Pauline Cafferkey, the Scottish nurse who nearly died twice from Ebola, has called on Public Health England to “recognise their own failings” in a botched Heathrow airport screening process that has led to one of her colleagues being suspended for two months.
She said she was “extremely disappointed” that PHE had employed a “blame culture” that highlighted the possible mistakes made by volunteers who risked their own lives to help Ebola patients but did not acknowledge its own.
Cafferkey made her remarks as Donna Wood, a nurse who was part of the same volunteer group who travelled to Sierra Leone in November 2014, was suspended by the Nursing and Midwifery Council (NMC) after it found she had concealed the nurse’s temperature during the screening process in Heathrow on 28 December 2014.
Najrul Khasru, the chair of the NMC panel, told Wood: “The seriousness of your misconduct … could have contributed to the risk of Ebola, a very serious and dangerous illness, spreading in this country.” The panel described Wood’s “dishonesty” as extremely serious and called it “a momentary lapse of judgment”.
Cafferkey said: “I am very sorry to hear the outcome of Donna Wood’s hearing. I still feel extremely disappointed that in making complaints against volunteers who willingly put themselves in danger for the benefit of others, Public Health England employed a blame culture and failed to recognise their own failings – which were many – on the day the volunteers arrived at Heathrow.
“I hope that Public Health England will now acknowledge their mistakes and accept that as a result of these, they took the decision to allow me to fly on to Glasgow, rather than transferring me to hospital in London. I look forward to this continuing ordeal eventually being concluded.”
During the eight-day disciplinary hearing, it emerged that PHE had run out of screening forms and monitoring kits and had only four cubicles for about 50 passengers.
It emerged during the hearing that Wood and Cafferkey were among five volunteers who decided to take their own temperatures to get out of the “uncomfortable” and “chaotic” screening area more quickly.
Donna Wood was cleared of falsification but the panel found she was aware of Cafferkey’s higher temperature and had failed to escalate the situation. Photograph: Yui Mok/PA
Wood denied she had falsified Cafferkey’s temperature, which a fellow volunteer recorded as over 38C, a degree higher than average body temperature and a potential early warning sign of Ebola. The panel cleared her of falsification, but found she was aware of Cafferkey’s higher temperature and had failed to escalate the situation.
Later, the doctor who took Cafferkey’s temperature raised the issue with an infectious diseases expert in their group and they agreed that Cafferkey should return to the screening area.
Her temperature was taken three more times by the lead clinician on the PHE team, Deepti Kumar, but she told the disciplinary hearing that she had not been told Cafferkey had taken paracetamol, which can mask a high temperature. Kumar then cleared Cafferkey to make her connecting flight to Glasgow.
The manager of the screening team, David Carruthers, a former police officer, told the panel that Cafferkey had told him she had taken paracetamol and that he had passed this information on to Kumar. However, he was not sure if the doctor had picked up that information.
It also emerged that the PHE manager had mistakenly phoned a hospital switchboard rather than an infectious disease team that was mandated to deal with any referrals from the screening team. Carruthers told the panel he had passed on enough information to those he spoke to get help but he never heard back.
All five of the volunteers were referred to their regulatory bodies by PHE following an early investigation into the screening on that day. The volunteer doctor who took Cafferkey’s temperature will go before a medical disciplinary tribunal in March.
Cafferkey faced being struck off but was cleared of any misconduct in a disciplinary hearing in September after an NMC panel found no evidence that she had set out to mislead PHE. Her solicitor at the time said she had found the proceedings stressful and upsetting.
The number of Australians taking their own lives has hit a 10-year high, while dementia is tipped to overtake heart disease as the nation’s leading cause of death within five years.
The number of suicide deaths climbed above 3000 in 2015 for the first time, rising more than 5% in 12 months, official figures show.
Suicide was the leading cause of death for 15-44 year olds, with males three times more likely than females to take their own lives.
Suicide rates were highest in the Northern Territory, while Queensland recorded the greatest increase in deaths.
The Australian Bureau of Statistics found that while suicide accounted for less than 2% of overall deaths in Australia in 2015, it claimed the lives of a third of those aged 15-24 and more than a quarter of 25-34 year olds.
Mental health groups were dismayed by the rising rates and called for a new national approach to suicide prevention.
The chairman of beyondblue, Jeff Kennett, said the Senate should set up a special commission to combat suicide, while Lifeline wants a national summit.
“These figures have to stop us in our tracks,” Kennett said. “The 2015 total is two-and-a-half times the national road toll and six times the number of Australian lives lost in the entire Vietnam War.”
The chief executive of Sane Australia, Jack Heath, said while much had been done to reduce the stigma around mild and moderate mental health issues, more help was needed among the 700,000 Australians with more complex conditions.
“There needs to be access to better-quality services and that particularly becomes an issue for people in rural and regional areas where there are a quarter of the psychiatrists and half the psychologists,” he said.
“And we need to do a better job to help people who are discharged from emergency departments after suicide attempts by making sure there’s better follow-up services.”
While deaths from suicide are rising, heart disease remains the main cause of death for most Australians with more than 19,700 fatalities last year.
However the ABS predicts dementia will topple heart disease from its top spot by 2021, with the number of deaths having doubled in the past decade to 12,625 largely as a result of our ageing population.
Dementia is now the second-biggest killer of Australians, while heart disease and stroke-related deaths have been steadily declining.
Alzheimer’s Australia’s CEO, Maree McCabe, said while one in 13 people in their 30s, 40s and 50s have the brain disorder there was not enough awareness about dementia among young and middle-aged people, who often mistakenly think dementia is a normal part of ageing.
“If we can delay the onset of dementia by five years we would reduce the number of people who get dementia by 30%,” she said.
McCabe called for a government-funded national dementia strategy, similar to those in the US and Britain.
She also advises people reduce their risk of developing dementia by exercising, eating healthily, socialising and keeping their brains active.
