Away On Vacation: With Kindle.

The Cockroach Catcher & his wife will again be travelling to somewhere where the coffee still struggles with mist and moisture to produce all the flavour and antioxidant you may want.

©2008 Am Ang Zhang

There is one drawback: you do not have easy access to books!

This is where Kindle comes in handy. Yes a 3^rd generation gadget that allows you to store and read books and other printed material.   You can pack with you thousands of books on this device that weighs less than a paperback.

This has inspired me to launch a Kindle edition of The Cockroach Catcher (yes, the book).   More importantly, the Kindle edition costs a fraction of the physical copy.  If you do not yet own a Kindle, you can simply download the free Kindle software and read Kindle books on your iPhone, iPad , iPod touch & your Personal Computer. You can read the book within seconds from ordering.        US Verson

Here are some reviews:

Most recent one from Chez Sam’s:

“And CC, your book is amazing! I am only on page 44 but so far, so wonderful. I think how you turned this anorexia patient around just goes to show what human interaction rather than tick box protocols can do in a short period of time and at low cost too. This is an exemplary illustration on perhaps one of the reasons why a good health system like the one in Singapore can not be fully implemented in Britain. it's the change of perceptions and methodology to suit that's difficult.

And, as a city girl, I found your early life in villages fascinating and very enriching for a bright child like yourself, I suppose, had I been your mother, I too would have not asked you any questions when you were told to leave that school ... but the school supplier of cockroaches! [shiver]Dearime! I run a mile when I see one, let alone catch them and dissect them! boys will be boys after all, now that I know that you weren't joking. you are a cockroach catcher, not only of the soul, but for real! @@

The book is a must read doc, I am really enjoying it :-)”

More here>>>>>>

Amazon:

“Zhang laments the dawning of the age of red tape in psychiatry, which is the same all over the world. The emphasis on "guidelines", also known as "evidence based medicine", and artificial restraints on access to services, have changed the landscapes of our practice. If everyone practices cookie cutter type of medicine, where will we find new thinking and new treatments? 
This book is a "must read" for all professionals in the mental health field, and for all interested individuals. It is a kaleidoscope of life seen from the eyes of the therapist who genuinely cares about his patients as people. Zhang provides an in-depth understanding of the human condition. 
In my view, this book gives us a glimpse into the soul of psychiatry, into holistic medicine at its best.”

From a doctor friend:

The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.

Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.

Objectively, a reader outside of the UK would find some chapters in the book intriguing because a lot of space was devoted to explaining the jargons (statementing, section, grammar schools) and the NHS administrative systems. Of course, your need to clarify the peculiar UK background of your clinical practice is understandable.

Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.            More>>>>

Review on Amazon

Readers' views.

The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US


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Grand Rounds is up at Sharp Brains

Ecology: Locusts & Serotonin

Australian farmers having just recovered from one of the longest period of drought in recent memory are bracing themselves for another ecological effect of the return of the rainfall: locusts.

The drought caused a decline in the number of birds and other insects that normally feed on baby locusts. The rain also provided ideal breeding condition for locusts.

September being spring in Australia is when the locusts hatch and there are clear indications that the locusts will swarm.

From Australian Government website:

Widespread high density hatching of eggs and the development of nymphal bands is expected during spring in the Central West, Far Southwest and Riverina regions of New South Wales, the Northwest and North Central regions of Victoria, and the Northeast and Murray Valley regions of South Australia. More localised high density hatchings are likely in Far West New South Wales, Southwest Queensland and the Far North and Southeast regions of South Australia.

Currently spraying with pesticides is the only means of control and they are not without problems.

“Some pesticides in use today are especially dangerous to wildlife. Two insecticides, carbofuran and diazinon, were involved in 55% of all bird incidents."

Earlier in 2009, scientists discovered that serotonin is the neurotransmitter that initiated the swarming behaviour in locusts:

Serotonin Makes Locusts Swarm

Martin Enserink on 29 January 2009

Serotonin, the brain chemical involved in depression, anger, and a variety of other human behaviors, turns out to have another surprising role: It transforms desert locusts from solitary, innocuous bugs into swarming, voracious pests that can ravage orchards and fields in a matter of hours. The findings, published in tomorrow's issue of Science, could point the way to new locust-control methods that don't rely on insecticides.

