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Our World Transcript — 17 June 2006

This transcript is provided as a service; there may be some variation between it and the program as broadcast.

MUSIC: "Our World" theme

Straight ahead on "Our World" ... emergency medicine at the breaking point ... a new treatment for a deadly childhood illness ... and legends of civil engineering.

WEINGARDT: "He said he got his idea for its unique structural framework from studying his wife's wire bird cage, which she carried around the house from place to place. Kinda strange where engineers get their inspiration, isn't it?"

Those stories, bringing oysters back to waters off New York, and more. I'm Art Chimes. Welcome to VOA's science and technology magazine, "Our World."

The U.S. emergency medical system is stretched to the breaking point, according to a report released Wednesday by the Institute of Medicine, the independent agency that advises the U.S. government on health policy.

The Institute's three-volume report — more than two years in the making — found serious flaws throughout the system that is the frontline treatment for victims of heart attack, stroke, and accidents.

At a press conference on Wednesday, the chairman of the committee that prepared the report, retired hospital administrator Gail Warden, noted that there ARE centers of excellence around the country.

WARDEN: "But yet at the same time, in most communities there is a crisis under the surface. We have overcrowded emergency departments in hospitals with long waits. We have ambulance diversions because the emergency room is overcrowded and is not able to handle the volume [of new cases] that is coming to it. We have a lack of specialists available to care for emergencies in many communities. We have a shortfall in pediatric care. And we also have inadequate preparation for large-scale emergencies in many communities."

Much of the problem is financial. By law, hospitals have to treat anyone who comes into their emergency departments, even if they don't really have an urgent medical problem. Also, many emergency room patients who do have a genuine emergency don't have insurance and can't pay their medical bills. Most Americans get health insurance through their jobs, but employers are not required to provide it, so many people — especially those with low-paying jobs and the unemployed — don't have health insurance.

The problems aren't confined to hospitals. The level of emergency care you get when the ambulance responds to a traffic accident or a call for help in the case of a heart attack can vary tremendously. Committee member Shirley Gamble, who heads the United Way charity in Austin, Texas, says emergency medical service, or EMS, systems vary widely

GAMBLE: "For example, there is as much as a tenfold difference by community in survival rates for sudden cardiac arrest. In one community, your chances of survival could be five percent; in another community, your chances of survival could be 50 percent. One of the contributing factors to that is the lack of evidence to guide the medical practice. We don't have a scientific basis to guide these pre-hospital medical providers on the best way, for example, to treat sudden cardiac arrest. And that scientific evidence base needs to be developed and disseminated throughout the country."

The Institute of Medicine panel recommends better coordination between various parts of the emergency medical system, among other things, and more money from Washington to support improvements.

At least one group of emergency room physicians welcomed the report. But Rick Blum, president of the American College of Emergency Physicians, wondered whether lawmakers will respond to the recommendations, many of which will be expensive to implement.

BLUM: "Whether the Congress has the political will to do that, I don't know. I would hope it doesn't require a collapse [of an emergency system] for that to happen, but the cynical view would be a system would collapse, and then Congress will suddenly say, well how did that happen? And we've been talking about it for 10 years."

That collapse could be triggered by a mass-casualty event -- a natural disaster, a pandemic disease outbreak, or a terrorist attack.

Throughout the world, diarrhea is one of the most common ailments. In adults it is normally an unpleasant inconvenience. But it can be deadly, and diarrhea kills more than two million people a year, mostly children under age five.

As we hear from VOA's David McAlary, scientists have demonstrated that a medicine now used to treat some forms of diarrhea could be more widely used.

McALARY: Diarrhea is among mankind's most common ailments. One-fourth of the world's population suffers from it every year. The form of the illness caused by the rotavirus has enormous medical and social costs. Half a million young children die from it annually in developing countries, while in industrial nations, one in 40 children are hospitalized.

Although effective vaccines have recently been developed to prevent the virus, there has been no effective treatment for people suffering it. Now, a study published in the medical journal "Lancet" shows that a drug used for several years against a form of diarrhea caused by a parasite called cryptosporidium also works against rotavirus and other viral diseases of the gut. The drug is nitazoxanide, available under the brand name Alinia from Romark Laboratories.