Leading causes of death in Australian in 2015
* Ischaemic heart diseases (19,777, down from 21,721 in 2010)
* Dementia, including Alzheimer’s disease (12,625, up from 9003)
* Cerebrovascular diseases (10,869, down from 11,200)
* Trachea, bronchus and lung cancer (8466, up from 8102)
* Chronic lower respiratory diseases (7991, up from 6129)
* Diabetes (4662, up from 3948)
Source: ABS (excludes suicide)
• Crisis support services can be reached 24 hours a day: Lifeline 13 11 14; Suicide Call Back Service 1300 659 467; Kids Helpline 1800 55 1800; MensLine Australia 1300 78 99 78
As a well-adjusted middle-aged man, I like to define myself by the things I don’t have. I don’t have a scarlet Lamborghini or a conspicuous tattoo or a 22-year-old girlfriend to jumpstart my libido. Nor do I possess a penchant for extreme sports or expensive psychotherapy. Midway through my fifth decade, I’ve avoided the obvious pitfalls and reckon I’m coping quite well, which is why I am on my way to discuss the male midlife crisis with the therapist Andrew G Marshall, who has written a book on the subject. It’s a task that requires a cool and dispassionate eye. We will be like two doctors, I decide, objectively diagnosing the problems of others.
Inside his therapy room, Marshall directs me to an armchair and stoops to pour out some water. First impressions could hardly be more reassuring: Marshall is a soothing, sober man in colourful clothes. He asks about my background and my health, moving from my childhood to my present circumstances. I respond as honestly as I can, still confident I’ll be given the all-clear. I tell him I sailed past my 40th birthday with no problem at all. After that, admittedly, there was a difficult spell, one that lasted perhaps four years. I list all the things that happened. I tell him that my relationship broke down and I moved out of my home. I tell him my best friend died suddenly, which threw me for a loop. I mention that my father fell ill. Oh, and that I also got married. I tell him that I then had a second child to set alongside my 11-year-old daughter from the previous relationship. I tell him I quit my job and quit London, and that we now live out west. I tell him I think that’s about it, although there might be some stuff I’ve forgotten. But by now I’m out of breath, shaken. Recited as a list, those past four years sound positively existential.
Marshall jots notes in his pad. He asks who I turned to for help during this difficult period. I tell him I didn’t really turn to anybody: I went through the worst parts alone. Why would I want to have people seeing me as a mess?
“It’s quite interesting,” he says. “You belonging to what we nowadays call the metropolitan elite. Most of my clients, by your age, have had at least three therapists. Whereas you went through this incredible period and not only did you not seek professional help, you actually detached yourself from your friends.”
Lots of people flunk the test. They anaesthetise themselves – with drink, generally. Or computer games, or porn. Or work
I nod dutifully, and yet something he said has already stuck in my craw. I don’t consider myself part of the metropolitan elite, and I’m annoyed that he would blithely stick me in that box. Nor, for that matter, am I convinced I’ve had a midlife crisis, despite the bald evidence of those torrid four years. But that’s the nature of cliche. We may see ourself as one thing, unique and specific; the world sees us as another – as a social demographic or a cluster of symptoms.
Marshall’s own interest is based on both personal and professional experience. His partner died when he was in his late 30s and this pitched him into what he describes as “the bleakest period of my life”. Meanwhile, all around, his patients were navigating a similar set of hurdles. The Office for National Statistics reports that 40- to 59-year-olds are the most anxious age group. Marshall believes this anxiety is sparked by a sudden awareness of mortality and a fear of failure; the nagging, nightmarish sense that we will never fulfil our true potential.
No one wants to own up to a midlife crisis: the condition is redolent of too many bad jokes. On setting out to write his new book, Marshall even deliberated before putting the term in the title, concerned that the mere mention might scare readers away. Finally, he opted for a cunning disguise, referencing the condition while denying its existence. The book is called It’s Not A Midlife Crisis, It’s An Opportunity, subhead: “How To Be Forty- Or Fifty-Something Without Going Off The Rails”.
Marshall has seen many casualties in his time – people who, when faced with the challenges of middle age, promptly crash and burn. “A lot of people flunk the test,” he says. “They anaesthetise themselves – with drink, generally. Or with computer games, or pornography. Or with work. And if you don’t answer the questions, you become bitter, closed off and cynical.”
Fail and you suffer an L-shaped life, you plummet and flatline. Pass, and win the U-shaped life: a brilliant late bloom
I start to wonder whether I flunked the test. Marshall certainly seems to think I was guilty of closing myself off. He says, “I’m getting a very strong message that you’re not allowed to be vulnerable. That you need to be loved, yet, when things get difficult, you withdraw from everybody. It’s a strange dichotomy. Because on the one hand you’re an open book in a rather controlled way, in that you’re a journalist and therefore in charge of the words. But the rest of you is completely closed.”
“I don’t think I was completely closed,” I say. “I just didn’t want people to see me in disarray.”
“I’m sorry,” he says firmly, “but that’s completely closed. You only wanted people to see the mask.”
“OK,” I say. “Fine.”
And yet, actually, it’s not fine: his whole premise is bullshit. Look at us here. Look at what we are doing. Almost shouting, I say, “It’s a ridiculous thing, you saying I’m closed. I’m going to write this bloody session up for everybody to read.”
Marshall smiles, unperturbed. “Yes, well,” he says. “Often in the second half of our lives, we have to do all of the things we didn’t do in the first.”
***
The term “midlife crisis” was coined in 1965 by the Canadian psychologist Elliott Jaques. Marshall believes the label has now outlived its usefulness. He prefers to call it “the midlife passage”. Approached in the right spirit, he says, this is a chance to engage with the big questions: who am I? What are my values? What gives my life meaning? You can meet your true self. You can become your own person.
Marshall has devised exercises to smooth our progress. He describes a simple counting meditation to reduce anxiety, explains how to “record your feelings”, and the events that trigger them. He also invites us to chart the highs and lows of our lives on a graph, moving from infancy through to middle age. I try this last one myself. The line leaps and dips with abandon. It makes my life look like a series of cardiac arrests.
