

• Vomiting, weight loss, or appetite loss.
• Black, tarry stools or blood in vomit.
• What feels like indigestion accompanied by shortness of breath; pain radiating to the jaw, neck or arm; or sweating.

If you do have any of these symptoms, see a doctor immediately.

B Vitamin Case Reaches Supreme Court Yahoo! NEWS
B vitamin deficiencies can cause a range of serious health effects, including spinal defects in children born to women with below-normal levels of folic acid and anemia in people not getting enough B12. That's why a two-step method of diagnosing those deficiencies that three medical school doctors patented in 1990 has become so widely used. It's performed tens of millions of times a year, at a cost of just a dollar or two, by laboratory testing companies nationwide. Now, to the surprise of patent attorneys, a case involving one of those companies, sued after it stopped paying some royalties, has landed in the Supreme Court, where arguments will be heard Tuesday. Even more surprising is that the Supreme Court may dredge up a bombshell question not asked when the lower courts considered the case: Have inventors been busy patenting laws of nature, natural phenomena and abstract ideas? At stake, attorneys on both sides of the case say, are 25 years of patent law and literally tens of thousands of patents on drugs, medical devices, computer software and other inventions. If the court reins in what can be patented, they say, it could be among the most important patent law decisions ever made. The two-step method covered by patent No. 4,940,658 is straightforward: The level of an amino acid called homocysteine is measured in a patient's blood or urine and, if elevated, it can be correlated with a deficiency of folic acid, or B12. The question before the Supreme Court is whether a doctor could infringe the patent "merely by thinking about the relationship" between homocysteine levels and B vitamin deficiencies after looking at a test result. In 1998, testing company Laboratory Corp. of America Holdings stopped paying some royalties on the patent. The patent's holders, including Metabolite Laboratories Inc. and Competitive Technologies Inc., sued. LabCorp lost, was ordered to pay about $5 million and then lost again on appeal. It now wants the Supreme Court to reverse the previous judgments. LabCorp, its attorneys and supporters argue in court filings that the patent gives its owners an effective monopoly over a basic scientific principle or natural phenomenon: high levels of homocysteine suggest deficiencies in two B vitamins. "If someone observes a correlation between X and Y and then announces he is going to use that correlation in a lab test, is that a patentable process? I think the court is troubled that that sort of correlation would be possible," said Jack Bierig, a Chicago attorney who filed a friend-of-the-court brief supporting LabCorp on behalf of the American Medical Association and five other medical groups. Metabolite Laboratories counters that the patent covers a practical application of the discovery made by the inventors when used as part of a diagnostic step. "The test itself is obvious when you have the correlation. It is the discovery of the correlation that is the real novelty here," said Mark Lemley, a Stanford University law professor who is helping represent Metabolite Laboratories. LabCorp originally argued that the patent was overly vague, and that allowed it to use tests, called assays, developed by other companies to measure homocysteine levels. Metabolite Laboratories disagreed. That sort of narrow dispute is the crux of many patent suits and normally wouldn't grab much attention. But the Supreme Court asked the federal government to weigh in on the case, specifically asking whether Metabolite Laboratories succeeded in patenting a law of nature, natural phenomenon or abstract idea — all no-no's under patent law. "They did pretty much shock everybody," said Chicago-Kent College of Law professor Lori Andrews, who submitted a friend-of-the-court brief supporting LabCorp. The Solicitor General's office replied to the Supreme Court that the question wasn't asked in the lower courts and thus LabCorp's isn't the case to decide it. It recommended the previous judgment be affirmed or the case be dismissed or sent back to the lower courts. Regardless of the outcome, that the Supreme Court even asked that question guarantees the case's lasting effect on patents and patent law, attorneys said. Glenn Beaton, an attorney for Metabolite Laboratories, suggested: "I think it's fair to say there will be a sudden surge in claiming unpatentable subject matter because defendants' lawyers out there are going to see someone on the Supreme Court has a question in their mind whether patents are getting granted on the type of thing when they shouldn't be." Since the original LabCorp ruling, there has been a rush to file patents on "scientific facts" or "mental processes," Andrews said. The case is Laboratory Corporation of America Holdings v. Metabolite Laboratories Inc. et al., No. 04-607.
On the Net: Supreme Court: http://www.supremecourtus.gov/
By ANDREW BRIDGES, Associated Press Writer

March 20, 2006
Bird Flu Likely in US This Year: Gov't Officials
By REUTERS
Filed at 5:18 p.m. ET

WASHINGTON (Reuters) - Bush administration officials said on Monday it was ``increasingly likely'' that bird flu could be detected in the United States this year, but added it may not mean the start of a human pandemic.

Speaking to reporters, Interior Secretary Gale Norton, Agriculture Secretary Mike Johanns and Secretary of Health and Human Services Michael Leavitt unveiled a plan to increase monitoring of migratory birds that are likely to bring the bird flu virus to U.S. shores.

``It is increasingly likely that we will detect the highly pathogenic H5N1 strain of avian flu in birds within the U.S. borders possibly as early as this year,'' Norton said.

As a result, the government is expanding its early warning system to deal with bird flu's eventual arrival.

``None of us can build a cage around the United States. We have to be prepared to deal with the virus here,'' Johanns said.

The H5N1 avian flu virus has spread across Europe, Africa and parts of Asia and killed at least 98 people worldwide since 2003. So far, it has a mortality rate of about 50 percent.

Although bird flu is hard to catch, people can contract the disease by coming into contact with infected birds, especially from bird droppings.

Scientists are concerned that the virus could develop the ability to transmit easily from person to person and trigger a worldwide pandemic which could kill millions.

Norton said the early detection plan would prioritize sampling in Alaska, where scientists believe the strain of highly pathogenic H5N1 virus currently affecting Southeast Asia would most likely spread to North America by migrating birds.

The government's expanded testing program will focus on Alaska, elsewhere in the Pacific Flyway for migrating birds and the Pacific islands, followed by the Central, Mississippi and Atlantic Flyways.

The Agriculture Department plans to collect between 75,000 and 100,000 samples from live and dead wild birds this year. Another 50,000 samples of water or feces from high-risk waterfowl habitats in the United States will also be taken.

Norton said she expected initial, so-called presumptive

H5N1 results could be announced some 20 to 100 times this year but those first tests would not tell whether the virus was the deadly strain or a weaker form.

Discovery of bird flu in the United States should not be reason to panic, Johanns said, noting that positive test results could turn out to be a harmless version of the virus.

The United States has dealt three times previously -- in 1924, 1983 and 2004 -- with outbreaks in domestic poultry of other forms of bird flu.

Should U.S. domestic poultry become infected with the high-pathogen H5N1, the Agriculture Department would act quickly to quarantine an affected area and destroy the infected flock, he said.

``Our producers have demonstrated that they will call us at the first sign of sick birds, knowing that with high-pathogen strains of bird flu we reimburse them for the birds that we destroy,'' Johanns said. ``This is a $29 billion industry in the U.S. and our producers are as eager as we are to protect the safety of our poultry.''

Poultry properly prepared would be safe to eat because cooking with high heat kills the virus, the officials said.

The U.S. poultry industry says it already has numerous safeguards in place to protect its flocks.

``Poultry in other parts of the world are in many cases allowed to run at large and are not protected from wild waterfowl or other birds that may be carrying viruses such as avian influenza,'' said Sherrill Davison, associate professor of avian medicine and pathology at the University of Pennsylvania School of Veterinary Medicine.

Meanwhile, U.S. regulators on Monday proposed banning the use of two types of human flu-fighting drugs in poultry to preserve their effectiveness for people in case of a bird flu pandemic.

The proposal would prohibit use of neuraminidase inhibitors, Roche Holding Ag's Tamiflu and GlaxoSmithKline Plc's Relenza, and the older drugs, rimantadine and amantadine, in chickens, turkeys and ducks, the Food and Drug Administration said.

While the federal government is stockpiling medicines and making other preparations, it is important for state and local governments, hospitals, businesses and schools to formulate their own plans, Leavitt said.

``Any community that fails to prepare, with the expectation that the federal government will at the last moment be able to come to the rescue, will be tragically wrong. There is no way in which 5,000 different communities can be responded to simultaneously,'' Leavitt said.



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March 21, 2006
Experts Reveal the Secret Powers of Grapefruit Juice
By NICHOLAS BAKALAR
In 1989, a group of Canadian researchers studying a blood pressure drug were astonished to discover that drinking a glass of grapefruit juice dangerously increased the drug's potency.

They were testing the effects of drinking alcohol on a medicine called Plendil. The scientists needed something that would hide the taste of alcohol so that subjects would know only that they were taking the drug and not know whether they were drinking alcohol with it.

"One Saturday night, my wife and I tested everything in the refrigerator," said David G. Bailey, a research scientist at the London Health Sciences Center in London, Ontario, and the lead author on the study. "The only thing that covered the taste was grapefruit juice."

So they used it in their experiment, expecting the grapefruit juice to be irrelevant to their results. But blood levels of the drug went up significantly in the control group that drank just grapefruit juice, without alcohol.

"People didn't believe us," Dr. Bailey said. "They thought it was a joke. We had trouble getting it published in a major medical journal."

Eventually the paper was accepted and published by Lancet, in February 1991.

Finding why juice had that effect was the next question.

The answer, it turned out, lay in a family of enzymes called the cytochrome P-450 system, in particular one known as CYP 3A4. This enzyme metabolizes many drugs, and toxins as well, into substances that are less potent or more easily excreted or both.

Grapefruit juice interferes with the ability of CYP 3A4 to do that, increasing the potency of a drug by letting more of it enter the bloodstream, in effect producing an excessive dose.

Grapefruit interacts with this enzyme only in the intestines, not in the liver or other places where it is found. As a result, the effect is seen only with medicines taken orally, not with injected drugs.

Numerous studies now show the interaction of grapefruit juice with many widely used medicines. Most interactions have no serious consequences, but a few do. For example, drugs used to lower cholesterol, like Lipitor, Mevacor and Zocor, have increased potency when taken with grapefruit juice. Excessive levels of those drugs can lead to a serious and sometimes fatal muscle disorder called rhabdomyolysis.

