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People with heart disease are at risk of dying sooner when they suffer from chronic depression and anxiety, a recent study suggests. 

Researchers examined data on 950 people in Australia and New Zealand with stable coronary artery disease, which happens when plaque accumulates in the arteries supplying the heart and causes them to harden and narrow. Also called atherosclerosis, this process can weaken the heart muscle, cause an irregular heartbeat and lead to heart attacks. 

About 4 per cent of participants reported regularly suffering from moderate or severe psychological distress over the first four years of the study, and they were roughly four times more likely to die of heart disease and almost three times more likely to die from any cause during the next 12 years compared to people with no distress.

The heart patients who reported only occasional or mild distress, however, did not appear to have an increased risk of premature death, researchers report in the journal Heart.

“This really indicates that over the longer term it is the amount of distress that matters,” said lead author Dr Ralph Stewart, a cardiologist at Auckland City Hospital and the University of Auckland.

“We do not yet know whether treatments for anxiety and distress reduce mortality, but there is enough evidence to recommend that people should look for ways to reduce high levels of persistent distress,” Stewart said by e-mail. 

At the start of the study, all of the participants had experienced a heart attack or hospitalisation for unstable angina, when the heart does not get enough blood flow or receive enough oxygen, in the previous three to 36 months. 

They completed a psychological questionnaire when they joined the study, and again after six months and at one year, two years and four years. 

Questions to assess depression and anxiety asked, among other things, if participants felt constantly under strain, found life a struggle all the time, got scared or panicky for no good reason, or thought they played a useful part in things. 

Overall, 587 people, or 62 per cent, were not distressed at any of the psychological assessments. Another 255 individuals, or 27 per cent, reported at least mild distress during two or more assessments and 35 people, or about 4 per cent, regularly suffered from moderate or severe psychological distress. 

Researchers followed half of the participants for at least 12 years. During this monitoring period, 398 people died from all causes and 199 died from cardiovascular disease.

The study was not a controlled experiment designed to prove that depression or anxiety causes premature death for people with heart disease. 

Another limitation of the study is that the psychological assessments stopped after four years, so it is possible the findings might underestimate the impact of persistent distress, the authors note. 

The psychological assessment used in the study also does not do a good job of pinpointing the exact nature of stress and is no longer used for assessing it, Dr Gjin Ndrepepa, a researcher with the German Heart Centre Munich at the Technical University of Munich, writes in an accompanying editorial. 

But mental distress can activate the body’s so-called flight or fight response, the sympathetic nervous system, and boost levels of stress hormones, Ndrepepa told Reuters Health by e-mail. This might contribute to elevated blood pressure, high cholesterol or diabetes and prompt unhealthy behaviours like smoking or drinking or being inactive. 

“These stress-related internal and external adverse reactions aggravate the progression of the disease and predispose people to poor outcomes including increased odds of death,” Ndrepepa said. “My belief is that depressed patients with coronary heart disease, particularly severely depressed ones, should be treated for depression.”

When I messaged a Jordanian friend of mine to tell her that I might be going to Mauritius, she asked me to wait while she Googled the place. After sometime, she replied back excitedly, with many happy emoticons accompanying her response. She informed me that the island was a tropical paradise, a favoured honeymoon destination for all newly weds and I must jump into the first plane and get there at once! 

The last time I visited a place that was frequented by honeymooners, things were different. I had just got married, my spouse and I had more hair on our heads and both of us were roughly half our respective sizes. Also, neither of us had ever stayed in a plush five- star hotel before, so we were easily intimidated by the staff in their sleek uniforms and foreign accents. We spoke to one another in hushed whispers, ostensibly cooing sweet endearments, but actually checking out the price of each edible item, before ordering it. Everything was atrociously expensive and I felt guilty eating a meal that cost half of our monthly salary. 

But we were young and fearless so decided to try out all the freebees the resort had to offer, from cycling and boating to mountain climbing and jungle trail walking. I took lots of photos to record this. On our flight back, I came across a newspaper clipping advertising a “made for each other” contest that was being held by a leading tobacco company in India, and impulsively, I filled in the form and posted it to the given address. 

A month later we got selected, along with ten other couples, for a full expense paid vacation to another luxury resort. We did not make the final cut eventually, because as one of the judges explained, all newly wedded folks seem made for each other. The real test is to win the compatibility challenge after twenty or so years of marriage.