The way Marshall tells it, there are three obvious routes through the midlife passage. Fail the challenge, and you suffer what he describes as an L-shaped life, where you plummet to Earth and then essentially flatline until death. Pass the test, and you win the U-shaped life: a glorious upswing, a brilliant late bloom. Then there is the third option, the joker in the pack, the switchback ride of the W-shaped life. This occurs when you reach for the quick-fix solution (the thrilling affair, the scarlet Lamborghini), or what Marshall calls “the myth of the great other”. The effect can be instant, galvanic. But it’s an artificial high, a dead cat bounce that leads only to more heartache.
Naturally, this makes me wonder about my own circumstances. The storm has passed; I have a new life in a new city. My days are a whirl of nappy changes and country rambles, augmented with odds and sods of semi-regular work. I’m pretty sure it’s not an L-shaped life. But is it a W or is it a U?
Is the midlife crisis a first-world problem? Marshall disagrees: ‘It’s intrinsic in mankind. It hits you over the head’
Out of the blue, I find myself telling Marshall about a man named Miroslav Novotny. I think he’s originally from the Czech Republic; he speaks rudimentary English. I picture Miroslav Novotny as something out of an Edward Hopper painting, a study in urban loneliness. He wears his trousers too high on his waist. He uses too much hair tonic, smokes discount cigarettes. I explain that my wife and I devised a game we would play when driving the outskirts of south London, in which we work out where Novotny would most like to live. So we place him in that impersonal block of flats out by the A20, or eating egg and chips inside some sad greasy spoon. Novotny, of course, does not exist – we made him up – yet the uncomfortable truth is that he’s the alternative me. He asks nothing of anyone and gives nothing in return.
All at once, I can see it clearly. “If I had taken a different route out of all this, I’d be Miroslav Novotny,” I say. “And I’m glad I’m not. But there’s a certain comfort in being Miroslav Novotny.”
Marshall nods. He says, “Life is small but it’s safe.” And I nod back in relief, because that’s it exactly.
Did I have a midlife crisis, I ask Marshall.
“Yes, you did.” He adds that it is not always advisable to throw absolutely everything in the air, as I seem to have done. But that’s by the by. Stable door, horse bolted. “You have been through it and navigated it and have had a reasonably soft landing.”
He asks if I have any further questions. So I ask whether he sees the midlife crisis as a peculiarly first-world problem, a kind of luxury accessory afforded to those with too much time on their hands. I’m not sure you have one if you’re under siege in Aleppo.
Marshall has his doubts. “It’s not a case of having too much time on your hands,” he insists. “It comes with a great mallet and hits you over the head. So I think it’s something intrinsic in mankind. The first world-third world distinction is the wrong idea.”
My second question is more personal: I ask if he believes it’s possible to be both horribly anxious and basically happy, because that’s how I’ve been feeling for the past year or so.
“Yes, I think you can,” he answers. “But if we were to continue working together, the anxiety is something we would be looking at. I think that anxiety and anger could be the keynotes for you.”
If you’ve done the work of the middle passage, then you’re in a very good place, the sunny uplands of life
He is keen to accentuate the positive, though. “It sounds to me like you have completely transformed your life. You’ve gone from closed to open. From work focused to family focused. From self-sufficient to more connected. From the small world of…
“Miroslav Novotny.”
“From the small world of Miroslav Novotny to the larger world of family and children and a new city. But the anxiety is something I would be working on. Anxiety and depression are like brother and sister.”
I walk back to the tube in something of a daze. I feel as though I’ve spent the past 90 minutes being dangled upside down by the ankles, watching all the detritus falling from my pockets. Some of this clutter was harmless ephemera, but other bits were jagged and rusted. Some were foul-smelling, some smeared with dried blood. With them gone, I feel lighter.
***
One month later, I meet Marshall again, this time in a bookshop above a cafe. It’s late August, and the therapist is on holiday. He’s bare-kneed in tan shorts, with a natty straw hat perched on his pink scalp, a copy of Graham Swift’s Waterland parked in the crook of one arm. Seeing him here is slightly disconcerting, like bumping into a teacher away from school.
He asks how I’ve been and I assure him I’m fine. I tell him, in fact, that I’ve been suspiciously fine. I’ve started to wonder whether the session itself was a kind of quick fix. I worry I painted myself in too positive a light; I worry he moved too quickly to endorse my depiction. This would normally be about a six-month process. We went through it in about 90 minutes flat.
“Well, yes,” Marshall agrees. “It’s not the best way of doing it, so you have to be careful. I mean, if I had been aware of some really horrible stuff, I would have skated over it, because I don’t want to open up that can of worms. If we saw there was a total car crash in the wings, I might well have acknowledged it – but I wouldn’t go up and peer through the window.
“But, happily, there wasn’t. And even if there was, I had the sense you’d come through it relatively unscathed.”
I feel I’ve made peace with my crisis, but what comes next? I want to know what other hurdles I’m going to face in my 50s, to steer clear of more trouble, if I can.
But the therapist grins. He’s in holiday mode. “What comes next? Well, wonderful times. If you’ve done the work of the middle passage, then you’re in a very good place, the sunny uplands of life. The next question is not what gives your life meaning, but what gives meaning to everyone’s life. It’s a more spiritual inquiry: the self versus the infinite.” Another grin. “I’m not even sure whether therapy is the right place to answer those questions. You may need to roll up your sleeves and go and do it yourself.”
The house where I now live is perched high on a hill, a steep 15-minute climb from the nearest train station. I try to make this journey on foot as often as I can (if I’m losing my hair, I figure I can at least shed some weight along with it). Sometimes I wonder how I must look to the motorists driving by. A sweaty, middle-aged man with a red face and bad posture, sometimes pushing hard at a buggy for added comedy value. The man is a wreck. Every step’s an ordeal. But near the top of the hill, the road swings out from the shadows. The city drops away and the horizon is endless. And this, I decide, is my favourite part of the journey. One might almost be entering the sunny uplands of life, approaching a house that feels very nearly like home.
The report from the ONS for 2013 also shows a standard decline in fertility in girls of all ages.
In 2013, there had been 698,512 births recorded in England and Wales, a decrease of 4.three% from 729,674 in 2012 and the greatest annual decrease considering that 1975.
