African trypanosomiasis currently puts 70 million people at risk. Though control efforts have produced good results, there can be no elimination without wider health system reforms
Elimination of Human African Trypanosomiasis, sleeping sickness as it's commonly known, has been on the global health agenda for well over a decade (pdf). In 2001, when unprecedented amounts of drugs were donated by the French pharmaceutical company Aventis (now Sanofi), the global health community began to think disease elimination would become a reality yet the disease remains endemic in 36 sub-Saharan African countries today, putting some 70 million people at risk.
World Health Organisation set the target for elimination: less than 2,000 new cases reported annually. To meet this goal it is estimated that there would need to be a 500 case reduction annually from 2012 until 2020. Systematic control and surveillance activities have been the main route towards elimination across the continent. When the cost of control has exceeded the capacities of the responsible governmentals (due to a lack of funds, political insecurity or decreasing staff), various NGOs have stepped in to bridge the gap – with some success.
In 2009, WHO announced that the number of new cases reported had dropped below 10,000 for the first time in 50 years, representing a decrease of 63% since 2000. In 2012, just 70 new cases were reported in Angola, compared to 4,500 (pdf) at the turn of the millennium. From Cameroon to South Sudan, the trends are all the same. Even the Democratic Republic of Congo a country marred by instability, civil war, and massive human migrations has shown progress.
This recent progress is a testament to growing co-operation in global health (pdf) between all the different stakeholders: international agencies, national control programmes, NGOs, and research institutions. Elimination efforts have seen developments on multiple fronts: a strong health system in place for early identification of clinical signs and symptoms, a referral system, laboratory diagnosis, and effective treatment.
Uganda for example has also recently launched a plan for the elimination of neglected tropical diseases, one that goes further to integrate public health services than ever before. "It is time now to heavily invest in other measures such as improved sanitation, provision of adequate and clean water, health education and community sensitization," said Dr Ruth Aceng the director general of health services.
This approach is in direct contrast to how the disease has been fought up until now - through an intensive and expensive system of detection and treatment. As the number of cases continues to fall, the elimination of sleeping sickness rests on the ability for control activities to be integrated into wider health systems. The challenge with integrated service delivery is that it reveals organisational, logistical and technical deficiences shortcomings.
Zambia too has be lauded for its success in fighting sleeping sickness but a recent study, which investigated the state of health care facilities for sleeping sickness management in the district of Mpika, showed that even here, where infection rates are low, much could still be improved. The country exemplifies what problems are faced by local health authorities, particularly when the disease begins to be forgotten.
A questionnaire to healthcare workers showed that none of the respondents knew how to differentiate the two clinical stages of trypanosomiasis. In the district, the last refresher course organised by WHO and ministry of health was back in 2009 – and only four medical staff from four health institutions attended.
In the whole district only Chilonga Mission hospital stocks the vital drugs needed to treat patients, and it has been reported that there were times when stocks ran out. The study showed that the supply of antitrypanosomal drugs to the only treatment centre was erratic. Only two health institutions in the district, Chilonga Mission hospital and Mpika District hospital, have functional laboratories that can diagnose cases.
What the Zambia study confirms is that the challenge sleeping sickness poses to communities is a real and enduring one as elimination is not synonymous with eradication. Elimination will enable this scourge to fall from the top of global health agenda, but ministries of health will need to ensure that resources and training remain available. The question then becomes are the capacities of African ministries of health being developed quickly enough?
Today, our festive countdown – extracted from Rogerson's Book of Numbers – delves into mystical realms
The five components are: Ren, Ka, Ib, Ba and Sheut.
The simplest concept is Ren, which is literally your name: it lives for as long as you are remembered, or can be read about on inscriptions, or included in prayers for the ancestors and their achievements.
Ka is also easy enough to translate into modern idiom, for it is that vital essence that makes the difference between the living and the dead, between life and dead meat, between a warm body and cold clay.
Ib is literally the heart, formed from a single drop of clotted blood extracted from your mother's heart at the hour of your conception or birth. By heart, the Egyptians meant not just the organ for pumping blood around your body, but the seat of your soul, the good directing force in your life, searching after truth, peace and harmony.
