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Age, gender and nationality affect how much sleep you get

By - May 15,2016 - Last updated at May 15,2016

Photo courtesy of nightmelody.com

What constitutes a “normal” night’s sleep?

That all depends, says Danny Forger, a biological mathematician at the University of Michigan and an expert in circadian clocks.

“People set guidelines all the time — you need eight hours, you need seven hours — but we’ve found that ‘normal’ sleep varies tremendously depending on your age, sex and what country you are in,” he said.

Forger is the senior author of a new study that analysed the sleep habits of more than 5,000 users of a mobile phone app known as Entrain.

The free app was designed by Olivia Walch, a graduate student in Forger’s group. It was launched in 2014 to help users efficiently overcome jet lag with the help of a complex algorithm based on Forger’s previous research. Essentially, the app tells people when to expose themselves to light and when to avoid it to minimise the effects of jet lag.

Entrainment is the scientific term for fully adjusting to a new time zone — hence the app’s name.

However, the group also invited users to send the sleep data they plugged into the app back to the servers at the university. Roughly 8 per cent of the app’s international users agreed to share their information anonymously, providing the team a treasure trove of real-world sleep statistics.

“Lab conditions in sleep studies are very regulated, and participants don’t have to deal with the stresses of the real world like spouses, children and all the stuff that keeps us up at night worrying,” Forger said. “Also, in the lab, it would cost about $20,000 per individual to get this type of information and we don’t have that kind of budget.”

In a paper published on Friday in Science Advances, Forger and his co-authors used the data they collected from Entrain to provide an overview of the social and solar cues that influence when we go to sleep and when we wake up.

Most people in the data set schedule between seven and eight hours of sleep a night, with a mean of 7.88 hours.

Of all the factors considered in their analysis, gender plays the biggest role in how long a person sleeps. On average, women schedule 8.07 hours of sleep, while men schedule 7.77 hours. Women both go to bed a bit earlier than men and wake up a bit later. The authors say this effect is most pronounced among people 30 to 60.

Age also seems to be an important factor for when people sleep. On average, older people schedule sleep earlier than younger people. Also, there is less variation in the times that older people sleep then younger people. The authors think this could be because older people are more sensitive to solar cues, and can only sleep during certain times of the days. Younger people, such as college students, donot seem to have those restrictions.

Nationality also plays a role in sleep duration. Residents of Singapore and Japan had the shortest sleep duration of the 20 countries represented in the study, getting an average of 7 hours and 24 minutes of shut-eye a night. People in the Netherlands were the most well-rested, averaging 8 hours and 12 minutes of sleep a night. In the United States, the average sleep duration is 7.87 hours.

The authors also note that despite black-out curtains, artificial lights and alarm clocks, solar cues — the time of sunrise and sunset — still have a significant effect on sleep patterns.

“We recognise that these solar effects are dulled compared to predictive models, but the fact that they are still there in the data was pretty shocking to me,” said Amy Cochran, an assistant professor at the University of Michigan who also worked on the study.

Both sunset and sunrise had a bigger effect on when people woke up, compared to when they went to sleep. Later sunrises (after 6:30am) were associated with later wake times and bedtimes. Later sunsets were also associated with later wake times and bedtimes, but the effect of sunset on what time a person went to bed at night was weaker than what models predicted.

The authors conjecture that the time we wake up is regulated by our internal, biological clocks but the time we go to sleep is more influenced by societal pressure to stay up.

“We didn’t expect to see that, since most people use their alarm clocks to wake up,” Forger said. “It could be that people are hitting snooze. They try to set their alarm clock for 5am, but it doesn’t work for them.”

But that’s just a guess. Forger said the Entrain data set is full of unanswered questions, as well as trends they would like to see validated in the lab.

In the meantime, the researchers are also hoping to soon collect even more detailed data from Entrain users. They are launching a new version of the app shortly that will take advantage of information collected by activity trackers that monitor both exercise and sleep.

“It is a much richer data set, and we will be able to rely less on self-reported data,” Forger said.

He added that a large-scale sleep study such as this one could never have been done without the help of citizen scientists willing to share their sleep data.

 

“It is really a new way of doing science,” he said.

Mawlana — master or servant?

