From the 14 November 2014 University of Florida press release:
From the 12 November 2014 University of Florida press release
ClinicalTrials.gov currently contains registration information for more than 178,000 clinical trials and summary results for more than 15,000. These numbers include trials that are not subject to FDAAA. Among the primary benefits of registering and reporting results of clinical trials, including both positive and negative findings, is that it helps researchers prevent unnecessary duplication of trials, particularly when trial results indicate that a product under study may be unsafe or ineffective, and it establishes trust with clinical trial participants that the information from their participation is being put to maximum use to further knowledge about their condition.
Developed by NIH in close coordination with the FDA, the proposed rule details procedures for meeting the requirements established by FDAAA to improve public access to clinical trial information. FDAAA and the proposed rule apply to certain interventional studies of drugs, biological products, and devices that are regulated by the FDA, but, generally, not to phase 1 trials of drugs and biological products and small feasibility studies of devices. The proposed rule specifies how data collected and analyzed in a clinical trial would be required to be submitted to ClinicalTrials.gov. It would not affect requirements for the design or conduct of clinical trials or for the data that must be collected during clinical trials.
“This proposed rule would close an important gap, making additional information about clinical studies of investigational drugs, medical devices and biological products available to the public,” said FDA Commissioner Margaret A. Hamburg, M.D. “It would help eliminate unnecessary duplicative trials, advance biomedical innovation, and provide the public with a much richer understanding about the clinical trials for these products.”
Notable changes from current requirements and practice that are outlined in the proposed rule include:
A streamlined approach for determining which trials are subject to the proposed regulations and who is responsible for submitting required information.
Expansion of the set of trials subject to summary results reporting to include trials of unapproved products.
Additional data elements that must be provided at the time of registration (not later than 21 days after enrolling the first participant) and results submission (generally not later than 12 months after completion).
Clarified procedures for delaying results submission when studying an unapproved, unlicensed, or uncleared product or a new use of a previously approved, licensed, or cleared product and for requesting extensions to the results submission deadline for good cause.
More rapid updating of several data elements to help ensure that users of ClinicalTrials.gov have access to accurate, up-to-date information about important aspects of a clinical trial.
Procedures for timely corrections to any errors discovered by the responsible party or by the Agency as it processes submissions prior to posting.
Read a summary of the proposed changes: http://www.nih.gov/news/health/nov2014/od-19_summary.htm.
Read the entire text of the proposed regulations here. Options are available for comment submission electronically or in written form.
The release of the results of the study coincides with World Pneumonia Day, commemorated annually on 12 November.
The study, titled: Effects of Vaccination on Invasive Pneumococcal Disease in South Africa, published in the latest edition of the New England Journal of Medicine (NEJM), compares IPD incidence after the introduction of PCV (post-introduction: 2011 and 2012) to incidence prior to its introduction (2005-2008), focusing on high-risk groups.
Although the majority of childhood pneumococcal deaths occur in Africa, evidence of the potential impact of pneumococcal vaccines in routine use has largely been drawn from high-income countries. However, two recent publications from South Africa have demonstrated PCVs to be effective in preventing pneumococcal disease among South African children, in conditions of routine vaccine use.
“The results show that the vaccine works as rolled out in our immunization program and this supports the hard work of our national and provincial Departments of Health. However, much still remains to be done in South Africa, other countries in Africa and elsewhere to prevent children from developing and dying from pneumonia,”said Dr Anne von Gottberg, lead author of the paper, Clinical Microbiologist, Head of the Centre for Respiratory Diseases and Meningitis at the NICD and Associate Professor in the School of Pathology at Wits.
This study demonstrates significant declines in pneumococcal disease cases caused by bacteria resistant to one or more antibiotics, a phenomenon of growing concern among health professionals. In fact, the rate of infections resistant to two different antibiotics declined nearly twice as much as infections that could be treated with antibiotics. This proportionately greater effect of vaccination on antibiotic-resistant strains points to a very valuable added benefit of immunization.
“These are very compelling results,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, a Geneva-based global health organization that part-funded the research. “Not only does it add significant weight to the growing body of evidence that PCV prevents disease, but it suggests that vaccines may have a role to play in the fight against antibiotic resistance.”
“Vaccination is one of the most effective and underappreciated tools available to reduce antibiotic resistance. The majority of resistant strains of pneumococcus are of types which are included in the vaccine, for this reason, vaccine introduction in South Africa, has led to a substantial decline in antibiotic resistant invasive pneumococcal disease,” said Dr Cheryl Cohen, co-author of the paper, Clinical Epidemiologist at the NICD and senior lecturer in the School of Public Health at Wits.
In 2009, South Africa became the first African country – and the first nation in the world with a high HIV prevalence – to introduce PCV7 into its routine immunization program. The current study shows a significant decline in IPD in children and in unvaccinated adults, which demonstrates the indirect protection conferred by herd immunity. Among children under two years of age, overall incidence of IPD declined nearly 70% after PCV introduction, and rates of IPD caused by bacteria specifically targeted by the vaccine plummeted nearly 90%.
A recent study published by the researchers in the Pediatric Infectious Disease Journal found that the risk of IPD in South African children increased with HIV exposure, as well as with underlying medical conditions, malnutrition, tuberculosis, upper-respiratory tract infections and exposure to other children.
“We have shown that HIV-infected and HIV-exposed children experience a disproportionate burden of pneumococcal disease. The vaccine has also been shown to be highly effective in HIV-exposed children and disease reductions have been observed in both HIV-infected and uninfected children,” said Dr Claire von Mollendorf, a medical epidemiologist from the NICD. “This study reinforces what the scientific community has known – that the pneumococcal vaccine saves lives.”
Although incidence of HIV among infants is decreasing in South Africa due to improved prevention of the mother-to-child HIV transmission and the use of anti-retrovirals, a large number of HIV-exposed yet uninfected children remain, for whom vaccination against pneumococcal disease may be of particular importance to ensuring reduced risk of life-threatening infections in childhood.
Date: November 12, 2014Source: University of NottinghamSummary: It is claimed one in five students have taken the ‘smart’ drug Modafinil to boost their ability to study and improve their chances of exam success. But new research into the effects of Modafinil has shown that healthy students could find their performance impaired by the drug.
GAINESVILLE, Fla. – Internet lessons and “tailored” text alerts can help some young people adopt healthier lifestyles, according to a national study aimed at preventing weight gain.
Although experimental group students didn’t gain or lose more weight than their control group counterparts, researchers remain hopeful the Internet-message approach can work because it helped college students progress from what researchers call the “contemplative stage” to the “action stage.”
An example of the contemplative stage would be someone who’s thinking about trying to eat fatty foods less frequently, but hasn’t taken action to do so, while someone at the action stage would choose to eat a salad, instead.
In the study, students aged 18-24 received individually targeted messages. Some students were in the “pre-contemplative” stage; others fell into the “action” stage, while others were in various stages between those two.
The study, published online last week in the Journal of Nutrition Education and Behavior, found more students who received the Web messages ate more fruits and vegetables and were more physically active than those in the control group.
Researchers weren’t as concerned about students losing weight as they were with giving them strategies to lead healthier lives to prevent weight gain, said Karla Shelnutt, a University of Florida assistant professor in family, youth and community sciences.
Date:November 12, 2014Source:ETH ZürichSummary:Medicine is drifting towards a major problem. An increasing number of bacteria is no longer sensitive to known antibiotics. Doctors urgently need to find new ways of fighting these multi-resistant pathogens. To address the problem, pharmaceutical research is turning back to the source of most of our drugs: nature.