If my memory serves me right, the gentleman who gave us these pearls of wisdom was none other than Mansoor Ali Khan Pataudi, the erstwhile captain of the Indian cricket team, and the husband of our renowned Bollywood star, Sharmila Tagore. They were married for eighteen years then, and when he was asked why his wife had not accompanied him, he said she kept away from functions that celebrated togetherness because according to her, he was made only for himself! At the time his statement had sounded very strange, but three decades into holy matrimony, it makes perfect sense.

I was thinking about this when the guest relations manager of the opulent hotel we were staying in Mauritius, told me that he had organised a surprise for us. On the shores of the ocean, with waves lapping at our feet, there was a table set perfectly for two people. Tall glasses of pink champagne greeted us and there was fresh seafood being prepared right there as well.

“Champagne and lobster, a perfect combination,” the manager announced.

“Made for each other, like sir and madam,” he gushed. 

“But she does not drink champagne,” my spouse stated. 

“And he does not eat lobster,” I added.

“Oh!”, exclaimed the manager disappointedly.

“I will have it, don’t worry,” I consoled. 

“And sir will try crabs?” he brightened up.

“No way!” said my horrified husband. 

“He is made only for himself,” echoed the voice in my head. 

“What?” the manager asked. 

“He means, not today,” I answered.

LOS ANGELES/ WASHINGTON — Espionage comedy “Kingsman: The Golden Circle” snuck away with the weekend box office crown for the second week running, industry figures showed Monday, narrowly edging out freaky horror sensation “It”.

With takings of $16.93 million, “Kingsman” sees a British spy organisation join forces with its American counterpart to take on a new global threat.

But despite a star-studded cast featuring Colin Firth, Channing Tatum, Halle Berry and even Elton John, it took less than half of last week’s $39 million earnings.

A sequel to the 2015 hit “Kingsman: The Secret Service”, the $104 million film debuted to a slightly less-than-expected $39 million in the US and Canada and has taken in $66.7 million so far, despite a 56 per cent drop from last week.

Meanwhile, “It” — starring Bill Skarsgard as a creepy clown who terrorises a sleepy Maine town — was a close second with earnings of $16.9 million, according to Exhibitor Relations.

That is some $12.8 million less than last week’s $29.7 million takings — but having stormed the box office over the last month, “It” is highest-grossing horror movie of all time with colossal total earnings of $291.1 million.

Slipping into third place in the tight race for number one was Universal’s newly released “American Made”, which raked in $16.7 million, above analysts’ expectations of $12 million to $15 million.

Universal Pictures’ $54 million film starring Tom Cruise, “American Made” tells the story of a commercial airline pilot recruited to carry out reconnaissance missions over South America for the CIA.

Another high-octane collaboration from Cruise and director Doug Liman (2014’s “Edge of Tomorrow”), the film is the latest test of Cruise’s draw as an action star in the US beyond the “Mission: Impossible” films. “The Mummy” flopped in June at the box office and was panned by critics.

Sitting comfortably in fourth place, having rung up $11.6 million, was animation “The Lego Ninjago Movie” — the third instalment of Warner Bros.’ “The Lego Movie” franchise.

Sony Screen Gems’ sci-fi horror “Flatliners”, in fifth place, earned $6.5 million in its first week, under analysts’ projections of $8 million. The PG-13 thriller, a remake of the 1990 film of the same name, follows five medical students obsessed with instigating their own near-death experiences to glimpse the afterlife. Ellen Page, Diego Luna, Kiersey Clemons, Nina Dobrev and Kiefer Sutherland star.

After expanding to 1,213 locations, Fox Searchlight’s “Battle of the Sexes” came in at No. 6 in its second week, earning $3.4 million over the weekend (under analysts’ projections of $6 million). Emma Stone and Steve Carell star in the film about the 1973 tennis match between Billie Jean King and ex-champ Bobby Riggs.

Rounding out the top 10 were “American Assassin” ($3.3 million), “Home Again” ($1.7 million), “Til Death Do Us Part” ($1.5 million) and “Mother!” ($1.4 million).

Lionsgate and Roadside Attractions’ “Stronger” added 645 theatres and brought in just $986,560 (a 39 per cent drop in earnings despite an added 71 theatres) for a to-date total of $3.2 million. The Jake Gyllenhaal-led drama is based on the true story of Jeff Bauman, a man who lost both of his legs in the 2013 Boston Marathon bombing.

