By: Omair Alavi

Pakistan may have won the first T20 against World Champions West Indies in Barbados but the victory was far from a convincing one; the team went out with a mixture of old and new players and sadly, it was the new ones who made the difference. Lets take a look at The Good, The Bad and The Ugly performers of the match and hope that either the bad ones get dropped or improve in the next outing.

The Good

Shadab Khan came, he bowled and conquered. The leg spinner made his T20 debut memorable by taking as many as 3 wickets for just 7 runs which is the most economical figures, ever for a newbie. He was rightly used as an attacking bowler by Sarfraz Ahmed who won his 5th consecutive match in charge. Due to Shadabs brilliant spell combined with excellent captaincy, Pakistan managed to restrict the hosts for just 111. It took a gutsy innings from Babar Azam to rescue Pakistan from a familiar collapse and his 29 off 30 proved to be one of the reasons the greenshirts came out victorious.

The Bad

Kamran Akmal once again proved that he is one of the worst fielders in the world with or without gloves. Yes, he did provide the explosive start but that doesnt mean that one can forget the blunder in the field. His opening partner Ahmed Shehzad also told the selectors that their confidence in his abilities was short-lived as he did what he always does nothing exceptional with the bat. He may be a wonderful fielder and for that, he might play as a 12th man, one who doesnt burden the team with his irresponsible batting at the top!

The Ugly

Once upon a time there was a fast bowler named Wahab Riaz who bowled a wonderful spell against Australia in the last World Cup, 2 years back. He has been playing in the side for that one performance and its about time that he should make way for young guns that actually fire and take wickets, not just donate runs. His 4 overs went for 35 runs and helped the West Indians more than the Pakistan side. Another player who proved to be useless in the final XI was former captain Mohammad Hafeez who bowled one over and scored 5 runs off 12 deliveries which is criminal if you do that in a T20. If he cant bowl, cant bat and cant field, then why is he in the team beats me. It is time that non-utility players like him are shown the door and young ones are included, because the young are the way forward for Pakistan, not the old ones!

Story first published: 27th March 2017

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Yamni Nigam is an associate professor of biomedical science; John Knight is a senior lecturer in biomedical science; both at the College of Human Health and Science, Swansea University.

Ageing can have drastic effects on the functions of the digestive system. One of these is reduced appetite due to changes in hormone production and analteration in smell and taste. Physiological changes in pharyngeal skills and oesophageal motility may lead to dysphagia and reflux. In the intestines, several factors contribute tochanges in the regular gut microbial fauna, making older people more prone to bloating, pain and bacterial infection. There is also a drastic age-associated rise in the incidence of several gut pathologies including cancer of the colon. This third article in our series on the anatomy and physiology of ageing explores the digestive system.

Nigam Y, Knight J (2017) Anatomy and physiology of ageing 3: the digestive system. Nursing Times [online]; 113: 4, 54-57.

The main role of the digestive system is to mechanically and chemically break down food into simple components that can be absorbed and assimilated by the body. The gut and accessory organs also play an important role in the elimination of indigestible food components, bile pigments, toxins and excess salts. The system performs a range of anatomically and physiologically distinct functions, each of which is affected differently by ageing (Fig 1).

2

Fig 1. Age-related changes to the gastrointestinal tract

Food intake diminishes with age due to a range of complex reasons that lead to reduced appetite. These include physiological changes and changes in psychosocial and pharmacological circumstances.

Appetite is controlled mainly by sensors in the gastrointestinal tract, which detect the physical presence of food and prompt the GI tract to produce a range of hormones. These are released before, during and after eating, and control eating behaviours, including the amount consumed. They include:

Table 1 highlights the changes that occur in the production of these hormones with advancing age; the overall result is reduced appetite.

ta

Table 1. Age-related changes in appetite hormones

We choose what we eat based on the smell and taste of food; however, the number of olfactory receptors decreases with age and the sense of smell diminishes. US research suggests that about half of people aged 65-80 and around three-quarters of those aged over 80years have a demonstrable loss of smell (Doty and Kamath, 2014).

This decreased sense of smell can have significant safety implications; for example, a disproportionately high number of older people die from accidental gas poisoning. It can also be an early sign of neurodegenerative disorders such as Parkinsons or Alzheimers disease (Httenbrink et al, 2013). Olfactory loss including loss of the ability to discriminate between smells may also be a consequence of age-related skull bone growth that results in a pinching of sensory nerve fibres.

