Most actors perform in movies, TV or theatres, but for others, the stage is an exam room at a medical school.  

At the University of Maryland School of Nursing, that involves an interactive performance with a medical student.

Ted Bell portrays a 55-year-old patient who'd had stomach pain for three months.

“I am a teacher," he tells nursing student Emily Tyrrell. "Several times it has happened at school."

Bell is actually a retired civil engineer. Acting as a patient for students training to be health-care professionals is his new career. The job’s formal title is “standardized patient”.  

“It has developed into a great part time, or retirement job actually, for me," he says, "and I go to all six [medical] schools in this region, Baltimore-Washington area.”

There are about 700 standardized patients in this region. The pay starts at $17 per hour and can go up to $35 depending on the project. And the demand for their services is high.

“It is quite common at schools of medicine," says Kathy Schaivone, clinical director at the University of Maryland. "So every medical school in the United States and many medical schools around the world use standardized patients.”

Acting experience, while helpful, is not required. Nor is medical knowledge. The schools provide training and payment for the performances.

“Many of them are professionals but I have never been paid for acting other than the [this] role-playing," Bell says, "but it requires some acting ability so I guess I would consider myself an actor.”<!--IMAGE-LEFT-->

Professional actor Tom Wyatt doesn’t think of his side job as acting.

“I use some of the acting skills, but honestly when it is going well, I am not really acting, I am reacting," he says. "I am listening to them and reacting naturally and honestly to what they are saying to me and what they are giving me.”

Wyatt and fellow standardized patients spend many hours training for each of the cases in order to know how to respond to questions appropriately. But memorizing their characters’ symptoms and medical history is not always easy.

“Especially when I do sometimes nine or 10 cases in a week at three different hospitals so they are all completely different,” Wyatt says.  

The actors' role is not limited to portraying a sick patient. After each session, they give feedback to the student.  

“The things that really stood out for me; your manner is extremely professional," Wyatt tells Kurt Haspert, the nurse practitioner student who treated him. "You command at all times, you kind of take charge of the room.”  

Haspert finds the session to be very useful.

“It is always good to do the standardized patients because it kind of keeps you thinking about how your thought process has to go," he says, "and how you can narrow down your differential diagnosis while you are asking questions.”

While the primary focus is on providing the best educational experience possible for the students, the actors enjoy performing.

“Very rewarding," says Bell, the retired engineer. "They say it is very helpful. That makes me feel good that we are turning out some good medical people.”

After three sessions here, Bell heads out to his next gig at another medical school, to continue his role in helping train tomorrow's health professionals.

He reproduced those words digitally by feeding the brain wave data into an electronic voice synthesizer.

The next step will be to see whether brainwaves generated not by hearing a word but by just thinking it could also be converted electronically into speech.  

“I think there’s some evidence that in certain cases the same brain areas will activate or turn on when you are imagining sounds or speech as to when you are actually listening," Pasley says. "But still, a lot of work needs to be done to really understand how similar those two processes are or how different.  We just don’t know at this point.”

Pasley’s mentor, Robert Knight, believes it’s only a matter of time before researchers are able to map the brain circuitry involved in conscious speech. He predicts the first device allowing people to talk with their thoughts - literally, to speak their minds - will become a reality in five years.

Monday, The U.N. Economic and Social Commission for the Asia Pacific opened a three-day meeting lauding impressive gains in recent years in the fight against HIV/AIDS.

Noeleen Heyzer, the executive secretary of U.N. ESCAP, told officials and activists from 34 Asia Pacific countries that more people than ever had access to HIV treatment. She says new HIV infections are down 20 percent since 2001 and she is expecting to meet a goal to begin to halt and reverse the spread of HIV/AIDS by 2015.

“Countries such as Cambodia, India, Myanmar and Thailand have successfully reduced their HIV infection rates with intensive, wide-reaching preventive programs, particularly among people who buy and sell sex,” Heyzer said.

However, Heyzer notes the gains are uneven and there are still gaps in the goal of universal access to HIV treatment.

She says the HIV epidemic is outpacing the response.  “There are still almost two new infections for every person who starts treatment. These new infections remain concentrated among key population of higher risk: People who buy and sell sex, people who inject drugs, men who have sex with men and trans-gender people,” Heyzer stated.

The United Nations is urging countries to speed up efforts to curb HIV in the region.
Officials say that 90 percent of Asia Pacific countries still have barriers to treating HIV, including laws that criminalize sex workers and injection drug users. They say the measures make it difficult for those groups to seek treatment.