In limited release, the Taye Diggs-led thriller “Til Death Do Us Part” opened with $1.5 million from distributor Novus Content, under analysts’ expectations of $4 million or less. The PG-13 drama tells the story of a woman who believes she is in a perfect marriage until her husband becomes abusive and controlling. Malik Yoba, Stephen Bishop and Robinne Lee also star.

PARIS — Messing with your body’s clock is dangerous business, in fact it could make you sick — or worse.

The inner timekeeper dubbed the “circadian clock”, governs the day-night cycle that guides sleep and eating patterns, hormones and even body temperature.

It is important enough that the Nobel Medicine Prize was awarded on Monday to three US scientists whose work illuminated the fundamentals of how it ticks.

The trio identified genes that regulate the clock, and the mechanism by which light can synchronise it.

Yet, humans have a long history of overriding the circadian-driven need for sleep, Russell Foster, a professor of circadian neuroscience at Oxford University told AFP — the most obvious example being night work.

Such tinkering with Mother Nature can have serious consequences ranging from impulsive behaviour to life-threatening conditions such as obesity and cancer, the experts say.

Just look at the poor health records of shift workers such as nurses or factory labourers.

The World Health Organisation has already raised the red flag, with a 2007 report noting that “circadian disruption” is “probably carcinogenic” — which means cancer-causing.

The trouble is that the human body never really adapts to operating outside the normal cycle of working by day and sleeping at night. 

Like everyone else, shift workers’ biological clocks are set by the rising and setting of the Sun — not their work schedule.

“There is no medicine in the world that allows you to... speed up or slow down your body clock,” said Claude Gronfier, a neurobiologist at France’s Inserm research institute.

When workers force themselves to stay awake, it triggers the release of stress hormones such as cortisol — the same one that rushes into your blood in a life-or-death situation.

The chemicals may keep you on your feet, but they are a bargain with the devil.

For example, cortisol works to suppress the immune system and in the long run can make you more susceptible to a range of illnesses, including cancer.

Such a lifestyle also opens one up to eating outside of normal times, when the body’s metabolism might be lower and the calories are more likely to be converted into fat instead of being burnt up.

“You’re raising your heart rate, raising your blood pressure and insulin levels at a time that you would not ordinarily do that,” Hugh Piggins, a neuroscience professor at the University of Manchester, told AFP. 

“You’re body is basically not ready for it and you’re giving it a bit of an insult.”

Even short-term disruptions of the circadian clock can wreak havoc with your body. Just think jet lag.

Flying from Paris to Los Angeles deposits travellers nine hours earlier in time, upending eating and sleeping patterns.

The results can be blunted interaction with the world and a lack of empathy, complex thinking, or even clear memories.

In such a state, people can do “overly impulsive things — jump the red traffic light and fail to see the consequences of actions”, explained Foster.

Better understanding of the workings of the body clock has opened up a fascinating field of scientific quest.

Circadian dysfunction has been linked to depression, bipolar disorder, cognitive function, memory formation and even some neurological diseases.

Over the past two decades, scientists have been studying how the timing of administering a medicine can impact how well it works. 

Already they have found that changing the timing can reduce the toxicity of some compounds.

“Now we are moving to the exciting stage where we can start translating some of this knowledge into understanding what happens when these systems go wrong and more importantly to develop new therapeutic interventions,” Foster said.

People who monitor their own blood pressure at home may get better results if they also have extra support like counselling and lifestyle coaching, a research review suggests. 

To see how blood pressure control is influenced by patients checking it themselves at home, researchers examined data from 25 previously published studies that randomly assigned a total of more than 10,000 people to either monitor themselves regularly or just stick with usual care including periodic checkups at the doctor. 

Overall, for people who did not get extra support to go along with their home testing, there was not much difference between self-monitoring and sticking with blood pressure checks only at the doctor’s office, the study found. 

But when home monitoring was paired with extra support or medication adjustments managed by patients based on test results, people achieved significantly lower blood pressure compared to usual care. 

“If self-monitoring is combined with ongoing tailored interaction with the patient, then this can enable important improvements in blood pressure control, over and above self-monitoring on its own,” said lead study author Dr Katherine Tucker of the University of Oxford in the UK. 

“Our research shows that increased collaboration between a patient and either their general practitioner, a nurse or a pharmacist in the treatment of hypertension can result in important decreases in blood pressure and improved control necessary to improve a patient’s health,” Tucker said by e-mail.