Most older people experience regional taste deficits in the mouth. However, what is perceived as a taste defect (gustatory dysfunction) is often a primary defect in olfaction although some studies suggest that age-related changes in the taste cell membranes diminish the sense of taste (Seiberling and Conley, 2004).

The gradual reduction in smell and taste, and therefore in appetite, leads to diminished food intake, possibly resulting in weight loss and malnutrition, while the inability to taste and enjoy food can lead to anxiety. The ability to taste salt also diminishes (Mauk, 2010) and may lead to increased consumption of salt-rich meals, which can aggravate health conditions such as hypertension. Older people should be encouraged to use herbs or mild spices in their dishes, rather than salt, if they need to add flavour.

The lips, tongue, salivary glands and teeth all play a role in chewing, breaking down and swallowing food. Age-related shrinkage of the maxillary and mandibular bones and reduction in bone calcium content cause a slow erosion of the tooth sockets, leading to gum recession and an increased risk of root decay (Pradeep et al, 2012). People without teeth (edentulous) or who have poorly fitting dentures may find chewing difficult and, therefore, eat less and become malnourished. Alternatively, they may choose highly refined, easy-to-chew foods, thereby consuming less dietary fibre; this will affect their bowel function, and may cause problems such as constipation.

A dry mouth (xerostomia) is common among older people; Smith et al (2013) showed that healthy subjects aged 70years and over produced less saliva than younger people. However, while the number of tongue acinar (saliva-producing) cells decreases with age, there is conflicting evidence as to whether the volume of saliva produced also decreases. Xerostomia can be an adverse effect of medication or can result from diseases such as diabetes. Although it is common among older people generally, it is more likely to occur in those who are taking more than four prescription drugs per day (Yellowitz and Schneiderman, 2014). Drug categories that may cause xerostomia include:

Having formed a bolus of food, the mouth prepares to swallow. The bolus reaches the posterior pharyngeal wall and the musculature contracts around it; swallowing occurs and food travels through the upper oesophageal sphincter into the oesophagus. With age, the muscular contractions that initiate swallowing slow down, increasing pharyngeal transit time (Nikhil et al, 2014). This may lead to swallowing difficulties (dysphagia), which can increase the risk of choking and the feeling that food is stuck in the throat. Up to 26.7% of people aged 76years and over experience dysphagia (Baijens et al, 2016).

In general, the motor function of the GI tract is relatively well preserved in healthy older people, but there are significant changes in oropharyngeal and oesophageal motility. In the very old, impaired oesophageal motility is common; oesophageal peristalsis weakens with age (Gutschow et al, 2011) and peristalsis may no longer be triggered by each swallow. Both upper and lower oesophageal sphincters lose tension; the lower one in particular undergoes a reduction in pressure, resulting in problems such as dysphagia, reflux and heartburn (Grassi et al, 2011). In addition, the gag reflex is absent in 43% of older people (Davies et al, 1995).

The stomach acts as a reservoir for food, allowing us to eat at regular intervals. With age, it cannot accommodate as much food, primarily because its wall loses elasticity.

As a normal part of digestion, the stomach secretes gastric juice containing hydrochloric acid and pepsin. Although, in general, older and younger people produce gastric acid at a similar rate (Merchant et al, 2016), acid hyposecretion occurs in 10-20% of older people versus <1% of younger subjects (Gidal, 2007). This can compromise the bioavailability of certain drugs, including vitamin B12, and lead to disorders such as chronic atrophic gastritis.

There is also an age-related reduction in mucus-producing goblet cells, which results in reduced secretion of protective mucus and therefore a weakened mucosal barrier. Consequently the stomachs lining becomes more prone to damage (Saber and Bayumi, 2016).

Gastric bicarbonate (HCO3-) and mucus normally provide an alkaline layer to defend the stomach lining against gastric juices; however, research suggests that advancing age is associated with a decline in HCO3- secretion (Saber and Bayumi, 2016). The protective prostaglandin content of mucus also decreases with age, making older people more prone to gastromucosal injury such as lesions and ulcers, especially after ingesting non-steroidal anti-inflammatory drugs, which are commonly taken by older people. However, proton pump inhibitors (PPIs), which suppress acid production, are often prescribed alongside NSAIDs (Fujimori, 2015).

Finally, gastric emptying slows down with age; this means food remains in the stomach for longer, prolonging satiation and reducing appetite (Nieuwenhuizen et al, 2010).

The main function of the small intestine is to digest and absorb food. It produces a range of digestive enzymes, supported by the pancreas and liver.