Tom Fayle /National Geographic

Most of the time, the desert locust (Schistocerca gregaria) is a bland, greenish insect that lives an inconspicuous life, shunning other members of its species and flying only by night. But when their densities reach a certain threshold, locusts become gregarious: They seek out one another's company, start reproducing explosively, and eventually form massive swarms that can move thousands of kilometers beyond their usual habitats and create havoc of biblical proportions.


 The behavior changes are accompanied by a complete physical makeover, taking several generations, during which the insects first turn pink and eventually black and bright yellow.

.    Read the full article here>>>>.

It may be some time before we can make use of this new found knowledge!!!

Interesting facts from another website:     >>>> video

• The 2010/11 locust season is predicted to be the worst outbreak in at least 30 years.
• A swarm covering one kilometre can eat up to 10 tonnes of vegetation per day.
• If 100 hectares of locust bands are not effectively controlled they may develop into 1,000 hectares of adult swarms.
• Past campaigns have shown that for every $1,000 spent controlling locusts, at least $20,000 worth of crops and pastures have been saved.
• Australian plague locusts generally mature within two weeks of becoming adult.
• Females can commence egg laying 4-7 days after maturing.
• In summer, eggs can hatch within 14–16 days.
• Female locusts lay eggs in batches, called pods, in the soil and each pod can contain up to 60 eggs.
• Locust “bands” can contain up to 15,000 hoppers per square metre at the front of the band.
• Swarms generally fly within 15 m of the ground and frequently at less than 3m and often appear to roll across the countryside.
• Swarms can infest areas up to 50 km2.
• Locusts can migrate up to 600 km or more in a single night.
• People in several countries eat locusts. Locusts are rich in protein and can be stir-fried, roasted or boiled.
• A swarm of locusts, covering 1 kilometre (km)2, could contain anything from 4 million to over 50 million individual locusts.

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Asthma: Hookworm or QOF

As recent research dashed all hope that hookworm may help to reduce the incidence of Asthma, there may indeed be a simpler way: QOF or abandoning QOF

The Telegraph

Doctors 'over-diagnose’
By Martin Edwards
20 Sep 2010

........The answer, unsurprisingly, involves money. The most recent contract between the NHS and GPs incorporates something grandly called the Quality and Outcomes Framework (QOF), which aims to reward GPs financially for good clinical practice. Under a complex and arcane formula, the more patients we diagnose with and treat for certain disorders, the harder we are deemed to be working, and the more income our practice attracts. Working in misery-soaked south London, we were staggered to discover that the prevalence of depression among our patients was far lower than expected, taking account of factors like class and income.

These regulations apply to all NHS GPs and this over-diagnosis is not limited to depression. Some children, and a few adults, develop a wheezy chest when they catch a cold. However, we only get money if we diagnose asthma, a label that might well follow a child through school and into employment. And that single entry of “raised blood pressure”, often occasioned by a last-minute dash to the surgery, is sufficient to label you as hypertensive. Each of these labels can affect insurance, mortgage, loan or employment prospects.......

                                                                                    Read all: The Telegraph

Jobbing Doctor in a recent re-posting:

The distortions of Performance-related payments.

There are certain outcomes that have occurred as a result.

Firstly, Government underestimated the amount of high quality medicine taking place in primary care at that time, and so did not budget for it (despite being told repeatedly). This saw GP income increase by around 33%. Practices like mine had no difficulty in hitting the targets - we were there, pretty much, already.

Secondly, performance measures were always a very crude measure of clinical excellence, and therefore - as a valid measuring tool - had significant flaws. I have seen this.

Thirdly, it encouraged gaming with the system. Some GPs, whose practice income depended on hitting targets, would be tempted to distort the measures and also (on occasions) invent data. I have seen this happen in my locality (but not in my practice).

Fourthly, the focus would be on conditions in the QoF areas and other conditions - outside this system - may well get less attention.