Does this mean a person could reduce the amount of medicine required simply by drinking grapefruit juice? No, according to Dr. Bailey.

"The problem is the unpredictability of the effect," he said. "You can't just lower your dose of Lipitor and increase your consumption of grapefruit juice. There's no uniformity from one individual to another or from one bottle of grapefruit juice to the next.

"There's huge variation in the amount of enzyme people have in their guts. Fooling around with grapefruit juice is not a good idea."

Grapefruit juice can also interfere with the metabolism of selective serotonin reuptake inhibitors, or S.S.R.I.'s, like Prozac, which are used to treat depression.

Dr. Marshall Forstein, an associate professor of psychiatry at Harvard, said he told patients to switch from grapefruit juice to something else because most oranges and other citrus fruits do not have the same effect.

"If they insist," Dr. Forstein said, "I try to prescribe the S.S.R.I. or other medication to be taken at a time when the grapefruit juice would have mostly been metabolized."

Among fruit juices, grapefruit has the strongest effect, but lime juice and orange juice made from Seville oranges similarly inhibit the CYP 3A4 enzyme. With some drugs, apple juice may interact in the same way.

While Dr. Bailey suggests avoiding grapefruit juice entirely when taking medicine, some experts say the effect of the juice should not be exaggerated.

"The circumstances under which an interaction will occur are relatively unusual," said Dr. David J. Greenblatt, a professor of pharmacology at Tufts. First, he said, the drug has to be metabolized significantly by intestinal CYP 3A4, and relatively few are. "When you look at the actual data for each drug, the scientific conclusions are that the interactions are unusual, sometimes quite small and not of clinical importance. But there are some cases in which it's significant."

Dr. Greenblatt and his co-investigators at Tufts have conducted research sponsored by the National Institutes of Health in this field for years, and he has been a paid consultant to the Florida Citrus Commission.

Dr. Richard B. Kim, a professor of medicine and pharmacology at Vanderbilt University, agreed that the interaction was a serious health concern in some patients.

"Grapefruit consumption is a clinically relevant issue, especially for the elderly, who are most likely to be taking the drugs affected by it," Dr. Kim said. "If you're taking multiple medications, or have recently switched to a different type of medication, you should be particularly careful. The easiest thing to do under those circumstances is to take the medicine with water and avoid the juice completely."



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America's Most Polluted Cities Forbes
Pollution
U.S. cities continue to pollute at a great rate. Still, to put this in perspective, they are all better than Chinese cities that hold the title of the world's worst. The Chinese wrested that title from Mexico City--since all ten in China are more polluted than Mexico's capital. China's dilemma is that it is caught between its response to outsourcing needs by Western nations (and their own industrial expansion) and its inability to contain the harmful emissions all this activity generates--from smokestacks to trucks, buses, construction equipment and, now, an increasing number of automobiles. There is no way to disassociate the state of air quality and the efficiency of transportation and its infrastructure. Trucks, buses and most particularly off-road vehicles contribute a large portion of the harmful pollutants. Their diesel emissions are a major source of both ozone and particle pollution. By 2010, in the U.S. these vehicles must by Environmental Protection Agency standards produce 95% less pollution than they do today. Smog reduces visibility and adds significantly to driving hazards and delay. Logistics costs as a measure against GDP are more than three times higher in China than in the U.S. Nor is there any sensible way to disassociate air pollution from health risks and death rates. In the U.S., the EPA has put out a series of timed regulations designed to improve air quality here. According to the EPA, an average person breathes in 3,400 gallons of air per day. Some 25% of Americans, according to the American Lung Association (ALA), are breathing air that is hazardous to their health. The EPA and other monitoring organizations have two major categories of emissions: particle pollution and ozone pollution. Particle pollution (traditionally known as soot in the air) is a mixture of solids and liquid droplets suspended in air. The solids are made up of nitric acid and sulfuric acid accompanied by traces of metals, dirt and organic chemicals. Ground-level ozone (often referred to as smog) is produced when sunlight combines with hydrocarbons and nitrogen oxide. It is most apparent on sunny days near busy highways and in cities, and appears as a dirty yellow haze from a distance. For the EPA, the next big round involving the Clean Air Act is slated for 2007, and it calls for more stringent emissions reduction (basically sulfur emissions). For U.S. truckers, this will require specifically reducing sulfur emissions from the use of new diesel fuel down to 15 parts per million from levels typically as high as 500 parts per million. The ALA sees the need for action and cooperation around the EPA mandate. It cites dreadful life-threatening and life-taking consequences from the levels of pollution in U.S. cities. Heart attacks and asthma attacks lead the list. The ALA states that 152 million U.S. citizens, or 52% of the population, are at risk from ozone and particle pollutants. Children, the elderly and people with asthma, diabetes, chronic bronchitis or emphysema (16.9 million) are severely at risk. Others with heart conditions are also at risk. "The emissions from cars and trucks have been a big problem for the past 40 years," says Janice Nolen, ALA director of national policy. Some communities, according to Nolen, have thought that building more roads to reduce congestion would be a prime way to solve the problem, but in fact that hasn't solved anything. Some experts are now looking at alternatives to how communities themselves are built so that commutes and distances traveled by vehicles are shorter, making roads less congested. Polluting emissions are also generated from vehicles moving or idling on highways and city streets while engines and exhaust systems are operating at less than optimum levels. The ATA makes a point of singling out off-road vehicles as very heavy polluters. Their fuel is among the dirtiest. Diesel locomotives with inadequately designed engines generate pollutants as well. Of course, factories produce pollution along with electrical generation plants (often coal driven), and known carcinogenic emissions are even created by dry cleaners. Nolen notes one positive development: She sees an increase in the use of electrical plugs in facilities at truck rest stops. This maintains refrigeration for the load and air conditioning for the trucker while reducing idling time. The trucking world today is a mix of good business and difficulties that are not always within the control of a particular trucking company. The downside of more stringent regulations includes higher diesel-fuel costs, a lack of trained truckers, a continuing loss of experienced drivers and more complex security processes and costs. The 2007 EPA rules are another large hurdle. Glen Casey, spokesman for American Trucking Association, has a different set of concerns than the ALA does. He sees two sides that have to be considered: first, taking the sulfur out of the diesel fuel and, second, factors governing engine emissions that have required redesign of truck engines, exhaust systems and subsequent costs. "Will there be an adequate supply of the new ultra-low-sulfur diesel fuel across the country in all locations?" he asks. "There may be contamination along the pipeline, and some fuel may not meet the 15 parts per million goal." There does not seem to be any clear idea as to how much this diesel fuel will increase in price. It will be significantly higher than the 1999 EPA prediction of 4 to 5 cents per gallon. The second side is the question of engines designed to meet the EPA standards. New engines are rolling out slowly into the fleets of trucks. The ATA had wanted two years' worth of testing and creation of data from fleets with, and fleets without, the new engines. There has been very limited testing to date of the fleets (around 250 trucks). Economic choices, of course, would best be made from reliable data about truck performance in a wide variety of conditions. The ATA does not feel this has been accomplished. More thorough testing would give an indication as to how many trucks to purchase and when, according to the ATA. Right now, many fleets are pre-buying 2006 trucks to avoid the 2007 EPA mandate. Some see increased time for testing as a delaying game, while others might agree with the ATA and see it as a prudent measure. Regardless of being pro-EPA mandate or not, many cities stand condemned, and they can take no comfort in being better than China. The list indicates that California and Texas have a great deal of work to do.

Ten Most Polluted U.S. Cities (Ozone Rated Only)
1. Los Angeles (Long Beach, Calif., Riverside, Calif.)
2. Bakersfield, Calif.
3. Fresno-Madera, Calif.
4. Visalia-Porterville, Calif.
5. Merced, Calif.
6. Houston (Baytown, Huntsville, Tex.)
7. Sacramento (Arden, Calif., Arcade, Calif., Truckee, Nev.)
8. Dallas/Forth Worth
9. New York (Newark, N.J., Bridgeport, Conn.)
10. Philadelphia (Camden, N.J., Vineland, N.J.)

Source: American Lung Association (for 2005)

Below are the most polluted cities in China (and the world), according to China’s Environmental Protection Administration. Most of these cities are west of Beijing in central China and in the mountainous regions of Shanxi Province. The dominant pollution source is coal burning and less than adequate emissions performance from trucks and other vehicles.

Most Polluted Cities In China (And The World)
1. Linfen, Shanxi Province
2. Yangquan, Shanxi Province
3. Datong, Shanxi Province
4. Shizuishan, Ningxia Hui Autonomous Region
5. Sanmanxia, Henan Province
6. Jincheng, Gansu Province
7. Shijiazhuang, Hebei Province
8. Xianyang, Shanxi Province
9. Zhuzhou, Hunan Province
10. Luoyang, Henan Province
Robert Malone