Home blood pressure monitoring is currently recommended for many patients because it can help get more accurate readings than are obtained at the doctor’s office, and it can also assist clinicians in adjusting medication between checkups. 

While some research suggests home monitoring can help achieve better results than testing only in the exam room, it is not yet clear who benefits most from this approach or how to make it most effective, researchers note in PLoS Medicine. 

In adults, a blood pressure reading of 120/80 mmHg (millimetres of mercury) or lower is considered normal or healthy. Pressure readings that are consistently 140/90 mmHg or greater are considered high blood pressure. 

When researchers looked at the “top number” known as systolic blood pressure (the pressure blood exerts against artery walls when the heart beats), they found home blood pressure checks were associated with average reductions that were 3.2 mmHg larger than with usual care over 12 months. 

When self-monitoring was not paired with any additional support, however, it was only linked to an extra 1-mmHg drop in blood pressure compared to usual care — a difference too small to rule out the possibility that it was due to chance. 

With plenty of extra help tailored to patients’ individual needs, self-monitoring was associated with a blood pressure reduction 6.1 mmHg larger than with usual care, the study found. 

One limitation of the analysis is that the smaller studies included had different methods and varying criteria for selecting participants, which made it difficult to draw broad conclusions from examining the combined results, the authors note. 

Still, the findings suggest that self-monitoring can play an important role in helping patients get blood pressure under control, said Dr Costantino Iadecola, director of the Feil Family Brain and Mind Research Institute at Weill Cornell Medical College in New York. 

For one thing, home testing can help spot variation in blood pressure between checkups, Iadecola, who was not involved in the study, said by e-mail. Readings outside an exam room may also be more accurate for some people who get what’s known as “white coat hypertension”, or stress-related blood pressure spikes during checkups, Iadecola added. 

Even though a 3-mmHg reduction in blood pressure might not seem that large, if it is sustained over time for a broad population of people it can translate into a significant decrease in heart disease and deaths, said Dr Ian Kronish, a researcher at Columbia University Medical Centre in New York who wasn’t involved in the study. 

“Taking action at the time of elevated readings provides opportunities for teachable moments in which education and counselling may be more likely to lead to behaviour change on the part of the patients,” Kronish said.

The sportier performance version of Audi’s second generation follow-up to the Ingolstadt automaker’s highly popular premium mid-size Q5 SUV, the new SQ5 is a cautiously evolutionary all-new model. A more eager drive than its predecessor, the new SQ5 makes significant efficiency gains and features extensive high tech driving aids and infotainment systems.

Launched globally earlier in the year and in the Middle East just last week, the SQ5 primarily competes with the likes of the Mercedes-AMG GLC43, Volvo XC60 T6 and Jaguar F-Pace, but also old hands such as the Infiniti QX50 in terms of size and sporty driving characteristics.

A more sure-footed and car-like character than its predecessor, the SQ5 shares the same turbocharged 3-litre V6 engine and latest incarnation MLB platform as the Audi S5 and S4. Though riding higher than its sporty performance coupe, saloon and estate siblings, the SQ5 also shares the same and more sophisticated five-link front suspension design and lighted suspension components for a lower un-sprung weight and tidier, more precise driving character. 

Only slightly bigger in most directions than the car it replaces, the new SQ5 nonetheless feels smaller and more agile, and with more body and construction aluminium, achieves significant weight loss.

Designed with emphasis on the horizontal plane, the new SQ5’s broader grille, multi-slat side intakes, more scalloped bonned edges and squintier, more heavily browed headlights with aggressive outward double check LED signature all lend a wider, fuller and more road-hugging appearance. 

Snoutier and with a thick metallic outline, the new SQ5’s grille and seemingly more rakish roofline lend a greater sense of momentum, while sharper character lines and ridges combine with more muscular wheels-arches and shoulders for a more assertive presence. Meanwhile, waistline-mounted side mirror stalks are slimmer and downwards-tilted dual exhaust tips hide behind faux rear fascia-integrated quad exhaust exits.

More go and growl

Powered by a reworked 3-litre V6 engine, the new SQ5 trades its predecessor’s supercharged induction for a twin-scroll turbocharger, and retains almost unchanged performance, with 0-100km/h dispatched in 5.4-seconds and an electronically-capped 250km/h top speed.

