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MUSIC: Our World Theme

Straight ahead on "Our World" ... getting quick treatment for accident victims  ... therapy for complicated grief ... and conserving marine treasures in the ocean off Hawaii.
WILHELM:  "We really can learn from the past and hopefully take the kinds of steps that are necessary to make sure that things that have happened elsewhere on the globe don't happen here."

Those stories, a few words about heart disease, and more. ... I'm Art Chimes.  Welcome to VOA's science and technology magazine, "Our World."

Most Americans live within one hour of a trauma center -- a hospital specially equipped to deal with patients severely injured in incidents such as a workplace accident, a highway pileup or a shooting. But a study published this week finds that one American in six lives far enough away from a trauma center that it could mean the difference between survival and death.

Severe injuries in trauma cases require special skills and quick treatment.

The goal is to have the patient in the emergency room of a trauma hospital within 45-minute to an hour after getting hurt.

Charles Branas, the epidemiologist at the University of Pennsylvania who led the study team, said specialized trauma hospitals give patients an edge.

BRANAS: "We are very confident that being treated at a trauma center as opposed to a non-trauma center hospital will give you a much higher chance of surviving."
Q: Is that because tools, better equipment, better training, better staff?
BRANAS: "It's because the staff are trained to do this, so they have the main type of surgeon, a trauma surgeon, available to them. Becuase injury is a surgical disease. Then they also have all sorts of different specialists available to them at a moment's notice."

Also, like any other kind of specialist, trauma surgeons are good at saving the lives of severely injured patients because they do it every day.

Dr. Branas and his colleagues found that access to trauma facilities is not uniform across the country. In the United States, we have no national system for deciding which hospitals should be upgraded to trauma center status. So in densely populated states, particularly in the East, trauma centers are within a hour of nearly everybody. But in many sparsely populated western states, half, even two-thirds of the population may be more than an hour away from a trauma facility.

The disparity endangers an injured Wyoming rancher, say, who has no trauma center nearby. But surprisingly it could also affect the survival chances of an urban shooting victim.

BRANAS:  "There is some speculation that some urban areas may have more trauma centers than they need, which actually may reduce the quality of care that's offered to trauma patients in those areas because if you don't have enough severely-injured people to go around, the providers can't see enough of them to maintain their skills."

The study, published in the American Medical Association journal JAMA, says the best way to extend the reach of existing trauma centers is to increase the use of medical helicopters, which could bring many more rural patients within that one-hour window for critical care.

Although Dr. Branas emphasizes that the United States has, in general, done an excellent job of providing trauma care, many states are still in the early stages of developing their trauma system, in parallel with some other countries.

BRANAS:  "The U.S. trauma system is a model for the rest of the world. However, there are also other countries that are just starting the concept of a trauma system and trauma centers and getting speciality care for injured patients and thinking of them as diseased. The truth is, because we're such a big country, we also have states that are really still developing their trauma system as well. And there's something for developing countries, I think, to be learned from these states, which are essentially starting from a clean slate and building a trauma system up from that."

The University of Pennsylvania's Dr. Charles Branas says he has gotten inquiries from Britain, Jamaica and Taiwan about his analysis as they work on upgrading their own trauma response systems.

An experimental vaccine for the painful nerve and skin infection known as shingles has done pretty well in a study published this week in the New England Journal of Medicine.

The vaccine prevented about half the shingles cases and dramatically eased symptoms and complications in cases it didn't prevent.

The study took more than five years and involved more than 38,000 older adults. About half of them got the vaccine; the other half got a placebo. There were minimal side effects.

The vaccine is a more potent version of a chickenpox vaccine, which has been used since 1995.

Shingles, also called herpes zoster, is caused by a reactivation of the virus that causes chickenpox.

More than half-a-million Americans develop shingles each year, as do millions more worldwide. In addition to a painful rash, some people develop more serious symptoms, and sometimes the pain persists for months, or even years.

At Our World we enjoy reading your letters and e-mails, and whenever we can we dip into the mailbag to answer a question. Our question this week comes from K.M.V. Shenoy in Karnataka state, in India, who asks about some terms related to cardiovascular disease, in particular heart disease, heart failure, heart attack and stroke.