Previously, the number of births had been increasing every single yr since 2001, with an exception of a .three per cent fall in 2009.
The regular amount of babies per woman has also decreased, from 1.94 in 2012 to one.85 in 2013.
The biggest declines in fertility costs were in girls aged underneath 24 even though the smallest decreases in fertility have been for girls aged 35 and over.
But the British Pregnancy Advisory Support (BPAS) explained that despite these “small” declines in 2013, growing numbers of girls had been delaying having children till later in lifestyle, with the fertility price for women aged 40 and more than possessing nearly trebled considering that 1991.
Ann Furedi, BPAS chief executive, stated: “Overall the fertility rate has decreased, with the most significant declines noticed in younger females. The common age of mothers in this country has hit thirty for the initial time as many females are deciding to start off their families later on in life.
“UK mothers are now on average older than girls elsewhere in the world when they have their first infant. There could be many motives for this, such as the time it requires to achieve educational and expert advancement, as effectively as fiscal security – and it could also be a reflection of how significantly couples take the duty of obtaining kids in the 21st century.
“While pregnancy and birth in older women may possibly present somewhat distinct challenges for healthcare professionals, the response is not to cajole women into getting infants before they are prepared but to make certain our family members planning and maternity services are set up to cater for the modifying wants and selections of women nowadays.”
Individually, the ONS figures display that in 2013, nearly half – 47.4 per cent – of all infants were born outside of marriage, in contrast with 47.5 per cent in 2012 and 41.4 per cent in 2003.
The ONS explained: “This continues the lengthy-term rise in the percentage of births outdoors marriage/civil partnership, which is constant with increases in the amount of couples cohabiting rather than coming into into marriage or civil partnership.”
The amount of births in England and Wales to mothers born outside of the United kingdom also continued to rise, from 18.six in 2003 to 26.5 per cent in 2013 while the number of stillbirths fell by seven.7 per cent, from three,558 in 2012 to 3,284 in 2013.
Louise Silverton, director for midwifery at the Royal University of Midwives, explained: “The numbers of births stays historically substantial. This modest drop in the birth-rate will enable the NHS to narrow the gap between the numbers of midwives we have and the amount we really need. We stay 4,500 midwives short in England and these figures need to not be a reason to slacken off, but to improve efforts to get far more midwives into the NHS.
“These midwives are also necessary due to the fact births are also becoming far more complicated for instance as the regular age of mothers increases. This puts further pressures on maternity services and midwives want to give these females the very best levels of care. They cannot do that if there are not ample of them.”
Major care doctor pay rose somewhat to more than $ 232,000 while specialists’ compensation rose to far more than $ 402,000 as insurers paid them primarily based a lot more on high quality of care offered rather than volume.
The most recent data from the Health care Group Management Association, the largest organization of medical professional practices in the U.S., stated median compensation rose to $ 232,989 in 2013 for primary care medical professionals although a similarly slight increase for specialists to $ 402,233. By comparison, MGMA’s 2013 report showed median main care compensation in 2012 at $ 220,942 and expert pay at $ 396,233.
However doctors are even now working largely in a charge-for-support atmosphere, that is quickly shifting as insurers , employers and government wellness packages underneath the Affordable Care Act move medical professional compensation away from a standard method that rewards companies with costs no matter the end result to rewards based mostly on high quality, transparency and accountability.
MGMA said primary care doctors who “indicated they had been not portion of an accountable care organization or a patient-centered healthcare home” reported an average of 5.96 % of their compensation in 2012 was primarily based on top quality measures. Meanwhile, professionals reported that 5.7 percent of their compensation was primarily based on high quality metrics.
“Physicians are providing good quality care to their patients, so it is not surprising that compensation methodologies are evolving to incorporate these metrics,” mentioned Dr. Susan Turney, president and chief executive of the Health-related Group Management Association, said of the group’s report that seems to be at data from ore than 66,000 medical care providers.
However the MGMA evaluation of good quality metrics demonstrates a subset of medical professionals not nevertheless component of an ACO and patient-centered medical home, it is only even more evidence that fee-for-service medication is taking a hit.
Across the nation, doctors and hospitals that are component of bigger practices, clinics and systems are more and more forming ACOs and other arrangements which put suppliers below one umbrella, contracting with industrial and government insurers to give care to a population of patients. The medical professionals and hospitals agree to be measured and their pay is based on high quality and outcomes, typically divvying up cost savings with insurers as a reward for the far better care they supplied.
MGMA executives stated the data displays medical professionals are more and more ready to report their high quality measures.
“They are realizing . . . they have to report that (high quality) data whether it be to commercial payers or the federal government,” explained Todd Evenson, vice president of consulting companies and information solutions at MGMA. “They are going to have to supply this data and be reviewed upon this information. Doctors recognize that this is going to impact them in the future.”
All significant insurers like UnitedHealth Group UnitedHealth Group (UNH), Aetna Aetna (AET), Humana Humana (HUM), Cigna Cigna (CI) and Blue Cross and Blue Shield programs are dramatically escalating the quantity of contracts through accountable arrangements.
Medical doctors, meanwhile, are seeing such contracts come at them in all forms.
“They are all in distinct stages,” Evenson said of physician practices.
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I like the proposed carbon emissions rules from EPA. They handle the true issue of balancing our power combine and may possibly be the only way to move forward in the absence of Congressional leadership.
But EPA has gone a tiny wild with their newest rule. This new proposed emissions rule is for nuclear electrical power plants (Federal Register). An working nuclear power plant has extremely reduced emissions of any variety except water vapor. No carbon emissions and almost no radioactivity emissions.
There has by no means been a problem with any nuclear power plant emissions in America and emissions from them do not have any influence on the nearby population (RADICON Research Comare Report). Even throughout the partial meltdown at Three Mile Island in 1979, radionuclide emissions to the surrounding population have been less than 1 millirem lifestyle-time committed dose in a background of over one hundred millirem per 12 months (NRC TMI). Many complete investigations, such as from Columbia University and the University of Pittsburgh, concluded that any radioactive release had no effect on human overall health and the setting.