Ba is that which makes each of us unique and different, that which makes us strive and achieve, the motivator but also the hungry elemental force that needs food and sex. In some form, your ba is destined to survive after death, often depicted or imagined as a human-headed bird, which with good fortune will go forth by day to enjoy the light, but might also end up existing only in the dark, like the bat or the ruin-haunting owl.
Sheut is your shadow, and by extension the other you, as well as being used to describe a statue, a model or a painting of a human.
Tomorrow: Six days of Genesis
Taken from Rogerson's Book of Numbers by Barnaby Rogerson (Profile)Barnaby Rogerson
Suzi Gage: Can your phone improve your mood? A new app developed by researchers at the University of Bristol might do just thatSuzi Gage
Deal set to scrap tariffs on major exports and includes controversial investor-state dispute settlement mechanismDaniel Hurst
Two years after surgery, scans on first recipients in the US show healthy blood vessel and tissue connections have formed
After two years the first full-face transplant recipients in the US are doing well, with medical scans showing the recipients have grown new networks of new blood vessels to connect the donor skin with their original tissue.
Dallas Wiens, the first US man to get a full face transplant, said: "My entire life is a miracle" as he spoke at the annual meeting of the Radiological Society of North America on Wednesday.
Flanked by his new wife and golden retriever guide dog, Wiens, 28, showed visible facial scars but otherwise all the signs of a strong recovery. His face was burned off in a 2008 painting accident at his church when his head hit a high-voltage wire.
After surgery Wiens lived for two years with no facial features and a slit for a mouth until his transplant at Boston's Brigham and Women's hospital.
Imaging studies on Wiens and two other full-face transplants done at the hospital in 2011 show that a network of new blood vessels had formed within a year of the operations. A fourth full-face transplant was performed at the hospital this year.
The same thing typically happens with other transplants and it helps ensure their success by boosting blood flow to the donor tissue. But doctors say this is the first time it has happened with full-face transplants.
The finding could eventually shorten the operating time for future face transplants, radiologist Dr Frank Rybicki said. The operations can take up to 30 hours and include attaching thin arteries in the patients' existing tissue to the donor face, but the findings suggested attaching only two facial or neck arteries instead of several could be sufficient, he said.
Face transplants, using deceased donors, are still experimental. Fewer than 30 had been done since the first in 2005, said Dr Branko Bojovich, a surgeon involved in a 2012 face transplant at the University of Maryland Medical Centre.
He called the Boston team's findings "very reassuring" for surgeons and for future patients. "We're assuming that these patients will hopefully go on to live productive and long lives," Bojovich said.
Wiens's life before the accident was troubled and he said he missed nothing about it except possibly his eyesight. "I've learned more about other people and myself, being blind," he said.
He met his wife, Jamie Nash, in a support group for burn patients and they were married in March at the same church where Wiens's accident occurred.
Learning the tongue of the world's second largest economy may seem daunting but le français also has its challenges
French has been the first foreign language for the English since the Norman Conquest. Should the English now switch their attention to learning Chinese? It would certainly be wise for more English people to know the language of the world's second largest economy, but it would also be foolish for England to stop learning the language of our nearest continental neighbour with whom we share centuries of common history.
Many universities and some schools already offer Chinese for those who want to study it, and students already make their choices. In fact, spoken Chinese is less fearsome than its reputation. Students get used to the four tones – where rising, falling or level intonation can change the meaning of a word – and cope reasonably well with the different range of consonants.
There are not many similarities between Chinese and European vocabulary, but where it gets really difficult is the writing system. There is no alternative to learning hundreds of characters to read even a simple text. This is why Chinese authorities developed an alphabetical equivalent, pinyin.
French, by contrast, uses the same alphabet as English, give or take a few accents, and we share a lot of very similar words even if they can sometimes have different nuances. Spoken French has its difficulties for English learners, including the rolled R and the pinched U, although the French rather enjoy an English accent.
The problems come with grammar features such as the conjugations of verbs, genders and agreements. Chinese grammar appears more straightforward in structure.
Ultimately, the real challenge in learning another language is to understand the subtleties of meaning, the complex relationships and the cultural baggage it carries with it. This is the joy and the despair of learning a new language whether it begins with bonjour or nihao.
Professor Mike Kelly, former Department for Education adviser on languages and head of modern languages at the University of Southampton
I don't wish to claim that the UK is the best in the world at turning science into innovative products, but Aditya Chakrabortty's article (4 December) about the country's efforts in exploiting graphene – the ultra-thin "wonder material" made from carbon – was unnecessarily gloomy.