To find an expert we called the Mayo Clinic, one of America's top medical centers, and they passed us on to staff cardiologist Dr. Bijoy Khandheria, who by coincidence is also from India. To begin with, I asked Dr. Khandheria to define heart disease.

KHANDHERIA:  Heart disease is like saying 'ice cream.' You can have many kinds of ice cream. It's a very generic term.

CHIMES: Well, what about some of the more specific terms. Now 'heart failure' is the first one that he mentions.

KHANDHERIA:  Well, heart failure is a term that is used when the heart, which is a pump, starts to fail. And the failing of the heart can be because the valve may be abnormal. It can be because the heart muscle may be abnormal. It may be because the heart muscle has died. So heart failure refers to the lack of the ability of the heart to pump blood and therefore to provide oxygen and nourishment to all parts of the body.

CHIMES:  Now, I've heard the term 'congestive heart failure.' Is that one particular kind of heart failure.

KHANDHERIA:  Heart failure and congestive heart failure are synonymously used, so they are interchangeable terms.

CHIMES:  OK. Another term we hear a lot is 'heart attack.'  What exactly is a heart attack?

KHANDHERIA:  Heart attack is where a portion of the heart muscle dies because it did not get enough oxygen or it did not get enough blood supply. And it's sometimes called 'acute coronary syndrome' or 'myocardial infarction.'

CHIMES:  Now is this sometimes or always the case when the coronary artery is blocked and the heart muscle is not getting enough blood itself?

KHANDHERIA:  The heart muscle may not get enough blood from a permanent blockage of the blood vessel called as coronary artery. Or sometimes the blood vessel can go into a spasm and remain in a spasm and therefore jeopardize the blood supply, but then the spasm goes away and blood supply is restored but the heart muscle is already damaged.

CHIMES:  The other term Mr. Shenoy asks about is 'stroke.'

KHANDHERIA:  Stroke is, again, a term that is used when there is deprivation of blood supply to certain parts of the brain. And that deprivation could be either from a blockage, or [it] could be from something compressing on the blood vessel, or [it] could be if a piece of plaque or a piece of fat component in the blood vessel that's dislodged and lodges itself in a smaller blood vessel.

CHIMES:  Now that would be a condition that doesn't affect the heart directly?

KHANDHERIA:  Yeah, in most instances the stroke would only affect, it would be brain, and then the brain would sort-of be saying that it's the right arm or the right hand or the right side of the body or the face or any other organ. Typically the heart happens to be an innocent bystander here.

CHIMES:  What we would generically call cardiovascular disease, because it is the cardiovascular system?

KHANDHERIA:  Yeah, that's right

CHIMES:  Y'know, let me talk about interventions for a minute. How rapidly has the ability of the medical profession to deal with heart disease progressed?

KHANDHERIA:  Oh, it has progressed in light speed. Because five years ago we did not talk about opening up blood vessels in the neck for prevention of stroke or to treat stroke. Nowadays that's being done as a routine clinical practice. Stents have only been in place for the last seven, eight, nine years, and drug-coated stents have only been in place for the last three-to-four years. So science is advancing very rapidly for minimally-invasive treatment approaches to different forms of heart disease.

CHIMES:  As a person from India, do you see some of these treatments becoming available to less-wealthier countries?

KHANDHERIA:  The answer to that question is, many of treatments actually are available earlier and quicker in the non-developed countries. For example, the minimally invasive bypass operation procedures were done first in India. Then it got approved in the United States. So because of the approval process, some of these treatments -- and stents, for example, drug-coated stents have been around in Europe longer than it has been [available] in the United States. And if it's been in Europe, it's available in India, Malaysia, Singapore, any of the other countries that you can think of in the Asian-Pacific rim. So sometimes -- not sometimes, I would say more than half the times these treatment options are available earlier. The only thing is, it is availble to a smaller segment of the population because these new techniques cost a lot of money, and not everybody can afford it.