Although hundreds of thousands of known active agents are found in nature, exactly how most of them work is unclear. A team of researchers from ETH Zurich has now developed a computer-based method to predict the mechanism of action of these natural substances. The scientists hope this method will help them to generate new ideas for drug development. “Natural active agents are usually very large molecules that often can be synthesized only through very laborious processes,” says Gisbert Schneider, a professor of computer-aided drug design at the Institute of Pharmaceutical Sciences at ETH Zurich. An understanding of the exact mechanism of action of a natural substance enables the design of smaller, less complex molecules that are easier to synthesize. Once a substance is chemically synthesized, it can be optimized for medical applications.
In order to understand the mechanism of action, researchers are studying which parts of a pathogen interact with the natural substance to inhibit its growth for example. In the past, this involved highly complex laboratory tests through which scientists usually identified only the strongest effect of a substance. However, this interaction alone is often unable to explain the entire effect of a natural substance. “Minor interactions with other target structures can contribute to the overall effect as well,” explains Schneider.
“By using the computer to break down the molecules, which can be quite large, into separate building blocks, we discover which parts might be essential for the mechanism of action,” says Schneider. Thus, it might be possible to design less complex molecules that chemists could synthesize instead of the laborious process of isolating them from the natural source.
Analysis of 210,000 natural substances
Using the computer-based method, the researchers led by Gisbert Schneider were able to predict a variety of potential target structures for 210,000 known natural substances.
Date:November 10, 2014Source:Center for BrainHealthSummary:The effects of chronic marijuana use on the brain may depend on age of first use and duration of use, according to new research. Researchers for the first time comprehensively describe existing abnormalities in brain function and structure of long-term marijuana users with multiple magnetic resonance imaging (MRI) techniques.
Date:November 10, 2014Source:Sissa MedialabSummary:Recognizing the emotions other people feel is crucial for establishing proper interpersonal relations. To do so, we look at (amongst other things) facial expressions and body posture. Unfortunately, in some neurological disorders this ability is heavily impaired. This happens, for example, in multiple sclerosis where scientific evidence shows that people affected by the disease often have trouble recognizing expressions that communicate emotions. A new study now demonstrates that the same difficulty may also be encountered with emotions conveyed by posture.
As discussed in one of my previous posts, the promotion of quackery is so ubiquitous in my town it’s become white noise for me. I mostly tune it out unless I’m personally asked my opinion. Often this promotion comes in the weekly newspaper, in the advertising-disguised-as-advice page “Ask the Expert.” Occasionally there are columns by financial advisors and home improvement experts, but by far the majority of “expert advice” comes from chiropractors, naturopaths, Chinese Medicine practitioners, and holistic nutritionists. One regular advertiser is a local who calls herself a “Divine Healer”. She has some initials after her name, none of which I can trace back to any actual licenced health profession, degree or diploma. Her services include reflexology, mediumship, craniosacral therapy, aromatherapy and card-reading. She also offers a special massage called “vibrational raindrop technique” which apparently involves the use of essential oils and tuning forks or singing bowls.
This actually sounds like it might be kind of relaxing and entertaining. Something I would personally never pay the money for, but harmless, right? Earlier this year, however, a local public health nurse who I consider a kindred spirit based on our views of alternative medicine contacted me about the weekly claim. In the wake of a severe local flu outbreak and depletion of vaccine supply, the healer recommended an essential oil called “Thieves” claiming that “research shows that it has a 99.96 percent kill rate against airborne bacteria – interrupting the life cycle and interfering with the ability of viruses to replicate.” Further information available on her website goes on to describe how you can boost your immune system by placing a few drops on your feet every morning (this old wives’ tale makes me shake my head, every time I read it – which is too often).
Also provided are several recipes for making your own capsules with various essential oils which you should then take three times a day if you actually become sick. In bold, she warns that you must never take essential oils internally unless they are Young Living brand, which of course, is the brand that she represents. I found that information to be very interesting, considering the Health Canada guidelines for approval for aromatherapy essential oils clearly states that they are for topical or inhalation only. Also interesting is the fact that Young Living doesn’t appear to have an NPN for Thieves.
Young Living has also been under fire recently from the FDA for boldly claiming that Thieves can kill Ebola. While the letter from the FDA may prompt some correction at their top level, I doubt the message has trickled down to their thousands of distributors who will still likely be selling it any way they can, and that really is the modus operandi of all multi-level marketing schemes. Dr. Harriet Hall discussed a similar MLM company, and states:
From the 6 November 2014 press release
Source:University of SheffieldSummary:Future ozone levels could be high enough to cause serious damage to plants and crops, even if emissions of greenhouse gases are reduced, says new research. And without sufficient reductions in emissions, ozone levels could also pose a risk to human health.
y combining projections of climate change, emissions reductions and changes in land use across the USA, an international research team estimate that by 2050, cumulative exposure to ozone during the summer will be high enough to damage vegetation.
Although the research findings — published in Atmospheric Chemistry and Physics Discussions — focus on the impact in the USA, they raise wider concerns for global air quality, according to lead researcher Dr Maria Val Martin, from the University of Sheffield’s Faculty of Engineering
“Modelling future air quality is very complex, because so many factors need to be taken into account at both a global and local scale,” says Dr Val Martin. “The picture isn’t uniform across the USA, with some areas seeing much higher surface ozone levels than others. However, our findings show that the emissions reductions we’re expecting to achieve won’t guarantee air quality on their own, as they will be offset by changes in climate and land use and by an increase in wildfires. This is an issue that will affect all parts of the world, not just the USA.”
The research looked at air quality under two scenarios set out by the Intergovernmental Panel on Climate Change: one which envisages greenhouse gas emissions peaking in 2040 and then falling, the other in which emissions continue to rise until 2100. The team combined data on climate change, land use and emissions to create a picture of air quality across the USA in 2050.
The model showed that, if greenhouse gas emissions peak in 2040, then by 2050 surface ozone will remain below levels set to safeguard human health, despite increases in ozone caused by higher temperatures and changes in agriculture and forestation. If emissions continue to rise until 2100, then some areas of the USA will see surface ozone above the safe levels set for human health.
Three scenarios depicting the simulated spread of a simple epidemic from a single point outbreak. Long-range jumps — mimicking air travel, for example — lead to sub-outbreaks. If long-distance jumps are rare, the main outbreak will quickly merge with the satellite outbreaks, leading to a rippling, wave-like growth (left). As the likelihood of long-distance jumps increases, the epidemic spread exhibits a super-linear power-law growth (center) or a stretched exponential or “metastatic” growth. (Simulations by Oskar Hallatschek, UC Berkeley, and Daniel Fisher, Stanford. Video editing by Christian Collins.)
From the 4 November 2014 UC Berkely press release
Robert Sanders, Media Relations
The current Ebola outbreak shows how quickly diseases can spread with global jet travel.
Yet knowing how to predict the spread of these epidemics is still uncertain, because the complicated models used are not fully understood, says a UC Berkeley biophysicist.
Using a very simple model of disease spread, Oskar Hallatschek, assistant professor of physics, proved that one common assumption is actually wrong. Most models have taken for granted that if disease vectors, such as humans, have any chance of “jumping” outside the initial outbreak area – by plane or train, for example – the outbreak quickly metastasizes into an epidemic.
Hallatschek and co-author Daniel Fisher of Stanford University found instead that if the chance of long-distance dispersal is low enough, the disease spreads quite slowly, like a wave rippling out from the initial outbreak. This type of spread was common centuries ago when humans rarely traveled. The Black Death spread through 14th-century Europe as a wave, for example.
But if the chance of jumping is above a threshold level – which is often the situation today with frequent air travel –the diseases can generate enough satellite outbreaks to spread like wildfire. And the greater the chance that people can hop around the globe, the faster the spread.
“With our simple model, we clearly show that one of the key factors that controls the spread of infection is how common long-range jumps are in the dispersal of a disease,” said Hallatschek, who is the William H. McAdams Chair in physics and a member of the UC Berkeley arm of the California Institute for Quantitative Biosciences (QB3). “And what matters most are the rare cases of extremely long jumps, the individuals who take plane trips to distant places and potentially spread the disease.”
