On leaflets delivered to students, an anonymous Cambridge couple asked young women to assist them in becoming parents. The couple were clients of Altrui.

“These leaflets were placed by one of our clients as part of their effort to find an altruistic donor” said Alison Bagshawe, the Managing Director of Altrui, “This was a personal appeal from them, which was officially approved by the University.

According to critics, Altrui is exploiting young students who are financially vulnerable and know nothing about the risks that may be involved in donating their eggs.

In a BBC report, Thomas Matthew, a spokesman for Bourn Hall Fertility Clinic in Cambridge said: “If the students are mature at 18 and they know the risk that is fine, but if they have not had children themselves and they have not had a family themselves, they do not know what they’re letting themselves into at that age and they do not know what the risk may be.

Bagshawe refuted the allegation that Altrui has been offering money to entice students to donate their eggs. She said “only matured and final year students were asked if they could help”.

In countries like the USA, many young women go through the laborious process of egg donation because financial incentives of up to $100,000 per cycle but in UK, donors only receive a set compensation of £750 per cycle.

There have been concerns on whether egg donation are done for financial or altruistic purpose and whether donors are fully informed about the risks of donating their eggs.

“The process of obtaining eggs from women bodies and process of IVF and medical procedure are largely shaped by commercial interest,” says Lisa Ikemoto, a law professor of University of California. “The financial model behind this comes from the fact that the clinic success is measured in terms of live births.”

Ikemoto adds that  “many women are not receiving sufficient information about the risk of egg procedure process.”

I talked to Catty Sidaway, a multiple egg donor to find out her experiences about the processes, whether she was given sufficient information about the process beforehand and if she had experienced any side effects.

Whether egg donation is for financial or altruistic purposes, donors should be informed and warned about the risks involved.

Image credit: by Natalie A. Cekleniak. Video produced by Funmi Olateju and Yuki Xue

The work raises new questions of just how common inter-species recognition might be in the natural world.

Dr Leanne Proops, a visiting scientist at Sussex University and lead author of the work, explained how the study was designed: “We used a technique called a ‘preferential looking paradigm’, which is also used in young infants who can’t speak yet, to look at what they know about the world.”

Preferential looking presents subjects with a combination of auditory and visual information and monitors their responses to determine whether they are linking the two pieces of information.

The research, published in Proceedings of the Royal Society B: Biological Sciences, involved using two familiar human handlers, one standing in front of the horse on the left and one on the right, with a hidden speaker between the two people. Recordings of the handlers’ voices were played out of the speakers and the researchers observed the direction of the horse’s attention.

“What we found was that they looked more often, and more quickly, at the person who matched the voice that they had heard”, said Proops.

Dr Proops’ team had previously shown that horses could tell each other apart in much the same way that we do – using the subtleties in the sound of an individual’s voice and their visual features.

The ability to recognise individuals of the same species is well-documented in primates and, more recently, has been demonstrated in meerkats and crows. However, recognition of individuals of a separate species is thought to be considerably rarer.

Proops described her surprise at horses’ abilities in inter-species recognition: “Some primates are able to do this with people as well but, because we’re evolutionarily more closely related to primates. The difference with horses is that we look so very different from them and are much more distantly related.”

Recognition from the right

A separate result, arising from the design of the study, suggested that it’s the left side of the brain that plays the pivotal role in recognition.

Horses in a herd recognise eachother as well as humans

The horses were much better at recognising people on its right-hand side. Since information from the right eye crosses over to the left side of the brain, that would seem to suggest that the information is being processed in the left hemisphere.

Dr Proops suggests, “there are a number of possible reasons why it might be the left hemisphere: matching to sample tasks and recognising familiar objects is something that occurs in the left hemisphere.

“With recognition in humans it involves the right hemisphere because the face-processing centres tend to be there so it would suggest that the horses aren’t using the faces per se to perform that task.”

Face blindness

When we see or hear another person we use a number of different audiovisual cues to identify them. We combine the anatomical features with the sounds that they make, allowing us to picture a person in our mind’s eye, or hear their voice even when they aren’t present.

Research carried out at MIT showed that the seemingly trivial task of identifying individuals by their voice actually relies on subtle differences in their pronunciation of words and sounds. We find it more difficult to recognise individuals who speak another language because we can’t recognise these differences as easily. People with dyslexia find this task particularly difficult as their ability to link sounds with meaning is often impaired.