By - May 15,2016 - Last updated at May 15,2016

The Televangelist
Ibrahim Essa
Translated by Jonathan Wright
Cairo — New York: 
Hoopoe/AUC Press, 2016
Pp. 481

This story could only have happened in Egypt, with its broad spectrum of public and secret religiosity, its glitzy television industry, and the security services’ all pervasive meddling. Yet, Egyptian journalist Ibrahim Essa’s novel has near-universal resonance, for it addresses the volatile point at which religion and political power intersect and/or collide. At the heart of the story is the difficulty of an intelligent, open-minded individual remaining true to him/herself and simultaneously making a living, especially when the authorities are determined to stifle dissent and keep the population in ignorance.

The main character, Hatem Al Shenawi, is a voracious reader and life-long learner, a serious Muslim scholar approaching middle age. From humble beginnings preaching in a small local mosque, his charisma and ability to speak to the common man gradually propel him to prominence.

He becomes a sought-after television sheikh with a daily programme where he answers questions from viewers, something he is very adept at, due to his extensive study of the Koran, the hadiths and various sources on the life of the prophet and Islamic history. Still, he is unable to display the full range of his knowledge on television, as producers and censors are not interested in anyone delving too deep into all topics or interpretations.

So Sheikh Hatem, or Mawlana, as everyone calls him, walks the tightrope between his beliefs and what is allowed. (Incidentally, “Mawlana”, is the title of the Arabic edition of the book published by Bloomsbury Qatar in 2012.)

Sheikh Hatem is sceptical of his promoters’ intentions, and irritated by the limits imposed on what he says and the wilful ignorance of Islam’s real teachings which he sees all around him, but he is also complacent. He and his wife have become used to the comfortable life style which his televangelism finances. He has twinges of conscience about the hypocrisy involved but also finds self-justifications. “He had lived a two-faced lie — the scholar and the merchant of learning, the original thinker and the conformist — and he had never let either side win total victory, out of fear for his livelihood. He really was ‘Mawlana’ in both senses of the word: it could mean ‘our master or leader’, but can also mean ‘our servant or follower.’” (p. 431)

Sheikh Hatem’s balancing act is totally disrupted when Egypt’s ruling family assigns him to dissuade one of its young members who has allegedly converted to Christianity. While the sheikh views the conversion as a case of adolescent confusion or rebellion, the rulers see it as a security threat. If word gets out, it might spark widespread unrest and tarnish Egypt’s image. Failure is not an option; the security services are breathing down his neck, ready to manipulate his attempt to discuss the issue rationally with the boy. At this point, the novel starts to read something like a political thriller, but it is much more.

Sheikh Hatem is thrown into a crisis which is both personal and professional. He is forced to reassess his life, both his relationship to the state and society, and to his wife, for his marriage has been deteriorating ever since he failed to cope with his son being physically and mentally disabled by an accident.

The novel’s ending is both shocking and inconclusive; it could well serve as the prelude to a whole new story, but the ideas forwarded by Sheikh Hatem’s introspection and his discussions with the aspiring convert are far from inconclusive. As Sheikh Hatem insists that faith be based on knowledge and rationality, that there is room for doubt, interpretation and discussion, and that interfaith tolerance should not just be an exercise in public relations, he mounts a powerful argument against extremism, ignorance and hypocrisy.

Essa is no stranger to controversy, and has also had to tread a perilous path between the truth and keeping his job, but he seems to have shunned the compromises made by his character, for 10 of the newspapers he has edited or worked for have been shut down by the government.

In “The Televangelist”, he combines psychology, sociology, cultural critique and politics to create a fascinating plot and a number of complex characters, as well as shedding light on Muslim-Coptic relations, the persecution of Sufis and the disastrous consequences of manipulating religion for political purposes. 

He also drops more than a few hints as to why the democratic gains of the 2010-11 popular uprising in Egypt could be so soon reversed. All in all, the novel is a brave exposure of terrorism, whether promoted by state power or extremist groups. “The Televangelist” is available at the University Bookshop in Gardens Street.

 

Car door windows don’t stop harmful UV rays

By - May 14,2016 - Last updated at May 14,2016

Photo courtesy of motorauthority.com

Car windows don’t protect against harmful sun exposure, so it might be a good idea to wear sunglasses and sun block even while driving, a new study suggests.

While windshields blocked the vast majority of ultraviolet (UV) radiation from the sun, car door windows offered varying levels of protection from the rays that are tied to cataracts and skin aging.