From the 6 November 2014 EurekAlert!
Study shows integrative medicine relieves pain and anxiety for cancer inpatients
Pain is a common symptom of cancer and side effect of cancer treatment, and treating cancer-related pain is often a challenge for health care providers.
The Penny George Institute for Health and Healing researchers found that integrative medicine therapies can substantially decrease pain and anxiety for hospitalized cancer patients. Their findings are published in the current issue of the Journal of the National Cancer Institute Monographs.
“Following Integrative medicine interventions, such as medical massage, acupuncture, guided imagery or relaxation response intervention, cancer patients experienced a reduction in pain by an average of 47 percent and anxiety by 56 percent,” said Jill Johnson, Ph.D., M.P.H., lead author and Senior Scientific Advisor at the Penny George Institute.
“The size of these reductions is clinically important, because theoretically, these therapies can be as effective as medications, which is the next step of our research,” said Jeffery Dusek, Ph.D., senior author and Research Director for the Penny George Institute.
The Penny George Institute receives funding from the National Center of Alternative and Complementary Medicine of the National Institutes of Health to study the impact of integrative therapies on pain over many hours as well as over the course of a patient’s entire hospital stay.
“The overall goal of this research is to determine how integrative services can be used with or instead of narcotic medications to control pain,” Johnson said.
Researchers looked at electronic medical records from admissions at Abbott Northwestern Hospital between July 1, 2009 and December 31, 2012. From more than ten thousand admissions, researchers identified 1,833 in which cancer patients received integrative medicine services.
Patients were asked to report their pain and anxiety before and just after the integrative medicine intervention, which averaged 30 minutes in duration.
Patients being treated for lung, bronchus, and trachea cancers showed the largest percentage decrease in pain (51 percent). Patients with prostate cancer reported the largest percentage decrease in anxiety (64 percent).
Two-year study of urban teens & young adults shows high risk of additional violent injuries among assault victims, especially those with PTSD or drug use
ANN ARBOR, Mich. — Teens and young adults who get seriously injured in an assault are nearly twice as likely as their peers to end up back in the emergency room for a violent injury within the next two years, a new University of Michigan Injury Center study finds.The study followed nearly 600 teens and young adults for two years after an emergency room visit for an assault injury or other condition. The assault group’s members were twice as likely to suffer another violent injury – most within 6 months.
The researchers call this repeating pattern of violent injury a reoccurring disease, but their landmark study also suggests potentially powerful opportunities to intervene in ways that could stop the cycle.
The first six months after a young person seeks care for a violence-related injury is an especially important time, the study shows.
Patients with post-traumatic stress disorder or drug abuse problems have the highest likelihood of suffering injuries in another violent incident, the researchers find.
The findings come from a unique effort that involved multiple interviews and medical record chart reviews conducted over two years with nearly 600 residents of the Flint, Mich. area between the ages of 14 and 24 — starting when each one sought emergency care at a single hospital. Nearly 350 of them were being treated for assault injuries at that first encounter.
Rebecca Cunningham, M.D., director of the U-M Injury Center and first author of the new paper, notes that it’s the first prospective study of its kind, and 85 percent of the young people enrolled were still in the study at 24 months. Five of the participants died before the study period ended, three from violence, one from a drug overdose, and one in a motor vehicle crash.
“In all, nearly 37 percent of those who qualified for this study because they were being treated for assault-related injuries wound up back in the ER for another violent injury within two years, most of them within six months,” says Cunningham, who is a Professor in the Department of Emergency Medicine at the U-M Medical School and the Department of Health Behavior and Health Education in the U-M School of Public Health.
“This ER recidivism rate is 10 percentage points higher than the rate for what we traditionally call chronic diseases,” she continues. “Yet we have no system of standard medical care for young people who come to us for injuries suffered in a violent incident. We hope these data will help inform the development of new options for these patients.”
The authors note that non-fatal assault-related injuries lead to more than 700,000 emergency visits each year by youth between the ages of 10 and 24. Fatal youth violence injuries cost society more than $4 billion a year in medical costs and $32 billion in lost wages and productivity.
Despite this costly toll, most research on how often the cycle of violent injury repeats itself, and in which young people, has relied on looking back at medical records. This has resulted in widely varying estimates of how big the problem is.
But through the Flint Youth Injury Study, based at U-M, the research team was able to study the issue prospectively, or starting with an index visit and tracking the participants over time.
The study was performed at Hurley Medical Center in Flint, where Cunningham holds an appointment and where U-M emergency physicians work with Hurley staff to provide care.
The study’s design allowed them to compare two groups — those whose index visit was for assault injuries and those seen for other emergency care. Each time a new assault victim was enrolled, the research team sought to enroll the next non-assault patient of the same gender and age range who was treated at the same ER.
Nearly 59 percent of the participants were male, and just over 58 percent were African American, reflecting the broader population of Flint. Nearly three-quarters of those in the study received some form of public assistance.
Among those whose first visit was for assault, nearly 37 percent wound up back in the ER for violent injuries in the next two years, compared with 22 percent of those whose first visit wasn’t for an assault injury. And a larger proportion of the “assault group” actually came back more than once for violent injuries, compared with the other group.
“Future violence interventions for youth sustaining assault-related injury may be most effective in the first six months after injury, which is the period with the highest risk for recidivism,” says Maureen Walton, MPH, Ph.D. senior author and associate professor in the U-M Department of Psychiatry. “These interventions may be most helpful if they address substance use and PTSD to decrease future morbidity and mortality.”
Swallowing a sponge on a string could replace traditional endoscopy as an equally effective but less invasive way of diagnosing a condition that can be a forerunner of oesophageal cancer.
“[The Cytosponge test] should be considered as an alternative to endoscopy for diagnosing the condition and could possibly be used as a screening test in primary care.” – Professor Rebecca Fitzgerald, lead author.
The results of a Cancer Research UK trial involving more than 1,000 people are being presented at the National Cancer Research Institute’s annual conference (link is external) in Liverpool.
The trial invited more than 600 patients with Barrett’s Oesophagus – a condition that can sometimes lead to oesophageal cancer – to swallow the Cytosponge and to undergo an endoscopy. Almost 500 more people with symptoms like reflux and persistent heartburn did the same tests.
The Cytosponge proved to be a very accurate way of diagnosing Barrett’s Oesophagus. More than 94 per cent of people swallowed the sponge and reported no serious side effects. Patients who were not sedated for endoscopy were more likely to rate the Cytosponge as a preferable experience.
Lead author Professor Rebecca Fitzgerald, based at the MRC Cancer Unit at the University of Cambridge, said: “The Cytosponge test is safe, acceptable and has very good accuracy for diagnosing Barrett’s Oesophagus. It should be considered as an alternative to endoscopy for diagnosing the condition and could possibly be used as a screening test in primary care.”
Barrett’s Oesophagus is caused by acid coming back up the food pipe from the stomach – known as acid reflux – which can cause symptoms like indigestion and heartburn. Over time people with these symptoms may develop changes in the cells that line the oesophagus. These cells can become cancerous and so patients with Barrett’s Oesophagus are tested every couple of years.
Barrett’s Oesophagus is usually diagnosed by having a biopsy during an endoscopy. This can be uncomfortable and carries some risks – and it’s not always practical for everyone who has symptoms like reflux and heartburn.
Oesophageal cancer is the thirteenth most common cancer in the UK. Around 5,600 men develop the disease each year compared with 2,750 women. And each year around 5,200 men and 2,460 women die from the disease.
Dr Julie Sharp, Cancer Research UK’s head of health information, said: “These results are very encouraging and it will be good news if such a simple and cheap test can replace endoscopy for Barrett’s oesophagus.
