Why moving intensive neo natal services will give best survival chance

THE transfer of intensive care service for newborns from North Wales to England will provide the most vulnerable babies with the best chance of survival.

That is the view of senior doctors and medical professionals at the Betsi Cadwaladr University Health Board and that is why they have backed the plan to move neonatal intensive care from Glan Clwyd and Wrexham Maelor hospitals to Arrowe Park on the Wirral.

In an open letter to the North Wales Community Health Council, signed by 23 doctors, nurses, GPs and consultants, many of whom are medical directors and chiefs of staff, they make the case for change.

Signatories to the letter include the health board’s acting medical director medical, Dr Martin Duerden, and consultant paediatrician Dr Brendan Harrington who chaired the board’s child and maternity review.

In the letter they said: “As senior health professionals in North Wales we recognise the concern felt by parents, the public and our staff over the future provision of neonatal care services.

“We are equally concerned however, that the reasons for the Health Board’s decisions are being lost in the heat of the debate.

“In January the Health Board decided to continue to provide Special Care Baby Unit (SCBU) facilities in each of our district hospitals alongside some lower complexity neonatal intensive care (as agreed with the Wales Neonatal Network), but that the safest and most reliable way to provide for a small number of babies from North Wales who require highly specialist care or longer term ventilation is in the Neonatal Intensive Care Unit at Arrowe Park Hospital.

“This was not an easy decision and was taken after careful consideration of all the evidence, and close scrutiny of how to ensure the best outcomes for these babies.

“We know that clinicians led this process, and worked carefully and dispassionately to assess, debate and decide what options were both safe, realistic and ultimately would offer the best chance of survival and avoidance of long term disability for these children.

“There are very clear guidelines from expert bodies such as the Royal College of Paediatrics and Child Health, The Royal College of Obstetricians and Gynaecologists and the British Association of Perinatal Medicine. As clinicians responsible for services such as these, we must always strive to meet these standards; indeed to take a decision that ignored them, or had little chance of providing a service that met them would be irresponsible.

“BMA Wales, the Royal College of Nursing, and the Royal College of Midwives have issued a number of statements, and a pamphlet opposing the health board’s proposal to meet these standards.

“We realise that not all doctors, nurses and midwives agree with the decision taken by the Health Board. It is right and proper that there should be a reasoned exchange of views on a matter as important as this, but we believe as senior clinicians that it is the right decision.

“None of the signatories to this open letter who are BMA, RCN or RCM members have been consulted by the BMA on this matter. We believe the BMA is presenting the views of the North Clwyd branch of the BMA as the views of the BMA membership in Wales; and we therefore cannot support the position of BMA Wales on this issue.”

The National Institute for Health and Clinical Excellence (NICE) and the recent Inquiry into Neonatal Care in Wales (September 2012) also support these quality standards which are designed to ensure the best possible outcome for very premature babies.

The Welsh Government has agreed that the NHS in Wales should meet these standards and we are advised by the Wales Neonatal Network that we must meet these standards.

To achieve this BAPM say that in future the UK will need fewer NICU serving larger populations.

We could attempt to recruit the required number of neonatal specialists to develop a NICU in North Wales. We would need a team of middle grade doctors and consultants. It is estimated that we will need to recruit seven neonatology consultants to maintain a rota but we have none at present.

We are advised by BAPM that it is highly unlikely that we could recruit adequate numbers of these doctors as there are not enough of them in the UK and most wish to work in larger neonatal units where more babies are treated.

Our view is that hospitals in North Wales do not have enough births or enough of these high dependency babies to attract and retain these doctors. To attempt to meet these standards in North Wales would have a considerable risk of failure.

Alongside the Wales Neonatal Network and the Cheshire and Merseyside Neonatal Network we have explored how we can best provide for the small number of babies needing complex or longer-term ventilation.

We have been advised that Arrowe Park Hospital is best placed to do this. They already have six consultants dedicated to neonatology and by March 2013, will have a full complement of trained nursing staff.

As described, they have the necessary transport infrastructure to collect babies from North Wales and this will be included in our contract with them. The hospital can also cater for the small number of women where imminent birth of premature or low birth weight babies can be predicted.

Deciphering an Ancient People and Their Language

It’s difficult to recognize and understand the meaning of ancient texts, words, symbols and the messages they contain. This is not only due to the very complexity of systems of communication, but mostly because we often don’t see them. During the holidays, I had the opportunity to go to the field with with Marlon Escamilla, a Salvadoran archaeologist and Ph.D. candidate from Vanderbilt University, who’s thesis focuses on the archaeology of the people who inhabited the Balsamo Mountain Range in coastal western El Salvador. While Escamilla focuses mostly on the Pre-Columbian structures that were built on the very ridges of the jagged mountain tops, the valleys and small canyons may hold clues to the very nature of the people who once lived in this region.