Our recognition of faces is controlled by the a part of the brain called the fusiform gyrus and involves inspection of the physical features of the individual, classifying them as known or unknown and then retrieving stored details we might have regarding that person. It has been shown that women are better than men at recognising faces. However, people with prosopagnosia, also known as “face blindness”, are almost completely unable to identify faces.

Whilst we haven’t seen evidence of similar issues in animals, many people will insist that their pets are clearly able to identify them. However, Proops suggested that the evidence appears to be anecdotal and inconclusive.

She said, “a lot of people who own animals say ‘well of course they recognise people’ but it’s not something that has actually been demonstrated, and particularly this ability to match the sound to the sight of individuals has been difficult to prove conclusively.”

Images courtesy of nicodeux and sheeshoo

The team compared the genome of turtles to that of different species to solve one of the last unanswered questions in vertebrate evolution: whether the turtle is a closer relative to crocodiles and birds than it is to lizards and snakes.

Their research, published in the Royal Society journal Biology Letters, shows turtles to be closer relatives to the former, contradicting previous anatomical and paleontological studies. Nick Crawford, lead author of the research, used computational analysis to examine regions of the different animals’ genomes.

“The idea was that this method should work well for really divergent things because we’d take the regions that are most similar and start there,” says Crawford.

“Turtles have been an enigmatic vertebrate group for a long time and morphological studies placed them as either most closely related to the ancestral reptiles, that diverged early in the reptile evolutionary tree, or closer to birds and lizards.”

These early anatomical studies compared skeletal structure, musculature and skull formation to similar animals but produced no definitive conclusions.

More recently, researchers have been able to compare the genetics of these animals,  with the genome sequencing of an ever-increasing number of species revealing branches of evolutionary history that tell a richer story than the anatomy alone.

According to Crawford, “In some groups, in fish and certainly in beetles, there are huge genetic differences – much more than in other groups, such as birds, where the genetic differences aren’t as distinct but they still get the same taxonomic ranking.”

A recently-hatched Midland Painted Turtle

On studying the turtles, Crawford concludes: “They are most closely related to archosaurs,” the group which includes crocodiles, birds and the dinosaurs.

“Our work looked at over a thousand individual genomic regions and our results match those of people who’ve studied reptile DNA so we have a complete story”, he added.

Crawford believes it is unlikely the discovery will have a major impact on how we class turtles as a species but says: “I suspect that this is the final word on the genetic perspective but I’m sure that people are going to continue to look at the morphological data and quibble about that!”

There’s no such thing as a fish…

This research forms part of a broader study that aims to build a detailed evolutionary tree by looking closely at changes within the genomes of related species. Colleagues of Mr Crawford have used similar analysis to examine the genomes of birds and fish.

We often group species together in a superficial way and it is only by looking at the genome of a species that we can begin to fully understand evolutionary lineage. Placing different plants or animals under an umbrella term can make life easier but it makes no sense on a genetic level to say that all things that live in the sea are fish, just as it makes no sense to say that all things that can fly are birds.

A lifetime study of sea creatures led the esteemed biologist and paleontologist Stephen Jay Gould to conclude that there is, in fact, no such thing as a fish. He explained that the term had no biological meaning and was an over-simplification that grouped aquatic creatures together.

As evolutionary biologist Richard Dawkins explains in his book The Greatest Show on Earth, “trout and tuna are closer cousins to humans than they are to sharks, but we call them all “fish”.”

Dawkins explains that, if we wish to be more accurate, we should use cladistics to group together species. This puts all living things into groups called “clades” by using their genome to find common ancestors and their relatedness on the tree of life.

“Cladistically inclined zoologists avoid the word “reptiles” altogether, splitting them into Archosaurs (crocodiles, dinosaurs and birds), Lepidosaurs (snakes, lizards and the rare Sphenodon of New Zealand) and Testudines (turtles and tortoises)”, explains Dawkins.

Whether or not there is such a thing as a reptile or a fish, genetic analysis is allowing us to better understand how branches of life diverged to give us the fascinating creatures on the planet today.

Images courtesy of mizmak and alumroot

The report from the Department of Health (DoH) minister Lord Howe investigated how the British regulator of medicines and devices – the Medicines and Healthcare Regulatory Agency (MHRA) – and the DoH handled the evidence and patients surrounding the PIP implant fiasco, and whether they could have done more.

It concluded that the MHRA acted appropriately and “fulfilled its obligations” and there was no evidence of inappropriate action.

The second review, led by NHS Managing Director, Professor Sir Bruce Keogh, is due later this year and will look at implant regulation as a whole and whether there should be a complete revamp in the regulation procedures, including the installation of an Implant Registry to help record and monitor problems.

