www.guardian.co.uk Rise in individual households bodes ill for biodiversity, say scientists Tim Radford, science editor Monday January 13, 2003 The Guardian

The planet's wild creatures face a new threat - from yuppies, empty nesters, singletons and one parent families.

Biologists studying the pressure on the planet's dwindling biodiversity today report on a new reason for alarm. Although the rate of growth in the human population is decreasing, the number of individual households is exploding.

Even where populations have actually dwindled - in some regions of New Zealand, for instance - the numbers of individual households has increased, because of divorce, career choice, smaller families and longer lifespans.

Jianguo Liu of Michigan State University and colleagues from Stanford University in California report in Nature, in a paper published online in advance, that a greater number of individual households, each containing on average fewer people, meant more pressure on natural resources.

Towns and cities began to sprawl as new homes were built. Each household needed fuel to heat and light it; each household required its own plumbing, cooking and refrigeration.

"In larger households, the efficiency of resource consumption will be a lot higher, because more people share things," Dr Liu said.

He and his colleagues looked at the population patterns of life in 141 countries, including 76 "hotspot" regions unusually rich in a variety of endemic wildlife. These hot spots included Australia, New Zealand, the US, Brazil, China, India, Kenya, and Italy.

They found that between 1985 and 2000 in the "hotspot" parts of the globe, the annual 3.1% growth rate in the number of households was far higher than the population growth rate of 1.8%.

"Had the average household size remained at the 1985 level," the scientists report, "there would have been 155m fewer households in hotspot countries in 2000. By 2015, 233m more households are likely to be added to hotspot countries as a result of continued reduction in average household size alone."

Paradoxically, smaller households do not mean smaller homes. In Indian River county, Florida, the average area of a one-storey, single family house increased 33% in the past three decades, from about 1,800 sq ft before 1970 to an average 2,400 sq ft for those built since 1970.

Dr Liu's work grew from the alarming discovery that the giant pandas living in China's Wolong reserve were more at risk now than they were when the reserve was first established.

The local population had grown, but the total number of homes had increased more swiftly, to make greater inroads into the bamboo forests.

Only around 1.75m species on the planet have been named and described. Biologists estimate that there could be 7m, or even 17m, as yet to be identified.

But human numbers have grown more than sixfold in the past 200 years, and humans and their livestock are now the greatest single consumer group on the planet.

The world population will continue to soar, perhaps levelling off at around 9 billion in the next century. Environmental campaigners have claimed that between a quarter and a half of all the species on earth could become extinct in the next century.

Gretchen Daily of Stanford, one of the authors, said: "We all depend on open space and wild places, not just for peace of mind but for vital services such as crop pollination, water purification and climate stabilisation.

"The alarming thing about this study is the finding that, if family groups continue to become smaller and smaller, we might continue losing biodiversity - even if we get the aggregate human population size stabilised."

news.mysanantonio.com By Tom Kim San Antonio Express-News Web Posted : 01/13/2003 12:00 AM   It's about 2 a.m., and Dr. Claudio Nunes is in his 19th hour of caring for the nightly troop of assault victims and drunken drivers.

Surgical resident Claudio Nunes (center) works with University Hospital emergency room staff during the first minutes of a trauma patient's arrival. Nunes' long workweek includes three 24-hour shifts and one 12-hour shift. Joshua Trujillo/Express-News

Paramedics rush the injured one by one through the double doors into the fluorescent glare of University Hospital's emergency room.

Whether they're aware of it, these patients have put their lives in the hands of Nunes, a second-year medical resident who has been working around the clock. The 28-year-old native of Brazil typifies the young doctor-in-training: dedicated to his profession and determined to get by on very little sleep, with the occasional aid of adrenaline and caffeine.

"It's my time to sacrifice now," he said during a 24-hour shift. "I'll rest when I'm old."

Nunes and most medical residents are a lifeline for many hospitals, especially teaching institutions affiliated with universities. They care for patients just like fully trained doctors, but at a fraction of the cost.