And this was a nuclear meltdown. Typical operations certainly have no results at all, mostly because we emplaced this kind of heavy rules on nuclear power plants from the extremely starting.
Photo credit: Jonas B
So why redo these laws now? Fukushima? We’ve already made huge alterations because Fukushima, most had been truly created from the lessons of TMI, these extremely lessons Japan ignored.
It turns out that a never ever-talked about radionuclide is at the center of these new rules. Krypton-85. It’s never ever discussed simply because it’s never been regarded as a hazard. And it still isn’t a hazard. When this proposal came out of EPA, individuals of us in the area looked at every other and explained “Huh?” I can see revisiting the big guns like the Pu and U series, Cs-137, C-14, Tc-99, and any of a host of nuclides that could be a dilemma in large ample concentrations.
But Kr-85? That’s nonsense.
Kr-85 is a noble gasoline. Not in the sense that it’s honorable and dignified, but in the chemical sense that it can not react with anything, can not kind chemical compounds or even person molecules. It moves by means of this Universe as a wholly separate single atom. Kr-85 cannot stick to anything at all or acquire anywhere. Even if you breathe it in, it cannot sorb, react, or construct-up within of you, considering that the only approach that has any impact on this component is Henry’s Law.
There is no way electrical power plant emissions of Kr-85 can harm human overall health or the environment simply because it can’t do anything except entirely dissipate immediately on leaving the reactor. This is 1 of these few aspects fully governed by anything named entropy, the purpose that all the air in a space cannot all of a sudden move in excess of to one particular side, a statistical likelihood, but one thing that entropy will not allow occur no matter how many trillions of years you wait. By the time Kr-85 reaches the setting outdoors the gates of a electrical power plant, it is under detection.
We have usually focused on these radionuclides that can affect us, like Cs-137, Sr-90, Tc-99, I-131 and different isotopes of Pu, Am, U and Np, since these can enter the physique, and react or sorb in various tissues and organs. They have numerous biological half-lives, that means they can enter biological pathways and be retained in the entire body for various occasions and can, if occurring in large enough concentrations, trigger issues.
But this is not the case with Kr-85 due to the fact it can not enter biological pathways. And Kr-85 decays to secure, non-hazardous, non-radioactive rubidium. This is very distinct than that other radioactive noble fuel that constantly gets discussed – radon-222.
Rn-222 does decay to many radioactive progeny, like Po-218, Pb-210, Bi-214, to identify but a number of. It is these radioactive radon-daughters that are worrisome considering that they are not noble and can stick in the lungs and enter biological pathways.
So there is no scenario in which Kr-85 released from a energy plant could result in any well being troubles. We’ve acknowledged this for 50 years and practically nothing has modified.
So why is EPA speaking about shifting this now? Dr. Per Peterson, a single of America’s most renowned nuclear engineers from UC Berkeley, recently discussed this quite topic and the answer could be…wait for it…political.
As Professor Peterson factors out, “The significant problem is that EPA might be attempting to regulate emissions of krypton-85, a noble gas that disperses so rapidly that it brings about no detectable dose to anything at all anywhere, and no public heath consequence even remotely. There exists no plausible public well being or environmental explanation to regulate Kr-85 emissions, given that they do not and can never have any substantial public overall health or environmental influence (Power Thorium).”
But setting absurdly low limits on Kr-85 emissions can make different new nuclear reactor styles far more expensive, maybe even economically not possible. These are the new designs that are safer, cannot meltdown, cannot have a Fukushima or a TMI. They’re what we’re supposed to be moving in the direction of in the nuclear arena.
Incurable cancer sufferer Stephen Sutton, 19, has hit back at a Twitter user who said he felt ‘duped’ that the teenager was out of hospital Photograph: Stephen Sutton/PA
Inspirational cancer fundraiser Stephen Sutton has hit back at a Twitter consumer who explained he felt “duped” that the teenager was out of hospital.
Stephen, who has raised almost £3.2m for the Teenage Cancer Trust, informed the Twitter “troll” that his sickness was nevertheless incurable regardless of his discharge from Birmingham’s Queen Elizabeth Hospital.
Dozens of the teenager’s friends and followers leapt to his defence on social media right after a message was posted on Twitter saying “plenty” of people who had donated to the Believe in now felt duped.
In a direct response to the message, Stephen explained: “Sorry to disappoint you! So you know, I still have my cancer and it’s nonetheless incurable, if that tends to make you really feel significantly less ‘duped’ x.”
Tweeting to his 188,000 Twitter followers, the 19-12 months-previous added: “RE the troll tweet I replied to, I actually did not count on the response to get so much publicity.
“I just gave a rapid response, imagined nothing of it and was (and nonetheless am) totally unaffected by it.
“Trolls and cynics exist. It truly is a shame. But just consider not to retaliate too aggressively or get too riled… Like I have stated ahead of: On the entire men and women are ‘good’, lets focus on that.”
Stephen was discharged from hospital on Friday, hours right after meeting David Cameron, who praised the teenager’s “extraordinary” zest for life for the duration of his three-year battle against numerous tumours.
The prime minister also tweeted a hyperlink to Stephen’s JustGiving webpage, the place he has raised £3,192,857 for the Teenage Cancer Trust. More than 132,000 men and women have so far produced donations to the JustGiving web page.
Stephen Sutton wrote: ‘One week ago I posted a thumbs-up farewell photo that went viral. I genuinely imagined I was a goner, but a single week on I’m nevertheless here!’
A terminally ill teenager has now raised a lot more than £3m for the Teenage Cancer Trust. Stephen Sutton, 19, originally aimed to raise £10,000 for the charity following getting diagnosed with bowel cancer 3 many years in the past.
Creating from his hospital bed right now – after a final-minute fundraising gig organised by the comedian Jason Manford – Sutton thanked individuals who had helped reach the milestone.
Posting a trademark thumbs-up image, Sutton wrote: “One week in the past I posted a thumbs-up farewell photograph that went viral. As talked about, at that level I genuinely thought I was a goner, but 1 week on I’m nonetheless here!