PIP maker, Jean-Claude Mas, has triggered an international debate into how medical devices are regulated

Howe said the responsibility for the suffering of women worldwide as a result of the breast implant lay with the French manufacturer, Poly Implant Prosthèse (PIP),and important lessons must be learnt from this experience to make the wider regulatory system more effective.

“It must be emphasised that this case was one of deliberate fraud by the PIP manufacturer which purposefully misled European regulators…But serious lessons must be learned from this scandal. The MHRA needs to look at how it gathers evidence so it is able to identify problems early.”

The two reviews were commissioned by the DoH after the discovery that substandard industrial silicone was used in breast implants made by the French company. Evidence suggests that this silicone is linked to an above average risk of rupture and could pose health risks to the thousands of women with these breast implants around the world, including an estimated 47,000 in Britain.

The majority of Health Ministries around the world issued guidance for PIP implant removal after this was revealed in 2010, although the review suggests problems with PIP were reported as early as 2002. These implants have since been banned and the company consequently went into liquidation.

A problem with PIP implants was uncovered in 2010 and evidence suggests a higher-than-normal rupture rate

Current measures mean an implant approved by one of the 70 European regulatory bodies is also licensed for use throughout Europe, and individual member states do not have the power to refuse its use.

According to Mr Fazel Fatah, President of the British Association of Aesthetic Plastic Surgeons (BAAPS): “Poor post-marketing surveillance of medical devices lies at the root of the PIP crisis. This is an opportunity for the DoH to get it right…to avoid a repeat fiasco. Clearly changes are also needed at European level of the CE marking process.”

The evidence included in Howe’s investigation showed that MHRA did monitor all incidents and ensured the appropriate action was taken, as its role entails. However, the fact that PIP was able to conceal their use of non-approved filler material “has rightly triggered questions about how this can have happened, and how it remained undetected for such a long period”. Improvements, therefore, are needed in the way MHRA, and indeed the whole European system, communicate the information they have, in order to protect everyone receiving the numerous types of medical implants.

In response to the report, Professor Sir Kent Woods, Chief Executive of the MHRA, said: “We sympathise with all the women affected and we welcome Earl Howe’s review and the recommendations.

“We will act quickly to implement the recommendations and use the lessons learned from this episode to improve the regulatory system for medical devices in the UK and Europe.”

BAAPS President-Elect, Mr Rajiv Grover, also responded to welcome the recommendations and said his organisation have been calling for changes which would have addressed these recommendations before now.

“We welcome the findings of the Government’s review into the PIP scandal, and agree in particular that there should be a better system of reporting for medical devices…for the last few years, the BAAPS has been championing the reinstatement of a compulsory implant register that would monitor…all types of implant put into the body…and would immediately address all the recommendations put forward in this report.”

The government has also published a response to the House of Commons’ Health Committee. The response notes the Committee’s many helpful suggestions, many of which will be taken forward in Sir Bruce Keogh’s review.

Images courtesy of beauty blogger, cosmetic breast surgeon and its political.

Individuals suffering from depression and stress often have an imbalance of hormones, and the research tried to relate this to telomere length. The study aimed to discover the relationship between telomere length and the biological as well as the psychological effects of stress in patients suffering from major depressive disorder and control participants.

The study tested the effects of an enzyme responsible for restoring telomere function, known as telomerase, in genetically modified mice. Switching off the gene responsible for telomerase production led to the development of ageing symptoms such as system failure and infertility. Turning the gene back on, however, reversed the ageing process, regenerating organs and reestablishing health.

The research, led by Dr Mikael Wikgren from Umeå University in Sweden, measured telomere lengths in the leukocytes of 91 patients diagnosed with MDD (major depressive disorder) and 451 other control participants. The results of the study, published in Biological Psychiatry, revealed significantly shorter telomeres among the depressed patients when compared to the control group and low levels of cortisol.

“It is possible that the low levels of cortisol permitted a higher level of inflammation in the body, which subsequently contributed to accelerated telomere length shortening,” said Dr Wikgren. He further explained that due to the nature of the study design, it is not certain that cortisol is directly involved in telomere length dynamics, only that it correlates with it.

“Other hormones are certainly also involved in modulating telomere length dynamics. Insulin signaling, for instance, is implicated the ageing process, and has in different ways been tied to telomere length,” said Dr Wikgren.