ROSSIGNOL: "It has been an anti-diarrheal from the beginning."

McALARY: This is the nitazoxanide study leader, physician Jean-Francois Rossignol of the Romark Institute for Medical Research in Tampa, Florida.

ROSSIGNOL: "We knew it was working extremely well in diarrhea, but the only proof we had at the time were the anti-parasitic effects. By accident we discovered about two years ago that this was a broad spectrum anti-viral."

McALARY: Rossignol and Egyptian and Italian colleagues tested nitazoxanide in babies suffering life-threatening rotavirus diarrhea in Cairo. Among 50 children admitted to Cairo Children's Hospital, infants who received nitazoxanide took an average of 31 hours to recover compared to 75 hours for a placebo group.

ROSSIGNOL: "We discovered that the drug was not only very effective but very well tolerated by babies who were vomiting and with intensive dehydration due to massive diarrhea. In the developing world, the first thing you want to do if you develop a drug is safety because the health care system is not really able to cope with side effects of drugs."

McALARY: In addition to nitazoxanide, two new oral rotavirus vaccines from the pharmaceutical companies Merck and GlaxoSmithKline have been very effective in South American tests. Experts at this week's International Rotavirus Workshop in Lisbon say they could become available to all children worldwide in 10 years. David McAlary, VOA News, Washington.

Some 15,000 scientists, doctors and patients were in Washington for the American Diabetes Association science meeting, which ended this week.

Among the topics: the complex relationship between diabetes and depression. The World Health Organization estimates more than 170 million people have diabetes, most of them Type 2 diabetes, which we'll hear about in a moment. Obesity is the biggest risk factor, and as obesity becomes more widespread, so does diabetes. Here's health reporter Rose Hoban.

HOBAN: Researchers have been studying the complex relationship between diabetes and depression.

Scientists have known for a while that people diagnosed with type 2 diabetes are more prone to getting depressed after they're diagnosed. According to Dr. Lawrence Fisher from the University of California in San Francisco, about one in every 5 or 6 patients with type 2 diabetes — also known as adult-onset diabetes — reported symptoms of depression. That's way above the general population. In a study of about 500 people with both diabetes and depression, Fisher found they had trouble keeping their diabetes symptoms under control.

FISHER: "When you're feeling grumpy and gloomy and kind of down, your energy level is low you're less willing to be creative and you're more restrictive, and that affects self-care behavior. You may not as motivated to manage your diet, or to go for that extra ten-minute walk this week or today."

HOBAN: Fisher says those depressed people ended up having higher blood sugar readings, which puts them at risk for long term complications of diabetes. Those complications can include kidney failure and heart disease.

FISHER: "People's ability to do the day-to-day simple, pedestrian problem-solving around disease management did decrease as their mood slipped."

HOBAN: Another recent, related study suggests people at risk for diabetes might not want to take an antidepressant if they're feeling blue. Dr. Richard Rubin, a researcher at Johns Hopkins University in Baltimore, Maryland, found overweight patients who were at high risk for diabetes were more likely to develop the disease if they took antidepressant medications.

RUBIN: "It's a striking finding. It does have some substantial public health implications because there are probably 40 million people who have what we call pre-diabetes, and there are probably 15 percent of the population and increasing all the time who are taking anti-depressant medication."

HOBAN: Rubin says the relationship between diabetes and depression needs to be explored further. The research was presented at the national American Diabetes Association conference in Washington. I'm Rose Hoban.

Time again for our Website of the Week, when we showcase interesting and innovative online destinations.

This week, it's an Internet site for people who love maps and want to learn more about the United States.

DONNELLY: "In essence, it's maps and geographic products and services that promote geographic awareness of the natural resources of the United States, and unlike other mapping systems on the World Wide Web, we attempt to step back a little bit and portray our nation's broad conditions, patterns and trends."

Jay Donnelly is Managing Editor of the National Atlas of the United States, online at

The website grew out of a printed atlas, last published in 1970 — 400 pages long, a hefty five-kilos, and long out of print. In the 1990s, an online edition was conceived, to harness the power of the Internet to emerging GIS technology

DONNELLY: "GIS, or Geographic Information System, is pretty much just software that allows people to build their own maps by allowing people to select their own 'layers' or themes of information that they choose to portray. But the great thing about it is that the lines, points and areas that represent features in the real world on the map display have information behind them that's stored in a database."