Developing the same 349BHP, the new SQ5, however, serves this over a broader and slightly lower 5400-6400rpm band, while torque output is significantly improved from 347lb/ft at 4000-4500rpm to a brawnier 368lb/ft over a wider and more flexibly accessible 1370-4500rpm. With new turbo induction, free-wheeling auto gearbox ability, improved thermal management, lower 1870kg weight and lower CD0.34 aerodynamics, the new SQ5 makes considerable fuel efficiency improvements.

Returning 8.5l/100km combined compared to 12.3l/100km, the new SQ5’s performance is an evolutionary improvement, with increased torque and reduced weight translating into better mid-range response and muscle. Slightly different in delivery, the turbocharged SQ5 is quick off the mark with virtually no turbo lag owing to optimised gas flow paths and valve timing. 

Almost as immediate from idling engine speed and high-revving as the outgoing supercharged SQ5, the new model is, however, much improved throughout, with excellent low-end responses, high-end urge and considerably more capable mid-range. Subtly growling, the new SQ5’s power builds progressively and is effortlessly underwritten by a wave of near constant torque.

Tidy and grippy

Reflected its shorter front and rear overhangs and a sportier, slightly more rearwards design aesthetic, the new SQ5 also drives with more car-like finesse, eagerness and control. With new sophisticated five-link suspension and lighter mass, the SQ5 seems tidier and more eager into corners, with its permanent Quattro for wheel drive dividing power with a default 60 per cent rear bias for a sportier more agile drive.

With its engine slung low and just ahead of the front axle, the SQ5’s body roll is minimised, and when pushed hard and tight into a corner, its threshold to understeer seemed much improved during a test drive on lush green mountain routes in Salalah, Oman.

With quick, meaty and direct steering and legendry Quattro road-holding, the SQ5’s longer wheelbase further improves stability and space. Power can be diverted by up to 85 per cent rearwards and 70 per cent frontwards as necessary and torque vectoring selectively brakes inside wheels into corners, while agility can be further improved by an optional limited-slip differential, which allocates power along the rear axle for better cornering finesse, traction and grip.

A more buttoned down and tidier drive than its predecessor, the SQ5’s optional adaptive air suspension delivers good body control through corners and settled vertical control over imperfections in “dynamic” mode. “Comfort” mode provides a smooth, refined and more forgiving ride that takes the edge off optional sporty low-profile 255/40R21 tyres.

Smooth and centred

Driving all wheels through a slick and quick-shifting 8-speed automatic gearbox, the SQ5 has a broad range of ratios including shorter lower gears for responsive performance and taller upper ratios for smooth refinement and efficiency. 

Well equipped with driver assistance safety systems, the SQ5 is available with lane, rear cross-path and parking assistance. Also available are adaptive control with traffic jam assistance that can handle some steering duties and collision avoidance and turn assistance systems, while Audi’s pre-sense city system is standard, and can warn the driver about pedestrians and vehicles, and even initiate emergency braking, within its operational parameters. 

Sporty and classy inside, the SQ5’s uncluttered cabin features clear instrumentation and an emphasis on horizontal design. Brimming with high tech infotainment features including smartphone integration and wifi hotspot capability, the SQ5 also features a slim tablet-style infotainment screen and configurable 12.3-inch configurable Virtual cockpit instrument panel.

Decked out with quality materials and textures, the SQ5 features contrast stitched leather steering and quilted leather seats, while driving position is supportive and adjustable, with good visibility and seating, steering, pedals and instrument display alignment is perfectly centred for the driver. Mostly spacious inside, the SQ5 handily features sliding rear seats that allow an additional 10mm legroom for tall passengers.

TECHNICAL SPECIFICATIONS

Engine: 3-litre, turbocharged, in-line V6-cylinders

Bore x stroke: 84.5 x 89mm

Compression ratio: 11.2:1

Valve-train: 24-valve, DOHC, direct injection

Gearbox: 8-speed automatic, four-wheel-drive

Ratios: 1st 4.714; 2nd 3.143; 3rd 2.106; 4th 1.667; 5th 1.285; 6th 1.0; 7th 0.839; 8th 0.667

Reverse/final drive: 3.317/2.848

Drive-line: self-locking centre differential

Power, BHP (PS) [kW]: 349 (354) [260] @5400-6400rpm

Specific power: 116.5BHP/litre

Power-to-weight: 179.4BHP/tonne (kerb)

Torque, lb/ft (Nm): 368 (500) @1370-4500rpm

Specific torque: 167Nm/litre

Torque-to-weight: 257Nm/tonne (kerb)