But long hours and hefty responsibilities have thrust these residents into the center of a national debate that has much of the medical community divided.

The Accreditation Council for Graduate Medical Education decided last year to limit the number of hours a medical resident can work. The standards, which take effect in July, cap the workweek at no more than 80 hours. Nationally, residents can now average 60 to 130 hours of work each week, depending on their specialty or the location of their residency.

The national cutback comes amid concerns that patients are at risk in the care of exhausted residents.

But some residents aren't convinced the limits are a good idea. And some hospitals aren't sure if they'll be able to meet the requirement or what effect the reduced hours will have on patient care.

Many institutions, such as University Hospital, already are facing severe staffing shortages, and complying with the mandate might theoretically require residents to have to walk out on their patients while providing care.

Nunes' workday usually begins near dawn when he often struggles to get out of bed. Waking up is never easy, and it usually takes about three hits of the snooze button before he finally rises.

On this particular Thursday morning, he arrives at University Hospital at 7. The emergency room where he is assigned for the month is in the basement. It has an otherworldly feel that makes it seem insulated from the rest of the planet.

There are no windows. Time has a way of slipping to the back of the mind.

"It's like Vegas down here," said Adam Blanchette, a third-year medical student who also works in the ER. "Six hours just goes like that."

For Nunes, the day is just beginning. He is briefed by the previous shift's resident-in-charge about the patients he's inheriting. One is from near the Mexican border. He suffered the loss of his hearing when a tree branch lodged in his right ear while he was being chased by Border Patrol agents.

Another is a jail inmate who claims to have lost feeling in his legs.

Known as the ER's "pit boss," Nunes assesses the hundreds of trauma patients who come through on his watch. It is his job to assess the extent of their injuries, as well as decide who needs surgery.

Because most of his waking hours are spent in the hospital, most of his life revolves around this place, leaving him little room for a social life. He works three 24-hour shifts and one 12-hour shift a week.

The idea of working fewer hours is appealing, but it also raises questions.

"I think the scale-back is great," Nunes said. "But it's not going to work for surgical residents because we do everything medical residents do, plus we operate."

Often, Nunes stays at the hospital after his regular 24-hour shift to watch surgical procedures because he couldn't when he was on call.

Such observation, he said, bolsters his training. But under the accreditation council's guidelines, any of those extra hours would count against his 80 hours.

He said limiting the number of hours he can stay at the hospital will affect his education.

"We have to be at the hospital to learn," Nunes said.

Another fear is that reducing hours might result in longer residencies, which already can last four years after medical school.

Much of the burden in figuring out how to comply with the new rules falls on faculty of teaching hospitals.

At the University of Texas Health Science Center at San Antonio, that's Dr. Lois Bready. The associate dean for graduate medical education says she's had trouble sleeping ever since the accreditation council made its decision.

She blames her insomnia on the logistical nightmare she and other faculty will face in trying to comply with the new standards.

University Health System has close to 700 residents who are overseen by about 600 full-time faculty doctors at the health science center.

The hospital, like almost all hospitals nationwide operated by colleges and universities, depends heavily on medical residents, who diagnose, treat and operate on patients. Faculty doctors oversee and assist residents, but residents can carry much of the responsibility of patient care.

Residents also provide a large and relatively inexpensive labor pool for hospitals such as University Hospital. However, if hospitals violate the allowed hours for residents, they risk losing accreditation, putting their federal funding at risk.

"We're trying to figure out how to contract all these hours and find out where we are going to have voids," said Greg Rufe, an administrator for the University Health System. "It's not like we can run out and get more residents."

The solution shaping up is to hire more physician assistants and nurse practitioners. But those people haven't yet been hired. And so the hospital still has its voids.

4:30 p.m. Nunes' pager goes off. A man who has fallen off a 60-foot billboard is en route. At 5 p.m., the patient is wheeled in.

"This one is a pretty big emergency," Nunes said. "He has a collapsed lung on his left side."