Many countries also reject, or even outlaw, homosexual and trans-gender people.

Fiji in 2010 became the first Pacific island nation to decriminalize homosexuality and is the only one funding its own antiretroviral treatments.  Fiji and China recently lifted travel restrictions on people infected with HIV.

Fiji President Ratu Epeli Nailatikau, spoke at the Bangkok meeting Monday. He encouraged delegates to ensure adequate funding for HIV programs.

“Countries and governments have the responsibility, after all their competing priorities and commitments, to ensure that they provide funds in their national budgets in their response to HIV/AIDS. After all, it is a government’s moral responsibility to provide for the welfare of their people,” Nailatikau said.

Despite the gains made in fighting HIV/AIDS, international funding for programs in the Asia Pacific has dropped in recent years and is still declining.

The U.N. says some countries, such as China, Malaysia, Pakistan, Samoa, and Thailand, have succeeded in funding much of their own HIV programs despite the drop from foreign donors. Heyzer urged other nations in the region to follow those examples.

There are six million people in the Asia Pacific living with HIV, about 15 percent of the world total.

Experts say it's the largest coordinated effort ever - to fight diseases that are widespread, but normally don't get much attention.  The new initiative launched in London this week has drawn almost $800 million in pledges to combat 10 so-called "neglected" diseases - such as sleeping sickness and guinea worm - that affect more than a billion people around the globe.

It was an unprecedented show of unity:  Leaders of government, public and private health groups and major drug companies pledging to work closely together -  to combat so-called  "neglected tropical diseases," or NTDs.

“We will increase our financial investment and cumulative spending five-fold, from 50 million pounds [$79 million] to 245 million pounds [$387 million] by 2015...[and] that is four treatments a second," said Stephen O Brien.

Stephen O Brien, a Member of the British Parliament, was one of a number of government representatives at the London event  - who pledged to fight these diseases, which sicken 1.4 billion people every year.

The World Health Organization says NTDs also cost governments and businesses billions of dollars in lost worker productivity.

Experts say these ancient maladies have been "neglected" because they affect mostly poor populations.  

Dr. Donan Mmbando is with the Ministry of Health and Social Welfare in Tanzania:

“The plight of NTDs is so real in my country," said  Mmbando. "You need to see people with severe itching, lizard skins, which is manifestation of river blindness."

The London Declaration calls for the control or elimination of 10 tropical infections by the year 2020 - among them, such ancient scourges as lymphatic filariasis, blinding trachoma, leprosy, sleeping sickness, and guinea worm.

Dr. Margaret Chan, director-general of the World Health Organization says the goals are ambitious but achievable.

“WHO is launching a road map - a road map that has been tested and proven effective, [and] that will guide work to achieve our goals in 2020," said Chan.

Microsoft chairman and philanthropist Bill Gates, whose foundation pledged $340 million, asked other philanthropists to donate more and to save millions of children affected by parasitic infections:

“The soil-transmitted helminthes - you won’t see a visual picture, but what actually goes on is that the parasitic load that young kids have of those worms means that they are malnourished in a way that their brain never fully develops," said Gates. "So the rest of their life they are permanently impacted by this.”

The thirteen drug companies partnering in the initiative have agreed to share their libraries of experimental compounds to speed up development of new drugs and treatment.

Experts hope that by the decade's end, the focus this initiative brings to neglected tropical diseases will mean they will no longer have to be called “neglected.”

Now, a new study suggests that massage may work on the cellular level in a manner similar to pain-relieving medications such as aspirin and other anti-inflammatory drugs.

Mark Tarnopolsky, a professor of pediatric medicine at McMaster University in Ontario, Canada, led a study that tried to pinpoint the biological mechanism that gives massage its healing property.<!--IMAGE-LEFT-->
“People have a lot of ideas about what massage does and doesn’t do.  And many of them were revolving around reduction in pain, and yet very few studies have actually been done to investigate this at the molecular and cellular level.”

Tarnopolsky's team conducted a study involving 11 young men who exercised to the point of exhaustion on stationary bikes.  

The men underwent muscle biopsies in each leg prior to jumping on the bikes, and each participant had one leg - chosen at random - massaged after exercise.  Muscle biopsies - small tissue samples - were taken from each leg 10 minutes after the massage therapy, and again, two-and-a-half hours later during the recovery period.

Researchers did a genetic analysis of each of the tissue samples.

“What we did is we looked at whatever genes were influenced by exercise in a different way in the massaged versus the non-massaged leg," Tarnopolsky says.  "And what came out of that were two different pathways.”