Absorption of nutrients occurs in the jejunum and ileum, the second and third regions of the small intestine. The lining of the small intestine is shaped into microscopic folds (villi), which increase the surface area available for absorption. Although an age-related reduction in villus height has been shown, the impact on nutrient uptake does not seem to be clinically significant (Drozdowski and Thomson, 2006).

There is evidence that the production of the enzyme lactase decreases with age, making older people more prone to lactose intolerance (Di Stefano et al, 2001); lactase is created following instruction fromthe LCT gene, which becomes less active over time.

Populations of certain bacteria that reside in the small intestine have been shown to increase as we age, leading to bloating, pain and decreased absorption of nutrients such as calcium, folic acid and iron. This can have a negative effect on health. In addition, PPIs have been shown to provoke bacterial overgrowth in the small intestine, which may exacerbate NSAID-induced small intestinal injury and foster the development of systemic conditions, including inflammatory bowel disease, diabetes and autoimmune diseases (Fujimori, 2015).

Peyers patches small nodules of lymphatic tissue that form part of the guts immune defence system monitor populations of intestinal bacteria to prevent the growth of pathogens. However, there is a gradual reduction in the number of Peyers patches in the small intestine, accompanied by a gradual loss of lymphoid follicles (Merchant et al, 2016); this can result in an uncontrolled growth of resident micro-flora.

As already mentioned, oesophageal peristalsis slows with age, but research has recently shown that small intestinal transit time does not seem to be affected (Fischer and Fadda, 2016). In contrast, there is an age-related slowing down of colonic transit caused by a decline in propulsive activity of the colon, whichis associated with a reduction in neurotransmitters and neuroreceptors (Britton and McLaughlin, 2013). This causes a delay in colonic transit of waste, leading to constipation (Wiskur and Greenwood-Van Meerveld, 2010).

Peristalsis is also affected by the age-related atrophy of the mucosa and muscle layers of the colon. The walls of the colon sag, prompting the formation of pouches (diverticuli). Straining to eliminate faeces may put additional pressure on weakened blood vessel walls, giving rise to haemorrhoids.

The rate of cell division declines in the digestive epithelium, which cannot repair and replace itself as well as it needs to. There is also a drastic age-associated rise in the incidence of several gut pathologies including cancer of the colon in fact, age is the key risk factor for colorectal cancer. Recent studies indicate that ageing induces changes in the DNA of epithelial intestinal cells, particularly in the colon; this process known as DNA methylation is believed to play a significant part in the development of colorectal cancers (Masoro and Austad, 2010).

Changes in the populations of gut microbes lead to an increase in facultative anaerobes including streptococcus, staphylococcus, enterococcus and enterobacteriaceae which are able to thrive in inflamed conditions (Pdron and Sansonetti, 2008). The ageing process mimics the intestinal microbe profile that accompanies inflammatory bowel diseases and obesity (Neish, 2009).

The commensal microorganisms inhabiting the lumen of the colon are prevented from entering surrounding tissues by a single layer of epithelial cells that form an impermeable mucosal barrier. This barrier becomes leaky with age (Mabbott, 2015). As the barrier function of the mucosal immune system is impaired, the incidence of GI pathogen infections is higher and is a major cause of morbidity and mortality in older people (Mabbott et al, 2015). This group is also at increased risk of infection with Clostridium difficile, which causes a potentially fatal dehydrating diarrhoea for which the two major risk factors are age of 65years and exposure to antimicrobials (Jump, 2013).

With age, the pancreas, which generates four major digestive enzymes, decreases in weight and some of its tissue undergoes fibrosis. Its exocrine function is impaired and the secretion of chymotrypsin and pancreatic lipase reduced (Laugier et al, 1991), adversely affecting the ability of the small intestine to digest food.

The liver undertakes more than 114 functions for the body; as it shrinks with age and blood flow to it decreases, its functional capacity also decreases (Drozdowski and Thomson, 2006). There is a decrease in the rate of protein synthesis and of metabolism, the livers ability to detoxify many substances, as well as the production and flow of bile (involved in fat emulsification). In addition, bile becomes thicker and its salt content diminishes, resulting in higher plasma concentrations of cholesterol, particularly in women (Frommherz et al, 2016). Drugs are no longer inactivated quickly by the liver and are therefore more likely to cause dose-related side-effects: dosages therefore need to be carefully checked when prescribing for older people.

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Fischer M, Fadda HM (2016) The effect of sex and age on small intestinal transit times in humans. Journal of Pharmaceutical Sciences; 105: 2, 682-686.