Money distorts!!!

Related:

Telegraph 2008

Pulse

Autism in Australia

Salmonella: Duck Eggs, Frogs & Others

Ducks in my home village, China /© 2008 Am Ang Zhang

Years back when I was a medical student, we were taught that ducks basically carry salmonella as a matter of course due to their aquatic habitat and for that reason the Chinese have always been careful to make sure that ducks are well cooked unlike some modern day fancy cooking where duck meat is often presented rare. 

As it is coming up to Chinese Moon Festival time, it is worth mentioning that our moon cake often have one or two duck egg yolks in them, yes, salted egg yolk in moon cake. They too are of course well cooked.

Recently there has been an outbreak of Salmonella Typhimurium DT8 food poisoning in the UK.

The Health Protection Agency (HPA) reported:

HPA investigates a national outbreak of salmonella

17 September 2010

The Health Protection Agency (HPA) has investigated an on-going national outbreak of Salmonella Typhimurium DT8. 

Salmonella Typhimurium DT8 causes a similar illness to other forms of Salmonella infection, so symptoms can include diarrhoea, vomiting, abdominal pain and fever.

So far this year, the HPA has confirmed 66 reports of human infection in England and Northern Ireland.  Figures for previous years were 34 in 2008 and 47 in 2009.   

Of the reported cases two are known to have been hospitalised, one of whom has died. Cases are mainly adults with an average age of 46 years, and most are men (61 per cent).  Cases have been referred from Northern Ireland and most regions in England, with predominance in the South East and North West.   

 “It became clear from our investigations that the increase was related to the consumption of duck products, mainly eggs. It is important that consumers and caterers are aware that all eggs, including duck eggs, may occasionally be contaminated with Salmonella and follow advice provided by the Food Standards Agency in order to reduce the risk of infection. Eggs should be cooked thoroughly and good hygiene practices, such as washing hands, utensils and kitchen surfaces should be followed after handling or using duck eggs.”

There is of course another very important source of the infection: pets especially frogs and turtles.

Center for Disease Control (CDC) reported earlier in the year:

Multistate Outbreak of Human Salmonella Typhimurium Infections Associated with Aquatic Frogs --- United States, 2009

Strawberry poison dart frog (nicknamed Blue Jean frog)
- Dendrobates pumilio/© 2008 Am Ang Zhang

During April--July 2009, the Utah Department of Health identified five cases of Salmonella Typhimurium infection with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns, predominantly among children. In August, CDC began a multistate outbreak investigation to determine the source of the infections. This report summarizes the results of this ongoing investigation, which, as of December 30, had identified 85 S. Typhimurium human isolates with the outbreak strain from 31 States.

31 States!!!

Environmental samples taken from patient homes in four states yielded the outbreak strain of S. Typhimurium. The Colorado Department of Public Health obtained matched isolates from two African dwarf frogs, and from a rock and water in the aquarium containing the two frogs. The New Mexico Department of Health matched the outbreak strain with isolates from the filtration system, gravel, and water from an aquarium in a patient's home containing fish and a small water frog. The Ohio Department of Health matched the outbreak strain with isolates from a patient's deceased African dwarf frog, its water, and the lid and edge of its aquarium. The Utah Department of Health obtained matched isolates from a container used to clean African dwarf frogs in a patient's home.

Traceback investigations of frogs associated with positive environmental isolates have been completed. African dwarf frogs from the homes of the Colorado patient and the Utah patient were prizes from games at two different carnivals. The vendor who distributed the frogs to both carnivals was from Utah and identified the source as a breeder in California. Environmental sampling from the vendor's home (of aquarium filters and skin previously shed from African dwarf frogs) yielded multiple isolates matching the outbreak strain. The aquatic frog from the home of the New Mexico patient was purchased from a pet store chain, whose distributor identified the same breeder as the source for all of its aquatic frogs. The family of the Ohio patient purchased its African dwarf frog from a department store, whose distributor identified the breeder as the ultimate source of its frogs.