The available layers cover a wide range of information, from forest cover to rainfall, birth and death rates, and a variety of information about the American population.

This Map Maker feature, as they call it, is a very powerful tool, but it only takes a few minutes to understand how it works, thanks to extensive testing of the interface.

DONNELLY: "It does not take a great deal of training. Most people get up and running [quickly]. When you sit down and first run the Map Maker, there's a link there that says, these are the four things you need to do to make your first map. From there on it's fairly intuitive, but there is online help, and there's also context-sensitive prompting of what to do next."

This is obviously faster if you have a high-speed Internet connection, but Jay Donnelly says he tests the site at home on a dial-up connection to make sure users with slower connections can still use the maps.

In addition, there are static maps, historic maps, and a wide variety of articles on history, geography and other subjects. The National Atlas of the United States — online at, or get the link from our site,

MUSIC:James Booker — "He's Got the Whole World In His Hands"

And you're listening to VOA's science and technology magazine, Our World. I'm Art Chimes in Washington.

We don't think much about civil engineers, the people responsible for designing and building our bridges, water systems, and highways. Yet their work is a critical part of society.

Richard Weingardt, an engineer himself, naturally thinks about other workers in his profession, particularly those he calls "Engineering Legends" — American engineers who have made key contributions to our way of life.

Take William Jenney, whose steel and cast iron structure for the 10-story Home Insurance Building in Chicago, built in 1885, earned him an honorary title.

WEINGARDT: "'The father of the skyscraper.' He said he got his idea for its unique structural framework from studying his wife's wire bird cage, which she carried around the house from place to place. Kinda strange where engineers get their inspiration, isn't it?"

Weingardt has written about William Jenney and others in a book called "Engineering Legends." He spoke about them this week at the Library of Congress here in Washington.

Another legendary engineer was Clifford Holland. His vehicular tunnel under New York's Hudson River was the longest ever built when it opened in 1927. Almost 80 years later, it's busier than ever: 34 million vehicles passed through it last year. Designing ventilation to get fresh air in and exhaust fumes out of the two and a half kilometer long twin tunnels was his biggest challenge, and the solutions devised for what is now known as the Holland Tunnel, have inspired designers ever since.

WEINGARDT: "It was the most innovative and longest underwater tunnel of its kind ever. And it's given guidance to all the underground tunnels built since, including the big one between England and France. They used a lot of the design concepts and theories and procedures that Holland developed.

New Yorkers rarely think of their Holland Tunnel as a landmark. Not so with another river crossing. The Brooklyn Bridge has been among the city's most beloved symbols since it opened more than 120 years ago. Washington Roebling was the engineer in charge of construction, but when illness confined him to bed, his wife Emily took over. She had no formal training in engineering or construction, and officially she merely conveyed her husband's instructions. But Richard Weingardt put her in his book, saying her role was much greater.

WEINGARDT: "If it weren't for Emily, the Brooklyn Bridge would never have been built as it was, certainly not when it was, nor as successfully as it was. And there's a plaque honoring her, right on the bridge."

Among the more recent engineers Weingardt highlights is Buckminster Fuller, a visionary whose unbuilt proposals leave you wondering, could he really have built a geodesic dome over New York City, three kilometers across?

WEINGARDT: "After Bucky built that 20-story dome to house the U.S. pavilion at the Montreal Expo in 1967, he proposed a gigantic dome to enclose midtown Manhattan. He said it would pay for itself within 10 years just from the savings from snow removal costs. (laughter) We'll never know, will we?"

Americans generally consider engineering a respectable if somewhat boring profession, without the glamor of law or medicine. We can't recall any American TV shows, for example, featuring good-looking engineers. Richard Weingardt says it's different in many other countries, though, where "engineer" is an honored title.

WEINGARDT: "They understand. They understand that their economy is solely dependent on their engineering base, their infrastructure improvements. Their standard of living is going to rise as they do more engineered works. And so the people who are doing that are more important than the person delivering the baby or the person shuffling the legal documents."