Daytime TV tied to poorer mental scores in elderly Yahoo! NEWS
Older women who say talk shows and soap operas are their favorite TV programs tend to score more poorly on tests of memory, attention and other cognitive skills, researchers reported Monday. That doesn't mean that daytime television is a brain drain, they say, since it's not clear that there's a direct relationship between the two. But the findings do point to some association between TV choices and intellectual function, and that could prove useful in evaluating older people for cognitive decline, according lead investigator Dr. Joshua Fogel of Brooklyn College of the City University of New York. A study of 289 older women without dementia found that those who rated talk shows and soaps as their favorite programs performed more poorly on tests of memory, attention and mental quickness than their peers who cited other types of shows. What's more, they were at greater risk of showing signs of clinical impairment. For example, compared with women who preferred to watch news programs, those who favored soaps were more than seven times more likely to show signs of impairment on one of the tests, while talk show fans were more than 13 times more likely to demonstrate impairment. "Those findings are quite robust," Fogel told Reuters Health He said it's not possible to tell whether the programs somehow contribute to cognitive decline or whether women in the early stages of decline gravitate toward those shows. Preferences for daytime TV could also be a marker of a sedentary, homebound lifestyle, and research suggests that staying physically and socially active can help stave off mental decline. But regardless of the reasons, a preference for talk shows and soaps "is a marker of something suspicious," Fogel said. He believes that doctors could ask older patients about their favorite TV shows as one way of spotting those who might need more screening for cognitive decline. "It's really a simple, friendly question to ask," Fogel said. The findings, which are published in the Southern Medical Journal, are based on questionnaires and standard cognitive tests completed by 289 women ages 70 to 79. None had dementia or physical disabilities and the researchers factored in variables such as education, race, depression and history of heart attack, high blood pressure or diabetes. Even with those factors considered, TV habits were related to cognitive performance. According to Fogel, a potential explanation rests in the fact that talk shows and soap operas involve so-called "parasocial relationships," where viewers feel a connection to a show's characters or host. Such shows may, for instance, be better able to hold the attention of older women with some cognitive impairment. "This doesn't mean 'Oprah' is bad for you," Fogel said. However, an older woman's fondness for the show could signal a possible problem, according to the researcher. Asking patients about TV viewing and other daily activities could be "very useful" in assessing their cognitive health, according to Dr. Joe Verghese of Albert Einstein College of Medicine in New York. But it's not time to toss the remote control, he writes in an accompanying editorial. Some programs, Verghese notes, might actually benefit intellectual functioning, and TV watching can help some people manage their stress levels.
By Amy Norton

Ebola Test Urgent Amid Globalism
http://www.terradaily.com/reports/Ebola_Te..._Globalism.html

Washington (UPI) Mar 21, 2006 - A rapid, inexpensive blood test that can identify 10 viral hemorrhagic diseases, including the Ebola virus and yellow fever, has been developed by researchers at the Mailman School of Public Health at Columbia University.

March 22, 2006
Flaw Seen in Genetic Test for Breast Cancer Risk
By ANDY POLLACK
The widely used genetic test for breast cancer risk can miss mutations that help cause the disease, according to a new study, a finding that is likely to increase the pressure to develop more thorough testing methods.

The test, which looks for mutations in genes called BRCA1 and BRCA2, missed them in about 12 percent of breast cancer patients from families with multiple cases of breast or ovarian cancer, according to the study's authors at the University of Washington.

Experts cautioned that the chances of such false negative results were much smaller for women who were not from such high-risk families, so that most women who tested negative had little cause for concern.

In addition, experts said that even Ashkenazi Jews, who have a relatively high incidence of mutations, tend to have specific types that are not likely to be missed by the test. In addition, if a woman is tested for the same specific mutation her mother has, the test is not likely to miss it if it is there.

Still, experts said women in families with multiple cases of breast and ovarian cancer should take precautions as if they had a mutation, even if none was found.

"Everyone who has a strong family history and is negative should be considering how negative that result really was," said Dr. Judy E. Garber, director of the cancer risk and prevention program at the Dana-Farber Cancer Institute in Boston.

The new study, being published in The Journal of the American Medical Association, is likely to increase the pressure on Myriad Genetics, which offers the test.

The company, based in Salt Lake City, has long been the focus of controversy because its patents give it a monopoly on the test, for which it charges as much as $3,000. Some geneticists say the monopoly has slowed development of better testing.

"A fuller testing process would include more than one technology, and competition would enable that to develop," Mary-Claire King, a professor of medicine and genome sciences at the University of Washington and senior author of the paper, said in an interview.

Professor King said a technique that could detect many of the missed mutations was already available in Europe but not in the United States, except in research projects.

Dr. Gregory C. Critchfield, president of the genetic testing division of Myriad Genetics, denied that the company's monopoly had impeded progress. The company hoped to have a more thorough test available by the end of the year, Dr. Critchfield said.

Five percent to 10 percent of breast cancers in white women in the United States stem from inherited mutations in the BRCA genes. Tens of thousands of women a year get the test, Myriad Genetics said.

Women with a mutation have a much higher risk of getting breast or ovarian cancer than the general population. Such women usually undergo more frequent screening to try to catch the cancer early, when it is more treatable. Some women opt to have their ovaries or breasts removed to prevent the disease.

Experts have long known that Myriad Genetics's test misses certain types of mutations it is not designed to detect. But the new study is believed to be the most extensive effort to quantify how often that occurs.

"We've known parts of the story but she's pulled it together very well," Dr. Lynn Hartmann, a professor of oncology at the Mayo Clinic, said of Dr. King.

Dr. King and her co-authors studied 300 women who had negative test results and who came from families with four or more cases of breast or ovarian cancer. The authors used various testing techniques beyond the one used by Myriad Genetics and found mutations in 35 of the women. None of the 30 Jewish women in Dr. King's study were found to have mutations undetected by Myriad Genetics.

Dr. Critchfield of Myriad Genetics said only 6 percent of the women who got the test came from such high-risk families. If the test is wrong for 12 percent of them, he said, then the rate of false negatives for all women tested is less than 1 percent.

The Myriad Genetics test looks for mistakes in the sequence of genetic letters in parts of the gene that contain the recipe for proteins. But it can miss errors in other parts of the gene, or deletions and duplications of chunks of DNA.



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March 22, 2006
Researchers Find New Details on Transmission of Avian Flu
By NICHOLAS WADE
Two groups of researchers, in Japan and in Holland, have discovered why the avian flu virus is transmitted rarely if ever from one person to another.

The reason is simply that the cells bearing the type of receptor the avian virus is known to favor turn out to be clustered in the deepest branches of the human respiratory tract. The viruses thus cannot be spread by coughs and sneezes, as are human flu viruses which infect cells in the upper respiratory tract.

The avian flu virus would need to accumulate many favorable mutations in its genetic material before it could become a pandemic strain, said Yoshihiro Kawaoka, a virologist at the both the University of Tokyo and the University of Wisconsin. According to a press statement he approved, "The finding suggests that scientists and public health agencies worldwide may have more time to prepare for an eventual pandemic."

Dr. Kawaoka's finding is published in today's issue of Nature and a similar finding, by Thijs Kuiken and colleagues of the Erasmus Medical Center in Rotterdam, appears in this week's Science.

Flu experts already knew that those attacked by the current avian flu virus, a type known as H5, were infected in the lower lung.

Paul Offit, a virologist at the Children's Hospital of Philadelphia, said the new reports made a lot of sense in explaining why the H5N1 virus, though it can infect people, does not easily spread from one person to another, making its outbreaks very limited.

Virologists agree that another flu pandemic will happen sooner or later as one of the 16 types of flu virus in the animal world, probably one that infects birds, will manage to switch hosts and grow and spread in humans. But they differ as to whether H5 is the likeliest candidate to make this switch. Previous known pandemics have been caused by H1 type viruses (the 1918 pandemic), H2 (the 1957 Asian) or H3 (the Hong Kong flu of 1968).

The H5 strain of avian flu has been infecting people since the late 1950's but has so far failed to develop a form that is easily transmissible from one person to another. Some virologists believe it could easily do so because it may only need better transmissibility to set off a pandemic. That could be obtained simply by switching its preference from the cell receptor found in the lower lung, known as alpha 2-3, to the receptor found on cells in the upper airways, known as alpha 2-6.

A team of scientists at the Scripps Research Institute reported in Science last week that only a couple of mutations might be needed to enable the H5 virus to make this switch to the alpha 2-6 receptor. This is about the same number of mutations as made by the H1, H2 and H3 viruses when they learned to infect people. Since viruses mutate quickly, a two-mutation step is not so big a hurdle.

Because the H5 virus has killed about half of the 187 people it has so far infected, "a lot of its genes are already optimized for virulence," said James C. Paulson, a member of the Scripps team. For H5 to become pandemic, "The key gene that needs to be mutated is the HA gene," he said, referring to the hemagglutinin gene, which makes the probe used by the virus to latch on to a cell's receptor sites.

But though H5 might seem only a couple of easy steps away from transmissibility among people, many virologists believe mutations in several other genes would be necessary as well. Viruses find it very hard to switch hosts, and though they may quite often cause outbreaks in just a few individuals, "viruses that produce a self-sustaining chain of transmission in the new host appear rare," Dr. Kawaoka wrote recently in the Annual Review of Microbiology,

The H5 virus has been present in the human population since the late 1950's, but has never acquired the full set of mutations needed to set off a pandemic. The epidemiological evidence "should make us feel safe that there's a substantial barrier," Dr. Offit said.

Dr. Offit said it was a good thing to worry about the next pandemic, given that about three can be expected every century. "What's not good is to try to sell the public on their fear of pandemic flu being this particular bird flu, since if it's not, crying wolf will lose you credibility," he said.

Peter Palese, a virologist at the Mount Sinai School of Medicine, said he did not believe the H5 virus could infect people, except when they were exposed to very large doses, such as by sleeping with chickens in the same room. "I feel strongly that H5 has been around in humans for a long time and never caused a pandemic, suggesting that this is not the virus which is likely to be the next pandemic."

But like Dr. Offit, Dr. Palese said he fully supported plans to get better prepared for the next flu pandemic. "People have to understand we are not really prepared should it come," he said.



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March 23, 2006
Younger Breast Cancer Patients More at Risk: Study
By REUTERS
Filed at 8:46 a.m. ET

LONDON (Reuters) - Young women under 45 years old diagnosed with early breast cancer have a higher risk of dying from the disease than older patients, scientists said on Thursday.

``The younger the woman, the poorer the chance of survival,'' said Dr Vincent Vinh-Hung, of University Hospital in Brussels.

Breast is the most common cancer in women, with more than a million new cases detected worldwide each year. Most are in women over 50 -- the disease is rare in young women.

But Vinh-Hung told Reuters that although only a small fraction of early breast cancers occur in young women, they account for a disproportionate percentage of deaths.

In a study of 45,000 breast cancer patients presented at the 5th European Breast Cancer Conference in Nice, France, Vinh-Hung and his colleagues found that the odds of dying from breast cancer rose by 5 percent for every year that a woman was under 45 when diagnosed.