“Death rates are unacceptably high in oesophageal cancer so early diagnosis is vital. Tackling oesophageal cancer is a priority for Cancer Research UK and research such as this will help doctors to diagnose people who are at risk quickly and easily.”
Flu infection has long-ranging effects beyond the lung that can wreak havoc in the gut and cause a dreaded symptom, diarrhea, according to a study published in the Journal of Experimental Medicine.
Gastrointestinal symptoms are often seen with flu infection, but because the virus only grows in lung cells, it’s unclear how intestinal symptoms develop. Researchers in China now show that flu infection in mice prompts responding immune cells in the lung to alter their homing receptors, causing them to migrate to the gut. Once there, they produce the antiviral mediator IFN-γ, which alters the natural composition of gut bacteria. In turn, the bacterial changes lead to inflammation that promotes tissue injury and diarrhea. Blocking inflammatory molecules in the intestine or treating mice with antibiotics to deplete bacteria attenuated flu-induced intestinal injury without affecting immune responses in the lung.
Why some flu infected patients develop gastrointestinal symptoms while others do not remains unknown. However, these findings suggest ways to directly relieve intestinal symptoms like diarrhea during flu infection without interfering with the body’s ability to fight the virus in the lung.
Reference: Wang, J., et al. 2014. J. Exp. Med. doi:10.1084/jem.20140625
Next time my physician urges a screening, I’ll wonder if it is because of his concern for my health (most likely- knowing my physician) or his corporation’s interest in profit…
As this article outlines is that physicians in corporations are often
in Catch-22 positions.
thought more highly of business folks until I started working for them. I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc. Once the vision was elucidated, everyone worked together like a team to make it happen.
Then I became employed by a large corporation as a family physician to provide medical care. And it’s been one eye opening experience after another ever since. To me, it’s quite simple. The vision of a medical practice should be to provide good medical care while being cost conscious, and maintaining strong patient satisfaction. That’s how all the money gets generated, right? The patient pays his/her premium, part of which gets funneled to our large corporation, who is then tasked to provide care for that patient. How is care provided to that patient? By having a doctor see, talk to, examine and treat that said patient.
OK. So we all know that it’s not quite that simple. Enter primary care 2014, the world of risk adjustment factor (RAF) scores (which entail the corporation getting paid more for sicker patients), electronic health records (EHR), and quality metric incentive payments (the corporation gets more money from insurance companies by meeting certain goals in screening, like colonoscopies, mammograms, etc.). Now health care has become more complicated. But it’s still all based on that interaction we physicians have with our patients. We can’t meet quality metric goals if we don’t see the patients, we can’t determine if they are sicker and therefore require more funds to care for if we don’t see them, and we can’t use EHR if we don’t see the patient. There’s just a bunch of road blocks and distractions added in….
In 2001, Joshua Lederberg, a Nobel Prize-winning biologist, coined the term “microbiome,” naming the trillions of microorganisms that reside in and on our bodies. Today, if you type that word into Google, you’ll turn up thousands of hits linking gut bacteria to a laundry list of health problems, from food allergies to Ebola. Between 2007 and 2012, the number of journal articles published on the microbiome increased by nearly 250 percent. Our bodily inhabitants are quickly being cast as culprits or saviors for a diverse array of ailments.
Still, despite the optimism, some researchers caution that much of what we hear about microbiome science isn’t always, well, science. Dr. Lita Proctor heads the National Institutes of Health (NIH) Human Microbiome Project (HMP), an outgrowth of the Human Genome Project. “We are discovering a whole new ecosystem,” she says. But “I do have some fear—we all do in the field—that the hype and the potential overpromise, and the idea that somehow this is going to be different—there is a terrific fear that it will all backfire.”
he goal of the first phase of the HMP was to identify the microbial makeup of a “healthy” microbiome. And, in a study published earlier this year, researchers made an important discovery—that there is no such thing. Even among people who were examined and found to be perfectly healthy, each person’s microbiome was unique.
“We were going about it all wrong,” Proctor explains. “It is not the makeup—these communities come together and they actually become bigger than the sum of their parts…It almost doesn’t matter who is present, it just matters what they are doing.”
Jonathan Eisen, a professor and biologist who studies the ecology of microbes at the University of California-Davis, shares Proctor’s concerns. In a series on his blog called “The Overselling the Microbiome Awards,” Eisen highlights what he considers to be skewed science. He has taken on transplants purported to treat multiple sclerosis, celiac disease, and Crohn’s disease. He casts doubt on a study claiming there’s a connection between a mother’s oral hygiene during pregnancy to the health of her newborn. He critiques the notion that you can use bacteria to battle breast cancer, prevent stroke, and cure Alzheimer’s.
Eisen says that one of the most common errors in studies is confusion between correlation and causation. [My emphasis!] “The microbiome has 400 million different variables that you can measure about it,” Eisen explains. “The different sites, the different species, the relative abundance of those species, the variation—if you have that many variables, I can guarantee statistically that some of them will be perfectly correlated with Crohn’s disease and have nothing to do with it.”
From the 31 October 2014 report
The New York Times recently pulled their reportorial and graphics know-how together to do a one-year assessment of the ACA. It concludes: “After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash.”
The package consists of seven sections that run the gamut, with some key numbers and charts. Overall it’s a positive but not uncritical look. The cost section is particularly nuanced, noting the challenges of narrow networks and high deductibles.
Most of these topics we’ve considered on this blog over the last few years. But the series provides a nice, compact overview and handy reference going into the second year.
Here are the seven sections covered, and the nutshell conclusion the Times provided for each.
- Has the percentage of uninsured people been reduced? Yes, the number of uninsured has fallen significantly.
- Has insurance under the law been affordable? For many, yes, but not for all.
- Did the Affordable Care Act improve health outcomes? Data remains sparse except for one group, the young.
- Will the online exchanges work better this year than last? Most experts expect they will, but they will be tested by new challenges.
- Has the health care industry been helped or hurt by the law? The law mostly helped, by providing new paying patients and insurance customers.
- How has the expansion of Medicaid fared? Twenty-three states have opposed expansion, though several of them are reconsidering.
- Has the law contributed to a slowdown in health care spending? Perhaps, but mainly around the edges.
Excerpts from the 29 October 2014 article
Source: Drexel UniversitySummary: Scientists are taking a closer look at aerosol formation involving an organic compound — called limonene — that provides the pleasant smell of cleaning products and air fresheners. This research will help to determine what byproducts these sweet-smelling compounds are adding to the air while we are using them to remove germs and odors.… while researchers are still striving to fully understand the health and environmental impact of increased levels of secondary organic aerosols in the atmosphere, studies have linked exposure to outdoor aerosols generally to morbidity and mortality outcomes.”
““For children, sleep deprivation can lead to behavior problems, trouble focusing and learning in school and it can affect their immune systems,” said Dr. Aneesa Das, a sleep medicine specialist at Ohio State’s Wexner Medical Center. “Chronic tiredness makes it harder to cope and process what’s going on around you.”
When children enter the teen years, sleep becomes a bigger issue. Das says a teen’s circadian rhythm, or internal body clock, tells them to stay awake later and sleep later than children and adults do. She says only 15 percent of teenagers get the recommended sleep they need.
“Sleep is time the body uses to restore itself. Muscles and other tissues repair themselves, hormones that control growth, development and appetite are released. Energy is restored and memories are solidified, so we need to try to get regular sleep on a regular basis,” Das said.
For adults, sleep loss is even more serious. It accumulates over the years and has been shown to contribute to several chronic diseases including heart disease, diabetes, high blood pressure, depression and obesity.”
To improve the chances of getting a good night’s sleep, Das offers a few tips: don’t perform vigorous exercise within four hours of bedtime; have a wind down routine that includes dim light; avoid using tablets, phones and laptops before bed because they emit blue light that interferes with sleep; try a warm bath two hours before bedtime and beware of sleep aid medications because they can have side effects.
