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Archive for June 4, 2012

Bagna Cauda Salad

Serves 4

2 small carrots, trimmed and peeled

2 radishes, trimmed

2 small turnips, trimmed and peeled

2 small beets, trimmed and peeled

1/4 small butternut squash (the seed end, preferably), seeded and peeled

8 brussels sprouts, trimmed

1/4 cup whole flat leaf parsley leaves

4 anchovy fillets

2 small (or 1 medium) garlic cloves


2 tablespoons lemon juice

5 tablespoons olive oil

  1. Cut the carrot into 3-inch-long, sliver thin batons (I first cut the carrot crosswise into 3-inch lengths; then I cut each piece in half lengthwise; finally, I cut each half lengthwise into 1/8-inch slivers.)
  2. Using a mandoline, slice the radishes, turnips, and beets crosswise into the thinnest circles possible – they should be translucent.
  3. Put the mandoline to work again: slice the butternut squash into the thinnest ribbons possible. Stop when you have 2 cups of ribbons.
  4. Pull the brussels sprouts into leaves – you may need to trim the stem as you go to help the leaves separate, and remember that the leaves tend to wind around the sprout, so you want to pull them off the sprout in an unwinding fashion.
  5. In a large mixing bowl, combine the carrots, radishes, turnips, squash, brussels sprouts, and parsley. (Leave aside the beets until the end; otherwise, they’ll stain the rest of the vegetables.) Mix with your hands to disperse the vegetables. You should have 4 to 6 cups of vegetables.
  6. In a mortar and pestle (or in a mini food processor or blender), pound the anchovy, garlic, and a large pinch of salt to a paste. Slowly beat in the lemon juice, followed by the olive oil, adding it in drops so the dressing has time to emulsify. Season to taste with salt, and add more lemon juice or oil if needed.
  7. Pour half the dressing over the vegetables and blend with your hands so you can separate the vegetables (they like to cling to each other). Mix and mix and mix! Then taste and adjust seasoning. If it’s good, slip the beets into the salad (but don’t really mix them in), and let the salad rest for at least 15 minutes before serving. Then eat, and feel virtuous.


Shrimp Skewers with Tzatziki, Spinach, and Feta

Tzatziki is a popular Greek sauce made from yogurt, cucumbers, garlic, and dill. In this Fast, Easy, Fresh recipe, we’ve subbed in shallots for garlic and used it to top skewers of shrimp.


1 cup Greek-style (2% or nonfat) yogurt*
1 cup 1/4-inch cubes English hothouse cucumber
3 tablespoons chopped fresh dill
2 tablespoons fresh lemon juice plus additional for drizzling
2 tablespoons chopped shallots
1 1/4 teaspoons aniseed, finely crushed, divided
Olive oil (for brushing and drizzling)
1 pound uncooked large shrimp, peeled, deveined, tails left intact
8 cups baby spinach leaves
3/4 cup crumbled feta cheese


Mix Greek-style yogurt, cucumber, dill, 2 tablespoons lemon juice, shallots, and 3/4 teaspoon crushed aniseed in small bowl; season tzatziki generously with salt and pepper. Chill.
Prepare barbecue (medium-high heat). Brush grill with oil. Thread shrimp onto 4 metal skewers. Brush shrimp all over with olive oil; sprinkle with salt, pepper, and remaining 1/2 teaspoon crushed aniseed. Grill just until shrimp are opaque in center, about 3 minutes per side. Divide spinach among 4 plates; drizzle lightly with additional lemon juice and olive oil. Top each with 1 shrimp skewer. Spoon tzatziki over shrimp; sprinkle with feta cheese and serve.
*A thick yogurt; sold at some supermarkets and at specialty foods stores, such as Trader Joe’s and Whole Foods markets, and Greek markets. If unavailable, place plain yogurt in cheesecloth-lined strainer set over large bowl. Cover and chill overnight to drain.


‘Hope’ for the paralysed?

Paralysed rat walking

Paralysed rat in harness walking after chemical-electrical stimulation

Seven years ago I stood on a bridge over the M40 doing a “piece to camera” for a report about spinal repair. The aim was to come up with a metaphor for how researchers at University College London were trying to overcome spinal cord paralysis.