Ancient writing systems vary from simple ideographs to complex iconography. Finding these symbols requires looking at rocks as canvases used by time travelers. I consider them time travelers, because although the artists have been dead for centuries if not thousands of years, their messages remain on the rock surface. A second level of complexity is understanding the meaning of these fragmented “texts”, and this is limited by the information we have on the culture that created them. In many cases there is a historical break, the loss of a language or the vanishing of a people and their traditions, which limits us from knowing. We are certain, however, that people dedicated time, effort and energy in developing symbols that conveyed their thoughts and experiences on earth, these symbols on the rocks are signposts to their world.

Marlon: Perhaps one of the reasons is related with a defensive necessity, they were looking for places that allowed them to have visual control of the landscape. But at the same time, maybe these ancient groups decided to live on this particular landscape because there was a symbolic implication as well, one that allowed them to practice their rituals on the top of the mountains.

You have probably been able to discover various symbols. Archaeologists use systematic recording methods in order to make sense of what is left of this human record. The site where the images were found is quite large and it took three stitched panels to capture the entire surface. You have also probably noted that the symbols have been painted in Red, White and Pink. This was not our doing, but rather some visitor who thought that painting them would make them more visible, but the fact is that the best way to preserve this fragile record is “not to touch it”. Perhaps you can make a list of all the symbols visible on the rock. If you do, point to their location and then use a simple tracing/drawing program to copy image. Leave comments below and I will follow up with the names of the contributors in a future blog.

I think yes. Although we cannot read the petroglyphs, at least at this moment, there is a carved figure depicting Tlaloc (principal rain god), one of the main deities of the Nahua-Pipil groups during the Postclassic period (850 – 1524 AD). During this period, the Nahua-Pipil groups were living on the mountain ridges and Tlaloc veneration was a very common ritual, usually practiced at hilltop places and next to rivers or lagoons, and the rock art site is located just next to a narrow river.

We all have different ways of seeing and that’s why we feel that this method of collaboration is a powerful one. We are interested in creating knowledge for all the citizens of the world. This is humanity’s past, this is their experience, this is their art. This is our heritage. It may be possible to discover something new, make sense of things. I believe in the notion that we create our own identity, and so, your contribution will go directly into the reconstruction of history and cultural identity for this region in Central America.

The development of archaeological research in the area will allow understanding about the daily life practices and ancient rituals, how the Nahua-Pipil lived, communicated and understood their world. Also, we can learn about the use and appropriation of space, landscape and other sources. Archaeology is a science that allows us to travel back in time, opening a wide window in order to learn about ancient ways of life and understand the complexity of human behavior.

I see a very positive future. El Salvador is such a rich country in cultural resources located in both contexts, terrestrial and underwater. In the recent past, archaeology was only practiced by a few foreign archaeologists; nowadays we have an academic program in archaeology at the Universidad Tecnológica (Technological University), and every year the number of students is increasing. At the same time some Salvadoran archaeologists are obtaining higher degrees. Still, there are a lot of things to do, however the archaeology of El Salvador is on the right track, the idea is to develop more archaeological research involving Salvadorans and foreign archaeologist in order to build a solid interpretation about the past. El Salvador is an archaeological treasure where you can explore different cultures, different periods and also you can practice underwater archaeology on Pacific Coast and volcanic lagoons.

Commentary Series

In winter, Vermonters can see further across the stark landscape, noticing things that are less visible with foliage on the trees. Educator, writer and commentator Mary McCallum says it offers a better view of an architectural detail that serves as a beacon to travelers and churchgoers alike.

(McCallum) When you approach a Vermont village by way of a wide open landscape, what you often see first is a white steeple that punctuates the sky and announces the location of a church. Early American villages commonly made their churches the tallest buildings in town and the heart of the community, visible by their graceful spires.

My own small town has four steeples of varying height that go largely unnoticed until they need painting or repair. And while there is no entry for steeplejack in the current Occupational Outlook Handbook, they are the fearless workers that are still called upon to scale the heights to patch the holes and renew peeling paint. In 1891, a hardy crew re-anchored the 190-foot steeple on Rutland's Grace Congregational Church after church fathers discovered it was swaying dangerously during high winds.