Excerpts from the 28 October 2014 article
“Our results may question the validity of recommendations to consume high amounts of milk to prevent fragility fractures,” they write. “The results should, however, be interpreted cautiously given the observational design of our study. The findings merit independent replication before they can be used for dietary recommendations.”
Michaëlsson and colleagues raise a fascinating possibility about the potential harms of milk, says Professor Mary Schooling at City University of New York in an accompanying editorial. However, she stresses that diet is difficult to assess precisely and she reinforces the message that these findings should be interpreted cautiously.
“As milk consumption may rise globally with economic development and increasing consumption of animal source foods, the role of milk and mortality needs to be established definitively now,” she concludes.”
A glass of milk Français : Un verre de lait (Photo credit: Wikipedia)
Excerpt from the commentary by M. Christopher Roebuck, PhD, MBA
Taking some types of vitamin supplement may make it harder to train for big endurance events like marathons, researchers in Norway suggest.
They said vitamins C and E should be used with caution as they may “blunt” the way muscles respond to exercise.
However, actual athletic performance was not affected in the 11-week trial leading other experts to questions the research.
The findings were published in The Journal of Physiology.
The team at the Norwegian School of Sport Sciences in Oslo argued vitamin supplements were readily taken and available, but were unsure if they affected athletic ability.
There was no difference in their performance during a Beep test – running faster and faster between two points 20m apart.
However, blood samples and tissue biopsies suggested there were differences developing inside the muscle.
Each muscle cell contains lots of tiny mitochondria which give the muscle cell its energy.
Those taking the supplements seemed to be producing fewer extra mitochondria to cope with the increasing demands placed on the muscle.
However, Mike Gleeson, a professor of exercise biochemistry at Loughborough University, is not convinced.
He said the biggest factor in performance was how fast the heart and lungs could get oxygen to the muscle, not mitochondria.
Johns Hopkins research team reports that major hospitals across the U.S. collectively throw away at least $15 million a year in unused operating room surgical supplies that could be salvaged and used to ease critical shortages, improve surgical care and boost public health in developing countries.
A report on the research, published online Oct. 16 in the World Journal of Surgery, highlights not only an opportunity for U.S. hospitals to help relieve the global burden of surgically treatable diseases, but also a means of reducing the cost and environmental impact of medical waste disposal at home.
The fact of surgical supply waste is nothing new, the researchers note, but say their investigation may be one of the first systematic attempts to measure the national extent of the problem, the potential cost savings and the impact on patients’ lives. While several organizations run donation programs for leftover operating room materials, such efforts would be far more successful if they were made standard protocol across all major surgical centers, the authors say.
“Perfectly good, entirely sterile and, above all, much-needed surgical supplies are routinely discarded in American operating rooms,”
The researchers tracked outcomes among 33 Ecuadorian patients whose surgeries were made possible as a result of the donations. Their analysis showed that donated surgical supplies prevented, on average, eight years of disability per patient.
In the study, materials topping the 19-item surgical supplies list included gauze, disposable syringes, sutures and surgical towels. However, the investigators say, it is important to tailor shipping to the specific needs of each hospital. Matching of donor leftovers to recipient need, they say, will prevent unnecessary shipping costs and avoid creating medical waste locally. In addition, the receiving hospital must have a demonstrated capability and the equipment to clean and sterilize the shipped materials before use in the operating room.
n 2011, the Institute of Medicine reported that 100 million Americans have chronic pain. The authors explained that the disparity between the estimated pain incidence in their study and what the IOM reported is attributable almost entirely to differences in operational definitions of persistent pain.
In the 2010 NHIS, an estimated 60 percent of adults reported lower back pain in the past three months, and all of them would have been described in the IOM report as having chronic pain. However, only 42 percent of the NHIS study respondents with back pain described their pain as frequent or daily and lasting more than three months.
From a public health perspective the difference is significant. Those with persistent pain have high rates of work disability, fatigue, anxiety and depression. They also are at higher risk for long-term exposure to and dependency on pain medications.
The authors concluded that measuring pain persistence has policy implications because persistent pain is an indicator of an unmet medical need for pain management in the general population, as well as a risk factor for anxiety and depression.
From the 28 October post
The systematic neglect of culture is the single biggest barrier to advancing the highest attainable standard of health worldwide, say the authors of a major new report on culture and health, led by Professor David Napier, a leading medical anthropologist from University College London (UCL), UK, and published in The Lancet.
Bringing together experts from many different fields, including anthropologists, social scientists, and medics, the Commission is the first ever detailed appraisal of the role of culture in health. The authors argue that cultures of all kinds – not only people’s religious or ethnic identity, but also professional and political cultures – have been sidelined and misunderstood by both medical professionals and society as a whole.
Until now, culture has largely been conceived of as an impediment to health, rather than a central determining feature of it. However, the Commission makes a powerful case to the contrary, showing that culture not only determines health – for example, through its influence on behaviours such as smoking and unhealthy eating – but also defines it through different cultural groups’ understandings of what it means to be well.
Culture is often blamed for clinical malpractice,…
From the 18 September 2014 post at iMedicalapps
A recent trial published in the Journal of the American Medical Association has demonstrated the efficacy of self-titration of blood pressure medications by patients with hypertension.
Personally, I’m a proponent of giving patients self-titration schedules, particularly in my patients with systolic heart failure in whom I’m trying to maximize medical therapy. It’s a strategy I use somewhat sparingly though in part because of the difficulty to follow the home monitoring these patients are doing between clinic visits.
In this study, the self-titration plan was agreed upon in a clinic visit and then transcribed onto a paper given to the patient. The patient then used an unconnected blood pressure cuff at home with pre-set parameters for the patient to notify their primary care physician if their readings were too high or too low. Notifications of self-titration were accomplished by having the patient send in paper notifications to their primary care physician.
There are clearly a number of opportunities here to streamline the process to help make it less cumbersome for the patient and improve the monitoring of patients undertaking this kind of self-titration strategy. There are a number of wireless blood pressure cuffs on the market as well as wired devices that can transmit data through USB connections to a computer.
With the coming standardization of health data being captured by personal health devices thanks to Google Fit and Apple HealthKit, this data can then be readily transferred into the electronic health record. Practice Fusion already does that with some personal health devices; Apple and Epic are working on developing that integration as well. Trials and pilots underway at institutions like Stanford and Duke are exploring the creation of automated alert systems to help filter the data being collected with pre-specified rules as it flows into their EHR.
There are a number of limitations in this study.
From the 23 October 2014 article
Just like those of humans, insect guts are full of microbes, and the microbiota can influence the insect’s ability to transmit diseases. A new study reports that a bacterium isolated from the gut of an Aedes mosquito can reduce infection of mosquitoes by malaria parasites and dengue virus. The bacterium can also directly inhibit these pathogens in the test tube, and shorten the life span of the mosquitoes that transmit both diseases.
The above story is based on materials provided by PLOS. Note: Materials may be edited for content and length.
- Jose Luis Ramirez, Sarah M. Short, Ana C. Bahia, Raul G. Saraiva, Yuemei Dong, Seokyoung Kang, Abhai Tripathi, Godfree Mlambo, George Dimopoulos. Chromobacterium Csp_P Reduces Malaria and Dengue Infection in Vector Mosquitoes and Has Entomopathogenic and In Vitro Anti-pathogen Activities. Plos Pathogens, October 23, 2014 DOI: 10.1371/journal.ppat.1004398
From the 22 October 2014 article
Herbal medicines such as licorice, Indian rennet and opium poppy, are at risk of contamination with toxic mold, according to a new study. The authors of the study say it’s time for regulators to control mold contamination. An estimated 64% of people use medicinal plants to treat illnesses and relieve pain. The herbal medicine market is worth $60 billion globally, and growing fast. Despite the increasing popularity of herbal medicine, the sale of medicinal plants is mostly unregulated.