It went something like this: “Imagine your spinal cord as a motorway, the cars travelling up and down are the nerve fibres carrying messages from your brain to all parts of the body. If this gets damaged the cars can’t travel. The messages are blocked, the patient is paralysed.

“Normally there is no way of repairing a severed spinal cord. But the team at UCL took nasal stem cells, and implanted them into the area of damage. These formed a bridge, along which the nerve fibres re-grew and re-connected.”

This is the World-Cup of neurorehabilitation. Our rats have become athletes when just weeks before they were completely paralysed.”

Prof Gregoire Courtine EPFL

The research at the Spinal Repair Unit at UCL involved rats, not humans. In my TV report we showed rats unable to climb a metal ladder after one of their front paws had been paralysed to mimic a spinal cord injury. But after an injection of stem cells, the rats were able to move nearly as well as uninjured animals.

“Difficult and complex”

The hope then – and now – is that such animal experiments will translate into similar breakthroughs with patients. Seven years on and the team at UCL led by Professor Geoff Raisman are still working on translating this into a proven therapy for patients. He told me “This is difficult and complex work and we want to ensure we get things right.”

So it was with a sense of caution that I approached some Swiss research in the latest edition of the journal Science in which paralysed rats were able to walk again after a combination of electrical-chemical stimulation and rehabilitation training.

The research prompted some newspaper reports talking of “new hope” for paralysed patients. The lead researcher, Professor Gregoire Courtine enthused: “This is the World-Cup of neurorehabilitation. Our rats have become athletes when just weeks before they were completely paralysed.”

My colleague James Gallagher has reported on the research and you can read his copy here.

A brief summary of the research is this: the team at the Federal Institute of Technology (EPFL) in Lausanne injected chemicals into the paralysed rats aimed at stimulating neurons that control lower body movement. Shortly after the injection their spinal cords were stimulated with electrodes.

The rats were placed in a harness on a treadmill which gave them the impression of having a working spinal column and they were encouraged to walk towards the end of a platform where a chocolate reward was waiting. Over time the animals learned to walk and even run again.

Prof Courtine, who holds the International Paraplegic Foundation Chair in Spinal Cord Repair at EPFL said: “After a couple of weeks of neurorehabilitation with a combination of a robotic harness and electrical-chemical stimulation, our rats are not only voluntarily initiating a walking gait, but they are soon sprinting, climbing up stairs and avoiding obstacles when stimulated.”

The major question is this: What does this mean for humans who are paralysed?


Prof Courtine said he was optimistic patient trials would begin in “a year or two” at Balgrist University Hospital Spinal Cord Injury Centre in Zurich.

Other scientists gave a mixed response to the findings. Dr Elizabeth Bradbury, Medical Research Council Senior Fellow, King’s College London, described the Swiss experiments as “elegant” and “ground-breaking”. But she said questions remained before its usefulness in humans could be determined.

She said: “Firstly, will this approach work in contusion/compression type injuries? These injuries involve blunt trauma, bruising and compression of the spinal cord and are the most common form of human spinal cord injury. Very few human spinal cord injuries occur as a result of a direct cut through spinal tissue (as was the injury model in the Courtine study).

“Secondly, will this technique work in chronic (long-term) spinal injuries? It is not yet known whether it is possible to generate extensive neuroplasticity in a system that has been injured for a long time and now contains many more complications such as abundant scar tissue, large holes in the spinal cord and where many spinal nerve cells and long range nerve fibres have died or degenerated.”

This is yet another example of research that will lead nowhere.”

Dr Jan Gawronski Royal National Orthopaedic Hospital

That term “neuroplasticity” is crucial. It refers to the ability of the brain and spinal cord to adapt and recover from moderate injury – something which researchers have been trying to exploits for years.

Prof Raisman of UCL said few people, even doctors, were aware that around half of all patients who become paralysed will walk again no matter what treatment they have. He questioned whether the improvements in the paralysed rats might in part be due to spontaneous recovery – neuroplasticity – rather than the combination of interventions.

Prof Raisman is now conducting trials with paralysed patients in Poland, who are all at least 18 months post-injury which removes any doubt that spontaneous repair may be the cause of any improvement.