In the muscle tissue of the massaged leg, researchers found a decrease in inflammatory cytokines, or proteins, and an increase in mitochondria, the energy producing units in cells, compared to tissue from the unmassaged leg.  

Inflammation is an indicator of tissue damage, while mitochondrial production is a sign of tissue recovery.

The researchers say the findings suggest that massage acts on the cellular level in the same way as many pain medications, which are known to have some serious side effects. They believe that massage may be an effective and safer alternative that could used in routine medical practice.

The report concedes that intensive livestock operations can pose serious ecological risks.  And that's why environmental critics are calling instead for reductions in global livestock production, and urging people to consume less, not more, meat in their diets.

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Feeding today’s population is a challenge for an already-stressed environment.  

Experts project that the world's population will grow from 7 billion people today to 9 billion over the next 30 years.   

Nancy Morgan is the Food and Agriculture Organization's (FAO) liaison to the World Bank.

“Basically, meat production and consumption will both need to double by the year 2050,” said Morgan.

The FAO says there are currently 1.5 billion head of cattle, 1 billion pigs and 6 billion chickens in the world.  

In the U.S. alone, millions of these and other animals are killed every year for food.  

Morgan says over the past decade, worldwide consumption and production of meat grew faster than any other commodity.  

“The challenge is how [do] you ensure food without increasing animal numbers and having an impact on fragile lands and our resource base?” Morgan asked.   

More than half of the agricultural land in the world is used to raise and feed livestock.  Those farm animals are also responsible for 18 percent of the greenhouse gases released into the atmosphere every year, methane emissions that scientists say are warming the earth's climate.

The World Preservation Foundation (WPF), a private environmental group, recently published a report on ways to slow that climate change. It focuses on reducing livestock populations.   

The group says it is especially concerned about widespread forest-burning to clear land for cattle operations, as seen in these fires in Brazil's Amazon forest region.

“Fire for pasture maintenance and fire for deforestation are our targets," said Gerard Wedderburn-Bisshop, the WPF's executive director.  "For methane, by far the greatest source is livestock agriculture.”  

The WPF wants governments to stop subsidizing meat and dairy production.       

“Meat and dairy consumption has helped to push global warming to tipping points," added Wedderburn-Bisshop.  "It is driving massive environmental destruction and pollution and is killing us with diabetes, heart disease and cancers.”

But in many rural areas, people depend on animals for food and income.

A reduction in global livestock production is improbable, says Jerry Hatfield, director of Agriculture and the Environment at the US Department of Agriculture.  

“We actually have more pasture and ranch land than we do arable land or land we put into cultivation,” said Hatfield.

He says research centers are looking at ways to make food animal operations more efficient while also protecting the environment.

“I think it’s all about balance, and I don’t think we have done a very good job,” added Hatfield. 

Experts agree that the next few decades will present a puzzle, how to feed nine billion people without wrecking the planet in the process.

Doctors generally check their patients' blood pressure during office visits, but a new study says many are not doing it the right way - and that by doing it incorrectly, the doctors could be putting their patients' lives at risk.

Cardiologist Oscar Garfein takes blood pressure readings from both of his patients' arms. That technique saved the life of one of his patients.

"I found that in one arm, it was very, very low, and in the other one, it was normal," says Garfein. "And it helped me arrive at a diagnosis of a potentially-lethal condition."

Garfein's routine is supported by a new study showing that different readings in the right and left arms could be a sign of heart disease or blood vessel problems. If the two readings of systolic blood pressure - the pressure of blood in arteries when the heart is contracting - differ by 15 or more, it could indicate a narrowing of arteries to the legs, decreased blood flow to the brain, heart disease and a 70 percent increased risk of dying from either heart attack or stroke.

If heart or blood vessel disease is diagnosed at an early stage, changing risky behavior or taking statin drugs can reduce death rates.

"You want to search for the risk factors that are associated with this," says Garfein, "such as high blood pressure or cigarette smoking or high cholesterol, and treat them very aggressively."

Many cardiologists routinely check blood pressure in both arms, but the practice is much less common on a routine doctor's visit. This study, published in The Lancet, confirms a double reading could flag an underlying vascular problem in someone who otherwise seems to be healthy.

The study shows it doesn't matter what the systolic number was, it's the difference between the two readings that matters.

"All it takes is about a minute and you can find something that really, most of the time, points to the fact that this patient has established vascular disease," says Garfein.

