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Archive for March 20, 2013

Ajo Blanco

Ajo Blanco

This version of white gazpacho, traditionally made with green grapes, is brightened with the addition of green apple.


  • 1 green apple (such as Granny Smith), peeled, cored, chopped
  • 1 large garlic clove, chopped
  • 3 cups crustless 1-inch cubes day-old white country bread
  • 1 cup seedless green grapes, halved
  • 1/2 cup whole blanched almonds
  • 1/2 cup whole milk
  • Kosher salt
  • 3/4 cup extra-virgin olive oil plus more
  • 3 tablespoons red wine vinegar plus more
  • Freshly ground black pepper
  • 1/2 cup sliced almonds


  • Combine apple, garlic, bread, grapes, blanched almonds, milk, and 2 cups water in a medium bowl; season with salt. Cover and chill for at least 6 hours and up to 1 day.
  • Transfer soup base to a blender and purée, adding water by tablespoonfuls if too thick, until smooth. With motor running, gradually add 3/4 cup oil and 3 tablespoons vinegar and blend until soup is emulsified. Season with salt, pepper, and more vinegar, if desired. Strain soup through a fine-mesh sieve into a large bowl; cover and chill until very cold, about 2 hours. DO AHEAD: Soup can be made 1 day ahead. Keep chilled.
  • Preheat oven to 350°. Spread sliced almonds on a rimmed baking sheet and toast, tossing occasionally, until golden, about 4 minutes. Let cool.
  • Divide soup among bowls; top with toasted almonds; drizzle with oil and vinegar.

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Agile Project Manager

Agile Project Manager: A project manager as powerful as it is robust




Agile Project Manager (Scrum Sprint Planner) iPad Only (4.5 stars with 147 Ratings)


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Study links 180,000 global deaths to sugary drinks

Sugary drink

Last week, a state judge blocked New York City from implementing Mayor Michael Bloomberg’s ban on sugary drink larger than 16 ounces.(Photo: Spencer Platt, Getty Images)

Americans account for about 25,000 obesity-related deaths blamed on over-consumption of sweetened beverages.

Researchers reported Tuesday that they have linked 180,000 obesity-related deaths worldwide to sugary drinks, including about 25,000 adult Americans.

Overall, 1 in 100 deaths of obese people globally can be blamed on too many sweetened beverages, according to a study presented at an American Heart Association scientific conference in New Orleans. Mexico leads the 35 largest nations in deaths attributable to over-consumption of sugary drinks, with the United States third. Japan, which has one of the lowest per-capita consumptions of sugary drinks, had the fewest sugar-related deaths.

Using data collected as part of the World Health Organization’s 2010 Global Burden of Diseases Study, the researchers determined that 78% of these deaths were in low- and middle-income countries.

Of the deaths in 2010 linked to drinking sugar-sweetened soft drinks, fruit juice or sports beverages, 132 000 were from diabetes, 44 000 from cardiovascular disease and 6,000 from cancer.

The most diabetes deaths (38,000) occurred in the Latin America/Caribbean region, with East/Central Eurasia reporting the largest numbers of cardiovascular deaths (11,000) related to over-consumption of sugar-sweetened drinks.

The finding that three quarters of the deaths were from diabetes “suggests that limiting sugary-beverage intake is an important step in reducing diabetes deaths,” co-author Gitanjali Singh, a postdoctoral research fellow at the Harvard School of Public Health, said in an interview.

Average consumption varied widely — from less than one 8-ounce drink a day among elderly Chinese women to more than five 8-ounce drinks every day among younger Cuban men.

“Because we were focused on deaths due to chronic diseases, our study focused on adults. Future research should assess the amount of sugary beverage consumption in children across the world and how this affects their current and future health,” Singh said.

In a statement, the American Beverage Association, the trade group for the non-alcoholic beverage industry, dismissed the findings as “more about sensationalism than science.”