Environmental sampling from the breeder's California facility yielded S. Typhimurium isolates matching the outbreak strain. Positive samples were collected from multiple locations in the facility, including water tanks that contained African dwarf frogs and gravel in the water filtration system.

CDC’s advice:

• Persons at increased risk for serious infection from salmonellosis are children < 5 years old, elderly persons, and persons with weakened immune systems.
• These persons should avoid contact with amphibians (e.g., frogs) and reptiles (e.g., turtles) and anything that comes in contact with them (e.g., aquarium, habitat, and water).
• Keep amphibians and reptiles out of homes with children < 5 years old or people with weakened immune systems.

Read more at CDC>>>>>>

CDC: Poultry, Reptiles & Amphibians

Iguana iguana, Costa Rica/© 2007 Am Ang Zhang

Remember the Iguanas?

HPA Latest: Bean sprouts!

Related:

Multiple Sclerosis, Iguanas and Wrong Foot

NHS: Frogs Frogs Frogs

Mosquito & Malaria: 3 Billion and Counting

From The National Geographic Magazine:

The mosquito has long, filament-thin legs and dappled wings; she’s of the genus Anopheles, the only insect capable of harbouring the human malaria parasite. And she’s definitely a she: Male mosquitoes have no interest in blood, while females depend on protein-rich haemoglobin to nourish their eggs. A mosquito’s proboscis appears spike-solid, but it’s actually a sheath of separate tools—cutting blades and a feeding tube powered by two tiny pumps. She drills through the epidermis, then through a thin layer of fat, then into the network of blood-filled micro capillaries. She starts to drink. To inhibit the blood from coagulating, the mosquito oils the bite area with a spray of saliva. This is when it happens. Carried in the mosquito’s salivary glands—and entering the body with the lubricating squirt—are minute, worm like creatures. These are the one-celled malaria parasites, known as plasmodia. Fifty thousand of them could swim in a pool the size of the period at the end of this sentence. Typically, a couple of dozen slip into the bloodstream. But it takes just one. A single plasmodium is enough to kill a person.  

National Geographic/ Michael Finkel

In May 2006, I was visiting some friends in Montreal. Their youngest son was extremely bright. At the time, he was just about finishing high school. He was most interested in nature and in conservation. I noticed the book he was reading: Silent Spring by Rachel Carson.

By then, there was a good deal of controversy about the impact of Silent Spring. I remembered having a very interesting discussion with him on DDT and his views on conservation. We agreed that to be fair to Carson, she never advocated a total ban.

In September of 2006, WHO backed the use of DDT.

3 Billion and Counting premieres today in Manhattan. It was directed, written and produced by D. Rutledge Taylor, MD, and it explores the devastating death toll caused by malaria since the ban on DDT (dichlorodiphenyltrichloroethane): 3 billion and counting indeed.

Elizabeth M. Whelan, the president of the American Council on Science and Health took up the story about the film:

"Dr. Taylor not only educates us, but he also sparks outrage about the unforeseen consequences of a scientifically ignorant chemical witchhunt, one that has caused untold human suffering and billions of deaths, primarily among children."

“Scientists have never found an effective substitute for DDT — and so the malaria death rate has kept on soaring.

“In his dissection of the rise of the environmental movement and the fall of science, Dr. Taylor not only educates us, but he also sparks outrage about the unforeseen consequences of a scientifically ignorant chemical witchhunt, one that has caused untold human suffering and billions of deaths, primarily among children. While any man-on-the-street interview will yield an overwhelming majority of negative comments about DDT — a ‘highly toxic, killer chemical’ – the reality is that DDT has saved more lives than any other man-made chemical.”

Now I must have another conversation with my friend’s son. 


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The Financial World: Lehman & Others

Lehman Brothers Building New York now Barclays Capital ©2009 Am Ang Zhang

This is the second anniversary of the collapse of Lehman Brothers and I thought it might be interesting to reprint some of my posts about the subject.

To Intervene Or Not: A Colossal Failure Of Common Sense.