The World Health Organization says hundreds of thousands of people around the world develop life-threatening illnesses each year from antibiotic-resistant organisms that are often found in hospitals. Ridding hospitals of contamination has become a major challenge and a huge expense. But a Texas-based company, called Xenex Healthcare Services may have the solution to this problem - with a device that uses light to kill micro-organisms.  

This machine fires bursts of ultraviolet, or UV, light that penetrate the cells of micro-organisms and kill them.

The organisms have no chance to adapt and gain immunity as they might with a chemical, says Dr. Mark Stibich, Xenex Healthcare co-founder and chief scientific officer .

“The high energy UV penetrates the cell walls of organisms and it is absorbed by the DNA, so it is really treating the organisms or disinfecting the organism at the root of where any mutation would develop," said Stibich.

Dr. Stibich says the device uses concentrated bursts of pulse xenon light, a technology that has been around for more than 30 years.  

But Xenex has developed the concept further.  Its device can sweep a room in a matter of minutes, eliminating most organisms on surface areas.

No one understands the importance of that more than Xenex Healthcare's Chief Executive Officer, Brian Cruver, who became sick some years ago after being treated at a hospital.

“I went in for a simple procedure and it turned into, well,  I acquired an infection in a hospital," said Cruver.

Cruver went through two months of intravenous antibiotic treatment to recover, but the experience introduced him to the crisis hospitals face.

“Finding out that hospital infections are the fourth leading cause of death in the United States, that hospital infections kill more people than AIDS, breast cancer and automobile accidents combined; that is staggering," he said.

Xenex is a small company.  But Cruver sees great potential for growth as hospitals here and in other countries discover how well the device works..

“The fact is this is a huge problem; it is global," he said. "Every hospital needs this product.”

The Xenex device is being thoroughly tested at the top cancer hospital in the United States - MD Anderson Cancer Clinic in Houston.  Dr. Roy Chemaly the hospital's chief of infection control, says patients there are especially vulnerable.

“We know they already have compromised immune systems, they have already infections and they are at risk for serious infections and infections from resistant organisms," said Chemaly.

Dr. Chemaly says preliminary tests show close to 100 per cent disinfection  using the Xenex device after a room has already been given an initial cleaning.  But he says he won't have full results for at least another year.

Curves is Dakar’s only exclusively female fitness center. Just a few years ago this type of gym may easily have gone bankrupt for lack of clientele. But today, on any given morning, the room is packed with women from 22 to 70 years old who are pushing, twisting and jumping their way to better health. A majority of them are overweight or fighting obesity.

Aissatou Sidime is a 27-year-old Guinean student who lives in Dakar. A year ago she decided it was time to get in shape and has been regularly exercising at least three times a week.

Growing emphasis on health

Aissatou said she decided to come primarily for physical reasons. She was too big, and needed something to do because she always felt tired. When you are young, she said, girls are more concerned about losing weight to be beautiful. But as they get older, and especially once married, most women are just trying to lose all the weight they put on after having children.

The World Health Organization says there are an estimated 1 billion overweight people and 300 million obese adults worldwide. This is more than double the rate it was 30 years ago.

In the United States and parts of Europe, recent studies have shown a leveling off of obesity rates among both adults and children. But in many developing regions, including Africa, this is simply not the case.

The World Health Organization says obesity-related problems threaten about 115 million people in developing countries, and some researchers believe that by 2025, three quarters of the world’s obese population will be in developing countries.

Fighting obesity

In South Africa, more than half the female population is considered obese or overweight, and there are growing obesity problems in countries like Ghana and Lesotho.

Biological anthropologist Enguerran Macia conducted the first study on obesity, and overweight men and women in Dakar.

Obesity is measured through a Body Mass Index, or BMI, which divides a person’s weight in kilograms by their height in square meters. A number over 25 is considered overweight and over 30 obese.

Macia said that while they found almost no women in Dakar between the ages of 20 and 25 who are obese, by 50 years old more than half of them are due to changes in the body due to age, marriage, pregnancy and lower activity.

Macia noted that the more education a woman has, the less likely she is to be obese. That's the same as in Western countries. He said Dakar is transforming from a traditional society, in which people once needed to show their wealth through weight, to a modern society where people show their wealth through weight control.

Learning to work out

Curves fitness trainer Mickael Lafarge has been working as a coach for the past 12 years. Lafarge said that even during the time he has been working as a fitness trainer, he has noticed a change in concepts of beauty. He said before, women always thought "bigger was better." Now those same women, however, are having health problems. So now the trend is to be thin, because most men want slimmer women.

But traditionally in Senegal, as in many other parts of West Africa, both men and women have valued a more voluptuous woman, even to the detriment of her health. Yet obesity can bring on a slew of chronic health problems, from hypertension and diabetes, to heart problems and arthritis.