They put an oxygen mask on the patient to help his breathing. But a problem has developed.

The air being built up in the patient's chest because of the collapsed lung is beginning to restrict his heart. Nunes has to act quickly or the man will go into cardiac arrest.

Nunes takes a scalpel and cuts above the left side of the ribs. The patient is still conscious as Nunes works. Nunes grabs a surgical clamp and pushes it into the slit he's made. The patient screams, but the oxygen mask over his nose and mouth muffles the sound.

Nunes is trying to puncture the wall surrounding the patient's lung to let the air escape. He is holding a long needle in one hand just in case the clamp doesn't make it through. The needle will provide an instant hole to release the air.

Nunes continues working the clamp. All of a sudden, a hissing noise fills the room. Nunes has broken through the sac surrounding the man's lung, releasing the pent-up oxygen. Nunes then inserts a chest tube into the hole and begins to sew the wound shut. Disaster has been averted.

Nunes often is thrust into these kinds of life-and-death situations as a resident. Faculty doctors are accessible if he needs to consult them, but sometimes, as in this case, he has to make a decision at the spur of the moment.

Teaching hospitals can't afford to have a doctor standing over the shoulder of every resident working at a hospital.

Most residents are paid salaries just above $30,000 a year. But when averaging 80 hours of work or more each week, that comes out to about $8 an hour before taxes — a figure less than the $8.25 lowest hourly wage set by University Health System last year. Most hospital employees receiving that wage are workers in housekeeping, food service and maintenance positions.

Because the system is Bexar County's tax-supported health provider, most of the money for residents' salaries comes from taxpayers.

If the number of hours a resident can work is reduced, additional staff will have to be hired to make up the difference. But with tight budgets, hiring more staff will be next to impossible, Bready said.

"Most teaching hospitals are hanging by a thread right now," she said.

The cutback comes at a time when states and the federal government have slashed health care dollars for this year. Publicly funded hospitals are wondering how they will be able to provide the same level of patient care with people working fewer hours with less money.

University is grappling with staff shortages and budget deficits that have, in part, resulted in patients being turned away from the hospital's emergency room. Nationwide, nurses have been leaving the profession in droves because of inadequate salary and long hours — a problem from which University Hospital has not been immune.

The accreditation council knows the pivotal role residents play in hospitals, but a resident is a student first, said Dr. David Leach, the accreditation council's executive director. Having full staffing levels shouldn't come at the expense of fatigued residents, he said.

"Residents are students," Leach said. "The primary purpose of students is education."

Changing the way hospitals approach health care is one way to resolve problems that could arise from the cutback, he said. Doctors, nurses and other support staff should find more effective ways of working as a team, he said.

"The lone ranger is not the best metaphor," Leach said. "The U.S. Navy SEALS is a better approach."

In preparation for the mandate limiting a resident's hours, the health science center's departments have been told to limit their residents to no more than 80 hours of work a week. Most appear to be doing so, Bready said, though a new survey is under way to determine that.

And a subcommittee organized to study the issue is recommending that some departments be able to apply for an exemption under special circumstances, increasing the limit from 80 to 88 hours.

5:30 a.m. Nunes is less than two hours from going home, but his shift is far from over. Another vehicle accident victim arrives. She tells Nunes she had been drinking and was on her way home.

Nunes works his hands across her body, performing an assessment. Despite having a night filled with patients — some belligerent and many unappreciative — Nunes is cordial.

He addresses her as ma'am when he speaks to her, though it's obvious she is younger than he is. He appears alert.

Whether working 100-hour or 80-hour weeks, Nunes said staying awake has never been a problem.

"Here, there is no way you're going to sleep because you're too busy," he said about the hospital's emergency room.

But not all residents feel like Nunes.

Dr. Maurice Sholas, who recently completed his residency at the health science center and lives in Chicago, believes the guidelines make sense. Sholas has served as the vice chairman of the resident and fellow section of the American Medical Association, which has endorsed the mandate.