From the 22 October 2014 press release
RxClass is a new application from researchers in the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM). RxClass allows users to search and browse drug classes and their RxNorm drug members through a simple Web interface (see Figure 1). Unlike RxNav, a related application from NLM LHNCBC which focuses on browsing and searching individual RxNorm drugs, RxClass provides a class-centric view of the drug information in RxNorm.
Figure 1: RxClass Homepage.
Drug Class Sources
RxClass includes drug classes from the following data sources:
- ATC – The Anatomical Therapeutic Chemical (ATC) drug classification is a resource developed for pharmacoepidemiology purposes by the World Health Organization Collaborating Centre for Drug Statistics Methodology.
- MeSH – The Medical Subject Headings (MeSH), developed by NLM, provides a rich description of pharmacological actions for the purpose of indexing and retrieval of biomedical articles.
- NDFRT – The National Drug File-Reference Terminology (NDFRT), developed by the Department of Veterans Affairs (VA), provides clinical information about drugs, such as therapeutic intent and mechanism of action.RxClass includes six sets ofNDFRT drug classes:
- Established Pharmacologic Classes (EPC)
- Chemical Structure (Chem)
- Mechanism of Action (MoA)
- Physiologic Effect (PE)
- Pharmacokinetics (PK)
Drug Class Relationship Sources
RxClass includes five sources which assert relationships between drugs and drug classes from ATC, MeSH, and NDFRT:
- ATC – provides relationships between ATC drugs and ATC drug classes.
- MeSH – provides relationships between MeSH drugs and MeSH pharmacologic actions.
- DailyMed – provides relationships between substances in DailyMed Structured Product Labels (SPLs) and NDFRT EPC, Chem, MoA, and PE classes.
- NDFRT – provides relationships between NDFRT drug concepts and NDFRT Chem, Disease, MoA, PE, and PK classes.
- FDA SPL – provides relationships between NDFRT drug concepts mapped to DailyMed SPL substances and NDFRT EPC, Chem, MoA, and PE classes.
RxClass includes drugs from the sources mentioned above, which are mapped to ingredients (IN), precise ingredients (PIN), and multiple ingredients (MIN) in RxNorm. RxNorm is a normalized naming system for generic and branded drugs developed by NLM to allow computer systems in hospitals, pharmacies, and other organizations to communicate drug-related information efficiently and unambiguously.
Browse Drug Classes
RxClass provides a simple tree browser for navigating through drug class hierarchies. You can click on the orange arrow next to a class to reveal its subclasses in the tree. Clicking on the name of a drug class populates the results area under the search box with the members of that class, if applicable, and the name, source identifier, class type, and contexts for that class (see Figure 2).
Figure 2: RxClass Class Browser. Navigate drug classes by clicking the arrows or class names.
Search by Drug Class/RxNorm Drug
RxClass also provides access to drug classes and their RxNorm drug members through a simple search box (see Figure 3). You can search RxClass by:
- Drug class name or source identifier
- RxNorm drug name or RxNorm identifier (RXCUI)
Figure 3: Search RxClass by drug class or RxNorm drug name.
When browsing or searching RxClass, the results display is populated with the drug class you selected and the RxNorm drugs that belong to the class (see Figure 4). For each RxNorm drug, RxClass displays the:
- Type (RxNorm term type)
- RxNorm Name
- Source ID (Unique identifier from drug class source)
- Source Name (Name from drug class source)
- Relation (Relationship between the drug and the selected drug class (direct or indirect))
- All classes (All drug classes of which this drug is also a member)
Figure 4: RxClass results display: Shows RxNorm and drug class source data for your results.
Application Programming Interface (API)
Behind the RxClass Web application is a set of API functions. The RxClass API can be used independently for integrating drug class information into programs.
For questions, comments or feedback about these resources, please contact us at firstname.lastname@example.org.
By Patrick McLaughlin
MEDLARS Management Section
Date: October 20, 2014Source: BioMed CentralSummary: Scientists have uncovered a surprising way to reduce the brain damage caused by head injuries — stopping the body’s immune system from killing brain cells. A new study showed that in experiments on mice, an immune-based treatment reduced the size of brain lesions. The authors suggest that if the findings apply to humans, this could help prevent brain damage from accidents, and protect players of contact sports like football, rugby and boxing.
- Richard P Tobin, Sanjib Mukherjee, Jessica M Kain, Susannah K Rogers, Stephanie K Henderson, Heather L Motal, M Rogers, Lee A Shapiro. Traumatic brain injury causes selective, CD74-dependent peripheral lymphocyte activation that exacerbates neurodegeneration. Acta Neuropathologica Communications, 2014; 2 (1): 143 DOI: 10.1186/s40478-014-0143-5
Designer viruses could be the new antibiotics | Ars Technica.by Oct 16 2014, 11:30am EDT
From the news article
Bacterial infections remain a major threat to human and animal health. Worse still, the catalog of useful antibiotics is shrinking as pathogens build up resistance to these drugs. There are few promising new drugs in the pipeline, but they may not prove to be enough. Multi-resistant organisms—also called “superbugs”—are on the rise, and many predict a gloomy future if nothing is done to fight back.
The answer, some believe, may lie in using engineered bacteriophages, a type of virus that infects bacteria. Two recent studies, both published in the journal Nature Biotechnology, show a promising alternative to small-molecule drugs that are the mainstay of antibacterial treatments today.
From basic to synthetic biology
Nearly every living organism seems to have evolved simple mechanisms to protect itself from harmful pathogens. These innate immune systems can be a passive barrier, blocking anything above a certain size, or an active response that recognizes and destroys foreign molecules such as proteins and DNA.
An important component of the bacterial immune system is composed of a family of proteins that are tasked specifically with breaking down foreign DNA. Each bug produces a set of these proteins that chew the genetic material of viruses and other micro-organism into pieces while leaving the bacterial genome intact.
In vertebrates, a more advanced system—called the adaptive immune system—creates a molecular memory of previous attacks and prepares the organism for the next wave of infection. This is the principle on which vaccines are built. Upon introduction of harmless pathogen fragments, the adaptive immunity will train specialist killer cells that later allow a faster and more specific response if the virulent agent is encountered again.
Until recently, people thought bacteria were too simple to possess any sort of adaptive immunity. But in 2007, a group of scientists from the dairy industry showed that bacteria commonly used for the production of cheese and yogurts could be “vaccinated” by exposure to a virus. Two years earlier, others noticed similarities between repetitive sections in bacterial genomes and the DNA of viruses. These repetitive sequences—called CRISPR for “clustered regularly interspaced short palindromic repeats”—had been known for 20 years, but no one could ever explain their function.
From the 20 October 2014 EurekAlert!
Ever wondered how people figure out what is fair? Look to the brain for the answer. According to a new Norwegian brain study, people appreciate fairness in much the same way as they appreciate money for themselves, and also that fairness is not necessarily that everybody gets the same income.
Economists from the Norwegian School of Economics (NHH) and brain researchers from the University of Bergen (UiB) have worked together to assess the relationship between fairness, equality, work and money. Indeed, how do our brains react to how income is distributed?
More precisely, the interdisciplinary research team from the two institutions looked at the striatum; or the “reward centre” of the brain. By measuring our reaction to questions related to fairness, equality, work and money, this part of the brain may hold some answers to the issue of how we perceive distribution of income.
“The brain appreciates both own reward and fairness. Both influence the activation of the striatum,” says Professor Alexander W. Cappelen. “This may explain why a lot of people are willing to sacrifice monetary rewards when this results in a fairer balance.”
Inequality vs. fairness
Cappelen works at the Department of Economics at NHH and is co-director of the Choice Lab, which consists of researchers devoted to learning more about how people make economic and moral choices.