They focused on women with early breast cancer which had not spread beyond the breast and whose tumors were less than 2 cm (0.8 inches) in size.

Doctors had previously suspected that the poorer prognosis in young women was due to being diagnosed later with a more advanced cancer. Breast tissue in younger women is usually denser which can make detecting a tumor more difficult.

Younger women may also ignore a suspicious lump in their breast thinking it is harmless or that they are too young to have breast cancer.

But Vinh-Hung said the findings suggest that in young women, age, more than other factors, affects the chance of survival.

He and his team suspect there may some type of unknown genetic damage that may increase the chances of developing the disease early and contribute to the poor prognosis in younger patients.

A family history of breast cancer, early puberty, late menopause, not having children or having them late and genetic mutations are risk factors for breast cancer.



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CDC Reports Increase in Resistant TB
By MIKE STOBBE, Associated Press Writer
2 hours, 3 minutes ago



Health officials said Thursday they are seeing what appears to be a disturbing increase around the world in tuberculosis infections resistant to both the first- and second-line antibiotics used against TB.

"It's basically a death sentence. If people are failing first- and second-line drugs and we don't have in the pipeline a new drug for immediate use, that's a crisis," said Dr. Marcos Espinale, executive secretary of the World Health Organization's Stop TB Partnership.

The CDC and WHO surveyed a network of 25 tuberculosis laboratories on six continents from 2000 to 2004 and found that one in 50 TB cases around the world is resistant not only to the usual first-choice TB treatments, but also to many medications that represent the second line of defense.

The survey represents the first international data on what is being called "extensively drug-resistant" TB.

For more than a decade, health officials have worried about "multidrug-resistant" TB, which can withstand the mainline antibiotics isoniazid and rifampin. One in five TB cases falls into that category, according to the survey.

But the survey also found many cases of a more difficult form of TB — one that does not respond to at least three of six classes of second-line drugs. That is especially worrisome, because second-line drugs are generally considered more toxic and less effective.

"These are individuals who are virtually untreatable with available drugs," said Dr. Kenneth Castro of the CDC.

The survey looked at 17,690 TB cases that were analyzed for drug susceptibility. Of those, 20 percent were multidrug-resistant and 2 percent were extensively drug-resistant.

The problem was worst in Latvia, where public health care deteriorated after the Soviet Union collapsed. Doctors believe TB develops resistance to drugs because some patients fail to complete a full course of medication.

In the United States, health officials looked at 169,654 TB cases from 1993 to 2004 that were analyzed for their drug response and found that 1.6 percent were multidrug-resistant and 0.04 percent extensively drug-resistant.

U.S. multidrug-resistant cases rose from 2003 to 2004, from 113 to 128. Though the number was small, it represented the largest single-year increase in more than 10 years. Ninety-seven of those 128 cases were in people born in other countries, mostly Mexico, the Philippines and Vietnam.

Overall, the TB rate in the United States has never been lower. In 2005, about 14,100 cases were reported, or 4.8 cases per 100,000 people. That is a 4 percent decline in the rate from 2004. However, the TB rate in foreign-born people in the United States was 8.7 times that of U.S. natives.

"Worsening resistance around the world poses a problem in the U.S.," Castro said.

Dr. Henry Blumberg, an Emory University medical school professor, said the figures are preliminary and the problem may be bigger than the numbers indicate.

Some drugs under development might become effective treatments for these difficult forms of TB. But CDC funding for TB control and research has not kept up with inflation in the past decade, Blumberg said.




Copyright © 2006 The Associated Press. All rights reserved. The information contained in the AP News report may not be published, broadcast, rewritten or redistributed without the prior written authority of The Associated Press.


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What Makes a Lefty: Myths and Mysteries Persist Yahoo! NEWS
Can openers, scissors and spiral-bound notebooks discriminate against lefties. Despite such challenges, 10 to 12 percent of the human population has historically preferred the left hand. Why doesn't the number ever waiver? Nobody knows for sure, but new research supports a body of evidence that suggests genetics have a hand in it all. In the meantime, the myth remains that lefties are more artistic. And the idea that left-handed fighters have an advantage persists on scant evidence, supported by Scottish lore and Rocky Balboa's heroics in the ring.

Look, Mom: Both hands!
Like many traits, handedness is probably determined by a complex interaction between genes and the environment, experts figure. Left-handers are more likely to have a left-handed relative. But researchers have yet to find the gene or set of genes that pick one hand over the other. Most scientists agree that handedness exists on a continuum. The idea helps explain why some people bowl with their left but hold a spoon in their right. Truly ambidextrous people, who have indifferent preference for either hand, are extremely rare. In a new study, researchers measured the width of elbows in living people and in skeletons from a medieval British farming community. The researchers assumed the 9-to-1 ratio of handedness would match the ratio of bigger right to left elbows. The prediction held true in the modern-day group, but not for the medieval bones. Most of the ancient farmers' left and right elbows were the same size. "It's obvious that they were using both hands equally," said anthropologist Amanda Blackburn from the University of Manitoba. "It's not fair to say they were ambidextrous in the true sense of the word, but they may have had a tendency to use both hands equally. It's a behavior they may have learned rather than just being born like that." The findings will be published in the April issue of the journal Current Anthropology.

Oppressing the left
Lefties have long suffered. In India and Indonesia, eating with the left hand is considered impolite. Chinese characters prove extremely difficult to write with the left hand. Not so long ago, teachers slapped the wrists of left-handed American elementary students. Humans have shown the ability to learn to use their non-preferred hand after injuries, when required to perform manual labor, or in the face of cultural pressure. Yet preference for handedness appears to take root in the womb, or even earlier. One genetic model, called the right shift theory and developed by psychologist Marian Annett at the University of Leicester, suggests that a single gene increases the likelihood of being right-handed. "The essence of my right shift theory is that there is a gene that helps to develop speech in the left hemisphere of the brain and increases the probability of right-handedness," Annett told LiveScience. Whatever evolutionary jog made humans left-brain dominant for speech also made us right-side dominant, Annett argues. Since our closest relatives—chimpanzees—can't talk, the gene must have arisen in recent evolutionary history. One study found most chimps prefer to fish for termites with their left hand. But other recent research shows most chimpanzees favor their right hand when throwing overhand. "The prevailing genetic model seems to be pretty strong. There are only a few weak points that are yet to be addressed. Not only can they not pinpoint a gene, there's conflicting data out there too," said David Wolman, author of "A Left Hand Turn Around the World" (Da Capo Press, 2005). In a twist on the genetic model, the gene for hand preference might also be the gene for hair whorl direction, the way a person's hair turns on the top of their head. Half of people with counterclockwise whorls prefer their left hand, according to research by Amar Klar at the National Cancer Institute. The same system that patterns hair and handedness could also play a role in the asymmetrical organization of the brain. "It is clear that the same genetics control both traits, along with the side of the brain where language is processed," said Klar.

The artistic myth
The answer to left-handedness is likely in the brain, and probably has to do with that organ's asymmetry, scientists generally believe. Somewhere in our lopsided brains is something, probably a gene or two that determines which hand prefers to throw a ball and which hand likes to write. Unfortunately, scientists can't open up someone's brain and see a sign for hand preference Wolman said. For anyone to move their left hand, or anything on their left side, instructions come from the right side of the brain. Motor centers of the brain control the hands; lefties have more dominant motor centers on the right side of their brain. But just because the directions come from the side of the brain associated with artistic function, doesn't mean a lefty's more likely to compose a Shakespearean sonnet. "The big myth is that the right side of the brain is somehow a creativity bull's-eye. That's not the case, and doesn't have anything to do with handedness. You need resources from both sides of your brain to be creative. All people use both sides of the brain," Wolman told LiveScience.

Fighting advantage
Lefties have had the upper hand in hand-to-hand combat since the Bronze Age, and even today, in the boxing ring. Left-handedness could be beneficial in times of violence, and genetically passed from one generation of fighters to the next, as shown by Charlotte Faurie and Michel Raymond of the University of Montpellier II in France. While a righty fought with a sword in his right hand and a shield in his left, a left-handed swordsman could make strong surprise attack on the opponent's unprotected right side. Recall Rocky Balboa's last-minute switch to his southpaw. The Kerr family of Scotland, known for sinister swordsmanship, went so far as to build Ferniehirst Castle with an unusual staircase that spiraled counterclockwise. The architecture provided left-handed fighters more freedom to swing their sword. Today, the common Scottish terms Kerr-handed, kerry-fisted and corry-fisted mean left-handed. The concept of lefties advantageously killing off all the righties doesn't hold strong, however. The 9-to-1 ratio of right- to left-handedness existed long before the advent of sword and shield warfare and continues to this day. Some researchers suggest prenatal levels of testosterone determine hand preference. Brain damage from trauma in the delivery room is another explanation. "Proud lefties cringe at the thought of it," said the left-handed Wolman. "The genetic model has wider support among the laterality community than brain damage at birth or levels of hormones in the womb," Wolman said. "At the end of the day, everyone seems to go back to the gene."

• Why You Can't Tickle Yourself
• Peace or War? How Early Humans Behaved
• How Fingerprints are Created
• The Biggest Popular Myths

Visit LiveScience.com for more daily news, views and scientific inquiry with an original, provocative point of view. LiveScience reports amazing, real world breakthroughs, made simple and stimulating for people on the go. Check out our collection of Amazing Images, Image Galleries, Interactive Features, Trivia and more. Get cool gadgets at the new LiveScience Store, sign up for our free daily email newsletter and check out our RSS feeds today!
Corey Binns, Special to LiveScience, LiveScience.com

http://upi.com/InternationalIntelligence/v...23-020654-3936r

Bird flu may threaten animals
By LAUREN MACK

UNITED NATIONS, March 23 (UPI) -- United Nations officials warn bird flu is a potential threat to biological diversity and a wide range of species including rare and endangered animals.

Experts attending a conference of the Convention on Biological Diversity in Curitiba, Brazil, said Wednesday there is growing evidence the H5N1 virus can infect cats, mammals and 80 percent of migratory and non-migratory birds. The CBD is administered by the U.N. Environment Program.