CHIMES:  We'll be sending him a special VOA gift as our way of saying thanks. If you've got a question about science, technology, health, or the environment, email us at, or listen for our snail mail address at the end of the show.

MUSIC : Connie Haines: Broken Hearted

A new form of treating grief following the death of a loved one has been found to be more successful than conventional psychotherapy in some patients.   VOA's Jessica Berman reports.

BERMAN:  Two years ago, Heather Chatterjee's daughter, Renee, was killed in an automobile accident. 

CHATTERJEE:  "There's no sadness or any emotion that you can feel that describes the agony.  It becomes physical pain.  It becomes debilitating.  It's the yearning and the longing."

BERMAN:  Ms. Chatterjee suffers from "complicated grief," a condition that afflicts an estimated 10 to 20 percent of bereaved individuals following the loss of a loved one. 

Complicated grief includes intense feelings that last six months or longer, according to psychiatrist Katherine Shear of the University of Pittsburgh.

SHEAR:  "It's characterized by symptoms of intense separation distress, yearning and longing for the person who died, and traumatic distress which is recurrent, intrusive images of the person who died."

BERMAN:  Experts say people suffering from complicated grief do not respond well to traditional psychotherapy.

So Dr. Shear and colleagues developed a new form of treatment designed to get those with complicated grief to both accept their loss and focus on their personal life goals.

The therapy includes "revisiting" -- tape recording the patient telling the story of the loved one's death -- and having the patient listen to the story daily, to help lessen the intensity of emotion. The patient also tells the loved one things they didn't get to hear in life.

In a study comparing the two types of therapy, 51 percent of people with complicated grief were helped compared to 28 percent of people receiving traditional psychotherapy.  

Dr. Shear was heartened by the results.

SHEAR:  "People who got complicated grief treatment were much more likely to tell us that the treatment made a very dramatic difference in their symptoms.  And sometimes they said the treatment even changed their lives."

BERMAN:  Among them is Heather Chatterjee, who has come to accept the death of her daughter.

CHATTERGEE:  "It's something that will be with me for the rest of my life.  But it's ok.  I can go on now."

The study on complicated grief therapy was published in Journal of the American Medical Association.    Jessica Berman, VOA News, Washington.

May was Asian Pacific American Heritage Month in the United States, and our Website of the Week might have been a better choice a couple of weeks ago, but it's too good to wait for next year, so better late than never -- it's the Smithsonian Institution's online Asian art museums, at

Massumeh Farhad, chief curator and curator of Islamic art, says the aim is to extend the museum's reach beyond the visitors who can come see the collection in person, here in Washington.

FARHAD:  "We feel that we should reach out to a much broader audience, especially the audience in Asia. So on the website we have highlights of our exhibitions, our current exhibitions but also past exhibitions. We have educational programs. And we have collections online, which enables people who can't come to Washington to see what we have in our collections."

The collections in the Smithsonian's two Asian art museums -- the Freer and the Sackler -- include art from China, Japan and Korea, South Asia and the Himalayas, and the Middle East, including Biblical manuscripts and art of the Islamic world.

One goal is to eventually have photographs of all 25,000 objects in the museum collection available online with descriptive text.

FARHAD:  "We have a large percentage of the collection online, but not everything. And the idea is to get everything online as soon as possible, and then just continue adding to the information, so it will be sort of like a constantly-revised catalogue of our holdings."

Other material on the website is related to special exhibitions, where Ms. Farhad says the aim is to go beyond the objects on display.

FARHAD:"It's more trying to give a sense of the meaning of the exhibition by using the medium of the web in a creative way"

One example is a current installation by contempoary Chinese artist Cai Guo-Qiang. It includes the wreck of a 15-meter Japanese fishing boat sailing on a glistening sea of white Chinese porcelain shards.

FARHAD: "No photograph can really convey the scale of the piece and how it feels in that space. So again, by video clips, by interviews with the artist, and just showing how the piece was put together, we hope to give our web users a sense of what this piece is all about."