Frommherz L et al (2016) Age-related changes of plasma bile acid concentrations in healthy adults results from the cross-sectional KarMeN study. PLoS One; 11: 4, e0153959.

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Merchant HA et al (2016) Age-mediated changes in the gastrointestinal tract. International Journal of Pharmaceutics; 512: 2, 382-395.

Neish AS (2009) Microbes in gastrointestinal health and disease. Gastroenterology; 136: 1, 65-80.

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Anatomy and physiology of ageing 3: the digestive system - Nursing Times

Truth About It is a blog that primarily focuses on all things Washington Wizards. We have media credentials and that access allows for up-close coverage of games, practices, and other activities, irreverent and otherwise. But occasionally we use that access to explore whats going on with the opposing team. We call this segment, From The Other Side,and in todays installment,@rashad20focuses on the visiting Brooklyn Nets.

On Thursday night, while the Washington Wizards rested, the Brooklyn Nets defeated the Phoenix Suns, 126-98.That win allowed the Nets to achieve three significantseason milestones: Their largest win (28 points), their first win streak (two), and the first time in franchise history they had six bench players score in double figures.

Brooklyntrailed Phoenixby 10 points after the first quarter, then head coach Kenny Atkinson called timeout to yell, scream and throw a clipboard to emphatically implore his team to play with passion and a bit more effort. The Nets responded by outscoring the Suns 104 to 66 the remainder of the game. Message received.

After the game, Atkinson had a choice: Do we travel south to Washington, D.C., arrive late, have a shootaround in the morning, and takethe traditional path NBA teams follow when they have back-to-back games; or do we sleep in our own beds, wake up early, and travel to D.C. on the day of the game? He chose the latter.

Six minutes into their tilt against the Wizards, Atkinsons travel decision appeared to be a stroke of genius. The Nets led 11-4 on the road, mainly thanksto five quick points by Jeremy Lin and careless decisions by John Wall (who, battling the effects of a migraine headache, was questionable to play entering the game) and Markieff Morris. But just as Atkinson had called timeout the previous night to stop his teams substandard effort on both ends of the floor, Wizards coach Scott Brooks did the same thing in an effort to reel in his team in and it worked. The Wizards went on a 27-11 run, and they led 31-22 once the first quarter ended. The Nets never got closerthan nine points the remainder of the game.

Washington outscored Brooklyn32-20 in the second quarter to extend their lead to 21 points. The Nets came out of halftime playing inspired ball and cut the lead to 14 points with 5:23 left in the third quarter, but the Wizards, as theyve been doing intermittently the past month or so, pulled out just enough offensive magic to keep a comfortable lead throughout the third quarter. The Nets ended up losing by 21 points to the Wizards, who clinched a playoff berth.

Prior to his postgame presser, Atkinson had plenty of excuses at his disposal as to why his team lost so badly to the Wizards. He could have blamed the timing of his travel between cities, the difficulties of playing the second night of a back-to-back, the talent disparity between his team and the opponent, or he could simply look inward and blame the loss on the substandard job of the coaching staff. He chose all of the above.

First, he highlightedthe ability of the Wizards bigs (Marcin Gortat, Jason Smith, Markieff Morris, and Ian Mahinmi) to guard their perimeter defenders, then the lack of energy of his team on the second night of a back-to-back, and finally the paltry performance of his bench (57 points), which was far short of the 81 points they scoredthe prior night against Phoenix.

Next, Coach Atkinson decided to contrast the performance of hisbench with the suddenly prolific Wizards bench, as well as criticizing the timid play of his offense. Washingtonsbench, which was justifiably criticized early in the season, has been injected with an energy boost of sorts, thanks toformer Brooklyn Net Bojan Bogdanovic and former New York Knick Brandon Jennings. The Wizards bench accounted for 70 of their129 points, and Bogdanovic and Jennings accrued 35 of those bench points. Jennings, who had nine assists to go with his 18 points his highest total as a Wizard played a sizable role his teams success by pushing the pace John Wall initially set and making the Nets uncomfortable. Coach Atkinson had no problems discussing how flummoxed this made his team.