Big cats like leopards and tigers, small cats such as the civet, mammals like badgers and weasels and members of the crow and vulture families are some of the animals that may be impacted, said experts. They suspect the highly refined olfactory systems of some mammals may make them particularly susceptible to infections like bird flu.

Experts at the conference called for increased monitoring of wild birds and mammals, more training of wildlife and veterinarian staff, vaccination of rare species in the wild and in zoos, and compensation for owners of culled poultry as ways to protect biological diversity. Biodiversity is the term given to the variety of life on Earth and the natural patterns it forms.

"Firstly, that the impact on biological diversity and on species may be far wider and more complex than might have been initially supposed," Ahmed Djoghlaf, CBD executive secretary, told conference attendees. "Secondly, that it is in many ways a threat of our own making. For example, reduced genetic diversity in domestic animals like poultry in favor of a 'monoculture' in the last 50 years has resulted in a reduction of resistance to many diseases."

"There is also growing evidence that a healthy environment can act as a buffer against old and the emergence of new diseases whereas a degraded one favors the spread of infections. If we are to realize international targets on fighting poverty by 2015 and on conserving biodiversity by 2010, we must urgently address these key links," said Djoghlaf.

Culling wild birds and draining resting sites like wetlands would do more harm than good, said the specialists. Such a move -- especially in developing countries where chicken is a key source of protein -- may lead to people turning to "bushmeat," which, in turn, may put pressure on a wider range of animals including wild pigs, chimpanzees and gorillas as people seek out alternative meat to eat.

The loss of predators from some habitats could trigger an abundance of pests like mice and rats which could lead to a rise in human and animal infections, according to the specialists.

Concern is particularly high for countries like Vietnam, which is a big poultry producer, and countries with extraordinary bird biodiversity like Brazil. Some islands like Hawaii, Galapagos, the Seychelles and Mauritius may want to consider a ban on poultry and wild birds to protect their biodiversity, said the experts.

A big contributor to spreading bird flu may be the illegal trade of animals across borders, they added, calling for an increase in surveillance and tougher penalties for illegal traders.

In an effort to encourage people to report potential outbreaks of the virus, experts have suggested governments give compensation to owners of culled poultry in poor countries.

Since the first human case of the latest avian influenza outbreak was reported in January 2004, U.N. agencies have been working with health organizations and government agencies to curb the spread of the deadly disease.

There have been 184 cases of bird flu including 103 deaths since 2003 and more than 150 million domestic birds have died or been collected in an effort to curb the spread the current outbreak, according to the World Health Organization.

Avian influenza was first identified 100 years ago during an outbreak in Italy and has cropped up several times since. The first documented cases involving humans infected with bird flu occurred in Hong Kong in 1997 and 1998. Hong Kong's entire poultry population, estimated at around 1.5 million birds, was destroyed in three days which probably averted a pandemic, said the WHO.

The disease is highly contagious and spread by excrement from migratory birds and from human interaction with infected animals. H5N1 is a particular concern because it mutates rapidly, said the WHO.

Migratory waterfowl, like wild ducks, are a natural reservoir for the virus, and are the most resistant to infection. Domestic poultry, including chickens and turkeys, are particularly susceptible.

The WHO has warned the virus could evolve into a human influenza pandemic that could kill tens of millions of people if it mutates into a form which could transmit easily between people. U.N. health officials have said a human flu pandemic is inevitable.

http://upi.com/ConsumerHealthDaily/view.ph...22-033044-9230r

Capital tries to stem HIV/AIDS epidemic
By CHRISTINE DELL'AMORE
UPI Consumer Health Correspondent

WASHINGTON, March 22 (UPI) -- In a city where new AIDS cases have reached 10 times the national average, government and community leaders here have taken promising steps to halt the disease, yet in many areas they continue to falter, a report card released today shows.

The DC Appleseed Center for Law and Justice graded the city in 12 areas originally targeted by their landmark August 2005 report, "HIV/AIDS in the Nation's Capital," which illuminated a dearth of leadership and coordination in fighting HIV/AIDS.

"We want to applaud and celebrate where steps forward have occurred, but criticize and lament where steps have not been taken," said Walter Smith, executive director of DC Appleseed, an independent non-profit. "We're talking about an issue that is of life-and-death consequence in the nation's capital."

The Washington AIDS Partnership, a local grant-making organization, commissioned the DC Appleseed report to address grave concerns about city leadership and a lack of overall data on the epidemic.

Since the document surfaced, a "surge of constructive energy" has motivated reforms in the district, where one in 20 residents is infected with the virus, the report card states. The district is thought to have the highest rate of HIV/AIDS in the country: New AIDS cases hit 179.2 per 100,000 residents in 2004, vs. 15.0 cases per 100,000 nationwide.

The district government has also embraced the DC Appleseed report as a blueprint for change, and Mayor Anthony Williams has publicly committed to putting the recommendations in action.

Although the six-month report card did not assign an overall grade to the district's efforts, the mixed grades reflect a city still struggling to come to grips with a public-health quagmire.

In the arena of leadership, city officials earned a relatively high grade -- B minus -- for working to make HIV/AIDS a top health priority. On Aug. 11, the day after the DC Appleseed report was released, Williams announced the formation of a task force that he would lead. The Administration for HIV Policy and Programs recruited 28 of the "best and the brightest" among corporate, government, non-profit and community entities, and the group will be officially announced very soon, Marsha Martin, director of the AHPP, told UPI.

The report has been a "rallying document" for the Washington community, said Martin, who was hired to head the agency a few weeks after its publication.

"Everybody would say unequivocally there is a renewed, reinvigorated energy of the government about HIV," she added.

Martin also emphasized although the DC Appleseed report is a useful tool, it is not the only way to bring about change.

This new leadership in the HIV office is substantial, said Washington Councilmember Jim Graham, who was the executive director of Whitman Walker Clinic from 1984 to 1999. Whitman Walker is the largest provider of care and services for people living with AIDS in the district.

"If you don't have confident people at the helm, you're whistling in the wind," he added.

Still, many of the leaders who rally against HIV do so in a hushed tone.

"With HIV, it can't be done quietly," said Josh Levinson, deputy director of DC Appleseed, who works with the HIV project. "You have to be loud, you have to be vocal, because at the end of the day, this is about sex and drugs."

Perhaps the most crucial issue in the report is data and surveillance, or how the city tracks infected people. DC Appleseed assigned an incomplete grade to this category, opting for a wait-and-see approach. Although the government attempts to collect data, their ability to do so is limited. For instance, AHPP's Surveillance Division has a staff vacancy rate of more than 50 percent.

As a result, no one actually knows how many people are infected with the virus.

"Who would have thought 25 years into the epidemic, one of the biggest problems would be that we don't know what the problem is?" Levinson said.

Martin cautioned that the lack of data means the rate of infection could turn out less dismal than imagined.

"We don't have the survey capacity to really know how to discern what our epidemic looks like locally," she said.

But that might change with the AHPP's new partnership with the George Washington University School of Public Health and Health Services, which will oversee and improve the current surveillance program. The university also plans to recruit a Ph.D.-level epidemiologist to assist AHPP in collecting data.

The district's management of grants to community-based organizations has also become more efficient, earning a grade of B.

Roberta Geidner-Antoniotti, the interim executive director of the Whitman Walker Clinic, said her organization has run more smoothly since timely deliverance of grants.

The district's public school system got a B minus for adopting revised health education curricula, which includes HIV prevention material. Barbara Rockwood, the executive director for health, physical education and athletics for the system, refrained from describing the particulars of the new health education material, but it will likely appear in the classroom by 2007.

In addition, a separate resolution passed in September 2005 by the School Board will take a harder look at the efficacy of the HIV curriculum. However, the superintendent of schools, Clifford Janey, has not responded to the School Board's request to present a plan for HIV education.

On the downside, the city's track record on substance-abuse treatment has not improved, warranting a D plus. Recommendations by the mayor's Interagency Taskforce on Substance Abuse, Prevention, Treatment and Control have gone largely unnoticed; their 2005 annual report stated the district "is not making significant progress" toward its goal of reducing alcohol and drug abusers. Cutting drug use is a clear prevention strategy for contracting HIV.

The city has also failed to make condoms widely available. AHPP distributed only 290,000 condoms in 2004, falling short of its goal of 600,000. Condom distribution received a D grade from Appleseed.

The lack of condoms represents only one example of how much still needs to be done, said Channing Wickham, executive director of the Washington Aids Partnership.

"With numbers like 1 in 20, the issue is impossible to ignore, yet people have found a way to ignore it," Wickham said.

Most community and government leaders agreed the key is visibility -- the more people place a spotlight the epidemic, the more action will occur.

"The Appleseed report put into words what most of us in the community level already knew. But we finally have the curtains drawn on this problem," said Adam Tenner, director of Metro TeenAids, an organization supporting young people in the fight against HIV.

"Unlike a lot of reports that are left on the shelf when they're written, we want to make the Appleseed report a living document," Wickham said. "This is a chance for a fresh start for a lot of people."