Providing a new dimension to an experience -- one of the things the World Wide Web does best. Our Website of the Week, the Smithsonian's Freer and Sackler Asian art museums, is at, or get the link from our site,

Beyond the populated islands of the Hawaiian archipelago lie the Northwestern Hawaiian Islands? a chain of islands, atolls and reefs that stretches 1,900 kilometers into the North Pacific.  This remote paradise is being considered for a National Marine Sanctuary, to ensure long-term protection of its coral reefs, marine species and archeological treasures.  As VOA's Rosanne Skirble reports, efforts are underway to determine how to manage this vast ecosystem, second in size only to Australia's Great Barrier Reef.

SKIRBLE:  The job begins with an assessment of the ecosystem, which encompasses 7,200 kilometers of coral reefs? among the healthiest on the planet.  These reefs and shoals are home to 7,000 species -- including many found only in these waters, and endangered ones, like the green sea turtle and monk seal.

The work this day begins at Snug Harbor in Honolulu where researchers are loading gear on board the Hi'ialakai. The former Coast Guard ship was commissioned last year by the National Oceanic and Atmospheric Administration to monitor, map and survey the reserve ? an important step toward gaining permanent protected status as a National Marine Sanctuary.

KOSAKI: (speaks to crew)

SKIRBLE: Randall Kosaki is a fish biologist with the Reserve, and chief scientist for this 25-day expedition.  He manages a small floating city equipped with dive boats, sea labs, multi-beam sonar and a decompression chamber in event of a diving accident.  Moments before departure he goes over last-minute details with his crew and members of the state and federal research teams. 

KOSAKI: (speaks to crew)

SKIRBLE: Their projects range from maritime archeology to the impact of coral bleaching ? when environmental stress whitens coral and eventually kills it.  An isolated bleaching event was recorded here in 2002, the first on record in the Northwestern Hawaiian Islands.

KOSAKI:  "And we hope that we will start seeing signs of recovery, new corals starting to recruit, small colonies starting to grow.  We are also looking at coral disease, which is thought to sometimes follow in the aftermath of a bleaching event, and so we are keeping an eye out for coral disease, but it is generally a very healthy reef."

SKIRBLE: Large predator fish are abundant in the Northwestern Hawaiian Islands.  Scientists plan to catch and surgically implant acoustic tags into tiger sharks and jack fish to chart their territory from receivers on the reef.

KOSAKI:  "And so we will go back a couple of times a year and download data from these receivers and get a very quick picture on the use of space by these animals, both within a given reef and also perhaps more interestingly, we are looking at whether or not they move between reefs.  So that impacts management very profoundly because that will tell us whether we can manage individual reefs as discrete, self-contained, self-functioning reefs or whether we actually have to manage them as a group because there is significant movement of animals between them."

SKIRBLE: "Scientists will also catch a variety of fish and take DNA samples for genetic analysis before releasing them.  Others will study algae and plankton to better understand the reef and what keeps it healthy." 


SKIRBLE: The Hi'ialakai motors out to sea, bringing the Northwestern Hawaiian Islands Coral Reef Ecosystem Reserve one step closer to Sanctuary status. The Reserve's Acting Coordinator Aulani Wilhelm says while few may ever visit this remote marine wilderness, the huge reef has captured the imagination of people across the globe at a time when other ocean systems face serious threats.

WILHELM:  "And that's why it is really important to look at special places in the ocean, not with an eye to 'Oh, my gosh, there's a problem, we need to fix it,' but 'Look at this incredible place.  We need to protect it,' because we need to have eyes that look beyond this current generation.  This is an opportunity in our lifetime that we see that we really can learn from the past and hopefully take the kinds of steps that are necessary to make sure that things that have happened elsewhere on the globe don't happen here."

SKIRBLE: You can follow the Hi'ialakai and read reports about its voyage online by logging on to the ship's website at I'm Rosanne Skirble.

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That's our show for this week.  Got a science question? If we answer it on the show we'll send you a special VOA gift as our way of saying thanks. Email us at Ourworld is all one word. Or the postal address is -
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Our World is edited by Faith Lapidus. Our technical director is Bob Doughty. And this is Art Chimes, inviting you to join us online at or on your radio next Saturday and Sunday as we check out the latest in science and Our World.