Now, I'm not a churchgoer, but I've always taken note of historic houses of worship when traveling. I remember a small city on the Missouri River with a sky pierced by a forest of spires, and wondered how all those nineteenth century buildings got filled on Sundays. As a child, I remember being amazed by a lone white clapboard roadside church that relied on a neon sign announcing 'Jesus Saves' to make its presence known - instead of its short, unimpressive tower. Here, we're not usually quite so flashy - and steeples are still the most common visual guideposts for finding a church.

I first became aware of this phenomenon through an online article with the alarming headline, How the Internet is Killing Off Church Steeples. The premise is that as steeples age, maintenance costs rise and congregations shrink, the church spire has outlived its usefulness as a signpost. People now rely on the internet to find churches, with Google reporting that quick 'searches for churches' spike just before every religious holiday.

Yet the technology that enables us to find a church with just a keystroke may also provide the funds for preserving steeples that are in need of repair and restoration - as cash-strapped churches buy into the trend of renting out their church steeples as cellphone towers.

Even the historic Brandon Congregational Church has sprouted one of these towers without changing the mission of its white cupola and steeple. While the tower silently transmits and receives the thousands of radio signals that allow area cell phone users to stay connected, the old steeple supporting it continues to announce to those who take the time to look up, "Here we are, this is the place, you have arrived."

Not so very long ago, every Vermont village had a clearly visible center, recognizable from a distance, and distinguished by an architectural convention that was both spiritual and utterly practical.

"It was one of the first recorded speculative market bubbles," says Maloney. "They were buying and selling a single tulip bulb for as much as a house in Rotterdam or Amsterdam.

"And, of course, like any speculative bubble, it collapsed. I'm reading about this as banks were all collapsing a few years ago, and I'm thinking, that's a really interesting idea."

Maloney, whose exhibition, Collapse, runs at the Kelowna Art Gallery until March 31, was in Britain to research the social histories surrounding humanity's fascination with flowering plants.

She had become interested in flowers through her earlier work with the human body - including pieces that visually melded lungs and trees, for instance - but was worried it was a facile theme for a female artist.
After all, women have long been linked with flowers in a variety of ways, and in days of yore, flower painting was considered a suitable pastime for genteel ladies, a reality not lost on an earlier generation of feminist artists.

So along with references to the emerging realities of early capitalism - especially its periodic bouts of recessionary collapse - Maloney also built in slyly subversive subtexts about women's subordinate position within the economic order.

The centrepiece of her exhibition is an antique reclining chair that was known as a fainting couch in Victorian times, presumably because women could use it when feeling stressed or overcome by what was then called hysteria.

Maloney covered the couch in red paisley, an intricately patterned fabric popular in the Victorian era, and implanted a bed of 20 bronze tulips. Their blooms partially open, the tulips swoon gracefully, just as the real-life plants do when they get too little light or water.

The exhibition also includes six wall pieces. Each features a pair of tulips that Maloney embroidered on paisley fabric and mounted in oak frames. They are shown from root to flower, as in botanical drawings, but twine engagingly together, almost as if they are courting.

In 2010 she graduated from Yunnan University with a master’s degree in art and anthropology. Xinman pursued her graduate studies under the renowned anthropologist Dr. He Ming, publishing many papers and articles. Since 2001 she has been teaching at Yunnan University College of Art and Design. She is a member of Yunnan’s Chinese Artist Association and an associate research fellow of Chinese art at the Chinese Academy of Fine Arts.

Xinman explores the intersection of Western art and Asian culture, using contemporary styles and techniques to express modern Chinese themes. For Western viewers, her painting is in the style of or influenced by the French Impressionist painter Henri Matisse.

But for me, I can also see some cultural elements of the Yunnan School of Heavy Color Painting, which was started more than 30 years ago by a group of artists working in Yunnan to celebrate the customs and lives of the ethnic minorities who inhabit China’s subtropical southwestern province of Yunnan. The ceaseless efforts of this group of artists’ artistic exploration soon gave rise to an entire school of painting that came to be known as the Yunnan School of Painting.

Since then the Yunnan School of Painting has gained critical international acclaim and established itself firmly in the Chinese art history. Its stylistic vocabulary and topical themes are characterized by uniformity in line work, bold usage of colors, a love for overlapping geometric design and a daring combination of both traditional Chinese form and Western abstract art, depicting subjects that centered on the indigenous ethnic people, culture and myths of the Yunnan province.

IBM advances cooling technology

The smartphone in your palm ― the one used for countless Google Maps searches and Facebook status updates ― actually contributes to pollution.

The smartphone itself doesn't emit carbon dioxide. The polluters are the football-field-sized data centers across the country responding to inquiries from phones, personal computers and tablets.

Data centers, humming with thousands of power-hogging computers called servers, use 2 to 3 percent of the world's energy, said Richard Doherty of the Envisioneering Group, a Long Island research firm. In the U.S., much of that energy comes from coal-powered plants, he said.