Macia said that one who is obese is five times more susceptible to hypertension, and that the poor may be the next group to suffer.

Macia said poor people are not the ones exercising. And they also have little choice but to take advantage of the cheap, high-fat foods that are available. Macia predicted the weight increase eventually will trickle down to the poor, because they are the ones not aware of the health problems and risks associated with weight gain.

While much of the Sahel region is preparing for yet another looming food crisis, with an expected 11 million people to be affected by food insecurity, discussing issues of obesity and overweight often are overlooked. In Senegal, more than half the population still does not eat the recommended number of calories every day, and a vast majority of these people live in the rural areas.

According to Macia, though, this “double-burden” of overweight and underweight people living in the same country has to be addressed sooner or later. Macia said that in Dakar this means that illnesses like diabetes and hypertension now co-exist with endemic illnesses like malaria. He said it places too much burden on a country without the means to handle it.

As part of a local initiative to help women fight obesity and get in shape, one of Senegal’s national TV stations, 2STV, is starting a weekday morning exercise program expected to launch this week.

The results of a stroke are painfully evident as this patient struggles to get out of a wheelchair and walk again.

Sudden numbness, physical weakness, difficulty speaking and comprehending and loss of balance are all common symptoms.

Stroke patients lucky enough to get to an emergency room in time often get the right treatment, and with physical therapy, manage to recover some of the motor skills they once had.

But scientists have found that a silent stroke, with no obvious symptoms, is often not diagnosed or treated as quickly. The patient continues daily routines, unaware that something has happened inside the brain. The damage is detected only when the patient undergoes a special MRI imaging procedure.

<!--IMAGE-RIGHT--> In this scan of a patient who has had two strokes, the arrows point to dark holes filled with fluid. Neuropsychologist Adam Brickman at the Columbia University School of Medicine, says these dark spots were once healthy cells killed by blood clots traveling to the brain.

<!--IMAGE-LEFT-->The hippocampus - the red block in another section of the brain - controls memory, and may also be affected by a stroke.

“When we see memory changes in aging, we usually attribute those changes to some sort of functional change or structural change in the hippocampus. What we found was that in silent strokes, the presence of strokes in the brain was also related to memory functioning,” Brickman said.

Brickman and his colleagues studied a group of more than 650 men and women 65 years and older with no previous signs of dementia or severe memory loss. They underwent MRI brain scans, as well as tests to measure their ability to absorb information. Previous studies had found that changes in the size of the hippocampus and strokes were related to cognitive functioning, but Brickman says this research confirms a strong link between silent strokes and a decline in memory.

"What our study shows is that they're both independently related to memory functioning, and that's a new observation," Brickman explained.

The MRI scans identified silent strokes in one fourth of the participants who also did not do as well on memory tests. The researchers hope to follow the group in coming year, watching for signs of Alzheimer’s Disease, the most serious form of dementia.

A new study finds that children exposed to common industrial chemicals, called perfluorinated compounds or PFCs, have a reduced immune response to vaccines intended to protect them from disease. PFCs are used around the world to make waterproof rain gear and food containers, and are known to pollute drinking water and seafood. PFC contamination could have a significant impact on the effectiveness of global immunization efforts.

When children are vaccinated their immune systems produce antibodies that protect them from debilitating and potentially deadly childhood infections, such as polio, measles, diphtheria and tetanus. The protection is supposed to last a lifetime.

But scientists say the effectiveness of these vaccines is severely reduced when children are exposed to high levels of PFCs:

“This was quite serious because we could also see some of the children were so low in antibody concentration that they were essentially not protected. They have been vaccinated four times and vaccines had not worked,” said Dr. Phillipe Grandjean of the Harvard School of Public Health.

Grandjean led a team of scientists in a study of children living on the Faroe Islands between Scotland and Iceland.

The islanders were chosen as subjects because their diet is mainly seafood, known to have high concentrations of PFCs.

The scientists followed a group of more than 500 children who'd been vaccinated against diphtheria and tetanus. But children who showed elevated levels of PFCs in their blood also had very low concentrations of antibodies against these infections.

“It was quite a striking fact, one that I would not have anticipated,” said Dr. Peter Hotez, president of the Sabin Vaccine Institute, which promotes vaccine development and delivery around the world.        

Hotez said if PFCs do, in fact, interfere with antibodies and immune system functions, then the public health problem is going to be much worse in the urban slums of low- and middle-income countries, where exposure to these industrial chemicals can be much higher.