“To celebrate even now getting here after this crazy week, to celebrate this superb journey known as life, and to celebrate being component of raising over £3m for Teenage Cancer Believe in, here is a enormous thumbs-up from me!”
Sutton has won several admirers for his constructive mindset and determination, attracting the assistance of celebrities, musicians and sports stars, garnering far more than 100,000 online donations to his lead to.
Manford, who met Sutton at a charity gig two years in the past, visited the teenager at Queen Elizabeth hospital in Birmingham on Thursday before Sunday night’s gig in the very same city. He said he was touched due to the fact Sutton, in spite of getting sick in bed, was “talking about putting the fun into fundraising”.
Sutton, from Burntwood, Staffordshire, set up a “bucket checklist” final 12 months of issues to obtain before he died – including raising £10,000 for the trust.
He has previously smashed through that target and the sums, along with the degree of goodwill and help, are continuing to expand.
Final week he released a ten-minute YouTube video known as When Lifestyle Provides You Cancer, featuring interviews with his mum, his schoolteachers and his best buddy. In it he uses the payoff line that “cancer sucks but existence is fantastic”.
Celebrities such as Stephen Fry and Russell Brand have backed Sutton’s fundraising efforts, and the music mogul Simon Cowell has pledged to make a “considerable donation”.
The band Coldplay plus the actors Benedict Cumberbatch and Simon Pegg and footballer Ben Foster have posed for photos holding indications to motivate men and women to donate, posted on Twitter with the hashtag thumbsupforstephen.
To donate, check out www.justgiving.com/Stephen-Sutton-TCT.
Hunger and malnutrition have historically been related with establishing countries, this kind of as those in sub-Saharan Africa, and in excess of-consumption with the produced globe. This might once have been broadly exact, but today’s worldwide nutrition picture is far far more complex.
In the past three decades, the number of obese folks in the developing world has tripled, with twice as several now residing in bad countries as in wealthy ones. The US may possibly be synonymous with quickly foods, but its southern neighbour, Mexico, now has the highest prevalence of grownup obesity in the planet, as the country’s developing economy gets reflected in expanding waistlines.
China also faces huge wellness consequences from its financial “miracle”. In September 2013, a study in the Journal of the American Medical Association recommended twelve% of Chinese individuals have diabetes – a lot more than in any other nation.
Why is this happening? The response lies in the ‘nutrition transition’, the phenomenon whereby greater industrialisation and urbanisation, allied with enhanced wealth, consequence in people doing much less bodily activity, and consuming much more calorific, meat-hefty diet programs – higher in fat, sugar and sodium.
The paradox for many emerging economies is that this is now taking place so speedily that they face a dual burden of in excess of and undernutrition. The pace of economic development indicates that, even though a lot more men and women create the continual conditions of the international wealthy, people who have been left behind continue to suffer from malnutrition.
In the West, we look to be better, or at least far more skilled, at tackling the latter. The first of the UN’s eight Millennium Growth Goals was to eradicate extreme poverty and hunger. Couple of governments would refuse to rally behind that ambition. And nevertheless the biggest killer globally is not poverty or malnutrition, but non-communicable diseases (NCDs).
The Planet Overall health Organisation (WHO) lists the four major worldwide NCDs as diabetes, cardiovascular condition, a group of cancers and continual lung illness. They cause the bulk of premature deaths and ailment all around the planet – and weight problems is 1 of their major chance aspects.
In January 2014, the Overseas Advancement Institute published a new report, Potential Diet programs, which argues that worldwide changes in diet plan (“far more excess fat, much more meat, a lot more sugar and greater portions”) are top to an unprecedented health crisis.
“The expanding prices of overweight [folks] and weight problems in building nations are alarming,” says ODI analysis fellow Steve Wiggins, co-writer of the report. “On present trends, globally, we will see a large enhance in the number of men and women struggling particular kinds of cancer, diabetes, strokes and heart attacks, putting an massive burden on public healthcare programs.”
The burden is probably as devastating for the environment, according to Dan Crossley, executive director of the Food Ethics Council.
“If everyone all around the world ate in the exact same way as the typical citizen in nations like the US or United kingdom, then we would require many planets to cope with the consequences,” he says. “That’s plainly unsustainable for the surroundings and our health.”
The international meals policy arena continues to emphasis predominantly on undernutrition, and although the Rio+twenty report, The Future We Want, mentions NCDs, it isn’t going to explicitly link them to obesity or overnutrition.
Why aren’t we discussing them far more? Professor Charles Godfray, director of the Oxford Martin Programme on the Future of Foods, says that governments, and other bodies, typically struggle with the perception of overnutrition.
There is some thing less glamorous about “tackling the relentless march of cardiovascular ailment in Middle Eastern nations,” he says, in contrast to the battle against malaria, tuberculosis or HIV.
It truly is also a significantly tougher sell to the public. “[Policymakers] just never know how to address diet modify,” he adds. “It is so politically contentious, as it cuts across [concerns] such as market regulation, and the state interfering with individuals’ lives.”
Crossley suggests it really is also hypocritical for the West to lecture others about their diet plans. “Those in Western countries need to not be dictating what individuals in the Global South ought to consume if they are not themselves prepared to shift in direction of diet plans that are greater for the planet and their very own overall health,” he says.
There are previously great examples of countries effectively avoiding or tackling in excess of-nutrition. South Korea managed to bypass the nutrition transition by utilizing vigorous social marketing and advertising and schooling campaigns that promoted the country’s traditional reduced-body fat, higher-vegetable cuisine more than rapidly foods and even provided coaching in its preparation to individuals who required it.
And in the 1970s, Finland, which had the highest coronary mortality rate in the world, with standard diet plans high in saturated fats and salt, partnered with the WHO and the foods market to promote healthier diet programs and lifestyles. In the subsequent 24 many years, cases of heart disease fell by 65%.
Professor Godfray says there is one basic way to publicly sanction political activity about the worldwide impact of nutrition transition, and that is for all of us to start talking about foods more critically.
“In the Uk, we either talk about foods at the ‘foodie’ finish – like how to make your own ciabatta – or it truly is the GM debate,” he says.