0-100km/h: 5.4-seconds

Top speed: 250km/h

Fuel consumption, urban/extra-urban/combined:

11-/7.1-/8.5-litres/100km 

CO2 emissions, combined: 195g/km

Fuel capacity: 70-litres

Aerodynamic drag co-efficient: 0.34

Unladen/kerb weight: 1870kg/1945kg

Steering: Electric-assisted rack & pinion

Suspension: Multi-link, anti-roll bars, adaptive air suspension

Brakes: Ventilated discs

Tyres: 255/40R21

Price, starting at: JD83,881

The Japanese Lover
Isabel Allende
Translated by Nick Caistor and Amanda Hopkinson
New York: Atria Books, 2015
Pp. 322

Isabel Allende situates “The Japanese Lover” in the shadow of two of the great injustices of the 20th century: Nazi Germany’s mass exterminations and the internment of Japanese-Americans in the US. Human cruelty and separation from loved ones would be the major themes of the novel but for several indomitable characters whose determination to live life to the fullest overcomes separation with love. Many others figure into the plot, each with a story of their own, and each with characteristics and habits ranging from the bizarre to the endearing. 

In 1939, as the Nazi threat looms over Poland, a Jewish family sends their six-year-old daughter, Alma, to live with their wealthy relatives, the Belascos, at Sea Cliff mansion in San Francisco; here she will spend the next seventy years of her life. Although the Belascos are more than kind to her, Alma is initially miserable, fearing she will never see her parents again. “The war images pursued her by day, popped up in her dreams, and never allowed her to behave truly like the girl she was.” (p. 56) 

From childhood, Alma develops a strong personality, added to her innate intelligence and creativity, but she is unhappy until forging a special relationship with Nathaniel, the Belasco’s son, and Ichimei, the son of the Japanese gardener at the mansion. These two are to be Alma’s lovers all her life, testifying to Nathaniel’s conviction: “Hearts are big enough to contain love for more than one person.” (p. 299)

However, separation reoccurs after the US entry into World War II. Ichimei’s family, like all Japanese-Americans, is interned in a desert concentration camp in Utah. Not until after the end of the war, and the intervention of the influential Belasco family, are they allowed to return home.

Over the years, there are other separations, yet copies of Ichimei’s letters to Alma interspersed throughout the novel attest to their many reunions — passionate, but secret, for their divergent social status, and Anna’s marriage to Nathaniel, preclude them from marrying.

The reader first encounters Alma in the 21st century via Irina, a young Moldavian immigrant who works at Lark House, a senior home in San Francisco. Alma has left the prestige of the Belasco family and the comfort of Sea Cliff mansion, given away most of her possessions and plans to spend her last years there. Both women have their secrets. Irina, who has also experienced a painful separation from her family, still bears the scars of trauma; for her, there is no reunion. Rather, she immerses herself in the lives of the Lark House residents. Eventually, she joins Alma’s grandson in his effort to elicit and record his grandmother’s memories so as to reconstruct a family history, and it is thus that the plot unfolds in retrospect and in a decidedly non-linear fashion. Soon, they “were endlessly caught up in a mythical past full of improbable anecdotes and people… Alma showed herself to be an imaginative storyteller”. (p. 73) 

Incredulous, the two young people think they have discovered that Alma is still rendezvousing with Ichimei, but Allende has many surprises in store, and she often pushes the story over the edge into the fantastic, reminding the reader of her magic-realism bent.

Into this tale of decades-long passion, Allende weaves a lot of social commentary, sometimes playfully poking fun at social pretensions or the California life style, at other times showing the power of love and human kindness to make a difference. Events in the novel warn against war and all forms of violence, not least because of its devastating impact on youth, but there are also contrasting examples of kindness, human creativity and healing. 

Most interesting is the novel’s perspective on the elderly as illustrated by Lark House, which is not a run-of-the-mill rest home, but designed to give the elderly maximum independence and dignity at an affordable cost. Residents are able come and go at will. They choose their own activities, and their opinions are valued. “Many led interesting lives, or invented them.” (p. 64)

They even go out to demonstrate against injustices and for peace. As the youngest resident tells Irina, “The elderly are the most entertaining people in the world… They have lived a lot, say whatever they like and couldn’t care less about other people’s opinions… This community stimulates them and they can avoid the worst scourge of old age: loneliness.” (p. 8)

Healthy, well-nourished women who breastfeed while pregnant do not seem to increase their risk of delivering prematurely, miscarrying, or having a low-birth-weight baby, the authors of a new research review conclude. 