Slowing data center energy use is one of the main missions for a cadre of IBM researchers in Poughkeepsie.

The 400-acre site is one of the global company's major meccas for developing cooling technology, said spokesman Michael Corrado.

The researchers made major advancements toward saving computing energy in December, when they wrapped up a two-year project with the U.S. Department of Energy. The department tasked IBM scientists with finding cheaper ways to keep computers cool, one of the major energy users at data centers.

The scientists overlaid a standard server, about the size of a pizza box, with a system of copper piping and plates. The pipes carry cold water over high-heat parts in the server and then outside, where it's exposed to the outside temperature, cooled down and then again circulated through the server, said IBM engineer Milnes David.

It's a closed-loop system, not unlike a radiator in a car. The system decreases the amount of energy data centers use to cool servers from 25 percent of their total energy to 4 percent, according to IBM.

David sees the retrofitted servers making headway in IBM's market ― large businesses and governments ― in the next three years.

The servers retrofitted with copper radiators are so widely used they're practically a commodity in the computing world, according to David. That means that their wide adoption could help significantly decrease energy use.

Heat in servers comes from their computing brains, chips. As chips become hotter, they become less efficient and need more energy to run. Keeping the chips cool helps them operate better and use less energy, Doherty said.

Water cooling ― as opposed to more widely used air-cooling systems ― is considered the way of the future for servers, Doherty said. Water cooling is more efficient, he said.

IBM's green energy data center, a server and supercomputer showroom in Poughkeepsie, demonstrates some of the company's sophisticated air-cooling technology.

The glass-enclosed room has thick bundles of network cables and piping running underneath a raised floor. The raised floor help with ventilation, said Roger Schmidt, IBM senior fellow.

IBM's work on energy efficiency is far ahead of any of its competitors, said Doherty, a physicist who closely monitors Big Blue's progress. The company's R&D budget last year totaled $6 billion.

Some of that money went toward work in IBM labs in Switzerland and Germany. They're experimenting with replacing heating systems in homes and offices with high-powered servers, Corrado said.

Lead in paint dust will close Hammarskjold High School on Monday. Cleaning up paint dust will keep students from Hammarskjold High School away from classes for an extra day following exam week. The school is expected to re-open on Tuesday. The Lakehead Board of Education advises that the closure is as a result of dust and ventilation issues created during the sanding of lockers. The paint dust was determined to have traces of lead.

"Lead is a soft, inexpensive metal extracted from ores and widely used in the manufacture of many consumer products such as pipes, automobile parts, electronic equipment, batteries, pigments, and radiation shielding. It can be found throughout the environment in soil, indoor and outdoor air, water, consumer products and food, and can enter living organisms by means of eating, breathing, or by absorption through the skin. Although it occurs naturally in the environment, significant concentrations of lead in living organisms can result in lead poisoning".

Kirin Nadar is Bringing Contemporary Indian Art Home in a Big Way

In April 2012 more than a few visitors to the DLF Place mall in Saket, New Delhi, believed they had come upon an unconventional retail display of stainless steel pots and pans in the form of a soaring mushroom cloud, nearly 33 feet tall. The installation was, in fact, the monumental sculpture Line of Control, a 2008 work by Subodh Gupta, the reigning star of contemporary Indian art. The baffled visitors had unknowingly left the mall proper and entered the Kiran Nadar Museum of Art (KNMA), an 18,000-square-foot exhibition space that opened in 2011 and bears the name of the collector, patron, and philanthropist who founded it.

Line of Control debuted in London in the 2009 Tate Triennial, which is where Nadar first encountered the piece. “Overwhelmed,” as she describes it, by the work’s “awe-inspiring” nature, she decided on the spot to acquire it for KNMA, India’s first private museum for modern and contemporary art. “It is one of the most phenomenal works any artist could have done. I had to have it,” Nadar said with conviction when asked if she had considered the logistical challenge that transporting and installing such a gargantuan work would present. Shipped to India in four containers, the 15-section sculpture was assembled over seven days by the team that had set it up at Tate Britain. The ceiling of the mall’s basement was reinforced to bear the colossal load, and a nearby shop front had to be dismantled to make way for the three cranes required for the sculpture’s assembly. Nadar remains mum about the amount she paid Hauser & Wirth, the gallery that represents Gupta internationally. “It wasn’t cheap,” is all she has been willing to share.