First, in describing the work by Nobel laureates Andre Geim and Sir Kostya Novoselov at Manchester University, where they discovered graphene in 2004, Chakrabortty fails to mention that the construction of the new, state-of-the-art £61m National Graphene Institute at the university has been specifically designed to encourage innovation.
Second, he cites AstraZeneca's closure of its research centre at Alderley Park in Cheshire as an example of Britain's lack of innovative nous. Yes, the centre closed this year, but it has been relocated to Cambridge. Of course, that raises separate questions over the north-south divide, but not to mention the centre's move seems a strange oversight.
Editor, Physics World
• Aditya Chakrabortty is right that government should be looking to science and innovation to improve our prospects for growth. Despite talk of continued austerity – which will no doubt be a feature of the autumn statement – there's scope to treble the science budget in four years' time.
On the latest official figures, the government is planning to go further than just balancing the books in the next parliament. In fact, it is targeting a surplus of £15bn in the structural budget by 2017-18. Instead of putting this cash aside for a rainy day, it could support the innovations Chakrabortty describes.
Building a more innovative economy will help raise our long-run productivity, growth in which is just 0.5%. If we keep going like this, forecasts by the Office of Budget Responsibility suggest that the pressures created by an ageing population will mean public sector debt rises above 100% of GDP, making recent public spending challenges pale by comparison.
Director, Social Market Foundation
Why do studies reinforce stereotypes about the male versus female brain, when the truth is that we are not so very different?
If you cut my head in half, out would spill sugar and spice and all things nice, obviously. The part of the brain that does parking would be small, but the part that organises cupcakes and friendship would fizz like sparkling rose. Because I am a girl whose mushy head is "hardwired" for girly things.
As ever, when I see the latest stuff on gender differences in the brain, I feel that I am barely female. Some parts of my brain have gone rogue. But before anyone gets out a soldering iron to rewire me, let's um … think about it.
What we are told is that neuroscience is actually a mass of disciplines: neurology, physiology, psychology, molecular biology and genetics, all of them ramped up by new ways of imaging the brain. Neuroscience has to be social, as we are social animals, and yet it stumbles over "a theory of mind". Are we simply a collection of brain processes that we experience as thoughts and feelings? If we are going to locate these inside the brain, we need some philosophical models too. It is all pretty epiphenomenal for my fluffy little brain. Which is smaller than most men's.
My brain also lives in a female body and clearly there are differences between men and women. But the latest overhyped study, which suggested that – guess what? – men are good at structure and co-ordinated action (map-reading?) and female brains are designed to facilitate communication (everything else?), is about as plausible as the finding reported in one notorious Daily Mail story that women were programmed by evolution to be "bitchy". This was based on showing 46 women in Canada pictures of other women in tight T-shirts. If this is science, I am Richard Dawkins.
Neuroscience is just as useful as evolutionary biology when it comes to reinforcing stereotypes in a pop-psychology manner. Are you right-brained (creative, intuitive) or left-brained (organised, systematic)? Do a quick quiz to see, rather than understand that this dichotomy has been fairly comprehensively debunked. The interaction between the hemispheres is what counts, but this is less marketable stuff. Such personality tests are sold to anxious parents, used in business recruitment and targeted at schools. All of them confirm what we already know, not what we could know.
The great insights now are around the plasticity of the brain, how new pathways can be formed even after damage, and how they are formed through experience. Yet there is a focus on imagery and which bits of the brain light up, because it is whizzy and fun. Spending a lot of time a while back with neurosurgeons after a close relative suffered a head injury taught me that brain scans are still blunt intruments, that we don't know sometimes if some functions can be taken over by other areas of the brain, if nerves can repair. It taught me that coma is still a mysterious state from which one does not wake up, but rather swims slowly to the surface. All these very clever doctors were more than happy to talk about what they did not know about the brain.
Now, though, neuroscience has achieved a quasi-religious status. There are, of course, drug companies waiting to improve our mental states; the military is also heavily invested in some of the research, as are those who think we will soon be able to predict "criminality" and lock people up before they do anything. Right now, we have politicians basically telling us that intelligence is innate and inequality therefore predetermined. There are, of course, many brilliant scientists who are appalled at this.