“This abstract, which is not peer-reviewed nor published in a way where its methodology can be fully evaluated, is more about sensationalism than science. It does not show that consuming sugar-sweetened beverages causes chronic diseases such as diabetes, cardiovascular disease or cancer – the real causes of death among the studied subjects. The researchers make a huge leap when they take beverage intake calculations from around the globe and allege that those beverages are the cause of deaths which the authors themselves acknowledge are due to chronic disease.”

The Harvard School of Public Health has a fact sheet on “sugary drink supersizing and the obesity epidemic.”

Some highlights:

Two out of three adults and one out of three children in the United States are overweight or obese, and the nation spends an estimated $190 billion a year treating obesity-related health conditions. Rising consumption of sugary drinks has been a major contributor to the obesity epidemic. A typical 20-ounce soda contains 15 to 18 teaspoons of sugar and upwards of 240 calories. A 64-ounce fountain cola drink could have up to 700 calories. People who drink this “liquid candy” do not feel as full as if they had eaten the same calories from solid food and do not compensate by eating less.

The American Heart Association recommends that based on a 2,000-calories-a-week diet, adults should not consume more than 450 calories from sugar-sweetened beverages.

Monday, Mississippi’s Republican governor signed into a law legislation that prohibits cities and counties from restricting or banning the size of soft drinks, or from requiring that restaurants post calorie counts or other nutritional information. Mississippi is the most obese state in the nation.

“It is simply not the role of government to micro-regulate citizens’ dietary decisions,” Gov. Phil Bryant said in a statement. “The responsibility for one’s personal health depends on individual choices about a proper diet and appropriate exercise.”

The action came a week after a New York state judge struck down Mayor Michael Bloomberg’s attempt to limit most sugary drinks to 16 ounces.

Bloomberg called the Mississippi legislation “ridiculous.”

usatoday –

Night nurseries: Sweden’s round-the-clock childcare

Leon in bed

As working parents around the world juggle their childcare issues, are Sweden’s night nurseries the solution to unsociable hours?


Sweden has long had a glowing reputation for its generous childcare facilities and is regularly ranked as one of the best places to raise a family.

Each child is guaranteed a place at a public preschool and no parent is charged more than three per cent of their salary, with fees capped at SEK 1260 ($197, £132) a month for the country’s highest earners.

All other costs are covered by the state, which spends SEK 56.6bn ($8.9bn, £5.0bn) a year subsidising preschool services, more than its annual defence budget.

Most public nurseries offer care from around 06:00 to 18:00. But with the numbers of parents working flexible or unconventional hours going up, local councils are increasingly providing more overnight and weekend services.

In south-east Sweden, the small, former industrial city of Norrkoping is among those already leading the way in out-of-hours care. There are four council-run nurseries open overnight here, the first of which launched 20 years ago.

The British expat’s story

Gina Tse, 33, is prima ballerina for the Royal Swedish Ballet Company, Prima Ballerina. She lives in Stockholm with her four-year old son Jacy.

“As an expat mum, I have the same rights as a Swedish national in terms of maternity leave and access to childcare. Being a ballerina, I regularly perform at night and at weekends.

For my son, the night nursery is in the same location as his day nursery, so he has the same teachers and it feels familiar.

When he was one they would put him to sleep in his pram so I could just roll him home after my performance and he wouldn’t even wake up.

When I speak to British friends back home I realise how lucky I am as the cost of childcare is tremendous compared with Sweden. I pay a total of SEK 890 ($138, £93) a month.”

“At first it was very hard to take my kids to sleep somewhere else and my heart was aching,” says mother Maria Klytseroff, 39, a part-time care assistant for people with learning difficulties.

Her children spend about two or three nights a week at one of the preschools, which is more like a homely apartment than an education centre.

“I am a single mum and I wanted to go back to my job, which is at night,” explains Maria.

“The children soon got used to it, they have friends and they adore the workers who look after them.”

Eighteen children are registered at the nursery.

The toddlers arrive in time to eat dinner, clean their teeth and then enjoy a bedtime story with a member of staff.

Two-year-old Leon is dressed in blue striped pyjamas and cuddles several teddy bears as he curls up beneath a duvet covered in cartoon characters.