False hope

Other scientists are scathing about efforts to repair the spinal cord. Dr Jan Gawronski, consultant in rehabilitation medicine, Royal National Orthopaedic Hospital, said the Courtine study was “yet another example of research that would lead nowhere”. He said scientists had been doing rat studies on neuroregeneration for decades and “not one had led to a breakthrough for patients.”

He pointed me to a recent article in the journal Spinal Cord, by neurologist Dr L S Illis in which he states: “There is not a single example of experimental work translating into a therapeutic effect. …It would be difficult to find any other branch of science with over a century of such sterile endeavour.”

Supporters of this field of research would counter with the case of Rob Summers, a paralysed American patient who is now able to stand with electrical stimulation of his spinal cord. We reported on his case last year, which appeared in the Lancet journal. He could walk on a treadmill while being supported. But doctors warned that the research was still very much at the early experimental stages.

There are research teams worldwide trying to find ways of curing spinal cord injuries.

But until there are successful trials involving several patients, scientists and journalists need to be careful about giving false hope to patients living with paralysis.

If you want to see a video release of the Swiss research then you should click on the box below. I should warn you that it shows experiments with rats in a harness walking on a platform while their spinal cord is being stimulated.


Premature birth linked to worse mental health

Premature baby

One in 13 babies are born before 36 weeks

Being born prematurely is linked to an increased risk of a range of mental health problems much later in life, according to researchers.

Bipolar disorder, depression and psychosis were all more likely, the study in The Archives of General Psychiatry suggested.

The overall risk remained very low, but was higher in premature babies.

Experts cautioned there have since been significant advances in caring for premature babies.

Full-term pregnancies last for around 40 weeks, but one in 13 babies are born prematurely, before 36 weeks.

Heightened risk

Researchers at the Institute of Psychiatry at King’s College London and the Karolinska Institute in Sweden analysed data from 1.3m people born in Sweden between 1973 and 1985.

They found 10,523 people were admitted to hospital with a psychiatric disorders, 580 of those had been born prematurely.

The academics showed full-term children had a two in 1,000 chance of being admitted. The risk was four in 1,000 for premature babies born before 36 weeks and six in 1,000 for those born before 32 weeks.

I don’t think parents should be worried”

Dr Chiara Nosarti King’s College London

Very premature babies were more than seven times more like to have bipolar disorder and nearly three times as likely to have depression.

One of the researchers, Dr Chiara Nosarti, said the real figures may be higher as milder conditions would not have needed a hospital visit.

However, she cautioned that the risk was low and the vast majority of premature babies are perfectly healthy.

She told the BBC: “I don’t think parents should be worried, but we know that preterm birth confers an increased vulnerability to a variety of psychiatric conditions and perhaps parents should be aware of this and monitor early signs of later more serious problems.”

She speculate that “disrupted development” may affect the babies’ brains.


The chief executive of the mental health charity SANE, Marjorie Wallace, said: “We already knew that premature birth may be linked to schizophrenia, but to see evidence linking it to a range of psychiatric conditions which required hospitalisation is striking.”

The baby care charity Bliss said it was well-established that early birth can affect the developing brain.

However, its chief executive Andy Cole cautioned that some of the people in the study were born “40 years ago and that neonatal clinical practice to limit neurological damage has been transformed over the past four decades, with significantly improved outcomes seen today.”

There have been developments in cooling the brain to reduce any damage as well as improvements in ventilation to ensure enough oxygen is getting to brain.


Doctors ‘risking email privacy breaches’

Email icon

Basic errors can lead to confidentiality breaches


As the email whizzes off into the ether, dread strikes. It’s gone to the wrong person.

Normally, the worst that can happen is a little embarrassment.

But a medical advice body is warning that while trying to use modern technology to contact patients, doctors are sometimes revealing confidential information.

The Medical Defence Union, which counts more than 50% of UK hospital doctors and GPs as members, says it is being contacted by medics worried about how to put right such data breaches.

In one case a practice sent patients an email reminder for a flu vaccination clinic, but mistakenly pasted the email addresses into the “To” rather than the “Bcc” – blind copies – box.

A patient complained that a friend, who had also received the email, had asked her why she was on the list.

She was being offered the jab because she had cancer – but she had not wanted her friend to know.