“Some cars were as low as 50 per cent blockage,” said researcher Dr Brian Boxer Wachler of the Boxer Wachler Vision Institute in Beverly Hill, California.

“Even cars that came with factory tint, there was no guarantee that would protect against UV rays,” he told Reuters Health.

UV rays account for a small portion of the sun’s rays but are the most damaging to human skin. UV-A rays are the most common and penetrate most deeply, according to the Skin Cancer Foundation.

Because drivers in the US have their left side exposed to sunlight, UV rays have been blamed for the increased number of cataracts and skin cancers that occur on the left side, Boxer Wachler writes in JAMA Ophthalmology.

UV rays can pass through clouds and glass. To see whether car windows are protective, Boxer Wachler took a UV-A light metre to a number of Los Angeles car dealers on a cloudless May day in 2014.

He tested 29 cars from 15 different manufacturers, made between 1990 and 2014.

On average, car windshields blocked about 96 per cent of UV-A rays. The protection afforded by individual cars ranged from 95 to 98 per cent.

But side door windows were far less dependable. The percentage of UV-A rays blocked varied from 44 per cent to 96 per cent. Only four of the 29 cars had windows that blocked more than 90 per cent of UV-A rays.

“It had no correlation at all with the cost of the car, high-end car or low-end car,” said Boxer Wachler.

Windshields are more protective than car door windows because they must be made of laminated glass to prevent shattering, writes Dr Jayne Weiss in a commentary published with the study. Car door windows, however, are usually just tempered glass.

“Don’t assume because you are in an automobile and the window is closed that you’re protected from UV light,” she told Reuters Health.

“For the eyes, your best bet is to get sunglasses that block UV-A and UV-B light and wraparound the face,” said Weiss, who directs the Louisiana State University Eye Centre of Excellence in New Orleans. 

Some of the car windows in this study let in enough UV-A rays to affect skin health, said Dr Paul Nghiem, who heads the division of dermatology at the University of Washington in Seattle.

“Wearing long sleeve clothing, or sunscreen that is ‘broad spectrum’ would be extremely effective and seems indicated on long drives on sunny days,” Nghiem, who was not involved with the new study, told Reuters Health by e-mail.

 

People can also get clear UV filters added to their car windows to protect from the damaging rays, said Boxer Wachler. 

Why you might soon text robots as often as your friends

By - May 14,2016 - Last updated at May 14,2016

Photo courtesy of techcrunch.com

SAN FRANCISCO — The robots are coming — to help run your life or sell you stuff — at an online texting service near you.

In coming months, users of Facebook’s Messenger app, Microsoft’s Skype and Canada’s Kik can expect to find new automated assistants offering information and services at a variety of businesses. These messaging “chatbots” are basically software that can conduct human-like conversation and do simple jobs once reserved for people. Google and other companies are reportedly working on similar ideas.

In Asia, software butlers are already part of the landscape. When Washington, DC, attorney Samantha Guo visited China recently, the 32-year-old said she was amazed at how extensively her friends used bots and similar technology on the texting service WeChat to pay for meals, order movie tickets and even send each other gifts.

“It was mind-blowing,” Guo said. US services lag way behind, she added.

Online messaging has become routine for most people, offering more immediacy than e-mail or voice calls, said Michael Wolf, a media and technology consultant. Messaging services are now growing faster than traditional online social platforms such as Facebook or Twitter, according to research by Wolf’s firm, Activate.

And experts say messaging bots can handle a wider range of tasks than apps offered by retailers and other consumer businesses. In part, that’s because bots can recognise a variety of spoken or typed phrases, where apps force users to choose from options on a drop-down menu. Reaching a chatbot can be as simple as clicking a link in an online ad or scanning a boxy bar code with a smartphone camera. A special-purpose app requires a download and often a new account sign-up.

“Bots are the new apps,” Microsoft CEO Satya Nadella said last month. Microsoft has just created new programming tools for businesses to build bots that will interact with customers on Skype, the Microsoft-owned Internet voice, video and messaging service.

Facebook is widely expected to unveil similar tools for its Messenger chat service at the company’s annual software conference starting Tuesday. It’s already partnered with a few online retailers and transportation companies so consumers can use Messenger to check the status of a clothing purchase from online retailer Zulily, order car service from Uber or get a boarding pass from KLM Royal Dutch Airlines.