“Even a modest reduction in vaccine coverage and vaccine immune responses could lead to subsequent outbreaks of childhood disease.  And there is a risk that we could see recurrences of childhood killers such as diphtheria or pertussis or other childhood diseases now becoming more common in the world’s poorest countries,” said Hotez.

Scientists say PFCs are stable and persistent chemicals that have been in wide use for decades - so much so that everyone probably has detectable levels of the compounds in their body.

“We have not done enough in regard to protecting the population against these old compounds, and now we are stuck because we all have them in our bodies and we are all using them,” said Grandjean.

Critics note that since the study was done on island residents eating a mostly fish diet, it should have taken into account polyunsaturated fatty acids [PUFAs], which are found in fish and may suppress the immune system.

Researchers say there is an urgent need to study the adverse health effects of perfluorinated compounds on larger populations.                                                                                                                                                                                                                                                                                  

That supports other research which suggests reading, writing and playing games may lower the risk of dementia.

Researchers worked with a group of 65 older-adult volunteers with no symptoms of Alzheimer's Disease.



They answered questions about how often they engaged in stimulating mental activities throughout their lifetimes. They also got PET brain scans which can identify beta-amyloid deposits. Those deposits are found in the brains of people who have Alzheimer's.

University of California-Berkeley research scientist Susan Landau says the study showed a link between the quantity of deposits and the lifetime level of brain stimulation.

"People who were the most cognitively active throughout their life, they had the least amyloid in their brains," she says. "So, based on this association between greater cognitive activity and less amyloid, we think that these people will go on to have a reduced risk of Alzheiemer's Disease."

_{PET scans reveal amyloid plaques, which appear as warm colors such as red, yellow and orange. On the left is a patient with Alzheimer's disease, and on the right is a person with no detectable amyloid deposits in the brain. The middle scan is of a normal person with no symptoms of cognitive problems, but with evident levels of amyloid plaque in the brain. (Credit: Susan Landau and William Jagust, UC Berkeley)}

Keep in mind that the people in this study, many of them in their 70s and 80s, did not show any symptoms of Alzheimer's. Scientists are still trying to understand the connection between beta-amyloid deposits in the brain and dementia.

Aging and a family history of Alzheimer's are both considered risk factors, but we can't control those. And even if your brain hasn't been particularly active up until now, Landau says it's not too late to start ratcheting up your mental activities.

"I think that cognitive stimulation is probably beneficial at any age. But, what our findings from this study show, is that the more cognitively active you can be over the course of your lifespan, the better"

Landau says she and her colleagues plan to follow the volunteers in this study as they age, to see whether there is a link between lifetime mental activity and Alzheimer's symptoms as some of them develop dementia in the years ahead. That may help the researchers better understand the relationship between stimulating mental activities, beta-amyloid deposits and dementia.

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Last November, the fund’s board decided to cancel its latest attempt to ask for pledges from donors. That put many planned projects in jeopardy.

“There is a crisis. The global fund is functioning, but it did not get in its donor replenishments an adequate amount of money for the period 2011 to 2014. And as a result of that, it actually suspended what they call Round 11, which was supposed to take place in 2011. And because of that, many programs in many countries are now in peril,” said Jeffrey Sachs, head of The Earth Institute at Columbia University, who was among those who lobbied for the fund’s creation.

Estimates say about $2 billion in pledges is needed for Round 11.

Nay to naysayers

Sachs said the global fund is a success story that needs to be championed.

“Since the financial crisis, governments have cut back in spending in general, but many have found it convenient to cut back on spending on the world’s poorest people. This is of course a double tragedy. Often waste goes unattended, but because the poor don’t have a voice they don’t get heard,” he said.

Sachs and others want the United States to lead efforts to replenish the fund. They’re calling on the U.S. to propose an emergency donor meeting. If that happens, they say, Round 11 could still take place.

Sachs said the global fund has proven all the critics and naysayers wrong.

“It showed how every skeptic 10 years ago who said - you could not treat AIDS in Africa, you could not get ahead of the epidemic, you could not control malaria because bed nets would not be used and every other myth that was said - has been proved wrong,” he said.

Two key donors

The fund did receive good news from the World Economic Forum in Davos, Switzerland.

“Two key donors cast votes of confidence with their checkbooks. Bill Gates announced a $750 million promissory note to the fund and urged support for the fund. And Japan, despite an earthquake, tsunami and a nuclear crisis, reconfirmed its $800 million pledge. These contributions are a strong endorsement of the fund’s impact and effectiveness and a challenge to other donors to step up,” said Joanne Carter, director of the RESULTS Educational Fund.