Maria Klytseroff : “We do pay high taxes but we get something back”

His older sister India, three, is wearing her favourite strawberry-print nightwear and has just finished a glass of milk.

In the morning, staff will zip them into their padded snow suits and wheel them by buggy to a nearby day centre while Maria sleeps off her night shift.

“I have travelled a lot, so I know that I am lucky compared to people in other countries,” says Maria, who pays a total of $112 (SEK 720, £75) a month in preschool fees.

Just over 78% of mothers with children under seven went out to work in 2012, according to Statistics Sweden’s latest Labour Force Survey.

In Sweden, it is up to local government regions (known as municipalities) to decide whether they want to offer publicly funded out-of-hours care.

It is currently available in 123 out of 290 areas and used by almost 5,000 children.

Both single parents and couples are eligible to apply as long as their employer provides evidence of their shift patterns.

Sweden’s welfare state

  • Both parents entitled to combined total of 16 months paid leave per child
  • First 13 months paid at 80% of the parent-on-leave’s most recent income, up to ceiling of approximately SEK 440,000 ($68,500, £45,900), rest is paid at flat rate of SEK 180 (SEK $28, £19) per day
  • Public childcare guaranteed to all parents with most facilities open between 0630 and 1830, with fees capped at 3% of parental income, up to SEK 1260 ($197, £132) a month for first child
  • Free pre-school for children between three and six, for up to 15 hours per week
  • All parents entitled to monthly benefit of SEK 1,050 ($163, £109) per child with supplements for large families

Swedish Government

Hospital workers, restaurant workers, transport workers and shop staff affected by longer opening hours in recent years, are among those who benefit from the service.

From July, the governing centre-right Alliance has promised to spend $17m (SEK 108.5m, £11m) over the next four years to help more areas improve their services.

It says a lot about the nation’s long-standing love affair with the welfare state that the main argument from opposition parties is whether that figure will prove to be enough.

“Sweden was earlier than other countries in terms of increasing women in the workforce and to make that possible we built up childcare,” says Sweden’s minister for gender equality, Maria Arnholm.

“We believe it is important that families can combine parenthood with work and that shouldn’t just include those who work nine-to-five but also those who work inconvenient hours,” she argues.

But not everyone is sold on the so-called Scandinavian model and its move towards 24-hour services.

“In terms of night care, I definitely don’t agree with the plans to expand it,” says Madeleine Wallin, president of the European Federation of Parents and Carers at Home, which represents its members at EU level and at the UN.

She sent three of her five children to public nurseries before deciding to raise the others at home in Hyssna, a small village in west Sweden.

Swedish children

“Spending hours and hours away from their parents can be incredibly stressful for children. You only have to look at their body language when they get dropped off at preschool,” she says.

Wallin, who now runs a business with her husband, says she felt pushed into using childcare for her first children, because of a “social stigma” against stay-at-home mothers.

“Sweden is an expensive country and when I gave up work for a while to look after the kids it was a struggle financially. But I was fed up of being told it was better to leave them with someone else,” she adds.

Since 2008, about a third of municipalities have started offering a special allowance to parents who choose not to work while their children are under three.

But this amounts to about eight per cent of an average monthly salary in Sweden and very few have taken up the benefit.

The European Federation of Parents and Carers at Home believes that offering parents more money could increase the numbers who stay at home.

However others argue that high employment among parents of young children is here to stay in Sweden.

“The problem is that once you have persuaded the majority of people to put their one and two-year olds in day or even night care, it is hard to have a debate,” says analyst Jonas Himmelstrand.

“It is painful putting your children in nursery and discussing it reminds parents of a choice they didn’t really want to make.”

We do pay high taxes but we get something back and I think that’s a great system”

Maria Klytseroff

A strong advocate of home teaching, he has also published controversial research suggesting that preschools can damage children’s mental health and lead to discipline problems in later life.

Now living in Finland, he is currently advising the Mothers at Home lobby group in the UK, where the government has promised to expand free early education to give more parents the choice of returning to work.