At those services, automated chatbots handle some interactions, with supervision from human operators. Similarly, Facebook has been testing a digital assistant called “M’’ — sort of like Apple’s Siri or Microsoft’s Cortana — that can answer questions or perform tasks like ordering flowers in response to commands on Messenger. It uses a combination of artificial intelligence and input from human overseers.

Another messaging service, Kik, which is popular among US teenagers, opened a new “bot shop” last week. Kik users can talk to bots that will answer questions about the weather, show funny videos or help with online shopping. Slack, a messaging service used by businesses, has partnered with Taco Bell to introduce a “Taco Bot” that helps Slack users order ahead for meals at a local outlet.

In Asia, many smartphone owners are used to playing games and buying items through messaging services like WeChat, which claims 700 million active users. One in five WeChat users has added bank or credit card information so that person can check balances, pay bills or send money to friends, according to the Andreesen Horowitz venture capital firm.

Tech experts are particularly eager to see what Facebook does with Messenger, since its 900 million users make it the world’s second biggest chat platform after WhatsApp, which claims 1 billion users. Facebook bought WhatsApp in 2014.

Both are free to users and don’t produce much revenue for Facebook. But if Facebook CEO Mark Zuckerberg has given WhatsApp’s co-founders leeway with their service, executives have signalled they are increasingly looking for ways to make money from Messenger.

Although Facebook has not ruled out advertising on Messenger, analyst Ken Sena of the Evercore investment firm says a more immediate revenue source could be fees from businesses, such as hotel and travel companies offering to provide reservations and other services through the chat app.

With the help of artificial intelligence programmes that learn from interactions, Sena said in a recent report, chatbots “are becoming scarily good” at carrying on human-like conversations.

 

Or sometimes just scary. Microsoft last month shut down an experimental chatbot, known as Tay, after malicious Twitter users taught the programme to repeat racist and sexist statements. Undeterred, the company has pledged to learn from the experience and build better software in the future.

Half-strength apple juice can help kids through stomach flu

By - May 12,2016 - Last updated at May 12,2016

Photo courtesy of marketbasketfoods.com

 

NEW YORK — When little kids have the stomach flu and need to drink fluids, half-strength apple juice — and whatever fluid the child prefers — can be as effective as expensive electrolyte solutions, researchers say.

The treatment of stomach flu, or gastroenteritis, usually focuses on replacing fluids lost through diarrhoea or vomiting, but the electrolyte solutions are relatively expensive and kids often don’t like the way they taste.

“In many high-income countries, the use of dilute apple juice and preferred fluids may be an appropriate alternative to electrolyte maintenance solution use in children with mild gastroenteritis and minimal dehydration,” Dr Steven D. Freedman from University of Calgary in Alberta, Canada told Reuters Health by e-mail.

Freedman’s team studied 647 children ages six months to five years old who came to the emergency department with mild dehydration from stomach flu.

Half the children were given half-strength apple juice followed by their favourite drink, and half received an apple-flavoured electrolyte solution, the researchers reported in the Journal of the American Medical Association. 

Twenty-five per cent of the kids who drank the electrolyte solution still needed intravenous (IV) fluids or other additional treatment, compared to only about 17 per cent of the kids who drank apple juice and their favourite drink.

Two-year olds and older children responded best to apple juice, but even the younger group fared slightly better with apple juice than with the electrolyte solution.

In addition, children treated with apple juice required fewer IV fluids and had lower hospitalisation rates than children treated with the electrolyte solution.

“These results challenge the recommendation to routinely administer electrolyte maintenance solution when diarrhoea begins,” the researchers say.

But apple juice is not always the best treatment.

“Our study specifically excluded high-risk children, and such children should continue to receive electrolyte maintenance solution,” Freedman said. “This would include children younger than six months of age, those with moderate to severe dehydration, children receiving care in a region where severe disease and dehydration are common, and those at risk for electrolyte abnormalities.”

He also favours electrolyte solutions for children with other significant medical conditions.

Dr Francois Angoulvant from Hopital Necker-Enfants Malades in Villejuif, France, who has studied this topic, told Reuters Health by e-mail, “If a child more than two years of age with mild dehydration refuses to drink electrolyte maintenance solution, the use of half-strength apple juice/preferred fluids therapy is legitimate.”

He would not use half-strength apple juice in younger children, however.