Patient safety should be the first priority at all cost, he said.

"We're not supermen, immune to the need of sleep," he said.

In New York, state law already enforces an 80-hour limit for residents. The restriction, which has been in effect since 1989, came about after an 18-year-old woman died under a medical resident's watch. The woman's father blamed her death on the resident, whom he alleged was overworked.

Even doctors who are skeptical, if not directly opposed to the cutback, are divided on why they think the mandate is a bad idea. Some, like Bready, support giving residents more time off.

Residents should get more sleep and free time, she said. She's just not sure how to accomplish that.

Others, however, feel that the new policy could pose a philosophical problem for future doctors.

Though scaling back hours might appear good on the surface, some doctors in reality work more than 80 hours a week, said Dr. Ronald Stewart, associate professor of surgery at the health science center.

Pushing residents to work when they're tired instills in them a sense of service, he said.

"It must be taught, patients' problems come first," he said. "A doctor's mindset has to be that a patient comes first. Not that a patient comes first if you're well rested."

citydesk@express-news.net

www.gulf-news.com Dubai |By Manoj Nair | 13-01-2003

Despite the economic risks involved, India should still take "sequential" steps towards full capital account convertibility, according to a senior economist.

"India's banking system is still weak and fiscal deficit is not under control. This is why small, incremental steps towards convertibility are what is required," said Jairam Ramesh, who, according to many in the know, could be a future Indian finance or commerce minister.

He later yesterday spoke at a meeting organised by the India Today group and the Indian Business Council in Dubai.

During his earlier tenure with the finance ministry - in 1997 -as a consultant, Ramesh was instrumental in putting together a position paper on India's road map towards full convertibility. According to it, the status was to be achieved by 2007.

Then, the Asean crisis sprang up, which slowed the momentum. This was followed by general elections which brought a new coalition government to power.

In recent months, a debate has sprung up in certain quarters about whether it was indeed advisable for the country to follow such a course. There were many who were cautioning a slower approach, or none at all.

Those who favour it point out to India's strong foreign exchange reserves position - of $70 billion. "There is still a lot of risk - Brazil lost $50 billion in just three weeks when it allowed convertibility during 1999. However, hot money represents only 20 to 15 per cent of India's overall foreign exchange reserves, which represents a far more stable situation than in other cases," said Ramesh, presently secretary in the economic affairs department of All India Congress Committee, the main opposition party.

"But, from the political perspective, India does not go in for big reforms unless there is a crisis." On India's economic situation, Ramesh said 2002-2003 has been bad with industrial growth not more than 5 to 6 per cent. "I do not think it is possible to achieve a 4 per cent GDP growth. Agriculture too has been badly affected."

On the plus side, "Many Indian companies are in the process of restructuring and getting results. Tisco is the lowest cost steel producer in the world, but not many know that. Telco was written off a few years ago, but is now a success story of transformation. There is a growing universe of Indian companies that are globally competitive.

"But we still have many issues - poor infrastructure tops. In balance, India has many macro successes, while having its large share of micro failures."

On the impact of possible war with Iraq and its fallout on India's oil bills, "Most of our calculations are based on an oil price of $25 a barrel. With $70 billion in reserves, the import scene is not what's worrying.

"What is of concern is the economic and social cost of the dislocation of a huge number of expatriate Indians in the Middle East back to the country.

"The recent global NRI summit in New Delhi made no effort to look at the Middle East, which accounts for $6 to 7 billion in annual remittances to India from an estimated three million Indians here. The whole focus of the meeting was on Indians in the West."    

www.infobrazil.com Analysis by Alcides Ferreira          Jan 11 - 17, 2003

President Luiz Inácio Lula da Silva's first few days in office offered the news media an abundance of photo opportunities. He visited poor towns in the Northeast and brought his entire cabinet with him for a close-up look. In many ways, Lula is still behaving as if he were in the middle of an election campaign – at times, he seems more like a pop star than a president in his public appearances.