But Gemma Lopez-Fernandez of Corporacio Sanitaria Parc Tauli in Barcelona, Spain, and colleagues write in the journal Women and Birth that more research is needed on the implications of nursing during pregnancy for mothers and children’s health. 

While many women will decide to wean after getting pregnant, it is not uncommon for women to continue to nurse, Melissa Kotlen, an international board-certified lactation consultant based in New York, told Reuters Health in a telephone interview. 

“If you’re healthy, you’re low risk, you’re not on bedrest, there’s really no problem with continuing to nurse while you’re pregnant”, Kotlen said. “Most of these moms end up tandem nursing once the baby’s born anyway.” 

But even paediatricians and obstetricians can fall prey to unproven but common beliefs about nursing during pregnancy, Kotlen added, for example that nipple stimulation will trigger the release of oxytocin and bring on labour prematurely, or that nursing during pregnancy will deplete a mother’s nutritional stores. 

To investigate these and other potential risks of breastfeeding in pregnancy, Lopez-Fernandez and her team reviewed 19 studies published between 1990 and 2015 and including a total of about 6,300 women. 

They found some evidence that women who nursed during pregnancy gained less weight, had fewer fat reserves and lower levels of haemoglobin — the molecule in red blood cells that carries oxygen. But the reviewers note that most research on the issue was done in the developing world. 

The investigators found no support for the idea that breastfeeding women were more likely to deliver prematurely or to miscarry. Evidence on the effects of nursing during pregnancy on foetal and infant growth, as well as on the growth of the nursing child, was mixed. 

Mothers who become pregnant while nursing should not be overly concerned about their nutritional status, as long as they are eating and drinking well, Kotlen said. “Your body knows exactly what it needs to take in. If you’re pregnant and you’re nursing, your body is going to know very quickly you need to eat a little bit more and you need to drink a little more.” 

Lopez-Fernandez was not available for an interview by press time. 

SAN FRANCISCO — The runaway success of “Pokemon Go” last year taught the world at least two things. One: Lots of people love Pokemon. And two: Creating good augmented reality — the kind that superimposes 3-D objects into the real world and convinces people they’re actually chasing a Pikachu — is really, really hard.

“It’s not so hard that it’s impossible,” said Jeff Kelley, an iOS developer at app design and development firm Detroit Labs. “But it’s hard enough that you’re probably not going to get a return on your investment.”

Previously, if developers wanted to add augmented reality to an app, first they would  have to spend months building their own tools and performing a bunch of math to calculate how a 3-D object should look when light hits it from different angles, and how it interacts with real-world objects, Kelley said.

That high barrier to entry all but disappear when iOS 11 launched September 19 with AR Kit, a set of developer tools that takes out the hardest part of developing augmented reality experiences for the iPhone.

“As a developer, you don’t have to do all the hard math stuff to get it to work,” Kelley said. “The minimum time investment now goes way down.”

That means there soon could be a surge in the number of apps that feature augmented reality experiences, exposing more people to a technology that was once considered the purview of hardcore geeks.

Despite the enormous popularity of “Pokemon Go” last year, only 31 per cent of Americans know what augmented reality is, according to a survey conducted in July by Skrite, a startup that makes a social augmented reality app.

As with its more immersive cousin, virtual reality, tech companies have for years tried to bring augmented reality to the mainstream, with little success. Google’s infamous Google Glass — a head-mounted display — was a flop that drew criticism over its conspicuous design and potential for privacy violations (the device could be used to record people).

Startups at the annual Consumer Electronics Show in Las Vegas year after year have hawked augmented reality screens that act as virtual dressing rooms, none of which have gained mass market adoption. And furniture stores and interior design firms have long offered tools to let people see what a sofa or coffee table might look like in their home, but these apps have been clunky or difficult to use.

Until “Pokemon Go,” most augmented reality experiences just were not very good, Kelley said. Even the most basic of experiences left much to be desired. Kelley recalls working on an app five years ago for wall decoration company Fathead, in which users could point a smartphone at a wall in their house and see how a Fathead wall sticker might look in their home. In order for it to work, though, users first had to print a PDF and stick it to their wall as a physical marker so that the app knew where to superimpose the virtual sticker.