Amember of the Nets media asked Atkinson point blank if the decision to travel on the same day was a justifiable scapegoat for such a lopsided loss. Based on the laws of coachspeak, it would have been perfectly understandable for Atkinson to roll out the thats no excuse, all NBA teams put their pants on one leg at a time platitudes. When Nets forward Rondae Hollis-Jefferson was asked about the same day travel, he said that it didnt matter and all NBA teams face adversity. Coach Atkinson was a bit more reflective with his comments:

We will evaluate how it went, what we can do better, but that is a good point. We definitely will look at that. How did the guys react? How did the coaches react to it? Obviously, the result is not very good. If we are just going on the result, it was not a smart move by the coach but then again, I do not regret it. It is part of finding out, being more efficient in what we do.

Jeremy Lin, who had not played in the previous two Wizards-Nets matchups due to injury, finished Friday nights game with 14 points and three assists in 20 minutes. He scored five of the Nets first seven points, he blocked a Markieff Morris shot early in the first quarter, and by halftime he had 10 points. His team was not playing well, but it looked as Lin was fully engaged and prepared to give Wall and Jennings fits in the second half. But after scoring the opening basket of the second half to cut Washingtonslead to 19 points, Lin was virtually a no-show the remainder of the game. He had two fouls and a turnover in the 7:04 he played in the third quarter, and as the Wizards began to make the game a laugher, he did not re-enter.

Afterward, Lin had both his knees and feet ensconced in ice and he slowly shook his head and stared at the box score. When the media came to him, Lin reluctantly spoke but was eventually quite candid with his comments and his role in his teamsblowout loss. Lin blamed himself for Brooklynspoor performance, and he specifically blamed his inability to get the team meaningful possessions and shots every time down the floor. He also took full responsibility for Brook Lopezs quiet night. Lopezentered the game averaging 20.5 points, 5.2 rebounds, and five 3-point attempts and nearly two makes per game. He finished with just six points, seven rebounds and no 3-pointers made in just two attempts. Lin took responsibility for that, too. I just look at the box score and think that I need to get Brook a lot more involved. I feel like he had a relatively quiet night. I have to be able to get him more touches.

Lin also cited the spacing and scoring brilliance of both Wall and Beal.

From a distance, Washingtonsblowout win looks like the latestin a series of malaise-causing events for a 15-57 Brooklyn team. But the Nets came into D.C. looking for their first three-game win streak of the season and their first win on the second night of a back-to-back. They are a team which has takenpride in their ability to play hard every night despite the dearth of talent something Scott Brooks made his business to praise the Nets forduring his pregame presser. They really havent had too much to look forward to this season, but a potential victory over the Wizards would have surely given them a sliver of joy in late March.

But the cold reality is that the Washington Wizards, even with their inconsistent play and their fleeting effort on the defensive end of the floor, are the third-best team in the Eastern Conference and one of the top ten teams in the NBA. Brooklyn gave a valiant effort in the first few minutes of the game and again in the third quarter when they scored 39 points to Washingtons34. But all that added up to a 21-point loss, a fourth quarter featuring borderline taunting and laughter by the Wizards, depressing explanations with long faces, and forced optimism about the possibilities of positivity that the next game might bring.

Rashad has been covering the NBA and the Washington Wizards since 2008his first two years were spent at Hoops Addict before moving to Truth About It. Rashad has appeared on ESPN and college radio, SportsTalk on NewsChannel 8 in Washington D.C., and his articles have appeared on ESPN TrueHoop, USAToday.com, Complex Magazine, and the DCist. He considers Kareem Abdul-Jabbar a hero and he had the pleasure of interviewing him back in 2009.

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From The Other Side: The Anatomy of Brooklyn's Blowout Loss in Washington - Truth About It - Washington Wizards Blog (blog)

Just one week ago, on the evening of Saturday 19 March, a generally quiet north London neighbourhood, Finsbury Park, was rocked by a terrible crime, when two toddlers were found with critical injuries. Aman, said to be the birth father, has been arrested and charged with murder and attempted murder. Three of the more restrained headlines in response to these attacks read, depending on which newspaper one read: Man arrested over murder of one-year-old boy as his twin sister fights for life after alleged hammer attack (Daily Mirror); Man arrested on suspicion of murder after mother heard screaming for help as one-year-old boy is killed and sister is fighting for life, (The Daily Telegraph); and Distraught mother ran into street screaming my kids, my kids after finding her son beaten to death with a hammer (MailOnline).

The case has been set for a plea hearing in June, with a provisional trial date in September. The arrested man has yet to enter a plea and we must not second-guess the facts in this tragic case. However, this was the third distressing instance of multiple family victimsnationally in just three weeks. And those only the ones known to any audience beyond the local newssheet.