Probably the last time Brazil had such a popular president was in the fifties, with the late Juscelino Kubitschek. This is not negative, but the big hopes for change that carried him to victory may well work like a double-edged sword, and turn into deep disillusion in a while. All it would take is a return trip by reporters to the same impoverished locations Lula visited in recent days, and their subsequent stories showing that not much has changed.

As I predicted here, Lula's economic team has so far produced the best performance among all cabinet members. Markets are reacting positively to that. There is, however, one important exception: new Labor Minister Jacques Wagner, who declared that the past administration's proposal to change Labor Legislation Consolidation (Consolidação das Leis do Trabalho, in Portuguese) – a proposal that gathered dust in Congress since the end of 2001 without being voted on – will now be set aside.

In fact, this is consistent since the Worker's Party was among the biggest opponents of the changes proposed. The fact remains that Brazil's labour regulations are a road to hell paved with nothing but good intentions. More than one thousand specific labour rules clutter the Constitution and the Labor Legislation Consolidation The end result of one of the most detailed and strict set of labor laws in the world is that just 40 percent of Brazilian workers are formally registered employees. The majority of workers in Brazil are informal, unregistered, without basic benefits.

As I have been saying here *, a thorough revision of Brazil's labour laws is a vital pre-requisite for employment growth. As things stand, when a company hires someone in Brazil it has to follow every detail in the law, and that means offering the new employee a number of benefits called for in legislation. It makes no difference whether the employer is in a poor state, or if it's a startup company – it will have to put out just as an established enterprise in a bustling city would have to.

Not only has this led to Brazil's enormous informal labour market, but there is also an incredible amount of labor litigation in Brazilian courts. According to University of São Paulo Professor José Pastore, one of Brazil's foremost labor law specialists, there are currently two million litigations making their way through the court system, all related to employment issues. In Japan, which has a labor market equivalent in size to Brazil's, there are just 1,500 lawsuits under way.

As Americans like to say, only a person who has never met a payroll would push aside this issue. Labour Minister Wagner said he intends to modernize labour regulations, and mentioned, for instance, the idea of ending the payment of a fine every time a company fires someone without just cause. Under current legislation, the company pays the employee a fine equivalent to 40 percent of the Employees Severance Indemnity Fund, known as FGTS account, when it fires a employee. FGTS are the initials, in Portuguese, of this fund. Every registered worker in Brazil has an FGTS account, which receives monthly deposits from the employer. These accounts are managed by the government, and can only be drawn in three circumstances: if the employee buys a home, opens a business, or is fired without just cause.

This penalty paid by the employer was created in 1988, when the Brazilian Constitution was given a thorough review in Congress. It was the result of a bizarre negotiation between right and left-wing parties. Leftists, led by the Worker's Party, wanted to re-introduce employment stability as a constitutional guarantee, something that was dropped in the 60s and replaced by the FGTS accounts. The left didn't get its way, but obtained this fine. **

The idea of penalizing a company because it fires someone is nonsense. The result of this is clearly visible in Brazil. What it has generated is a growing informal market, as well as giving rise to yet another very Brazilian "solution" for regulations that don't make a lot of sense. It is quite common for companies and employees to reach informal agreements, in which the company agrees to fire the employee. This allows the worker to draw the funds from the FGTS account. To return the "favour", the employee agrees to give back to the company the 40 percent fine. This money returns to the company under the table, since this type of deal between employer and employee is not recognized in the law books.

Labour unions in Brazil consider this fine is a hard-earned "conquest" and a form of insurance for employees, so predictably, reaction against the new Labour Minister's suggestions was strong. And not surprisingly, Jacques Wagner was forced to backtrack, saying he never really intended to remove the fine specifically. This was another clear indication of the contradictions the Worker's Party will face in government. On one side, part of its members recognize the need to continue reforms and modernize the economy, in spite of the fact that in the recent past, the Worker's Party voted against all major reforms.