But when you speak to mothers and fathers back in Sweden, most do appear fully sold on the country’s public preschool model.

“Thanks to affordable childcare, I was able to study and retrain as a nurse,” says Martina Stenbom, 44, a mother-of-one who lives in Stockholm.

“In my area there is out-of-hours care, so I have had the chance to work and study at evenings and weekends.”

She also supports the expansion of overnight services, even though they didn’t work for her daughter when she was very young.

“We did try the night nursery when my daughter Pixie was 18 months old, but I didn’t enjoy being apart from her for so long. I would try it again in future though, if she felt happy with the idea.”

In Norrkoping, Maria Klytseroff remains passionate about the preschool facilities in her snowy city.

“It doesn’t matter if you are rich or poor or in between like I am, the nurseries mean that everyone here has the chance to work,” she says.

“We do pay high taxes but we get something back and I think that’s a great system. I am very happy to be a mother in Sweden and I wouldn’t want to bring up my children anywhere else.”


Dr Livingstone: missionary, explorer and medical pioneer

Henry Stanley and David Livingstone are paddled by natives along the river Rusigi

Dr David Livingstone, born 200 years ago, is known for exploring Africa, and as a missionary who campaigned against slavery, but he also made a lasting contribution to combating tropical diseases.

In Victorian Britain, parts of Africa were nicknamed the “white man’s grave” because so many missionaries died of malaria and other diseases.

But when Livingstone led his expeditions, they had a far lower death rate. The difference was that he worked out an effective treatment for malaria based on how much quinine you needed and the answer was quite a lot.

Portrait of Dr David Livingstone
Livingstone’s notes on malaria were vital to modern medicine

“His breakthrough was the medical implementation of quinine to treat malaria,” says Mike Barrett, Professor of Parasitology at Glasgow University, who has studied Livingstone’s medical work. “He brought chests full of it with him on expeditions. He would have died 100 times over without it.”

Livingstone contracted malaria many times on his trips. But he did not realise, as we know today, that mosquitoes were spreading the disease.

“Livingstone held the common view of the time that you caught malaria from breathing the putrid air of swamps,” says Barrett. “The word comes from the Italian ‘mala aria’, meaning bad air.

“Livingstone never made the connection to say the disease was carried by mosquitoes, but he noticed you were more prone to catch malaria in areas where they were present.”

“Quinine kills the malaria parasite. But he thought his recipe was cleansing the system of malaria by clearing the bowels. At the time Livingstone didn’t know the real reason it was working, but his diligent note-taking helped those that came after him.”

Livingstone’s malaria remedies were known as “rousers” by his travelling companions as they would get them back on their feet when they fell ill.

Livingstone’s ‘Rousers’

  • 6 to 8 grains of resin of jalap
  • the same of rhubarb
  • three each of calomel and quinine
  • made up into four pills with tincture of cardamoms

Victorian medicine – from fluke to theory

Following Livingstone’s success with the medicine, the pharmaceutical company Burroughs-Wellcome sold a quinine-based medication based on his recipe. They marketed it as “Livingstone’s Rousers” and it remained on sale until the 1920s.

Medical training

Livingstone trained as a doctor at Anderson’s University in Glasgow, which has since become the University of Strathclyde.

He began his studies in 1836 at the age of 23. He funded his education from years of hard work at a cotton mill in nearby Blantyre, where he was born.

He had always shown a strong desire to learn. His father taught him how to read and write. The mill provided school lessons in the evening and he enjoyed reading about natural sciences and religion.

What is malaria?

Mosquito carrying malaria
  • Caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes
  • In the human body, the parasites multiply in the liver and then infect red blood cells
  • If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs
  • In many parts of the world, the parasites have developed resistance to a number of malaria medicines

NHS Choices: Symptoms of malaria

It was religious belief that drew Livingstone to Africa. After completing his training in London, he joined the London Missionary Society. In 1840 he sailed for Cape Town in South Africa.

Livingstone would travel far to preach, learned tribal languages and was highly respected for his medical work. He specialised in obstetrics and ophthalmology.