Less than two weeks before the Finsbury Park incident, police in Stowmarket found 65-year old carpenter and decorator Richard Pitkin dead. Also dead in the extended family home that used to boast a tea room was Sarah Pitkin, 58. The Pitkins, by report, were well-liked and respected. Police were not looking for anyone else in connection with their inquiries.

White House Farm in Essex, scene of the Bambermurders. The court decided Jeremy had placed the gun in his dead sisters hands to make it look like murder-suicide (Rex)

Stowmarket is a fairly small Suffolk town. Wolverhampton, by contrast, is a city of 250,000 inhabitants. But, just three days after news of the Stowmarket tragedy, the people of Wolverhampton were nonetheless alarmed to read in their copies of the Birmingham Mail: Man killed sister and knifed mum before killing himself.Had citizens and neighbours in that part of the Black Country turned to The Sun, even less would have been left to their imaginations: Maniac knifeman stabbed his sister to death and injured his mum before turning blade on himself in bloodbath at flat.

***

So in cases where there is family annihilation, what is it and why and why does it happen?

One of the most infamous family annihilations evertook place in sprawling White House Farm, Essex, on 7 August 1985. Sheila Bamber, her parents Neville and June Bamber, and her sons Nicholas and Daniel, were all killed that fateful day. Worse, Sheilas brother Jeremy Bamber, then aged 24, apparently staged everyones murder as if Sheila herself were the culprit. Homicide/suicide, surely? Police who initially attended the scene ironically in response to a panicked-sounding telephone call from Jeremy seemed content to accept that interpretation.

For weeks lasting into months, that narrative amazingly stayed unchallenged; and it is fair to say the incarcerated Bamber still maintains his absolute innocence three decades after his belated conviction. Five years ago this spring, his lawyers failed in their most recent attempt to gain his acquittal, or at least his release, this time before the European Court of Human Rights.

Conventional instances of homicide/suicide where the perpetrator cannot go to jail because he it is statistically far more likely to be a he is already dead, either at the scene of horror or perhaps at some secluded beauty spot nearby tend to have 10 common features.

The historical cases show is that in murder-suicides, first, the killer is, as said, likely to be a man: where familial, a son, brother or father rather than daughter, sister or mother. Second, isolation is frequently a factor, if not the deciding factor: geographical isolation, psychological or psychiatric isolation, perceived isolation within the family bullying, deprivation, marginalisation, or isolated status, disgrace.

Newspapers offer lurid headlines on the act, but rarely shed light on motive

Third, often the perpetrator is consumed with hatred: sometimes hatred is fuelled by resentment. And, fourth, one influence persuading someone to attack his own family so viciously is frequently a grudge: expulsion from the home, threatened separation, refusal of money, not being mentioned in a will, unfair accusations, a partners alleged infidelity or even something as trivial as youre forever nagging.

Fifth, the instrument of death is more often than not extremely violent: gun, sword, knife or hammer are preferred over suffocation or gassing. However, in recent years, fire appears to have been used more, perhaps because perpetrators are more aware of the importance of destroying DNA evidence, and with the terrible bonus that it is the fire or the smoke or both doing the killing, not the instigator.

Sixth, typically escape routes are blocked, and a time chosen when the family are near-at-hand, sleeping or watching TV. Keys are hidden. Those who rush upstairs are pursued. And those who rush downstairs are trapped. Elaborate precautions are taken that a getaway car is not to hand except for the killers use. Also, that killer needs to be faster down the street were one of his intended victims to achieve temporary freedom.

Seventh, it is likely that there have been lesser preparatory and experimental attacks before the final showdown. For example, survivors of domestic violence typically endure between 20 and 200 assaults before sounding the alarm and calling on neighbours, trusted siblings, or the police. Perhaps the family car is in an inexplicable crash. Or prowlers, maybe suspected of mere rogue-trading or peeping Tom-ery, are been seen near the later site of execution.

In the 1977 Pottery Cottage murders, Billy Hughes (inset) butchered a family in Eastmoor, near Baslow in Derbyshire (Derby Telegraph)

Eighth, pleas for mercy are routinely and callously ignored. Ninth, the perpetrator usually neither expects nor tolerates retaliation. He likely relies on past romance or deep-seated trust placed in him as one of us to deter any last-minute fracas.

Womens aid, womens assertiveness, women survivors, and womens self-defence groups place emphasis on attempting realistic self-protection. Naturally it is a truism that fighting back is risky, statistically abortive, sometimes provocative prior to an even worse fate, or very occasionally peremptory: a false alarm. Nobody should expect doomed family members always to have a heavy chair or flower-pot to hand but advice is sensibly given that if you are going to die in any case, you might as well attempt some resistance. And there is rare forensic evidence that the escaping man, whether or not he later self-harms or takes his own life, bears scratches, bruises, cuts or organ-damage that must have been inflicted by one, more, or even all, his targets.