Along with his NHH Choice Lab colleagues Professor Bertil Tungodden and Professor Erik Ø. Sørensen, Cappelen wanted to explore how the brain’s reward system works. To help them answer this question, the NHH team got in touch with brain researchers Professor Kenneth Hugdahl, Professor Karsten Specht and Professor Tom Eichele, all from the Bergen fMRI Group and UiB’s Department of Biological and Medical Psychology.
Together, the NHH and UiB researchers set out to prove that the brain accepts inequality as long as this inequality is considered fair. The researchers published their results in the article Equity theory and fair inequality: A neuroeconomic study, which was published in the scientific journal PNAS on 13 October 2014.
People’s preferences for income distribution fundamentally affect their behaviour and contribute to shaping important social and political institutions. The study of such preferences has become a major topic in behavioural research in social psychology and economics.
“Our research showed that the striatum shows more activity to monetary rewards when the reward was judged to be fair,” says Kenneth Hugdahl.
Despite the large literature studying preferences for income distribution, there has so far been no direct neuronal evidence of how the brain responds to income distributions when people have made different contributions in terms of work effort.
Inspired by an article in Nature
The background for the joint study between the NHH and UiB researchers was an article in Nature in February 2010, where an interdisciplinary team of American researchers found evidence that people’s brains react negatively to inequality. The American researchers reached their conclusion by studying how the striatum responded to different levels of inequality in a situation where everyone had made the same contribution….
Website of The Choice lab, Norwegian School of Economics: http://blogg.nhh.no/thechoicelab/
Website of the The Bergen fMRI Group, University of Bergen: http://fmri.uib.no/
From the National Post news item by Lindsey Bever, The Washington Post, National Post Wire Services | October 20, 2014 | Last Updated: Oct 20 11:26 AM ET
You knew that drinking sugary sodas could lead to obesity, diabetes and heart attacks — but, according to a study published in the American Journal of Public Health, it may also speed up your body’s aging process.
What got my attention was his remark about celery.
You know: the dieters’ wishful thinking on whether eating celery is a sum negative activity, or not.
He was certainly entitled to speak. His name is Dr. Gerald Krystal and he’s a professor of pathology and laboratory medicine at University of British Columbia, as well as Distinguished Scientist at the Terry Fox Laboratory at the BC Cancer Agency.
We were perched like vultures over a buffet table, commenting on the many ways to die. Fats, salts, sugars, alcohol: pick your delicious poison. I like ’em all.
As you age, caps on the end your chromosomes called telomeres shrink. In the past several years, researchers at the University of California at San Francisco, have analyzed stored DNA from more than 5,300 healthy Americans in the National Health and Nutrition Examination Survey (NHANES) from some 14 years ago. And they discovered that those who drank more pop tended to have shorter telomeres.
The shorter the telomere, the harder it is for a cell to regenerate — and so, the body ages.
“We think we can get away with drinking lots of soda as long as we are not gaining weight, but this suggests that there is an invisible pathway that leads to accelerated aging, regardless of weight,” psychiatry professor Elissa Epel, senior author of the study, told CBS San Francisco….
The findings were reported online October 16, 2014 in the American Journal of Public Health.
The headlines in the opening to this story are not taken from today’s newspapers. They were published in the Chicago Tribune 96 years ago. From 1918 to 1919, the world was in the throes of the greatest plague in recorded history. It was called the Spanish Flu, named for the country where people thought it had originated..The headlines we are seeing today over fear of the spread of the Ebola virus are very real. Many of the events that have already taken place — such as the cruise ship being banned from entering Belize — adds to our fears, although the restrictions were probably unnecessary. We are a country that is totally unprepared for an epidemic of national proportions, yet this is not the first time wehave been tested.
The headlines in the opening to this story are not taken from today’s newspapers. They were published in the Chicago Tribune 96 years ago. From 1918 to 1919, the world was in the throes of the greatest plague in recorded history. It was called the Spanish Flu, named for the country where people thought it had originated……
From the 18 October 2014 article
On July 20 a man who was ill flew on commercial planes from the heart of the Ebola epidemic in Liberia to Lagos, Nigeria’s largest city. That man became Nigeria’s first Ebola case—the index patient. In a matter of weeks some 19 people across two states were diagnosed with the disease (with one additional person presumed to have contracted it before dying).
But rather than descending into epidemic, there has not been a new case of the virus since September 5. And since September 24 the country’s Ebola isolation and treatment wards have sat empty. If by Monday, October 20 there are still no new cases, Nigeria, unlike the U.S., will be declared Ebola free by the World Health Organization (WHO).
What can we learn from this African country’s success quashing an Ebola outbreak?
Authors of a paper published October 9 in Eurosurveillance attribute Nigeria’s success in “avoiding a far worse scenario” to its “quick and forceful” response. The authors point to three key elements in the country’s attack:
- Fast and thorough tracing of all potential contacts
- Ongoing monitoring of all of these contacts
- Rapid isolation of potentially infectious contact
From the 17 October 2014 news article
Every minute counts in the event of an overdose. ETH professor Jean-Christophe Leroux and his team have developed an agent to filter out toxins from the body more quickly and efficiently. It can also be used for dialysis in patients suffering from hepatic failure.
To date, antidotes exist for only a very few drugs. When treating overdoses, doctors are often limited to supportive therapy such as induced vomiting. Treatment is especially difficult if there is a combination of drugs involved. So what can be done if a child is playing and accidentally swallows his grandmother’s pills? ETH professor Jean-Christophe Leroux from the Institute of Pharmaceutical Sciences at ETH Zurich wanted to find an answer to this question. “The task was to develop an agent that could eliminate many different toxic substances from the body as quickly as possible,” he says.
Leroux and his team knew that lipid emulsions can bind to drugs when injected into the blood stream. The researchers pursued this approach in their own studies, developing an agent based on liposomes, which are tiny bubbles with a lipid membrane as an outer layer. Instead of an intravenous injection, the agent is used as a dialysis fluid for so-called peritoneal dialysis. This method of dialysis is less common than haemodialysis, which is mainly used as a long-term form of treatment of kidney failure.
[Deep down I believe that climate change should not be addressed as a threat to our security, but as a threat against all of us humans. If we do not unite on a global basis, surely this will be a disaster for all of us. Climate disruption (it is not simple change!) knows no boundaries. The effects cannot be stopped at any border.]
Climate change is a threat multiplier, and the Defense Department is taking steps to incorporate this issue into all planning.
ASHINGTON, Oct. 13, 2014 – Climate change is a threat multiplier, and the Defense Department is taking steps to incorporate this issue into all planning, Defense Secretary Chuck Hagel said in Peru today.
Climate change has the potential to exacerbate many of the challenges the world already confronts, from the spread of infectious diseases to spurring armed conflicts, Hagel said at the Conference of the Defense Ministers of the Americas.
“The loss of glaciers will strain water supplies in several areas of our hemisphere,” he said. “Destruction and devastation from hurricanes can sow the seeds for instability. Droughts and crop failures can leave millions of people without any lifeline and trigger waves of mass migration.”
This already happening in the Sahel region of Africa, where desertification is placing millions at risk, and climate extremes in Australia are worrying leaders there. The Western Hemisphere is not immune, Hagel said. “Two of the worst droughts in the Americas have occurred in the past 10 years – droughts that used to occur once a century,” he added.
“In the Caribbean, sea level rise may claim 1,200 square miles of coastal land in the next 50 years, and some islands may have to be completely evacuated,” the secretary said. “According to some estimates, rising temperatures could melt entire glaciers in the Andes, which could have cascading economic and security consequences.”
These climate trends clearly will have implications for regional militaries, Hagel said, as more extreme weather will cause more natural disasters and military personnel will be called on to deliver humanitarian assistance and relief.