While Livingstone’s early years in Africa focussed on his work as a medical missionary, his later journeys were about exploration. In 1849 he became the first European to cross the Kalahari Desert to Lake Ngami, and in 1851 he reached the upper Zambezi river.

Sleeping sickness

Back in Britain, Livingstone published his best-selling ‘Missionary Travels and Researches in South Africa’.

It was more than just an account of his adventures. It revealed important discoveries that helped scientists develop treatment for deadly ‘African trypanosomiasis’, also known as sleeping sickness.

The disease has animal and human forms. Livingstone suspected the disease in animals was transmitted by the bite of the tsetse fly.

Professor Barrett says his notes were “hugely influential” when human sleeping sickness was identified later.

Arsenical drugs are still used in treatment today. The thread runs right back to Livingstone and his observations”

Prof Mike BarrettGlasgow University

He added: “Livingstone wrote about how he treated a horse that had fever after being bitten by a fly. He used a solution containing arsenic and the horse recovered temporarily.

“Researchers could read his notes 50 years later and determine that arsenic had an effect. By tinkering with the chemical structure they could develop drugs to treat human trypanosomiasis. Arsenical drugs are still used in treatment today. The thread runs right back to Livingstone and his observations.”

Later life

Livingstone’s breakthroughs did not come without a cost. He returned to Africa in 1858 to explore the Zambezi region. His wife Mary joined the expedition but in 1862 lost her life to malaria.

When Livingstone led his final expedition in 1866 to seek the source of the River Nile, he also fell seriously ill.

He died in present-day Zambia in 1873, at the age of 60, suffering from malaria and dysentery. He never succeeded in finding the source of the Nile.

Thirty years after his death, fellow Scot David Bruce was able to identify the cause of sleeping sickness. Another Scottish scientist, Ronald Ross, would be awarded the Nobel Prize for proving the link between mosquitoes and malaria.

Livingstone could not have realised how important his medical notes would be to the future researchers.

Many patients receiving their treatment today will be unaware of the debt medical science owes to Livingstone and his first steps into the unknown.


Early death link to learning disabilities ‘shocking’

Child with Down's
People with learning disabilities face inequalities of care, says the care and support minister


People with learning disabilities die on average 16 years earlier than they should, due to NHS failings, according to official research.

The Department of Health, which commissioned the work, says this is unacceptable.

The deaths occur due to delays or problems investigating, diagnosing and treating illnesses.

The charity Mencap estimates 1,200 people with learning disabilities under NHS care die needlessly each year.

Avoidable deaths

The Bristol University researchers who carried out the work looked at all deaths over a two-year period at five primary care trust areas in the south-west of England.

This included the deaths of 233 adults and 14 children with learning disabilities and 58 adults without learning disabilities.

And it revealed that people with learning disabilities were more likely to have a premature death than those in the general population.

A scandal of avoidable deaths on the scale of Mid-Staffs takes place every year for people with a learning disability in the NHS”

Jan TregellesMencap’s acting chief executive

Women with learning disabilities died on average 20 years earlier than other women. Men with learning disabilities died 13 years sooner.

One of the researchers, Dr Pauline Heslop, said: “These are shocking findings and must serve as a wake-up call to all of us that action is urgently required.

“This report highlights the unacceptable situation in which people with learning disabilities are dying, on average, more than 16 years sooner than anyone else.

“The cause of their premature deaths appears to be because the NHS is not being provided equitably to everyone based on need.”

Christine Papalabropoulos describes how doctors failed her severely disabled daughter

Basing its statistics on the new research, the charity Mencap believes the failure to properly understand the health needs of people with learning disabilities results in 1,238 people in England dying needlessly each year.

Mencap’s acting chief executive Jan Tregelles, said: “A scandal of avoidable deaths on the scale of [that at the Mid-Staffordshire NHS Trust] takes place every year for people with a learning disability in the NHS.

“These deaths, caused by poor care and delays in diagnosis and treatment, highlight the scale of discrimination faced by disabled patients in the NHS.”