Saturday, August 15, 2009

“It would not surprise anyone to find that in our work we come across some rather peculiar cases which are indeed stranger than fiction. You often saw the life story of some child unfold in front of you and there appeared little you could do to effect any change in the course it was going to take.” Chapter 36 Entrepreneur, The Cockroach Catcher .

Stranger than fiction!

“At the age of ten, I resided in some kind of a marital no-man’s-land, a beautiful but loveless gabled house.”

“……father had accepted the end of his marriage and had left my stunning fashion-model mother to bring up their five children all on her own. I was the oldest……”

“……mom now in desperate financial straits, my three brothers and

one sister and I ended up in a housing project in the worst part of a distinctly suspect city……”

“……there were gangs of trainee criminals staging shoplifting raids and night time burglaries all over the city……”

“……in eighteen months I went to three different schools, each on a bigger disaster than the last…….”

No this was not from one of my cases; this was extracted from a book I have been reading:

A Colossal Failure Of Common Sense

Read the full Post here>>>>>

Lehman filed for bankruptcy protection on the 15^th of September and

Barclays Capital wasted no time in acquiring the main Lehman US operation on the 17^th of September. Common sense?

Since March 2009 Barclays share price has gone up seven times.

A Colossal Failure of Common Sense is published by Crown Business, Random House.

Lawrence McDonald, The Players

Goldman Sachs, SEC & The Greatest Trade Ever

Sunday, April 18, 2010

Wall Street Journal: OCTOBER 31, 2009

It was the fall of 2007, financial markets were collapsing, and Wall Street firms were losing massive amounts of money, as if they were trying to give back a decade's worth of profits in a few brutal months. An investor named John Paulson somehow was scoring huge profits.

His winnings were so enormous they seemed unreal, even cartoonish. His firm, Paulson & Co., would make $15 billion in 2007.

Mr. Paulson's personal cut would amount to nearly $4 billion, or more than $10 million a day. That was more than the 2007 earnings of J. K. Rowling, Oprah Winfrey and Tiger Woods put together. At one point in late 2007, a broker called to remind Mr. Paulson of a personal account worth $5 million, an account now so insignificant it had slipped his mind.

The Wall Street Journal’s Gregory Zuckerman in his book, “The Greatest Trade Ever” wrote:

Paulson & Co. had bet against about $5 billion of CDOs and made more than $4 billion from these trades—including $500 million from a single transaction—according to the firm’s investors and an employee of the firm. One of the biggest losers, however, wasn’t any investor on the other side. It was the very bank that worked with Paulson on many of the deals: Deutsche Bank. The big bank had failed to sell all of the CDO deals it constructed at Paulson’s behest and was stuck with chunks of toxic mortgages, suffering about $500 million of losses from these customized transactions, according to a senior executive of the German bank.

These were some of Paulson & Co.’s largest scores.

Mr. Paulson bought a $41 million home in early 2008 in Long Island and he lives with his wife and two daughters on the Upper East Side of Manhattan.                                            The New York Times.

Read all about it here>>>>>>>>>

History & Democracy : Liar’s Poker & The Big Short

Friday, August 6, 2010

 

I think there is something fundamentally scary about our democracy…. Because I think people have a sense that the system is rigged, and it’s hard to argue that it isn’t.

“By late September 2008, the nation’s highest financial official, US treasury secretary Henry Paulson, persuaded the US Congress that he needed $700bn to buy sub-prime mortgage assets from banks. Once handed the money, he instead essentially began giving away billions of dollars to Citigroup, Morgan Stanley, Goldman Sachs and a few others unnaturally selected for survival.”

“By then it was clear that $700bn was a sum insufficient to grapple with the troubled assets acquired over the previous few years by Wall Street bond traders. That’s when the US Federal Reserve took the shocking and unprecedented step of buying bad sub-prime mortgage bonds directly from the banks. By early 2009 the risks and losses associated with more than $1tn worth of bad investments were transferred from big Wall Street firms to the US taxpayer. The events on Wall Street in 2008 were soon reframed as a simple, old-fashioned financial panic, triggered by the failure of Lehman Brothers.”

More>>>>>>

Dr Am Ang Zhang is the author of The Cockroach Catcher.