Most mix-ups occur when senders inadvertently use the To or Cc boxes instead of Bcc, allowing all recipients to see the names and email addresses of everyone on the list.


The MDU is issuing advice to doctors about how to send out group emails, and what to do if it goes wrong.

Its author, Dr Carol Chu, MDU medico-legal adviser, said the organisation had received a significant number of requests for advice from members.

“These are breaches of confidence. It shows those in the email group that other individuals are part of that practice, and part of that particular group.

“And, while you may not be directly releasing clinical information, it can be possible for people to make assumptions, especially in small communities.

We do not want to see patient confidentiality compromised”

Katherine Murphy Patients Association

“For example, on a flu jab reminder list, you may be on there because you are immunosuppressed, because you have cancer or HIV – or other reasons you don’t want people to know about.”

She said practices also used email to contact groups of people with particular conditions, such as diabetes or heart disease.

“If a mistake is made in an email to a group of patients about a particular treatment or service, such as an asthma, immunisation or diabetes clinic, doctors run the risk of a triple breach of confidence – by revealing the patient’s email address; that the person is a patient; and that they are likely to have a condition that might benefit from the service being offered.”

Dr Chu added: “Electronic communication can bring a wealth of benefits to doctors and to patients, however it is not without risks.”

‘Embrace technology’

Doctors are at risk of being in breach of both the Data Protection Act 1998 and the Privacy and Electronic Communications regulations 2003 – and the Information Commissioner would have to be informed.

A spokesman for the Information Commissioner’s office said GP practices, like hospital trusts and local councils had a responsibility to take care of the data they hold.

He added: “Bcc and group emails are a concern. If we find a breach related to Bcc, and particularly if that’s caused damage or distress, we would take enforcement action.”

Katherine Murphy, chief executive at the Patients Association, said it had received complaints from patients about their GPs’ use of texts or emails.

She added: “Whilst we fully recognise that the NHS needs to embrace technology, we do not want to see patient confidentiality compromised as a result.

“Every GP practice has a duty to ensure that this does not occur.”


Brighton hospital fined record £325,000 over data theft

Brighton General Hospital
The trust was fined after computers taken from Brighton General Hospital were found on eBay

A hospital trust has been fined £325,000 after computer hard drives containing confidential information on thousands of patients were stolen.

The Information Commissioner’s Office (ICO) said the fine, for Brighton and Sussex University Hospitals NHS Trust, was the highest it had ever imposed.

Personal data belonging to patients and staff was taken from Brighton General Hospital in September 2010.

The trust said it could not afford to pay the fine and would appeal.

Highly sensitive personal data belonging to tens of thousands of people, including some relating to HIV and Genito Urinary Medicine patients, was discovered on hard drives sold on eBay in October and November 2010.

The ICO said the data included details of patients’ medical conditions and treatment, disability living allowance forms and children’s reports.

Destroy hard drives

It also included staff details including National Insurance numbers, home addresses, ward and hospital IDs, and information referring to criminal convictions and suspected offences.

We still do not know why they have imposed such an extraordinary fine”

Duncan Selbie Brighton and Sussex University Hospitals NHS Trust

The data breach occurred when an individual working for the trust’s IT service provider, Sussex Health Informatics Service (HIS), was told to destroy approximately 1,000 hard drives at Brighton General Hospital.

A data recovery company bought four hard drives from a seller on eBay, who had purchased them from the individual.

The ICO said the trust was unable to explain how the individual removed at least 252 of the hard drives that were supposed to be destroyed from the hospital.

The worker was not believed to have known the key code needed to access the room where the drives were stored, and was usually supervised by staff working for HIS.

‘Dispute findings’

The ICO’s deputy commissioner David Smith said the fine reflected the gravity and scale of the data breach.

“It sets an example for all organisations – both public and private – of the importance of keeping personal information secure,” he said.

The trust’s chief executive, Duncan Selbie, said no sensitive data had entered the public domain.

“We dispute the Information Commissioner’s findings, especially that we were reckless, and a requirement for any fine,” he said.

“We arranged for an experienced NHS IT service provider to safely dispose of our redundant hard drives and acted swiftly to recover, without exception, those that their sub-contractor placed on eBay.

“It is a matter of frank surprise that we still do not know why they have imposed such an extraordinary fine.”






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