Dr Ivan D. Florez from Universidad de Antioguia, Medellin, Colombia told Reuters Health by e-mail that more information is needed before switching from electrolyte solution to apple juice.

 

“[People] should think of apple juice as a promising intervention that needs further studies,” he said, adding that “these results are not applicable in low- and middle-income settings.”

Samsung Gear expands virtual-reality arsenal

By - May 12,2016 - Last updated at May 12,2016

Photo courtesy of samsung.com

SAN FRANCISCO — Virtual reality specialist Oculus is trying to dazzle consumers by adding more entertainment and educational options to the Samsung Gear headset in hopes of transforming the technological curiosity into a cultural phenomenon.

The new selections announced Wednesday include “Nomads”, a three-dimensional video series from Felix & Paul Studios that examines wayfaring lifestyles in remote parts of the world. There’s also an upcoming video game called “Tactera” that requires players to plot a battlefield strategy on a holographic tabletop, and another 360-degree video called “6X9” providing a grim look of what it’s like to be stuck in a prison’s solitary confinement cell.

They join a menu of more than 250 apps designed for the Gear VR since its consumer model was released nearly six months ago. That’s a meagre amount compared to the millions of apps available for the iPhone and devices running on the Android operating system.

Devices that build an arsenal of compelling apps usually are easier to sell to consumers. Programmers, though, put a lower priority on designing apps for devices until they have amassed a large audience.

That hasn’t happened yet with the Gear, though Oculus says it is winning over fans faster than it anticipated when the headset hit the market just before last year’s holiday shopping season. About 1 million people used the Gear VR last month for an average of 25 minutes per day, according to Oculus. About 80 per cent of that time was spent watching video.

Samsung designed the Gear for its most recent smartphones with the help of Oculus, a little-known start-up until online social networking leader Facebook bought it for $2 billion two years ago to help introduce virtual reality to the masses.

“Oculus can help people experience anything, anywhere,” boasted Max Cohen, the company’s head of mobile. “We think this [technology] can actually change people’s lives.”

The concept of virtual reality, a technology that immerses people in an artificial world, has been around for years, but has never taken off.

Facebook CEO Mark Zuckerberg is convinced it is destined to become technology’s next big breakthrough, and other influential trendsetters Google and Apple are now scrambling to catch up in the still-nascent field. Google is widely expected to unveil a virtual-reality device next week at its annual developers conference in the next step beyond its rudimentary product called “Cardboard” that works with smartphones.

The Gear was a forerunner to a more advanced virtual-reality headset called the Rift that costs $600 and requires a connection to a high-powered computer. The Rift began shipping nearly two months ago, although many buyers still haven’t received the headset yet because of delays that Oculus has blamed on parts shortages.

In contrast, users of the Gear only need a set of headphones and one of these Samsung phones: the Galaxy S6, S6 Edge, S6 Edge Plus or Note 5. As part of its attempt to make it easier to find stuff to watch and play on the Gear, Oculus plans to release a new version of its app for the device next month.

 

The Gear VR is turning into an assembly line of apps for the Rift. More than 20 of the games originally designed for the Gear are also compatible with the Rift.

Elusive handwriting recognition

By - May 12,2016 - Last updated at May 12,2016

We live with the great promise of self-driving cars in five to ten years, with amazing cloud-based applications, virtual server computers, and a myriad of small apps that process, solve and answer virtually every question you may throw at them, short of the basic existential ones perhaps. So you’d think that in the realm of IT there is a software or hardware solution to every problem on the Earth.

Whereas indeed, fantastic solutions often exist for extremely complex, challenging matters, other apparently simple ones remain only partially addressed; quite surprisingly. Handwriting recognition (HR) is one of them. Today it remains to be perfected, especially when it comes to alphabets like Arabic.

HR goes through optical character recognition (OCR). First the text is scanned, then the “shapes” are analysed to be converted into digital characters, as if they were typed in a word or text processor of some kind. In most instances there is a need to OCR an existing already typed (i.e. not handwritten), paper-based document to convert it into a digital document for further editing.

With such documents OCR works like magic. From the amazing Omnipage by Nuance, definitely the world reference software system in this field, to free web-based OCR services, converting a typed hard-copy document you have into editable text is fast, affordable, easy, and achieves a output precision in the range of 95 to 99 per cent, depending on the quality of the printing, the font used, and other considerations. Unfortunately, recognising handwriting in another story.