Cordelia Fine, for instance, is wonderful at debunking the neuroscience of sex differences, which began in the mid-19th century. These differences were used to argue against giving women the vote. Now they are being used to confirm that women are empathetic, but not power hungry or good at maths. Something as complicated as language does not live in one part of the brain, whether that language is poetry or maths. What Fine dubs "neurosexism" explains female inferiority, lower pay and the lack of women in public life. Is this inferiority located in individual brains or in culture?
Indeed, the latest debate on education shows that we absolutely need a combination of creativity and analytical skills; the binary of left/right brain thinking is inadequate. Of course we can find studies that reinforce gender stereotypes and use a determinist model of the brain. All kinds of self-help books are flogged on the back of this.
How hormones change brain organisation has yet to be fully explained. Many people feel neither male nor female. We see more autism in men, more Alzheimer's in women – and all of this is to be explored. But the idea of plasticity, the ability to change our ways of thinking, gets lost in the new neuro-mythology, which, as authors Hilary Rose and Steven Rose have argued, ignores the ways in which "culture and education shape neuro-cognitive function".
The truth is our brains are much more similar than they are different. That's not a headline you will ever read, is it? "Men and women: much the same!"
• Comments for this article will be switched on on Thursday morning.Suzanne Moore
Witnesses from Nasa and MIT suggest to House committee that scientists may be on verge of breakthrough in search for aliensTom McCarthy
Scientists say DNA strands in thigh bone of 400,000-year-old early human can help build clearer picture of human family tree
Researchers have read strands of ancient DNA teased from the thigh bone of an early human who died 400,000 years ago in what is now northern Spain.
The genetic material was pieced together from a clutch of cells found in bone fragments – the oldest human remains ever to yield their genetic code.
The work deepens understanding of the genetics of human evolution by about 200,000 years, raising hopes that researchers can build a clearer picture of the earliest branches of the human family tree by studying the genetic make-up of fossilised remains dug up elsewhere.
"This is proof of principle that it can be done," said Matthias Meyer at the Max Planck Institute for Evolutionary Anthropology in Leipzig. "We are now very eager to explore other sites of a similar age."
The thigh bone was among the remains of at least 28 early human ancestors found at the bottom of a vertical shaft in a cave complex in the Atapuerca mountains in northern Spain. The Sima de los Huesos, or "pit of bones", lies 30 metres underground and half a kilometre from the cave system's nearest current entrance.
The individuals at Sima de los Huesos looked a little like Neanderthals, and many anthropologists classified them as Homo heidelbergensis, a potential forerunner of modern humans. The corpses were probably washed into the pit rather than buried intentionally.
Meyer's team sequenced DNA found in tiny sausage-shaped structures called mitochondria, which sit inside cells and provide them with power. Mitochondria are passed down the maternal line only, unlike DNA found in the cell nucleus, which carries genetic information from both parents and their ancestors.
The age of the bone fragments meant the cells and their DNA were badly degraded. "This is the hardest sample I have ever worked on that yielded a result," said Meyer.
Meyer's team dated the bone fragments to 400,000 years old, but further analysis left them baffled. The mitochondrial DNA did not match that of Neanderthals, but was closer to a sister group called the Denisovans that lived in Siberia. Details of the study appear in the journal Nature.
Meyer says there are a number of explanations, but admits more work is needed. One possibility is that an older lineage of human ancestors, perhaps Homo erectus, bred with the ancestors of the Sima de la Huesos individuals, and passed on their mitochondria. But several other explanations are being explored by anthropologists."Either way, this new finding can help us start to disentangle the relationships of the various human groups known from the last 600,000 years," said Chris Stringer, head of human origins at the Natural History Museum in London. "If more mitochondrial DNA can be recovered from the Sima population of fossils, it may demonstrate how these individuals were related to each other, and how varied their population was."
Meyer said the Leipzig group now hopes to extract so-called nuclear DNA from the Sima fossils, which contains more information but will be much harder to extract because there is far less material.
"We have taken a first glimpse now and what we find is unexpected and confusing," he said. "But I'm confident we'll get more data, and then it's very likely we'll be able to nail down some hard facts, about whether these Sima de la Heusos guys are the ancestors of Neanderthals, the ancestors of both Neanderthals and Denisovans, or even something completely different."Ian Sample