Alzheimer's May Be Diabetes-Like Illness Yahoo! NEWS
Giving more weight to the notion that Alzheimer's may be a diabetes-like disease, researchers say rats depleted of insulin in the brain went on to develop an Alzheimer's-like illness. By depleting insulin and its related proteins in the rodent's brains, the researchers say they have been able to replicate the progression of Alzheimer's disease. This included amyloid plaque deposits, neurofibrillary "tangles," impaired cognitive functioning, cell loss, and overall brain deterioration. All of these are characteristic of Alzheimer's disease. "True Alzheimer's disease is a kind of insulin resistance in the brain," concluded lead researcher Dr. Suzanne M. de la Monte, a neuropathologist at Rhode Island Hospital and a professor of pathology and clinical neuroscience at Brown Medical School, in Providence, R.I. She called the study "very exciting," adding that it "leads to new concepts of how to treat the disease." According to the researchers, the study demonstrates that Alzheimer's is a brain-specific disorder, distinct from other types of diabetes, such as the inherited form, type 1, and obesity-linked type 2. "This study shows that Alzheimer's is a [new] type of diabetes," de la Monte said. "It's type 3 diabetes." Other experts remained unconvinced, however. "To date, the construct that Alzheimer's is type 3 diabetes remains largely unsupported," said Dr. Sam Gandy, chairman of the Medical and Scientific Advisory Council at the Alzheimer's Association and director of the Farber Institute for Neurosciences at Thomas Jefferson University, Philadelphia. The report appears in the March issue of the Journal of Alzheimer's Disease. According to de la Monte, a loss of insulin in the brain may trigger Alzheimer's onset because brain cells need insulin to function and survive. When this happens, oxidative stress increases, the brain deteriorates, and there is loss of cognitive function, plus a buildup of plaques and tangles in the brain, she said. Whether restoring insulin to the brain can slow or reverse the progression of Alzheimer's is something that de la Monte's team is looking at now in animals. "The results are under review," she said. "We are looking at a brain form of diabetes," de la Monte said. "One can look forward to approaches that may work in the brain which we already have available, or that might be modified to treat patients with neurodegeneration," she said. De la Monte is convinced that what doctors call Alzheimer's is really several different conditions under one umbrella. "We will have to develop ways to be certain who has what kind of neurodegeneration," she said. About 50 percent of patients diagnosed with dementia have Alzheimer's, de la Monte noted. "The others have a mixed condition or something else wrong with them," she said. "There are a number of conditions that people call Alzheimer's disease," de la Monte said. "People are developing ways of testing insulin resistance in the brain, which will be necessary to validate any therapy that comes out of this." However, one expert doesn't think that her team has yet made a convincing case for the theory. "The paper overreaches," said Gandy. He noted that de la Monte's group injected the rats' brains with Streptozotocin, the compound they used to inhibit local insulin production. So, it's not clear whether the brain changes her group noted were related to a lack of insulin, or this insult to the brain. "Streptozotocin, which causes oxidative stress, would be predicted to cause such stress in many tissues, including the brain," Gandy said. In addition, changes the researchers observed in the brains of the mice were only modest, with no clear structural pathology evident, he said. Another expert believes insulin's role in Alzheimer's may only be part of the picture. "There is definitely speculation that insulin is linked to Alzheimer's," said Dr. Zoe Arvanitakis, an assistant professor of neurological sciences at Rush University Medical Center, in Chicago. "But given the complexity of the illness, it is probably unlikely that addressing a single mechanism of illness, for example giving insulin, is probably unlikely to cure the disease," Arvanitakis said. "It might help some people. It might help to some extent. But it is unlikely that a single approach will be the answer to the problem," she said. More information For more on Alzheimer's disease, head to the Alzheimer's Association.
By Steven Reinberg, HealthDay Reporter

Dozens Fight New Orleans Hospital Closure Yahoo! NEWS
Doctors, former patients and preservationists rallied outside a public hospital that closed in the wake of Hurricane Katrina, urging officials not to abandon the shuttered medical center. Charity Hospital, the city's only Level 1 trauma center, was closed after its basement flooded, ruining its electrical system. Officials have said the hospital cannot be saved because of asbestos in the interior and bacteria that flourished in the steamy, late-summer air after the Aug. 29 hurricane. "This hospital is not as damaged as they say it is," said Dr. James Moises, a former emergency room physician who resigned from the Louisiana State University-run Charity Hospital system so he could speak at the rally without violating a gag order imposed by hospital administrators. "Reopening our public hospital right now is the right thing to do," Moises said. The crowd of about 100 called Saturday for an independent group of architects and engineers to evaluate the building, saying they're skeptical of the findings by an LSU-hired consulting firm. LSU is working with the U.S. Department of Veterans Affairs to build a shared medical center in New Orleans. Hospital officials said it likely would be five years before the medical center could open. It's unclear how much the joint medical center — or LSU's individual hospital on the site — would cost. In the meantime, the system has opened small clinics in the New Orleans area, one in an old department store that also flooded after Katrina. Moises said he believed Charity could be reopened in a matter of weeks if there was the political will to do so. The state should not leave the city without a public hospital in the meantime, even if it means only reopening only parts of the building. The first Charity Hospital opened in New Orleans in 1736. The current building — a massive, multiple-wing, 21-story hospital built in 1939 of steel and pale limestone embellished with allegorical reliefs — was designed by Julius Dreyfous, who also helped design the Louisiana State Capitol in Baton Rouge.
By BRETT MARTEL, Associated Press Writer

March 27, 2006
Study: Pumping Iron Helps Cancer Survivors
By THE ASSOCIATED PRESS
Filed at 12:17 a.m. ET

ATLANTA (AP) -- Weightlifting appears to improve breast cancer survivors' outlook on life, suggests one of the first studies to scientifically measure the effects of such exercise.

About 80 percent of women who took up twice-a-week weight-training saw improved scores on a quality-of-life survey, researchers said, in a study to be published in an upcoming issue of the journal Cancer.

In contrast, 51 percent of participants in a control group did.

The physical and psychological benefits of exercise are well-documented. But this study is the first to apply scientific methodology to looking at how weight-training helps women who have had breast cancer.

''This may seem like common sense to most folks, but there's really been no literature or science where researchers tried to quantify and verify the effect,'' said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society.

Researchers recruited 86 women from the Minneapolis-St. Paul area in late 2001 and early 2002. Each of the women had completed successful treatment of breast cancer within the previous three years.

Half the women were assigned to an exercise group. For three months they met twice a week with personal fitness trainers to develop a weightlifting regimen. They were then encouraged to follow it for another three months.

The second group had no such regimen.

Researchers asked women in both groups a series of questions about physical well-being, marital happiness, sexual activity and other aspects of life.

Women in the exercise group had a modest improvement over members of the non-exercising group, Lichtenfeld noted.

However, the women in the exercise group said they felt they had more strength, speed and self-confidence as a result of the workouts. It appears the weightlifting helped them regain a feeling of control of their bodies, researchers said.

The more women improved on bench press, the better they said they felt overall. That may be because breast cancer treatment can reduce the ability to lift and carry things, said Kathryn Schmitz, a University of Pennsylvania researcher who co-authored the study.

The study also tried to observe weight-training's effect on depression. The researchers didn't measure any significant effect, but they said that might be because such a small number of women were deemed to suffer from depression at the outset of the study.



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March 27, 2006
Q&A
How Serious Is the Risk?
By DENISE GRADY and GINA KOLATA
Over the last year, it has been impossible to watch TV or read a newspaper without encountering dire reports about bird flu and the possibility of a pandemic, a worldwide epidemic. First Asia, then Europe, now Africa: like enemy troops moving into place for an attack, the bird flu virus known as A(H5N1) has been steadily advancing. The latest country to report human cases is Azerbaijan, where five of seven people have died. The virus has not reached the Americas, but it seems only a matter of time before it turns up in birds here.

Even so, a human pandemic caused by A(H5N1) is by no means inevitable. Many researchers doubt it will ever happen. The virus does not infect people easily, and those who do contract it almost never spread it to other humans. Bird flu is what the name implies: mostly an avian disease. It has infected tens of millions of birds but fewer than 200 people, and nearly all of them have caught it from birds.

But when A(H5N1) does get into people, it can be deadly. It has killed more than half of its known human victims—an extraordinarily high rate. Equally alarming is that many who died were healthy, not the frail or sickly types of patients usually thought to be at risk of death from influenza.

The apparent lethality of A(H5N1), combined with its inexorable spread, are what have made scientists take it seriously. Concern also heightened with the recent discovery that the 1918 flu pandemic was apparently caused by a bird flu that jumped directly into humans.

In addition, A(H5N1) belongs to a group of influenza viruses known as Type A, which are the only ones that have caused pandemics. All those viruses were originally bird flus. And given the timing of the past pandemics — 1918, 1957, 1968 — some researchers think the world is overdue for another. It could be any Type A, but right now (A)H5N1 is the most obvious.

The virus lacks just one trait that could turn it into a pandemic: transmissibility, the ability to spread easily from person to person. If the virus acquires that ability, a pandemic could erupt.

Everything hangs on transmissibility. But it is impossible to predict whether A(H5N1) will become contagious among people. The virus has been changing genetically, and researchers fear that changes could make it more transmissible, or that A(H5N1) could mix with a human flu virus in a person, swap genetic material and come out contagious.

But most bird flu viruses do not jump species to people. Some experts say that since A(H5N1) has been around for at least 10 years and the shift has not occurred, it is unlikely to happen. Others refuse to take that bet.

The A(H5N1) strains circulating now are quite different from the A(H5N1) strain detected in Hong Kong in 1997, which killed 6 of 18 human victims. Over time, A(H5N1) seems to have developed the ability to infect more and more species of birds, and has found its way into mammals—specifically, cats that have eaten infected birds.

The actual number of human cases may well exceed the number that have been reported, and may include mild cases from which victims recovered without even seeing a doctor. If that is true, the real death rate could be lower. But no one knows whether mild cases occur, or whether some people are immune to the virus and never get sick at all.

In the absence of more information, health officials must act on what they see — an illness that apparently kills half its victims.

Q. How will we know if the virus starts spreading from person to person and becomes a pandemic?

A. If there is a pandemic, it would be everywhere, not in just one city or one country. To detect such an event as early as possible there is an international surveillance system, involving more than 150 countries, that searches for signs that a new flu strain is taking hold in humans. One hallmark of a pandemic flu would be an unusual pattern of illnesses — lots of cases, possibly cases that are more severe than normal and, possibly, flu infections outside the normal flu season.

Ordinary human flu viruses, for reasons that are not entirely understood, circulate only in winter. But pandemics can occur at any time. A pandemic would also involve a flu virus that was new to humans, meaning that no one would have immunity from previous infections.