Richard Weingardt, speaking this week at the Library of Congress. His book, "Engineering Legends," is published by the American Society of Civil Engineers.

And finally today, a curious bit of natural engineering. Oysters. They may be particularly unattractive shellfish to some, a tasty food to others. But in their element, they are miniature filtration plants. They help remove pollutants from coastal estuaries, places where fresh river waters and ocean salt waters co-mingle. Many of the world's largest cities are built near estuaries, and the delicate ecosystems are threatened by pollution and other factors. In response, some grassroots groups hope oyster beds can help restore and stabilize damaged estuaries. VOA's Adam Phillips reports on one effort in the waters near New York City.

PHILLIPS: On an unseasonably blustery spring day on the shores of the Nevasink River in the town of Red Bank, New Jersey, a group of girl scouts counts the oysters they've grown from seeds over the winter. They are among the more than 400 grassroots volunteers for New York and New Jersey Baykeeper, an organization committed to the restoration of the region's vast estuary, which includes about 1,100 kilometers of shoreline. Katie McCrone is their oyster program coordinator.

McCRONE: "An oyster has a soft body within two hard shells. An oyster is a bivalve, so it basically looks like a big beige blob inside. But within that blob It's a whole animal inside there!"

PHILLIPS: This animal also serves as a highly efficient water-filtering machine. An average adult oyster filters as much as 190 liters of water a day. That figure impresses one girl scout named Jackie.

JACKIE: "That might not seem like much. But when you put a million together it makes a big difference. And it helps the ecosystem."

PHILLIPS: Julia and Gabby, two 11-year-old scouts, have enjoyed doing their part.

JULIA: You get a lot of responsibility with the oysters, remembering all your data charts, getting there on time, taking care of them, getting the proper things you need to scrub off the cage and all the muck and stuff.

ABBY: "If they are not cleaned, they won't grow as much. So, after they are big enough, about the size of two baby fists, then they dump them in this big reef so that they are all together."

JULIA: "It's a great way to help the environment."

PHILLIPS: Do you care about the environment a lot?

JULIA: "Yes I do!"

PHILLIPS: As these girls are discovering, oyster beds and the reefs they form are home to many kinds of marine life that non-experts might consider a bit "yucky." Ms. McCrone explains.

MCCRONE: "Oyster reefs are on the bottom of bays and estuaries and they provide homes for lots of other species of crabs, fish, worms - you name it. Any invertebrate living down there will hide under a shell, anything that needs to attach to a shell to grow -- anemones, barnacles, sea grasses and things like that that will attach to hard surfaces will maybe attach to the oyster reef… So oysters are a kind of dual-function filter feeders and habitat creators."

PHILLIPS: Mark Wolf Armstrong is president of Restore America's Estuaries, a coalition of eleven environmental groups in cities around the country. He thinks of estuaries as nurseries.

ARMSTRONG: "Three out of every four fish depend on an estuary for some part of their life. And it's usually the juvenile stage. It's usually when they're young and they're trying to grow up."

PHILLIPS: Armstrong adds that throughout history, humans have also loved estuary habitats.

ARMSTRONG: "That's where we love to be because it's protected. It's also rich in food. We like to eat! And what we do is, we move into an estuary and we blossom ourselves. Our populations grow. Look at our cities. They are huge and getting huger."

PHILLIPS: A casual visitor to today's New York would never know it, but until the 1920s, New York City was home to some of the world's most productive oyster beds, says Andrew Willner, director of New York and New Jersey Baykeeper.

WILLNER: "Oysters were so ubiquitous that they were a penny apiece on a wagon on the corner of downtown Manhattan and people would eat three, four, five dozen for lunch."

PHILLIPS: Typhoid from the raw human sewage dumped into New York waters killed off the local oyster industry in the 1920s, demonstrating the sensitive link between humans and their natural environment. According to Mark Wolf Armstrong, estuary restoration and protection is a challenge that is finally being addressed globally - from Britain, to Africa, and from South America to Bangladesh.

ARMSTRONG: "And it's really gratifying to see that people are finally 'getting it!' Otherwise, we won't have fish! We won't have table to enjoy the bountiful nature of this kind of habitat."

PHILLIPS: On the Nevasink River in Red Bank, New Jersey, I'm Adam Phillips.