The Bristol University academics have made several recommendations, including:

  • the creation of a review body to investigate the deaths of people with learning disabilities
  • a named health professional to co-ordinate the care of those with multiple health needs
  • improved guidelines on when a “do not resuscitate” order should be used

In a statement, the Care And Support Minister, Norman Lamb, said: “This important and sobering report highlights, yet again, the inequalities that people with learning disabilities face with regard to their health and care.

“It is just not acceptable that people with learning difficulties have such a high risk of dying prematurely.

“The findings from this report will feed into the work going on to address the issues identified from the Winterbourne [View private hospital abuse] scandal and the Francis report [into the Mid-Staffordshire NHS Trust scandal].”


‘180 hospital beds’ to close in NI health shake-up

Edwin Poots

Health Minister Edwin Poots announced a major reform of the health service


One hundred and eighty hospital beds are to close in major changes to the health service in Northern Ireland, the BBC understands.

The number of statutory residential care homes will be cut by half to 27.

Greater emphasis will be placed on providing care at home and on nurses working in the community.

Addressing the Assembly, Health Minister Edwin Poots outlined how health services would change over the next three to five years.

He said the health service would be divided into five area networks, reflecting the five trusts.

Each network will have one main hospital or hub. While no hospitals are to close, each area will house one main emergency department.

Stronger links

In Belfast, the Royal Victoria Hospital will be the main hospital with clinical services divided between the others. Although this is still out to consultation, it is thought the Royal will house the main emergency site including operating one of two regional coronary intervention services.

Antrim Area Hospital will be the main hub in the northern network. It will deliver all the core services including emergency, maternity and renal. The Whiteabbey and Mid Ulster Hospitals will remain. However, people will be expected to travel to Belfast more.

The Causeway Hospital, Coleraine, will change. Doctors will provide emergency care and cater for other, fewer, specialities. But the major question is whether the Causeway will remain with the Northern Trust.

It is most likely to move to the western area, forming closer links with Altnagelvin. The Londonderry site will specialise in emergency care, orthopaedics, cancer services. The Derry hospital will house the second regional coronary service.

The new South West Acute Hospital in Enniskillen is self-contained and will form stronger links with Altnagelvin.

In the South Eastern area, the central emergency department will be at the Ulster Hospital with out-of-hours service operating at the Downe Hospital, Downpatrick and, eventually, Lagan Valley Hospital, Lisburn.

In the southern board area, Craigavon Area Hospital and Daisy Hill Hospital in Newry already provide a network system sharing staff and specialist units.


The minister said new integrated care partnerships would bring together doctors and other health workers alongside care providers and charities.

Their job will be to plan care and provide support in their area. There will be 17 of them across Northern Ireland operating from community health centres.

They will initially be focused on the elderly and people with long-term conditions like diabetes.

Mr Poots said the health service would focus on providing better targeted care for older people closer to home. About 50% of statutory residential homes will close over the next three to five years.

He said £3.2m would be invested in social care reform with plans for an extra 470 supported living places.

£1m will be invested in training staff in nursing homes to support people at the end of their lives.

The health minister said that for hospitals, the plan was to move from an “individual- institution based” approach to a “networked” approach. He referred to the use of a telepresence robot, which enabled doctors at Craigavon Hospital to support patients in another hospital, a story that made national news headlines.

“It is this ‘without walls’ approach that I want to see replicated across Northern Ireland as we work together, not as individual institutions but as networked services which respond flexibly to our patients and service users’ needs,” he said.

Janice Smyth, from the Royal College of Nursing, said nurses would want to know on what basis decisions about closing homes were made and what criteria were used.

“If it is about putting better models of care into the community to support people and their families in their own homes, then no-one will argue. But in the past, that has not always been the case,” she said.

“What happens when people go looking for that 24-hour support? Will it be there for those who need it? That will be the test of this.”

Ms Smyth said Mr Poots stressed this was not about the closure of homes, but about alternative provision of better models of care in the community.

“The question that nurses are asking has anyone costed these models. Are they affordable and will they provide a better quality of care,” she said.


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