“But these are a sideshow in contrast to the actually big problems of food supply and demand. By not discussing those, we are not legitimising our politicians to consider the issue significantly.”
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The letter has been signed by a lot more than 500 folks, charities, and campaign groups, which includes Paul Burstow, the former Coalition care minister, the Law Society, Age Uk, and Sir Tony Robinson, the actor and tv presenter. It will be delivered to No10 this week.
The appeal follows issues that 1000′s of frail pensioners, many of whom have dementia, are being swindled out of their money or subjected to abuse by folks who ought to be caring for them.
Mr Burstow, a Liberal Democrat MP, mentioned: “There is a clear gap in the law protecting frail and vulnerable men and women.
“My proposal would give the court a electrical power in restricted circumstances to enable access so that they can be protected. I hope the Prime Minister will pay attention to the effective situation being made by so several charities and professionals in this area.”
Mr Burstow has tabled an amendment to the Care Bill, providing courts the electrical power to authorise a police constable and a social employee to enter a house, when there is proof suggesting a vulnerable adult is suffering abuse or neglect and investigations are getting blocked by a third get together.
Police can at the moment only intervene if there is an instant risk to life and limb, Mr Burstow said.
A Division of Well being spokesman mentioned: “People employing care providers must be treated with kindness and compassion and the Care Bill will, for the first time, set out the nearby authority’s legal duty to make certain this transpires.
“Power of entry is a sensitive and complicated situation, which is why we consulted extensively on this proposal – the bulk of folks who would probably be subject to this energy had been largely opposed to it.
“Councils and the police already have powers to enter the house of a man or woman in which they suspect grownups are getting abused. We want social employees to perform with these organisations if they suspect abuse but to focus on creating relationships with folks in their care.”
Just before my grandmother got sick, any stroke sufferer referred to in a lecture had been just a faceless, hypothetical patient. Photograph: Alamy
Obtaining chosen to research medication for up to 6 years, it is simple to presume medical college students are properly prepared to deal with illness and ailment. But is that actually the situation when illness hits near to home?
This is a query I recently found myself asking when my grandmother unexpectedly suffered from a stroke.
I’m in my third 12 months of learning medicine. Getting covered the ins and outs of stroke in lectures, and obtaining had a couple of interactions with stroke patients on best of that, I (perhaps naively) thought that I had a fair comprehending of what it should be like to have a loved ones member take sick in this way. It turns out that it really is in reality a very various expertise to what I’d imagined.
After it took place, I recalled teaching we would lately had on stroke. Until finally now, facts that we’d been advised about threat variables and survival rates had appeared so distant and far-removed from my personal daily life, but now every little thing abruptly appeared so true.
Just before, any stroke sufferer referred to in a lecture had been just a faceless, hypothetical patient, or an anonymous statistic but now the stroke patient was my grandmother. I would imagined that learning medication would have far better prepared me for a scenario like this, but getting a household member grow to be significantly sick is anything you can in no way actually be prepared for.
I’m in my third yr at university, so my time has primarily been invested in lectures and seminars rather than in hospitals or clinics. In learning medication you are exposed to so many diverse illnesses and conditions that it really is simple to grow to be desensitised.
Sickness gets anything impersonal and abstract. It really is some thing that you discover about that transpires to other individuals. The emotional aspect of it all would seem a million miles away when you’re sitting in a lecture theatre hungover and striving to stay awake. It really is not until something affects you or someone shut to you that you produce a accurate appreciation of the effect it can have.
Illness is widespread amongst students. All around 20% of healthcare college students in the United kingdom are imagined to have personally suffered from critical injury or illness in the past 3 many years, and a additional forty% are believed to have a near good friend or relative affected by damage, illness or death in the exact same time time period.
In the short term, these experiences have been linked with poorer exam functionality and higher levels of anxiousness, which is something any pupil can most likely discover truth in.
But a great deal of health care students also report discovering a silver lining in an otherwise quite grey cloud. In one review, health care students cite personalized experiences of illness as “a constructive element in their determination to review medication”, and say their experiences have “aided them relate to sufferers and see their viewpoints”.
Kate, a health care graduate, echoes these sentiments. Whilst at university she created a neurological situation that left her reliant on a wheelchair. She says, “I grew to become far far more empathetic. Having been through some of the processes as a patient, I could use my personal experiences to assist other folks.”
Obtaining the tables turned and discovering yourself as the patient or the relative of a patient offers you a greater viewpoint on factors. It’s sometimes easy to get bogged down in the countless scientific detail of medicine and neglect that you’re really dealing with genuine individuals and real feelings.
We’re taught to express empathy and compassion at healthcare college, but truly experiencing illness 1st-hand can teach you skills that no guide is able to.
The last time I wrote this headline was in 2012 and the quantity was $ three trillion (here). To arrive at that figure in 2012 I extra the Sustainable Development Charge deficit (accrued over 10 years) to our Nationwide Healthcare Expenditure. The combined total was efficiently $ 3 trillion. Complexities and historical past aside, the Sustainable Growth Charge (SGR) deficit is on the books, it is all healthcare spending, so it actually requirements to be incorporated in any figure summarizing yearly healthcare spending.
According to the Congressional Price range Office (CBO), the expense to repeal the SGR in 2012 was about $ 316 billion. Today, the CBO says it is a considerably far more manageable $ 116 billion, but neither figure includes what many say is a significantly essential increase to the Medicare doctor payment formula. I can see the place each asking and receiving a pay raise in this climate is very likely to be a main sticking stage – in each route.
A $ 200 billion reduction in the SGR deficit is good news – and there is a lot more great information on the SGR (aka “doc fix”) front. There’s a expanding consensus that there may possibly be a congressional resolution later this yr. A Kaiser Health Information piece from just final month (here) had this encouraging quote:
Right after many years of legislative wrangling and last-minute patches, expectations are large among doctor groups, lawmakers and Medicare beneficiaries that Congress could act this year to permanently exchange the existing Medicare doctor payment formula.
The bad information, however, is virtually the subsequent sentence.