With Apple’s AR Kit leveling the playing field, developers can spend less time worrying about the tech that powers augmented reality, and spend more time focusing on the experiences they want to create, Kelley said, which could ultimately lead to more experimentation and better products.

“The main push is that it’s priming the consumer field and the developer field,” said Gregory Curtin, whose Los Angeles firm CivicConnect works with city and transit agencies to integrate city data with augmented reality.

Curtin’s firm spent three years developing its own augmented reality platform, which can integrate transit schedules and commuter data, so when a person opens a transit app and points a phone at a bus stop the bus schedule appears on the screen.

Although a lower barrier to entry could mean CivicConnect will soon see more competition, Curtin welcomes it, because greater awareness of what augmented reality can do will mean more opportunities for developers in new markets.

Some challenges still will lie ahead, though.

AR Kit can solve the tech component, but many augmented reality experiences require 3-D art. Even Snapchat’s dancing hot dog, silly as it may be, had to be drawn and rendered by someone.

“For a lot of developers, that’s another difficult piece, because developers aren’t always good 3-D artists,” Kelley said.

The other challenge is that while the new iPhone 8 and iPhone X are optimised for augmented reality viewing, many phones — particularly cheaper options with lower-end cameras — are not. At a starting price of $699 for the iPhone 8 and $999 for the iPhone X, experiences made for those phones may exclude many potential users.

But it will be just a matter of time before the technology is readily available to everyone, developers said. Facebook already offers its own platform, AR Studio, for developers wanting to create augmented reality experiences for the social network, and dozens of third-party platforms such as Vuforia and EasyAR allow developers to create AR experiences across multiple platforms, including iOS and Android.

That Apple is throwing its weight behind AR Kit, with augmented reality-ready phones, is a big deal, developers said.

“I do think this will be a milestone in terms of changing the game,” Curtin said.

Women exposed to the highest quantities of agricultural pesticides in California’s San Joaquin Valley while pregnant were at heightened risk of giving birth prematurely and delivering low-weight infants, a new study found. 

Offspring of expectant mothers who lived near farms that applied the heaviest concentrations of pesticides were most at risk, the research showed. Mothers who lived in close proximity to agricultural operations using the highest percentage of pesticides — the top 1 per cent — had an 11 per cent increased probability of preterm delivery and a 20 per cent increased probability of having a low birth-weight baby. 

For most women, living near farms growing fruits, nuts and vegetables failed to increase the possibility of low birth weight and preterm delivery, the research found. But an examination of the areas exposed to the heaviest concentrations of pesticides applied showed magnified fetal vulnerability. 

“There is a smaller subset that seems to be bearing the burden,” said lead author Ashley Larsen, a professor at the Bren School of Environmental Science and Management at the University of California, Santa Barbara. 

“Hopefully we can pinpoint how to reduce these very high levels,” she said in a phone interview. 

Larsen and her team coupled birth certificate records for more than 500,000 San Joaquin Valley births between 1997 and 2011 with pesticide-use data to examine how exposure by trimester and pesticide concentration might influence birth weight and gestational length. 

The San Joaquin Valley is California’s most productive agricultural region. 

The new study found that women exposed to the top 25 per cent of pesticide loads in the San Joaquin Valley had babies with no detectable effect. But those in the top 5 per cent of exposures had increases in the range of 5 to 9 per cent in adverse outcomes, according to the report in the journal Nature Communications. 

Larsen said she would like to see educators and policymakers work with farmers to reduce extreme pesticide concentrations. 

But Robert Gunier of the Centre for Environmental Research and Children’s Health in Berkeley, California, said he doubted such a change would reduce adverse birth outcomes. 

Although he agreed that reducing pesticide use in the highest use areas could eliminate adverse birth outcomes, he said in an e-mail: 

“Unfortunately, combining all pesticides in the analysis obscures the relationships with specific pesticides or pesticide mixtures, preventing concrete policy changes.” 

“I would bet that if a law was passed to limit pesticide use in high pesticide-use areas, the reduction would be for the most heavily used and often least toxic pesticides, and this would not eliminate adverse birth outcomes related to agricultural pesticide use,” he said. 

Gunier, an environmental health researcher, was not involved with the new study. 

Future studies should evaluate pesticide mixtures to identify substances of concern, he said. 

Prior research on the effects of pesticides on birth outcomes has been inconclusive, the study’s authors write. 

But the relationship between pesticides and premature birth and low birth weight has been observed in previous studies, Gunier said.