Despite some progress accomplished since 1990, HR accuracy remains stalled in the 60 to 80 per cent range for mostly Latin-based alphabets, and falls below 60 per cent for Arabic. Such poor levels of accuracy make it not practical at all for actual use in the real world. The inherent complexity of the Arabic script, the variety of all the possible calligraphies, they all make it difficult if not impossible to meet the challenge, to this date at least. If HR accuracy is below 90 per cent you may as well retype the whole thing, it is faster and easier than correcting the faulty 10 per cent remaining.

Surprisingly the S-Note Android app that comes built in some of Samsung’s tablets and smarpthones is able to achieve HR with stunning accuracy, often higher than more complex Windows applications that claim to do the same, but still not good enough to make it a recognised standard that you can count on every day. Again, it does it well enough if you write English, French, German, Spanish, etc., not Arabic, and if you become familiar and skilled at using the company’s famous S-Pen. Although Samsung system claims Arabic HR, it is still experimental, by any standard.

Perhaps the reason for not achieving successful HR of languages like Arabic is not the technical difficulty per se, but the fact that no one in the industry wants to invest more time and effort on a task that may become useless in a few years. Given that we are typing much more than handwriting these days — and the best is yet to come, of course — who then needs HR?

 

Text is entered digitally in so many ways today, especially on mobile devices, that in the near future traditional handwriting is bound to become the exception not the norm. Just don’t tell schoolchildren yet.

Celebrating Europe Day with Jordanian band Jadal

By - May 12,2016 - Last updated at May 12,2016

Pop band Jadal performs on Wednesday at the Roman Amphitheatre in downtown Amman as part of the Europe Day celebrations (Photo by Jean-Claude Elias)

AMMAN — In celebration of Europe Day, Jordanian pop band Jadal gave a highly energetic concert Wednesday night at the small Odeon at the downtown Amman Roman Theatre.

The tone was set from the very first song that the celebrated rock-pop group performed. With bass sound so loud that the audience could feel it in their bones at least as much as they could hear it with their ears, the mood was for dancing and singing along. It showed clearly how popular the band is with the younger generation.

Many knew the songs of Jadal that often included words that tell of the social woes of their generation. They relate to the subject, with the simple, colloquial, every day words that the band uses to convey their message. 

The fact that it was a packed, full house at the Odeon that night and the weather was just perfect for an outdoor performance, largely contributed to the success of the event. At one point and for just one song, the band was joined by another popular local musician, Aziz Maraqa, to the audience sheer delight.

When Romanian guest musician Alexander Arcus went on stage to play with Jadal, many in the Odeon were already waving Romanian flags to welcome the artist. The virtuoso saxophonist played lines that blended very well with the band’s style.

For those above 30 the sound might have been a bit too loud and the singers’ voice not clear enough to understand what they were saying, being covered by the drums, the bass guitar and the heavily distorted electric guitar. For those under 30, however, and who were the absolute majority that night, all that mattered was the energy the band channelled, and there was plenty of it.

Jadal popularity has crossed the borders and reached Palestine, Lebanon, Egypt, the UAE, Morocco and Turkey. They recently returned from Tunisia where they participated in a music festival in Carthage.

 

The annual Europe Day is celebrated around the world on May 9, to commemorate how the European Union was put forward in 1950. The event was funded by European Union and implemented by the European Union National Institutes for Culture in Jordan. The concert was organised by OrangeRed.

Time to have your own family doctor

By - May 11,2016 - Last updated at May 11,2016

Photo courtesy of cimedicalcenter.com

During my first lecture in medical school we were strongly advised to get our own family doctor if we did not already have one. We were told that even doctors need to have their own doctor. 

So it was a surprise once coming to Jordan that most people do not have a family doctor. In fact, it seems that people shift from one specialist to another for each different complaint, inevitably leaving them with fragmented care, or at times frustrated with multiple different opinions. A friend of mine with a young child-suffering from night-time cough navigated her way through multiple specialists each one saying that the management of the previous one was incorrect, leaving the mother frustrated and confused.

Other friends think it is a waste of time not to go directly to a specialist for the specific care they need. They feel that most primary care doctors would refer them on anyway, so it just creates an extra step in their care. 

In fact, experience and evidence suggests otherwise. A strong primary care system prevents multiple referrals, is much more cost effective and results in better health for the population. 