While committees in the two chambers have authorized their personal “doc fix” proposals, the approaches have nevertheless to be reconciled, and none have recognized how they would spend for repeal.
What ever takes place politically, the SGR is a healthcare budgetary dilemma and it is on the books. Just like client revolving credit – we’ll almost certainly elect to shell out it down above time, but until we formalize that selection it is a lump sum that gets punted every 12 months (regardless of who’s sitting the place politically).
Recent headlines have also been constructive on the smaller sized fee of healthcare spending development (3.seven% is “slowest development fee on record” right here). That’s also welcome information relative to the historic trend, but it’s also prudent to calculate the complete annual healthcare spending due to the fact it’s (arguably) the more important of the two metrics (development rate versus total yearly paying).
The most often quoted figure for our National Healthcare Expenditure (NHE) is the one presented by the Centers for Medicare and Medicaid Companies (CMS – pdf right here – Table 1, pg five). That is undoubtedly a sensible baseline (with a projection of $ 5 trillion by 2022), but at least one particular group – the Deloitte Center for Health Remedies – calculates a substantially higher figure. Somewhere in 2011, Deloitte issued a report – The Hidden Expenses of U.S. Well being Care: Customer Discretionary Well being Care Investing (pdf right here) which was then revised upward for 2012. I’m hoping they’ll update this for 2014, but they did skip 2013. Remain tuned.
While it is tempting to low cost their findings, Deloitte itself is fairly effectively known globally when it comes to the company of economic accounting. A lot more importantly, offered the aging population, the “sandwich generation” (as it is now identified) is also expanding at a healthful clip. This group – sandwiched between children and aging mother and father – is providing a whole lot of healthcare that the government just has no way to calculate or include in their summaries.
With all that as a backdrop – and keeping the Deloitte figures unchanged from their original calculation in 2010 – here’s the math I’m seeing for the 2014 edition of Annual U.S. Healthcare Investing.
On page 9 of the Deloitte study is this chart that itemizes the two additional components ($ 129 billion direct fees and $ 492 billion imputed indirect charges respectively).
Appendix B on page 25 of the Deloitte review incorporated this chart which describes how they calculated the $ 492 billion for the category named “Supervisory Care.”
Regardless of whether you agree with the Deloitte specific calculation or not, Supervisory Care is a category of healthcare that is significant and additive to the Nationwide Healthcare Expenditure (NHE).
The greater issue is just that we’re not generating any headway on a single of the most important healthcare measurements of all – cost. There are 4 reputable companies that calculate the annual GDP for each country every 12 months. The United Nations, the IMF IMF, the Globe Bank and the CIA Globe Factbook (right here). By any of these 4 calculations, our annual healthcare paying is an economic unit greater than the GDP of Germany (which is itself the 4th or 5th largest GDP on the planet).
“Put basically, with Obamacare we’ve modified the rules connected to who pays for what, but we haven’t carried out significantly to change the charges we pay out.”Steven Brill – Bitter Pill: Why Health care Bills Are Killing Us (Time – March 4, 2013 subscription required right here)
Paddy Ashdown said men and women really feel excluded from the political method altogether now. Photograph: Adrian Dennis/AFP/Getty Photographs
Voter trust in national institutions is “crumbling into dust”, in accordance to the former Liberal Democrat leader Paddy Ashdown.
Lord Ashdown, who is operating Nick Clegg’s 2015 election campaign, says he fears a series of scandals has contributed to declining faith in politicians, journalists, bankers, the BBC and NHS, which could push individuals into the arms of “demagogues” such as Ukip’s Nigel Farage.
“I am reminded of the terrible line in Larkin: ‘England, with a cast of crooks and tarts.’ Now I’m not saying that’s accurate. [Nevertheless] I believe all of these add up to a mood of Jacobinism which I believe is fairly frightening,” he told the Instances. “If this is the age of the collapse of beliefs, the dissolution of institutions, then what you happen to be going to uncover is people who locate an appeal in solutions that are simplistic.”
Some of Ashdown’s harshest criticism was reserved for the BBC and NHS, two of the UK’s historically most treasured nationwide instutitions. “The BBC is revealed as an organisation which cannot handle its personal affairs, misspends public funds and seems to have been complicit in aggrandising a person [Jimmy Savile] whose proclivities would be rejected by most folks.
“The NHS, we are informed, is to be failing right down to the level of medical professionals. Nurses were angels but some turn out to be witches.”
While not predicting further riots, Ashdown stated he was surprised that Britain has received via the economic downturn with so tiny protest on the streets. “I do not predict them and I never want them – and I don’t want to be scaremongering. But there is something very unsettling out there.
“I are not able to exclude the likelihood that we’ll see individuals who never think they can make their stage inside the political system generating their level on the street alternatively.”
Ashdown stated voter disaffection could have a radical effect on the general election following year. “We are all proceeding on the basis that the following election will be a traditional election. I am not entirely certain that if the leviathan lying under the surface decides to swish its tail, which is necessarily the situation.”
His remarks come right after the Guardian published ICM analysis displaying that practically half of Britons say they are angry with politics and politicians, in a survey analysing the disconnection between British men and women and their democracy.
The research located anger with the political class and broken promises created by higher-profile figures that most rile voters, rather than boredom with Westminster.
Earlier this week, Sarah Teather, the Libl Dem former children’s minister, also spoke about some of the factors for declining trust in politicians. She stated ministers have turn into caught up in a “cycle of democratic self-harm” in which they spent as well significantly time “flapping all around making an attempt to be pertinent” and responding to imaginary troubles in the hope of pleasing the public.
“We get ourselves into our own tiny spiral. We finish up inventing troubles to pretend we’re appropriate, and then attempt to resolve the difficulties we’ve just invented. The EU migration things is a traditional illustration.
“The public know it truly is guff, so their believe in in politicians goes down. And then our anxiousness about not currently being appropriate goes up, so we type of get into a cycle of democratic self-harm, so we get progressively a lot more frenzied about chasing wilder and wilder straw guys and the public get much more and a lot more cynical. I am not convinced that is the ideal way of demonstrating we’re in touch.”