Currently, the results cannot directly be of help to the clinic other than to contribute knowledge, which may assist in diagnosing and treating depression down the road. “Stress and cortisol have for several decades been of interest for researchers investigating the biology of depression, and we think that our study brings another piece of knowledge to the field,” said Wikgren.

According to Wikgren, some intriguing results from animal studies suggest that elongating telomeres may indeed slow down and even reverse aging under some circumstances. In 2010, Jaskelioff et al published a paper in Nature which showed how mice which had the telomerase enzyme reactivated reversed the aging process in several tissues. The experiment was performed in cancer-resistant mice as telomerase may provoke cancer. Dr Mikael said: “It is still early, but perhaps telomere research may help us live longer, healthier and merrier in the future.” ]]> http://www.elements-science.co.uk/2012/05/ageing-link-to-depression-opens-new-research-avenues/feed/ 0 http://www.elements-science.co.uk/2012/05/berries-keep-your-brain-sharp-as-you-age/ http://www.elements-science.co.uk/2012/05/berries-keep-your-brain-sharp-as-you-age/#comments Sun, 13 May 2012 19:11:28 +0000 Rafi Meguerditchian http://www.elements-science.co.uk/?p=11446 New research gives another boon for the blueberry: high consumption could delay memory decline in older women.

Scientists enrolled 101 HIV positive Tanzanian breastfeeding mothers and their infants to test the technique. Mothers were encouraged to breastfeed for 6 months, then flash heat expressed breast milk if their infant was HIV negative. During the process peer counselors provided equipment and instructions on flash heating.

Eighty six infants were still alive and participating in the study at 5 months of age when they were tested for HIV. Of these infants, 72 were HIV negative, and more than half of their mothers chose to flash heat their breastmilk.

The new report, published in Journal of Acquired Immune Deficiency Syndromes, showed that women adhered to the protocol consistently over an average of about 10 weeks, with some mothers utilizing the method up to a full year. This in-home technique for heating breast milk inactivates HIV although preserving its nutritional and anti-infective properties.

“More women with HIV than we anticipated were willing and able to flash heat their breast milk and make it safe despite very limited resources,” said Caroline Chantry, professor of pediatrics at UC Davis Children’s Hospital and lead author of the study. “These findings show that the World Health Organization’s recommendations are feasible in a real-world setting.”

Flash-heating breast milk is recommended by the World Health Organization (WHO) for HIV-infected mothers during times of increased transmission risk. “It’s a very high-risk period for diseases and deaths from gastrointestinal infections,” Chantry said.

Even when there are no medications for mothers to take to reduce the risk of HIV transmission to their infants, studies have shown exclusive breasting of children for the first six month of life can be successfully supported in HIV infected women.

According to a 2007 study in The Lancet, exclusive breastfeeding is better for babies than other forms of feeding, including intermittent breastfeeding. It reduces the chances of mother to child transmission during the first months of life.

In 2011, the WHO recommended that mothers worldwide should exclusively breastfeed infants for the child’s first six months to achieve optimal growth, development and health

“Flash heating can help women provide nutrient and antibody-rich breastmilk to their infants beyond 6 months of age and reduce the possibility of HIV transmission at the same time,” said Chantry. “This method is inexpensive in terms of costs and workforce and could be sustainable in resource-limited settings.”

Image credit: Cimmty on flickr

With the report from a second, public inquiry due in June, what have we learned from Mid-Staffs and what has been done to prevent a recurrence of such dramatic failings?

The Health and Social Care Act (HSCA) will introduce measures to more carefully scrutinise healthcare providers, as well as what it describes as: “a move away from centrally-driven process targets which get in the way of patient care; and a relentless focus on outcomes and the quality standards that deliver them”.

However, one issue arising from the initial Mid-Staffs inquiry, and overlooked in the HSCA, is the role and regulation of Healthcare Assistants in the NHS.

There are more than 300,000 Healthcare Assistants (HAs) working in hospitals around the UK. They support the work of nurses and midwives, as well as performing simple duties such as cleaning and feeding patients. They play an important role in hospitals and are often involved in intimate treatment – yet they are completely unregulated.

There are no national standards requiring a minimum level of training for HAs, they are increasingly expected to perform roles outside of their duties or without supervision and they are often indistinguishable from the registered nurses. The combination leaves patients feeling uncertain as to the quality of care they are receiving and may contribute to mistakes, such as those seen at Mid-Staffs.