Finally and disturbingly, tenth, if the killer dies during or following his act of family annihilation, could well be set to be rather than blamed: Poor soul ; Must have borne terrible suffering in the Army, at work, as a child....; Moment of madness ; Wonderful dad ; Not round to put the record straight, whatever. And this (probably undeserved) taking into account of past misfortune has possibly been orchestrated by the killer long before the act. Maybe letters have been written, certificates displayed, thousands of pounds raised for charity, compensation successfully awarded... anything to perpetuate a story of awful injustice, noble self-abnegation, valid self-sacrifice.Because the killers unbelievable yet curiously tenable accomplishment is to write the first version of history.

History he has himself fulfilled. History he has himself shaped. Maybe history could supply us with detailed statistics for (a) homicide/suicides; and (b) whole- family killings not attributed to an integral, or past, members of those threatened families?No such fortune. Whereas homicides (murders) appear in one table of figures, Suicides (sometimes attempted suicides) appear in other lists. Even then, statistic-gathering is chaotic, partly due to coroners hesitant to issue suicide verdicts.

Do other countries perhaps keep better records? No. What we do know is that family annihilation is occasionally cultural; also imitative. South Africa is blighted with two kindred phenomena: isolated Boer and/or white men, on the margins, killing their entire families then themselves; alternatively, a son: not impossibly a black or mixed-race son, killing his parents, maybe his siblings as well, with appropriation of assets an attributed motive.

As for the US, comparisons with UK family-killings are ever more fraught with difficulty. Guns and harmful weapons far more available than in Britain, and spree-killings of all types are hard to separate out from targeted killings of a culprits relatives, say with one or two bystanders also killed or injured. Home invasions in the States are certainly frequent but as few as 100 people each year die as a direct consequence of burglary or attempted burglary within the broken-into home; compared with at least 18,000 US suicides labelled suicides each year.

The Laitner familly at Suzannes (centre) 1983 wedding in Sheffield. Basil (left) along with Richard and Avril (right) were murdered hours later

Is alcohol an important component, giving the instigator more courage? Or are perpetrators drug-dependent? The jury is still out over mitigation. Who knows whether a killer with little or no regard to his own safety, his own discovery, his own lifespan, would have been more restrained with more inhibitions. Harmful substances certainly dont seem to reduce instances of family annihilation or their intensity.

***

So where do my 10 common factors leading to family annihilation leave we who survive; we the relations and friends who are not subject to our own familys annihilation or someone elses; we who read about it from the comfort of our armchairs; we who are safe, secure, cherished and uplifted at home? A difficult quandary. Arguably, more difficult in the aftermath of family annihilation than in the wake of almost any other crime, any other catastrophe, even any other unforeseeable disaster.

Nor do the police, the courts, psychiatrists, or social workers those whose daily employment is to help those in distress, but not this degree of distress give the rest of an easy lead; give us reasons, perhaps in reply to that familiar plea: give us a clue! Society buries family annihilation (undertakers, literally) because the subject is too painful; it is seemingly too far beyond comprehension. Maybe falsely, family annihilation is considered a flash-in-a-pan; perhaps it is put down far too quickly to the mental illness of which it is so obviously a manifestation; and crucially there is rarely a survivor, less so an attendant survivor, to enlighten either the authorities or the public.

Police, press, parliament, the Church, social services, the NHS, everyone most likely to be listened to, can usefully move on to more pressing issues because there is there is nobody to prosecute, and/or nobody who can be subject of a child protection conference, and/or nobody who can be reassessed as a risk; or else the intentional killer who is an accidental or purposeful survivor makes a full confession. In which case there are only three available disposals: long-termimprisonment, enduring committalto hospital, or leeway enough, without intention, for the prisoner to finally take his own life (far more likely, statistically, if he lived through an initial attempt so to do).

Ironically, societys certainty thatits all over and done with militates against prevention, mitigation, avoidance, of family annihilation in the future. So onlookers and professionals alike are tempted to close the chapter, to let bygones be bygones. Instead, it is beholden on everyone to take account of warning signs: buildups of spite and resentment; previous domestic violence; acrimonious divorce and separation; bankruptcy; custody and access sessions denied or giving rise to concern; threats.