Q. If bird flu reaches the United States, where is it likely to show up first?

A. Although health officials expect bird flu to reach the United States, it is impossible to predict where it may show up first, in part because there are several routes it could take. If it is carried by migrating birds, then it may appear first in Alaska or elsewhere along the West Coast.

But if the virus lurks in a bird being smuggled into the United States as part of the illegal trade in exotic birds, it could land in any international airport. Bird smuggling is a genuine problem: in 2004, a man was caught at an airport in Belgium illegally transporting eagles from Thailand, stuffed into tubes in his carry-on luggage. The birds turned out to be infected with A(H5N1), and they and several hundred other birds in a quarantine area at the airport had to be destroyed.

In theory, an infected human could also bring bird flu into the United States, and that person could fly into just about any international airport and go unnoticed if the virus had yet to produce any symptoms.

Q. Does bird flu affect all birds?

A. No one knows the full story. Scientists say A(H5N1) is unusual because it can infect and kill a wide variety of birds, unlike a vast majority of bird flus, which are usually found in wild birds, not domestic fowl, and which cause few symptoms.

Some researchers suspect that wild ducks, or perhaps other wild birds, are impervious to A(H5N1), and may be the Typhoid Marys of bird flu — getting the virus, spreading it to other birds but never becoming ill themselves. No one has good evidence of this yet, but that may be because the way scientists discovered A(H5N1) infections was by finding birds that had gotten the flu and died.

As virologists like to point out, dead birds don't fly. So migratory birds cannot spread the virus if they are dying shortly after being infected. That is why some researchers say that if wild birds are spreading the A(H5N1) virus, it must be a bird species that can be infected but does not become ill.

Q. When people die from avian flu contracted from birds, what kills them?

A. Like victims of severe pneumonia, many patients die because their lungs give out. The disease usually starts with a fever, fatigue, headache and aches and pains, like a typical case of the flu. But within a few days it can turn into pneumonia, and the patients' lungs are damaged and fill with fluid.

In a few cases, children infected with A(H5N1) died of encephalitis, apparently because the virus attacked the brain. A number of people have also had severe diarrhea — not usually a flu symptom — meaning that this virus may attack the intestines as well. Studies in cats suggest that in mammals the virus attacks other organs, too, including the heart, liver and adrenal glands.

But more detailed information about deaths in people is not available because very few autopsies have been done. In some countries, like Vietnam, where many of the deaths occurred, autopsies are frowned upon. Researchers say they may glean useful information from autopsies, but fear that pressing for them would alienate the public in some areas.

Q. When experts refer to bird flu as A(H5N1), what does that mean?

Click here to see the answer.

Q. If I got bird flu, how would I know?

A. There is no reason to suspect the disease unless you may have been exposed to it. Since the virus has not reached North America, doctors do not look for bird flu in people unless they have traveled to affected regions or have been exposed to sick or dead birds.

The early stages of the illness in people are the same as those of ordinary flu: fever, headache, fatigue, aches and pains. But within a few days, people with bird flu often start getting worse instead of better; difficulty breathing is what takes many to the hospital.

In any case, patients with flulike symptoms that turn severe or involve breathing trouble are in urgent need of medical care.

Q. Can I be tested for avian flu?

A. There is no rapid test for bird flu. There is a rapid test for Type A influenza viruses, the group that A(H5N1) belongs to, but the test is only moderately reliable, and it is not specific for A(H5N1).

State health departments and some research laboratories can perform genetic testing for A(H5N1) and give results within a few hours, but they do not have the capacity to perform widespread testing.

Because of the limited availability of testing and the extremely low probability of A(H5N1) in people in the United States, the test is recommended only for patients strongly suspected of having bird flu, like travelers with flulike symptoms who were exposed to infected birds.

Q. Do any medicines treat or prevent bird flu?

A. Two prescription drugs, Tamiflu and Relenza, may reduce the severity of the disease if they are taken within a day or two after the symptoms begin. But Relenza, a powder that must be inhaled, can irritate the lungs and is not recommended for people with asthma or other chronic lung diseases.

Both drugs work by blocking an enzyme — neuraminidase, the "N" part of A(H5N1) — that the virus needs to escape from one cell to infect another. But just how effective these medicines are against A(H5N1) is not known, nor is it clear whether the usual doses are enough. Also unknown is whether the drugs will help if taken later in the course of the disease. Although government laboratories and other research groups are trying to develop vaccines to prevent A(H5N1) disease in people, none are available yet.

Q. If there is an epidemic of flu in humans, how can I protect myself?

A. If there is a vaccine available, that would be the best option. But if there is no vaccine it may be hard to avoid being infected. Flu pandemics spread quickly, even to isolated regions. The 1918 flu reached Alaskan villages where the only way visitors could arrive was by dog sled.

The vaccines produced every year to prevent seasonal flu are unlikely to be of any use in warding off a pandemic strain. But a flu shot could provide at least some peace of mind, by preventing the false alarm that could come from catching a case of garden-variety flu.

Similarly, people over 65 and others with chronic health problems should consult their doctors about whether they should be vaccinated against pneumococcal pneumonia, a dangerous illness that can set in on top of the flu. Again, that vaccine will not stop bird flu, but it may prevent complications.

Some health officials have recommended stockpiling two to three months’ worth of food, fuel and water in case a pandemic interferes with food distribution or staffing levels at public utilities, or people are advised to stay home.

Many health experts have advised against stockpiling Tamiflu or Relenza, the prescription-only antiviral drugs that may work against bird flu. Doctors say the drugs are in short supply and hoarding may keep them out of reach of people who genuinely need them.

Also, they say, self-prescribing may lead to waste of the drugs or misuses that spur the growth of drug-resistant viruses. But people may not trust the government to distribute these drugs, and may want their own supplies. Doctors say people can take precautions like avoiding crowds, washing their hands frequently and staying away from those who are sick. Masks may help, but only if they are a type called N-95, which has to be carefully fitted. So far, masks and gloves have been recommended only for people taking care of sick patients.

Avoiding the flu can be hard because it is not always possible to spot carriers. Many people get and spread flu viruses and but never know they are infected.

Q. Is the government prepared for a bird flu pandemic?

A. No. The nation does not have an approved flu vaccine for people or enough antiviral drugs or respirators for all who would need them. The best protection in any flu pandemic will come from a vaccine, but scientists cannot tell ahead of time what strain the vaccine should protect against.

Efforts are under way to make a vaccine for A(H5N1). But the virus could mutate in a way that makes experimental vaccines ineffective, requiring more than one vaccine.

Moreover, there is no assurance that the next pandemic will even involve A(H5N1). It may involve a different strain of bird flu, and an A(H5N1) vaccine would not work for it. Recent efforts to develop a sort of universal flu vaccine that would work across strains have failed.

For now, the hope is to spot a pandemic early and quickly make a vaccine. Investigators are developing new and better ways to make vaccines — a bird flu, for example, cannot be grown in fertilized eggs like other flu viruses because it kills the chicken embryos — but these new methods must first be approved by the Food and Drug Administration.

Preparations also include government plans to stockpile drugs to protect people who were exposed to the flu and to reduce the severity of the disease in those who are ill. But the one antiviral drug that everyone wants to buy and stockpile, Oseltamivir, also sold by Roche as Tamiflu, is in short supply.

In retrospect, scientists say, maybe the nation should have started preparing sooner. But until the current bird flu appeared, there was little interest in such expensive and extensive preparations.


Graphic: Stockpiling Drugs

Q. If bird flu reaches the United States, will it be safe to eat poultry or to be around birds or other animals?

A. Poultry is safe to eat when it is cooked thoroughly, meaning that the meat is no longer pink and has reached a temperature of 180 degrees Fahrenheit. The risk is not from cooked meat — cooking kills viruses. Instead, it is from infected birds that are still alive or have recently died. So the person who killed an infected chicken, butchered it or put it in the pot would be at greater risk than the one who ate it.

It's not clear how long the virus lives on a dead bird, but it is unlikely to survive more than a couple of days. And it seems unlikely that infected chicken will find its way to supermarkets.

If the bird flu strikes poultry farms, the farmers will know there is a problem. Before they die, the birds develop major hemorrhages, with blood streaming from their cloacas and beaks. When the flu gets to a poultry farm, farmers have to destroy their flocks, and poulgreater risk than the one who ate it.

It's not clear how long the virus lives on a dead bird, but it is unlikely to survive more than a couple of days. And it seems unlikely that infected chicken will find its way to supermarkets.

If the bird flu strikes poultry farms, the farmers will know there is a problem. Before they die, the birds develop major hemorrhages, with blood streaming from their cloacas and beaks. When the flu gets to a poultry farm, farmers have to destroy their flocks, and poultry from infected farms cannot be sold for meat.

As for contact with healthy birds or animals, there is no need to panic. The A(H5N1) virus is a nasty one. If chickens or other animals became infected they would get sick and die, and you would know the virus was present.

But animals can carry many diseases besides influenza, and whenever you are around animals it is a good idea to wash your hands afterward. Because cats in Europe have caught A(H5N1), apparently from eating infected birds, health officials there advise keeping pet cats indoors, but no such recommendation has been made in the United States.

For now, officials at the Centers for Disease Control and Prevention say it is safe to have bird feeders, and they note that even if the virus does arrive here, the kinds of birds that perch at feeders are far less likely to carry A(H5N1) than are aquatic birds like ducks and geese.

Q. Is it safe to buy imported feather pillows, down coats or comforters and clothing or jewelry with feathers?

A. Imported feathers may not be safe. There is a risk to handling products made with feathers from countries with outbreaks of bird flu, according to the Centers for Disease Control and Prevention. Feathers from those countries are banned in the United States unless they have been processed to destroy viruses.



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March 28, 2006
Making a Ferret Sneeze for Hints to the Transmission of Bird Flu
By DENISE GRADY
ATLANTA — One way to collect nasal secretions from a ferret is to anesthetize it, hold a petri dish under its snout and squirt a little salt water up its nose so that it will sneeze into the dish.