Learning on the job

HAs are typically given a week’s induction before starting their work on the wards. There seems to be an expectation that healthcare is the sort of thing you can pick up on the job – if you watch a nurse treating a patient a few times you should be able to absorb all of the knowledge required to do it yourself.

One of the concerns raised in the initial Mid-Staffs hospital inquiry was the ratio of unregistered Healthcare Assistants to qualified nurses. There were times when, on some wards, the divide was 60:40 in favour of HAs. The Royal College of Nursing recommends a minimum split of 60:40 in favour of registered nurses on any ward, with calls for further research into the best skill mix and staff ratios on particular wards.

The key reason for favouring HAs is the savings made in staffing costs. These support workers are paid much less but are increasingly being expected to perform the same duties as the higher-salaried nurses.

Nurses aren't always easy to distinguish from healthcare assistants on a ward

Many of the checks in a medical examination involve observations, inferences and judgements that are not visible to an unqualified person watching. The idea that you could leave someone to diagnose a patient, or even treat their symptoms, when a week earlier they might have been working in the local Post Office is cause for concern.

If HAs who have no proper medical training are asked to report to a nurse or doctor, there can be no certainty that the salient information is being relayed. Seemingly trivial details that could be overlooked may paint a different picture when looked at as a whole. It is vital that communication between a patient’s first point of contact and the person who ultimately delivers care is effective, otherwise there is a risk of misdiagnosis or clinical negligence.

Failings in patient treatment have often been put down to the quality of higher education for nurses but this tends to miss the broader context of their work after they leave university. The role of the registered nurse has shifted towards a managerial position, overseeing the work of the HAs.

Research has been conducted into whether the savings made by replacing registered nurses with healthcare assistants outweighs the cost of repeat treatments and any mistakes that might be made. The evidence suggests that the extra costs incurred by far exceed the money saved through staff restructuring.

But the NHS has not been alone in looking at ways to cut its staffing budget, as part of the Government measures to tighten the public purse.

In early April we saw criticism over trials in South Yorkshire where the local Police Authority are trialling a scheme that will replace bobbies on the beat with Police Community Support Officers (PCSOs). Last year, Panorama revealed undercover footage of the routine abuse of vulnerable patients at Winterbourne View residential care home after questions were raised over the behaviour of support workers towards patients. And back in 2008, UNISON called for greater controls over the use of teaching assistants as “cut-price” teachers.

If this is suggestive of some form of pattern, then is the scaling down of higher salaried professional nurses in favour of low-paid, unregulated healthcare assistants simply part of the “Big Society” plan?

With lives potentially at risk, and short-term savings in staffing outweighed by long-term costs in extra treatment, this is an NHS strategy that needs serious rethinking.

Images courtesy of Fotos Gov/Ba and clemsonunivlibrary

In the study, scientists compared the placentas of obese rats and obesity-resistant rats. All were fed a healthy diet throughout their pregnancies. Results showed that despite not gaining much weight, the “obesogenic” environment already established inside the overweight mothers remained and caused unhealthy effects on the foetus.

Offspring were up to 17 percent smaller than they should have been and, according to the authors, this was due to changes on the surface of the placenta which influenced nutrient transport to the baby.

“We can see fat sequestered in the placentas of obese mothers when it should be going to the baby to support its growth,” said co-author Dr Yuan-Xiang Pan from the Department of Food Science and Human Nutrition at the University of Illinois. “The nutrient supply region in the placenta of an obese mother is half the size of that of a normal-weight mother, even when both are eating the same healthy diet.”

Obesity during pregnancy is now a common condition affecting approximately one in five pregnant women. Reporting in the Journal Biology of Reproduction, the authors analysed placentas for fat accumulation and expression of the DKK1 gene, a protein involved in embryonic development. By monitoring the levels of DKK1, scientists were also able to demonstrate, for the first time, that DKK1 controls certain aspects of lipid metabolism in the placenta. They hope monitoring the protein could provide markers for healthy pregnancy.

“Obesity creates unhealthful conditions in the mother’s body that take time to correct,” said Dr Pan. “Understanding this process should help us identify some biomarkers that would allow a potential mother’s doctor to say ‘yes, you’ve lost weight, the chemical conditions that were created by your excess weight are gone, and this is a good time for you to become pregnant’.”

This report adds to the body of knowledge from previous studies into the health risks posed by maternal obesity, both for the mother and child during and after pregnancy.

For instance, according to a 2001 study from Imperial College, maternal obesity carries significant risks for the mother and foetus, likely to be related to the altered metabolic state associated with morbid obesity.

Photo credits: tobyotter on Flickr