On the other side, there are those within the party, as well as key supporters in the labour movement, who will continue to react strongly to these changes, much as they did while in the opposition. In the case of this specific change involving labor regulations, those who might benefit most – the unemployed – have no way of applying pressure, since there are no lobbies or unions acting for the jobless. Barring an unexpected burst of internal defiance, the unfortunate likelihood is that we'll continue to see union leaders grabbing headlines, calling on the new government to preserve, and never extinguish these "worker's rights".

news.ft.com By Raymond Colitt Published: January 13 2003 4:00 | Last Updated: January 13 2003 4:00

Like a firefighter in a rescue operation, Luiz Inácio Lula da Silva leaned from a shanty over a 10ft drop into filth and mud and shouted "I'll get you out of there," to the occupant of the next hut, promising a new home.

The rickety construction on stilts risked collapse from the crowds of supporters that had flocked to see Brazil's newly elected president in Brasília Teimosa, a slum on the outskirts of Recife.

It was the second of three stops on a two-day "reality tour" on which Mr Lula da Silva took his cabinet through some of Brazil's poorest regions in the north-east. Himself a former shoeshine boy and lathe turner, Mr Lula da Silva said: "I want my ministers to look misery in the eye."

He is off to a quick start to try and fulfil his campaign promise of radical action to tackle Brazil's infamous social inequalities. The trip marks a new style of government in Latin America's largest country, in which not only the president but, he hopes, the entire government will be working more closely with the people.

Brazil has one of the world's most unequal income distributions. While regions in the country's south boast living conditions similar to those of Spain, between 10m and 30m of the 175m inhabitants live in conditions similar to those in sub-Saharan Africa. Pockets of misery are concentrated in the drought-stricken north-east and in city slums.

The mayor of Recife, also of Mr Lula da Silva's Workers' party (PT), seemed to have missed the point of the trip, sending in cleaning crews to pull out 10 tonnes of garbage before the distinguished guests arrived.

Still, there was no hiding the sub-human living conditions in Brasília Teimosa (Fearsome Brasília). There is no running water and latrines are little more than a hole in the floor. On particularly stormy days huts are washed out to sea.

Several of Mr Lula da Silva's ministers were deeply impressed. "I have seen this only in movies," said Celso Amorim, foreign minister, who had just returned from the comforts of being ambassador in London.

With teary eyes and a choking voice, Luiz Fernando Furlan, one of the few businessmen in government, admitted the experience would mark his tenure as industry and trade minister. "Without a doubt I'll be more socially aware. Look at their eyes. In all that misery, they are still hopeful."

Wherever he goes, Mr Lula da Silva is greeted with spontaneous celebration and requests for help. Geazi Belarmino da Silva was one of many in the crowd hoping to pass the president a letter. He would like to get back his job as a mailman, which he lost 12 years ago.

One of numerous signs hung from windows read: "Brazil is 1000 times bigger than its problems - congratulations Lula." Another read: "Lula you have been sent by God to save the poor. Now keep your promises - thank you!"

Mr Lula da Silva is walking a fine line between meeting demands and generating even higher expectations. Critics say his high-profile anti-poverty campaign is beginning to smack of populism. Yet, well aware that the post-election honeymoon could soon fade, he must show results to maintain the support he needs to implement much-needed and often controversial reforms.

Stern-faced and visibly tired from the first two intense weeks on the job, the former metalworker did not appear to be basking in his massive popularity at the weekend. "This is not about him, he is a humble person," said Mr Amorim.

While talking of a gradual social revolution to Brazil's masses, Mr Lula da Silva's discourse of economic austerity has also encouraged Wall Street in recent days.

Travelling between "poverty hot spots" on the presidential aircraft, he detailed plans to address investors at the World Economic Forum this month. Deep budget cuts that could help meet International Monetary Fund targets were also on the agenda.

Pledging to grant property titles and expand housing resettlement projects for slum dwellers, Mr Lula da Silva asked the poor for patience. "I cannot promise you that tomorrow everything will be resolved. The government is like a baby. It takes nine months to be born and another 11 to walk."