There are many influences that drive specialisation. One is the vastness of medical knowledge, where it is impossible that anyone can grasp all of it, warranting specialisation. Thus specialist care is a fundamental part of healthcare delivery. However, there are also market influences and cultural influences that push towards the fragmentation of care. We must also remember that the human body itself is not fragmented, and each part, organ or system cannot live or function without the others.

Let’s take the case of a typical patient who comes in complaining of being tired, and wishes to have her blood tested seeking for a cause. I can quickly order some blood tests, which will probably come back with a borderline iron level, then ask about blood loss and diet and put the patient on iron tablets and ask her to come back in one or two months. However, as I know the patient, and also see her children and husband as patients, I am aware that her husband is working abroad, that she is managing her household on her own, and also looking after her sick mother. On further questioning it becomes clear that she is losing interest and her mood is lowering. Her appetite has been decreasing. As a generalist I am skilled in assessing and treating not only the biological health of the patient, but also their psychological and social health. Multiple other issues arise, and care can be given that does in fact promote her well-being, and ultimately the wellbeing of her family. 

In other words, the primary care physician should be a master of the patient, understand their frailties and strengths, and collaborate with the patient to enhance their health. For those of you that already have your own doctor, who you trust and turn to, you can attest to this. For those that do not, it is time to find one. And if a suitable one cannot be found, then patient demand will in time shift the system, so that all can have the benefit of having their own regular doctor.

 

The writer, who contributed this article to The Jordan Times, is an assistant professor of Family Medicine at the Jordan University of Science and Technology.

Caesar revisited

By - May 11,2016 - Last updated at May 11,2016

While browsing the Internet the other day, I came across a very fine rendition of Mark Antony’s speech. To mark the 400th anniversary of William Shakespeare’s death, the acclaimed British actor, Damian Lewis, delivered it. These lines were from Act III, scene 2 of the play, Julius Caesar. 

Now, people of my generation, who went to schools that were run by Catholic sisters, had this speech drilled into our heads. The book “The tragedy of Julius Caesar” was a part of our curriculum, and we were made to conduct an in-depth analysis of it. So intense was our study that we were supposed to know every bit of the “reference to context” that was presented to us at any point in time. In fact, some of the quotes that we were made to learn were quite out of context too. 

Why did our English teacher, who was a formidable nun in a starched white uniform, make us memorise Mark Antony’s speech? What did “Friends, Romans, countrymen, lend me your ears; I come to bury Caesar, not to praise him…” have to do with the gangly and giggly 14 year olds? Where was the necessity to understand the difference in pitch between “For Brutus is an honourable man” to “And Brutus is an honourable man” to the final “And, sure, he is an honourable man”? How was it considered imperative to learn “My heart is in the coffin there with Caesar, And I must pause till it come back to me”? Also, grammatically speaking, should it not have been “comes back to me” rather than “come back to me”? 

I don’t know the answers to these questions because I never had the courage to ask them. Our educators were made of sterner stuff. The friendly interaction that I witnessed, between the teachers and students in our daughter’s International school, did not exist during our time. When we were told to do something by our tutors, we simply did it. The nuns did not beat us, of course not. They did not need to. One heavily arched eyebrow over a piercing gaze, combined with a curl of the upper lip, was enough to instil fear in our childish hearts. The thud of a thick wooden ruler on a table top, followed by a “mug-up this paragraph for tomorrow” instruction, gave us sleepless nights. If we forgot to do so, we had to endure the assault of chalk bullets that were swiftly hurled in our direction.

All these memories came rushing back when I toured my nephew’s school in India recently. Two kids were walking up and down the corridor trying to learn Mark Antony’s speech by rote. When a nun appeared from the side room, they paused to wish her deferentially, and then continued once she moved off. 

I stopped to watch as time stood still for me. 

“You all did love him once,” the boy muttered. 

“Not without cause, not without cause,” the girl repeated. 

“What cause withholds you then to mourn for him?” asked the boy

“O judgement! Thou art fled to brutish beasts, And,” the girl said. 

“Thou art fled to brutish beasts, And?” the boy mimicked.

“And, I’ve forgotten the next line,” she whispered. 

“And men have lost their reason,” I supplied. 

“Bear with me, thank you ma’am,” they smiled in gratitude. 

“My heart is in the coffin there with Caesar,” I prompted. 

 

“And I must pause till it come back to me,” they chorused.

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