One outcome of this spectacular purchase is the emergence of Line of Control as a visual magnet to lure mall-goers who might otherwise not visit the museum, where admission is free. “We hope that the viewership of Subodh’s piece will bring more traction for the museum,” Nadar explained at the April press conference marking the unveiling of Line of Control. Although Gupta’s work has won critical accolades and collector support on the international art circuit, his intricate assemblages had never been presented to a popular audience in India. For Gupta, who was present at the press conference, the thrill lay in having the work ― whose shape alludes to the potentially deadly tension along the India-Pakistan border ― displayed in his native country. “An artist couldn’t be prouder to have his work come home,” he said.

A comparable commitment to home and heritage motivates Nadar, and a key mission of KNMA is to bring significant art by Indian modernists back to India so the full range of the country’s art history can be viewed and appreciated. In 2010, for example, she paid a record breaking $3.5 million at Christie’s London for Saurashtra, a 1983 painting by Syed Haider Raza. The artist was a central figure in the Bombay-based Progressive Artists Group, which was established in 1947 and included Maqbool Fida Husain, Tyeb Mehta, Akbar Padamsee, and Francis Newton Souza. Discouraged by the lack of a thriving art scene and the dearth of indigenous collectors, Raza, like many of his contemporaries, moved abroad. He lived in Paris for six decades before returning to New Delhi in 2011. Saurashtra came from the French collector who had bought the work directly from Raza. A large, square canvas featuring geometrically arranged blocks of reds and oranges and the bindu motif, symbolizing spiritual consciousness, Saurashtra was Nadar’s most famous acquisition prior to Line of Control and was displayed prominently on one of the four red walls that framed a section of KNMA’s 2012 show “Crossings: Time Unfolded II.” That show also included Souza’s electrifying The Red Road, a 1962 landscape whose palette and coarse texture are influenced by laterite, the rust-red soil of his birthplace, Goa, a coastal state south of Mumbai.

Nadar’s pursuit of art isn’t limited to acquiring high-priced, high-profile works abroad, though several Indian art critics have grumbled, especially after she paid ￡993,250 ($1.5 million) at Sotheby’s London in 2010 for Bharti Kher’s The Skin Speaks a Language Not Its Own, 2006, a life-size fiberglass elephant with Kher’s trademark bindis affixed across its surface. Her collecting is part of a larger philanthropic vision she shares with her husband, Shiv Nadar, who founded a technology start-up in 1976 that has grown into the global behemoth HCL Enterprises. She began to acquire art in the late 1980s with the simple aim of decorating her walls. “I started collecting for our home, which we were building at the time. There was no thought of a museum,” she explains. “I commissioned art from Husain and bought works by Manjit Bawa and Rameshwar Broota; all three pieces are still in the house.”

Nadar’s acquisitions budget ― and her vision ― grew with her husband’s success. The two met when Nadar was working for an advertising agency, and they soon became bridge partners. (She continues to play competitive bridge and has represented India in international tournaments.) HCL was flourishing, and Nadar, not content with being the idle wife of an entrepreneur, became instrumental in the company’s philanthropic and educational initiatives, which include the Shiv Nadar Foundation, established in 1996, and Shiv Nadar University, which had its first graduating class in 2011. She was on Forbes Asia magazine’s “48 Heroes of Philanthropy” list in 2010; her husband followed one year later.

By 2005 the Nadar home could no longer accommodate the collection, which had steadily grown, its focus no longer confined to Indian Progressive artists but expanded to embrace contemporary Indian lights like Atul Dodiya, Rina Banerjee, Ranbir Kaleka, and Anish Kapoor. “At some point I had a lot more art than I had wall space, and I had to decide whether to stop collecting or to keep putting works in storage,” Nadar says. “Keeping them in storage didn’t seem like a very wise thing, so I decided to do something more meaningful and set up a museum. And after I first had the thought, in 2006, it took me two or three years to plan it and get down to it.”

“In late 2009 Mrs. Nadar and I started looking at all she had acquired since the late 1980s, so that the first step ― to put the inventory in place ― could begin,”recalls Roobina Karode, director and chief curator of the museum. KNMA opened in 2010, first in a location on the vast HCL campus in Noida. The inaugural exhibition, “Open Doors,” was curated by Karode. “The title had both a literal and a metaphoric sense, as KNMA opened its doors to the larger public to share Mrs. Nadar’s art collection, which was now placed in the public realm,” Karode explains. “Some rare works by Souza, Husain’s Mothers, 1990; Broota’s Runners, 1982; Bikash Bhattacharjee’s “Doll” series, 1971; A. Ramachandran’s Towards the Sun, 2004; N.S. Harsha’s Nations, 2007; and Gulammohammed Sheikh’s Speechless City, 1975, were all part of this exhibition, which introduced the collection to the art community and the general public.”