Because threats are not always empty. What everyone takes to be bragging, bad-mouthing, intimidation or hyperbole might actually be a signpost to future family annihilation. So statutory reviews must in future be held before the event, not after.

***

Which brings me to my own commitment to find out more concerning family annihilation. That prompt came from four instances a little too near where I lived for comfort.

2017 marks 40 years after escaped prisoner Billy Hughes, now deceased, took a family hostage at a cottage in Eastmoor, near Baslow in Derbyshire, butchering Grandma, Grandad, the couples son-in-law and their granddaughter. Only Mum survived the Pottery Cottage Murders, even she within seconds of her own shooting or knifing. And Eastmoor is just four miles up the road from where for more than three decades we made our home.

The Shropshire estate at which in 2008 a millionaire with business problems murdered his wife and daughter before shooting dead their dogs and horses, setting fire to the house, and finally killing himself (PA)

Six years later came the Dore Wedding Day Massacre. A talented pupil taught by my wife crouched in her bedroom, in an affluent suburb of Sheffield, towards the end of the family celebrations that crowned her elder sisters marriage ceremony just hours earlier, and listened, listened, as every single member of her cherished family to hand solicitor father, doctor mother, older brother faced arbitrary execution at the other side of her hasty barricade. Grim. With worse for this young woman still to come. And all at the hands of a robber not a relative.

Came the day 10 years after that: at the time a I was a local government officer charged with supervising three childrens access to their mother at a voluntary-funded contact centre. I was returning from the centre when I heard that, in a lay-by just a few miles down the same road I was driving along, a jealous father, also a centre user, had had set light to himself and his two sons by a woman he had acrimoniously split from within the exactly parked care he had used for access to the children. Three bodies discovered within. No lads able to survive their ordeal, survive their access, and see their mother again; nor chance that mother should encounter, look after, love, her boys again. Total immolation. Total elimination.

One final coincidence: from 2011 to 2014, when I needed my car in the evening, I chose to park it at the other end of the alley opposite where Id moved to. And one enchanting summer afternoon, the cul-de-sac was full of police cars, sentries, men in white suits. I had not consciously registered the house before. It was semi-detached, privately owned, on the outer edge of a large post-war municipal estate. In succeeding days, I soon learnt Stepdad had murdered the widowed shopkeeper he had recently married, then laid on the same bed and stabbed himself to death. All because she had told him she had had enough.

In the face of such terrible calumny, in the light of such unimaginable discoveries, most observers, most survivors, most people holding Twitter or Facebook accounts, most readers of newspapers, will remain baffled as to why anyone, anywhere, would want to take them (those the murderer has known or loved) all with me thus releasing them from agony. Is this really the freedom from oppression a crazed killer yearns for? Or is this too speedy an escape from lifes trials and tribulations; too convincing a hope of a Better World than that into which we were all born?

Purportedly, family annihilation, family extinction, is absolute love absolute hatred? expressed absolutely. And whatever the reasoning behind it, this is an act committed so suddenly, so ruthlessly, so wilfully, it permits no second thoughts. No opportunity for reverse. No retrieval.

1) Christopher, aged 50, shot dead his wife, 49, and daughter, 15, before gunning down their horses and dogs and then setting alight his 1.2m Shropshire home in 2008. The former mattress and pizza-box salesman had made himself into a millionaire, but his business interests collapsed, leaving him in 4m of debt. Some say he killed his family in a crazed attempt to protect them from poverty they were about to face. The killer was caught on CCTV on the night of the blaze walking his mansion's grounds carrying a bucket, a rifle and lighter fluid for setting the fire.

2) The bodies of a mother, 44, her son, 13, anddaughter, nine, were found in February 2011. The mothers husband was working abroad. Police broke into the familys detached house, in the Midlands, after they were contacted by a concerned relation. The children were found in their bedrooms with stab wounds to their neck and chest. Their mother, a devout Roman Catholic, was in the bathroom with multiple knife wounds to her arms. An inquest heard that the womans mother called police after she was unable to contact her daughter. Police investigated the tragedy as a suspected double homicide-suicide.

3) A report into the care of a North-east of England ex-soldier, who shot dead four members of his family in 2006, found failings in the mental health care he received. David, 41, killed his aunt and uncle, both 70, and their sons Davids cousins aged 41 and 44. He was sentenced to a minimum term of 15 years after admitting manslaughter. There was a lack of communication between agencies.

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The anatomy of family murder - the patterns and warning signs | The ... - The Independent