The Bill and Melinda Gates Foundation has been one of the world’s biggest contributors to health-related programs. Over the past 10 years, it gave the global fund $650 million. Gates described the promissory note as an innovative funding mechanism.

“It frees up funds for (the) global fund and so they can immediately use the money and continue to save lives.” He said.

Gates says the global fund can change the fortunes of the world’s poorest countries. Supporters estimate the fund saves 100,000 lives every month by funding programs and projects in 150 countries.

The researchers found even installing simple latrines can cut infection rates in half.

Parasitic worms thrive in tropical and subtropical climates - areas that are home to some of the world's poorest communities.

At least one billion people are thought to be infected. Sanitary facilities are frequently non-existent in these communities, and when infected people defecate in the open, the infection can spread to others who eat raw, unwashed vegetables or even just walk barefoot on contaminated soil.



The World Health Organization has endorsed a program of preventive medication. The pills, given once or twice a year, are very effective. But researcher Jürg Utzinger, of Switzerland's Tropical and Public Health Institute, says that's not enough.

"Problem with this strategy is of course, after successful de-worming, the next day you can become re-infected," he said.

Removing the source of the infection can have an immediate and more lasting impact. Utzinger and his colleagues analyzed three dozen published studies and reported their findings in PloS Medicine.

"And what we then found [was] that people having access and use of sanitation facilities are approximately at half the risk of an infection than those people without sanitation facilities."

And when he talks about sanitation facilities, he's not talking about flush toilets. The studies indicate that even the very simplest and cheapest facilities - pit latrines - can have a dramatic impact on parasite infection rates.

Utzinger stresses that the biggest impact in combating parasite infection comes from combining different strategies.

"And we need preventive measures, and sanitation is clearly one way forward. So then, the combination of sanitation, along with the drug component, [and] health education, this really should be the way forward."

Utzinger points out that these kinds of parasitic worms were once common in the southeastern United States, a region that was desperately poor until the mid-20th century. The fact that public health programs successfully eradicated these soil-transmitted parasites suggests that eliminating them in places like sub-Saharan Africa and Southeast Asia is an achievable goal.

The gene therapy technique they used may someday stop vision loss in humans.

Retinitis pigmentosa (RP) is an eye disease that causes the light-sensitive cells in the retina - the rods and cones - to die.

The loss of eyesight normally happens slowly, over years or decades.



RP is caused by a genetic mutation, so scientists at the University of Pennsylvania's Scheie Eye Institute and veterinary school teamed up to see if injecting a normal version of the mutant gene into dogs with the disease would stop the die-off of those light-sensitive cells.

"What we were able to show is that we can stop the degeneration, we can stop the cell death of both the rods and the cones," says University of Pennsylvania veterinary ophthalmologist William Beltran, the study's lead author. "What the gene therapy approach is doing is, in fact, rescuing those cells that are diseased but have not died yet."

Canine RP is like the human variety, which makes dogs a good model for studying the disease and possible treatments.

Beltran says the gene therapy appears to be safe and effective in stopping the progression of the disease, but he cautions that it can't do much to reverse vision loss. It can't restore the light-sensitive cells that have died, and it can't grow new ones.

Beltran says tests in humans are still an estimated four-to-five years off. He wants to do more animal testing to see, for example, if the gene therapy has a long-lasting effect.  

"And the reason for doing so is that the likelihood is when we get to treat patients, we will be treating individuals that are at a rather later stage of degeneration."

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First Lady Michelle Obama announced new Department of Agriculture standards for school meals that double the portions of fruits and vegetables, cut the fat and salt, and use more whole grains, rather than white flour or white rice.

“When we send our kids to school, we have a right to expect that they won’t be eating the kind of fatty, salty, sugary foods we’re trying to keep from them when they’re at home,” the first lady said.

The aim is to tackle two growing problems in the United States and around the world.
On the one hand, rates of childhood obesity have nearly tripled in the U.S. since 1980. On the other, two-thirds of the 32 million children in the lunch line rely on government-subsidized or free school meals - more than ever before.

“For many kids whose families are struggling, school meals can be their main or only source of nutrition for the entire day. So when we serve higher quality food in our schools, we’re not just fighting childhood obesity. We’re taking the important steps that are needed to fight childhood hunger as well," Mrs. Obama said.

The new standards get a round of applause from nutrition advocates like Margo Wootan with the private Center for Science in the Public Interest.  “It’s terrific. The new standards from USDA are a very important advancement for our nation’s kids. It’ll mean healthier school lunches for 32 million kids around the country,” Wootan said.