At the Centers for Disease Control and Prevention, ferret sneezes are frozen in tiny vials and locked up in a high-security chamber called an enhanced biosafety Level 3 laboratory. It takes a fingerprint scan to get in, and an iris scan to open the freezer. Scientists wear scrub suits, gowns, double gloves and hoods, breathe filtered air and open vials only by reaching into a safety cabinet designed to keep germs from escaping into the air.

The vials are in this lab because the animals have been exposed to A(H5N1), the notorious avian flu virus that has swept across Asia, Europe and Africa, wiping out flocks of poultry and sometimes killing people as well. Researchers at the disease centers and in other labs are studying the transmission and virulence of bird flu in ferrets and mice, trying to answer questions that take on more urgency as the virus advances.

"We have never had a situation like the world is experiencing today, such an unprecedented spread among poultry," said Dr. Timothy Uyeki, an epidemiologist and influenza expert at the disease centers. "The geographic spread is unprecedented, and the mortality unprecedented as well, and this virus has been clearly confirmed to transmit directly from poultry to people and to cause severe and fatal illness."

The big question is, will A(H5N1) cause a human pandemic? Many scientists think the world is overdue for one and find it worrisome that this dangerous virus has popped up now. Even so, in its present form this flu does not seem to be a pandemic germ because it does not spread easily from birds to humans, and because infected people rarely transmit it to others. But everything could change if the virus were to mutate in a way that made it easier for people to catch and spread.

"Why would a particular virus be transmitted easily human to human, and another not?" asked Dr. Peter Palese, chairman of microbiology at the Mount Sinai School of Medicine in New York. "Even though I am 35 years in this field, we do not have molecular parameters or signatures which make that clear, although many groups, including my own, are working on this exact question."

The virus is a moving target, and two distinct subsets of it have developed, one from Vietnam and one from Indonesia, that differ enough to make scientists think separate vaccines will be needed. Scientists are trying to understand how a virus can be wildly contagious among birds but almost impossible to spread in mammals — and what type of mutation could change that. They are also comparing different strains of A(H5N1) to see if it is becoming more virulent, and they are examining the structure of the virus in hopes of figuring out what makes it so deadly.

Ferrets are used for some studies because, unlike mice, they easily catch human flu viruses and get sick, and so are considered a better model for people. At the disease centers, Taronna Maines and Terrence Tumpey have infected ferrets with A(H5N1) and then monitored them to see if the severity of the disease varies by strain and by dose, and to see if the infected animals cough up the virus or sneeze it out and spread it to healthy ones.

It turns out that ferrets do not transmit the disease easily, though some healthy animals develop antibodies to the virus, indicating that they have been exposed. If a strain comes along that is contagious in ferrets, it might be bad news for people.

Research like this may help determine whether (A)H5N1 is heading down the path to becoming a pandemic strain, and may also help to guide the development of vaccines and drugs.

Aside from the virus's recent horrible track record, several other things about it can help explain why some scientists worry that it has pandemic potential. The A means it belongs to a larger group known as Type A influenza viruses, which cause many of the human flu epidemics that occur every winter. But more ominously, Type A also includes the only viruses ever known to have caused human pandemics, in 1918, 1957 and 1968.

Flu viruses mutate a lot, and pandemics occur when a Type A virus undergoes a big genetic change to produce a new type of virus to which people have little or no resistance. Sometimes the change occurs when a person or a pig acts as a "mixing vessel" for two flu viruses — maybe a human one and a bird one — which swap genes to produce a new virus. That kind of change is believed to have caused the 1957 and 1968 pandemics. But the 1918 pandemic, the worst by far, is thought to have occurred without a gene swap, when a bird flu somehow mutated enough to jump into humans.

All Type A viruses are found in birds. They probably originated in wild birds and usually do them little or no harm. Only a few evolved into strains that could easily infect people. A(H5N1) is not adapted to people, and researchers suspect that human victims so far may have been infected because they were exposed to enormous amounts of the virus from birds.

The letters H and N stand for two proteins on the outside of all Type A viruses. The H, hemagglutinin, helps the virus get into cells, which it must do to reproduce. The N, neuraminidase, helps it get back out to infect more cells. There are 16 kinds of H and 9 kinds of N; they mix and match, and so can produce 144 possible Type A strains. The worrisome thing about H5 is that H5 viruses are avian flus and have not been known to cause human epidemics, so many people may have little or no resistance to them.

Not long ago, A(H5N1) may well have been what scientists call a perfect parasite, meaning one that does little harm to its host, Dr. Ruben Donis, a flu expert at the disease centers. said. Some wild ducks seem to carry it without getting sick at all, so scientists think that ducks were probably its original host and that the two evolved together into a peaceful coexistence: the virus did not hurt the duck, and the duck's immune system ignored the virus. Thriving in the bird's intestines, the virus multiplied rapidly and was spread far and wide by droppings. Other aquatic birds may have adapted in a similar way.

Not so for chickens or other domestic fowl: A(H5N1) attacks their lungs and other organs, and it quickly kills them. But the chicken's immune system tries to fight back, and that battle may alter the virus. The bird may fight off some viruses, ones with certain mutations. Other viruses survive, multiply and become more common. And since they have beaten out the chicken's immune system, they may also be nastier.

It is just a theory, but some scientists suspect that its forays into huge poultry flocks may have brought out more virulent forms of A(H5N1), which may explain why the virus now seems to be killing off more wild birds than in the past. At the same time, the virus has begun to invade more species, including mammals — infected cats, pigs and dogs have been reported. Researchers consider that a bad sign.

"The more opportunities this virus has to mutate during replication in a mammalian host, the more likely it is to mutate," said Dr. Nancy Cox, director of the influenza branch at the disease centers.

In the laboratory, Dr. Maines and Dr. Tumpey have found that the virus seems to have become more virulent over time. With some strains, an unbelievably small amount of virus will kill a mouse, Dr. Tumpey said. Last September, in the Journal of Virology, they reported that viruses from people infected in 2003 and 2004 were more deadly in mice and ferrets than were samples taken from 1997 victims. But there is not enough information about the human cases to tell whether the disease in people has gotten more severe.

Recent studies by several research teams have focused on hemagglutinin. The virus can attach only to cells that have the right receptors — compatible molecules on their surfaces. Many scientists think hemagglutinin, and mutations that change its structure, may control where the virus can go and what it can do. For instance, hemagglutinin may determine which species the virus can infect and which tissues it can invade.

The more organs and tissues a virus can attack, the more likely it is to cause severe disease. Scientists are especially interested in a part of the hemagglutinin that sets A(H5N1) apart from many other bird flu viruses by enabling it, in some species at least, to latch onto many types of cells and thus to cause systemic disease.

Studies published recently in Science and Nature by two research groups suggested that one reason A(H5N1) is not transmissible among people is that the virus can latch on only to cells deep in the respiratory tract, too far down to be coughed up or sneezed out to infect other people. They discovered that only the deeper cells had the right type of receptors.

But if the virus were to mutate so that it could connect with cells higher in the respiratory tract, then it might become transmissible. Several mutations would be needed, and virologists disagree about whether they are likely to occur.

Another major unanswered question concerns how severe bird flu really is in people. Based on cases in hospitals, it looks like a horrific disease with a 50 percent death rate.

But what if some people get infected and recover without seeing a doctor, or never get sick at all, and so are not counted? Then, the death rate would be lower.

A study published in January in The Archives of Internal Medicine suggests that there may be mild, unreported bird flu cases. Over a three-month period in 2004, researchers studied 45,478 residents in a rural district in Vietnam that had A(H5N1) outbreaks to find out how many had contact with sick birds and how many had flulike illnesses.

They found that statistically, those exposed to sick birds were most likely to have gotten sick, and of 8,149 who had a flulike illness, 650 to 750 probably caught it from birds. The study was not conclusive because the researchers did not test their subjects to find out for sure whether they had A(H5N1).

But if human cases are more common than previously thought, it could be both good news and bad news: good if not everyone becomes deathly ill, but not good if more people are infected and might act as the dreaded "mixing vessels" that could let A(H5N1) trade genes with an ordinary human flu virus and produce a new, highly contagious strain that could turn into a pandemic.

"The viruses are changing, and in ways of concern to me and other scientists," Dr. Cox said.

She said scientists had a unique window of opportunity now, in which they could see the disease in both birds and people and try to stop it or at least slow it down.

"Could we quench an incipient pandemic?" Dr. Cox asked. "I don't know, but we could try."



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Diabetes limb loss 'unnecessary' BBC NEWS
People with diabetes are having to have unnecessary lower limb amputations, a study has suggested. Diabetes can lead to amputation because of damage to the nerves and blood vessels that serve the limbs. People with diabetes are 15 times more at risk of lower limb amputation than people without the condition. A study by Wolverhampton-based researchers showed too few were getting the right foot care, leading to the unnecessary limb loss. Diabetes is the UK's second most common cause of lower limb amputation. Data published by Diabetes UK shows up to 70% of people die within five years of having an amputation.

Lack of education
Research presented at the Diabetes UK Annual Professional Conference in Birmingham looked at the care of people with diabetes prior to amputation. A survey of 30 people with diabetes, aged between 60 and 80, who had had amputations, found 90% had been considered high risk in the period leading up to the procedure. A history of ulcers, nerve damage, circulation problems and foot deformities can all put people at high risk of amputation. But more than a quarter of those thought to be at high risk of amputation are not being offered any kind of specialist care, the Wolverhampton study suggested. And two in five are not being educated on how to prevent and treat infections which can lead to amputation. Over a third did not have any kind of diabetes review to assess how they managed their condition and to ensure they did not develop any other complications prior to amputation becoming a risk.

Foot checks
Dr Baldev Singh, who carried out the research, said, "This research clearly shows that care for high-risk patients is inadequate. "Mandatory foot care plans should be put in place to ensure that all people get the right care and education." Douglas Smallwood, chief executive at Diabetes UK said: "It is shocking that some people with diabetes are getting sub-standard specialist foot care, or even none at all, if they are at high risk of amputation. "We know that the rate of amputation may be reduced by 40% or more through effective care. "All people with diabetes should receive at least a yea