Wootan says it will cost more to use more fruits and vegetables, leaner meats and whole grains. Schools will get more government funding to help cover the cost. Wootan says it will pay off in the long run.

“That investment is so important. We either pay now or we pay later. Because obesity costs this country about $150 billion a year,” Wootan said.

So while the students at Parklawn got a special visit from the First Lady, school children around the country will get a longer-lasting treat:  better meals on their cafeteria trays.

Seventeen-year-old Alaina Kvapil was diagnosed with asthma when she was 13.

“When you have an asthma attack, your airways actually close up and people don’t realize that you can’t breathe, you can’t get the air out,” Kvapil said.

The World Health Organization says asthma is the most common chronic disease among children.  No one knows exactly why, but studies show a link between asthma and acid reflux disease.  Up to 70 percent of people with asthma have gastroesophageal reflux disease, or GERD, which occurs when food and stomach acids leak back up into the esophagus, the tube that connects the mouth to the stomach.

Children and babies can suffer from gastroesophageal reflux disease. In children, as in adults, the most common symptom is heartburn.

Alaina Kvapil participated in a study to see if treating her acid reflux disease would also treat her asthma. She was one of more than 300 children who participated in the study. The study involved treating some of the children with powerful drugs called proton pump inhibitors, which reduce the amount of acid in the stomach.   

Dr. Janet Holbrook from Johns Hopkins School of Public Health is one of the study's co-authors. “This study is important because proton pump inhibitors are widely used drugs and there’s been a lot of conflicting data about whether they’re effective for the treatment of asthma," Holbrook said.

Half of the children were given a proton pump inhibitor, or PPI, along with an inhaled steroid that helps with breathing and digestive problems. The other half were given a placebo.

Although medication that treats acid reflux disease often helps to relieve asthma symptoms, the children without acid reflux symptoms who took PPIs did not see any reduction in their asthma symptoms. In fact, the drugs were shown to do some harm.

"In the children who were taking the active drug they tended to have more upper respiratory infections during the study. So not only is the treatment not effective...it may also come with some risk,” Holbrook said.

Even in the children who had documented acid reflux, the PPI did not help their asthma symptoms.

The American Lung Association helped support the study. Journal of the American Medical Association published its findings.

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The World Health Organization (WHO) lists 69 countries that have reported what is officially called "extensively drug-resistant" tuberculosis (XDR-TB).  It's a form of the mycobacterium that, like the one reported in India, isn't killed by first- and second-line anti-TB injectable drugs. The WHO says at least 25,000 cases of XDR-TB are reported worldwide every year.

Dr. Margaret Chan, WHO's director-general, views the emergence of drug-resistant tuberculosis with alarm.

"Call it what you may, a time bomb or a powder keg. Any way you look at it, this is a potentially explosive situation," she said.

Officials say drug-resistant TB has been a growing problem in countries such as India and China because patients are frequently misdiagnosed and often receive inappropriate or inadequate treatment with antibiotics.  Misuse of these drugs increases the danger that the target pathogen will gradually develop resistance to them.

Dr. Neeraj Mistry, a public health physician, says surveys show that very few Indian doctors are actually treating TB patients with the right drugs for the right length of time.

"The emergence of totally-resistant TB is a result of failed public health intervention strategies," said Mistry.  "When we deliver ineffective treatment regimens and when we don't have full adherence and compliance to treatment, it enables the emergence of resistance within the individual."

Experts say that with the current arsenal of drugs failing to hold the line against TB, the need for new drugs and compounds has become more urgent.  Preventing TB through vaccination is one promising strategy.

"The ideal would be to develop a vaccine that works in all age groups. Everyone from newborn through the elderly," noted Dr. Ann Ginsberg of the Aeras Global TB Vaccine Foundation.

Ginsberg and her colleagues are running clinical trials on two TB vaccines they hope will provide long-lasting immunity to TB and stop transmission of the disease. If all goes as planned, she says, the vaccine will be ready by 2020.

"The clinical development program for a TB vaccine is a very long process, and it's long because, first of all, it's the nature of the disease itself - people get infected with TB and often don't get sick for years," added Ginsberg.  "So when you do a vaccine trial, you have to vaccinate people and watch them for years to see whether or not they will get the TB.  So that makes these clinical trials very long."

While the world waits for that TB vaccine, the WHO says a new line of TB drugs - fortified with a new class of potent anti-mycobacterial agents - could be available by the end of this year or early next.