“Our coastal installations could be vulnerable to rising shorelines and flooding, and extreme weather could impair our training ranges, supply chains and critical equipment,” the secretary said. “Our militaries’ readiness could be tested, and our capabilities could be stressed.”
Climate change roadmap
Hagel announced a Defense Department Climate Change Adaptation Roadmap during his speech. The roadmap is based on science, he said, and describes the effects of climate change on DoD’s missions and responsibilities.
“We have nearly completed a baseline survey to assess the vulnerability of our military’s more than 7,000 bases, installations and other facilities,” Hagel said. “Drawing on these assessments, we will integrate climate change considerations into our planning, operations and training.”
Climate change affects everyone, and DoD will work with partner nations bilaterally and multilaterally to address the threat, the secretary said. “We will share our findings, our tools for assessment and our plans for resiliency,” he added. “We will also seek to learn from partner nations’ experiences as well.”
Hagel encouraged the Western Hemisphere nations represented at the conference to participate in the Defense Environmental International Cooperation program. “I recognize that our militaries play different roles and have different responsibilities in each of our nations,” he said. “I also recognize that climate change will have different impacts in different parts of the hemisphere. But there are many opportunities to work together.”
Peru will host a United Nations convention on climate change in two months, Hagel noted, adding that the militaries of the world must be part of the discussion. “We must be clear-eyed about the security threats presented by climate change, and we must be pro-active in addressing them,” he said.
(Follow Jim Garamone on Twitter: @GaramoneDoDNews
Related article from the Scout ReportClimate Science, Awareness and Solutions
The Climate Science, Awareness and Solutions (CSAS) team at Columbia University has a specific, targeted goal: a near universal carbon fee on fossil fuels. The group’s mission statement, under About Us, is a great place to start. Then explore Dr. James Hansen’s TED talk, an eighteen minute argument for the political responsibilities of climate scientists as well as regular citizens. The section titled Our Work will take readers to five headings – Climate Research, Climate Data, Public Awareness and Policy Solutions, 350.org, Citizen’s Climate Lobby, and Our Children’s Trust – each of which links to timely and educational projects. Finally, the In the News section features videos and articles showcasing the work of Dr. Hansen and his fellow climate activists. [CNH]
Many military personnel and veterans experience chronic pain, a condition that can be debilitating and is often difficult to treat. Post-traumatic stress, traumatic brain injury, depression, and substance use are other conditions that tend to co-occur in these same service members and are also challenging to treat. Opioid medications are often prescribed for chronic pain conditions, but use and misuse of opioids resulting in hospitalizations and death has been on the rise. A study published in the journal JAMA Internal Medicine examined the prevalence of chronic pain and opioid use among U.S. soldiers following deployment. The researchers found that of the more than 2,500 participants surveyed, 44 percent had chronic pain and 15 percent regularly used opioids—rates much higher than the general population.
Many military, veterans, and their families turn to complementary and integrative health approaches such as mindfulness meditation and other practices in an effort to enhance the options for the management of pain and associated problems. This page provides resources and information on health conditions of special concern to military, veterans, and their families and the complementary and integrative health practices being studied for this population.
From the AHRQ Web site
A new research review from AHRQ’s Effective Health Care Program found that while the evidence on the effectiveness and harms of opioid therapy for chronic pain treatment is limited, there is an increased risk of serious harms based on the opioid dose given. The research review assesses observational studies that suggest that use of long-term opioids for chronic pain is associated with increased risk of abuse, overdose, fractures and heart attack, when compared with patients who are not being prescribed opioids. The review noted that more research is needed to understand the long-term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and strategies. The review is titled, “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain.” AHRQ has also released a statistical brief from the Healthcare Cost and Utilization Project titled, “Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993-2012.” According to the brief, hospitalization rates for opioid overuse more than doubled from 1993 to 2012 and increased at a faster rate for people age 45 and older. In addition, AHRQ Director Rick Kronick, Ph.D., has published a blog about opioids.
From the October 2014 EurkAlert!
New research by biomedical engineers at the University of Minnesota shows that people who practice yoga and meditation long term can learn to control a computer with their minds faster and better than people with little or no yoga or meditation experience. The research could have major implications for treatments of people who are paralyzed or have neurodegenerative diseases.
The research is published online in Technology, a new scientific journal featuring cutting-edge new technologies in emerging fields of science and engineering.
In the study, researchers involved a total of 36 participants. One group of 12 had at least one year of experience in yoga or meditation at least two times per week for one hour. The second group included 24 healthy participants who had little or no yoga or meditation experience. Both groups were new to systems using the brain to control a computer. Both groups participated in three, two-hour experiments over four weeks in which they wore a high tech, non-invasive cap over the scalp that picked up brain activity. The participants were asked to move a computer cursor across the screen by imaging left or right hand movements.
The participants with yoga or meditation experience were twice as likely to complete the brain-computer interface task by the end of 30 trials and learned three times faster than their counterparts for the left-right cursor movement experiments.
“In recent years, there has been a lot of attention on improving the computer side of the brain-computer interface but very little attention to the brain side,” said lead researcher Bin He, a biomedical engineering professor in the University of Minnesota’s College of Science and Engineering and director of the University’s Institute for Engineering in Medicine. “This comprehensive study shows for the first time that looking closer at the brain side may provide a valuable tool for reducing obstacles for brain-computer interface success in early stages.”
Researchers have been increasingly focused on finding ways to help physically disabled individuals who are paralyzed, have lost limbs, or suffer from diseases such as ALS or cerebral palsy. In these cases, brain function remains intact, but these people have to find a way to bypass muscular control to move a wheelchair, control an artificial limb, or control other devices.
Professor He gained international attention in 2013 when members of his research team were able to demonstrate flying a robot with only their minds. However, they found that not everyone can easily learn to control a computer with their brains. Many people are unsuccessful in controlling the computer after multiple attempts. A consistent and reliable EEG brain signal may depend on an undistracted mind and sustained attention. Meditators have shown more distinctive EEG patterns than untrained participants, which may explain their success.
Professor He said he got the idea for the study more than five years ago when he began his brain-computer interface research and noticed one woman participant who was much more successful than other participants at controlling the computer with her brain. The woman had extensive experience with yoga and mediation, referred to by researchers as Mind-Body Awareness Training (MBAT).
The next step for He and his team is to study a group of participants over time who are participating in yoga or meditation for the first time to see if their performance on the brain-computer interface improves.
“Our ultimate goal is to help people who are paralyzed or have brain diseases regain mobility and independence,” He said. “We need to look at all possibilities to improve the number of people who could benefit from our research.”
This research was funded by the National Science Foundation, the National Institutes of Health, and the University of Minnesota’s Institute for Engineering in Medicine. In addition to He, the University of Minnesota research team included research lab technician Kaitlin Cassady, biomedical engineering undergraduate student Albert You, and biomedical engineering master’s and medical student Alex Doud.
Corresponding author for this study in Technology is Professor Bin He, Ph.D., email@example.com. This study can be found at http://www.worldscientific.com/doi/abs/10.1142/S233954781450023X.
From the article at Philosophical Society of the Royal Society
As long ago as the sixteenth century, Paracelsus recognized that ‘the dose makes the poison’. Indeed, environmental concentrations of pharmaceuticals excreted by humans are limited, most importantly because a defined dose is given to just a fraction of the population. By contrast, recent studies have identified direct emission from drug manufacturing as a source of much higher environmental discharges that, in some cases, greatly exceed toxic threshold concentrations. Because production is concentrated in specific locations, the risks are not linked to usage patterns. Furthermore, as the drugs are not consumed, metabolism in the human body does not reduce concentrations. The environmental risks associated with manufacturing therefore comprise a different, wider set of pharmaceuticals compared with those associated with risks from excretion. Although pollution from manufacturing is less widespread, discharges that promote the development of drug-resistant microorganisms can still have global consequences. Risk management also differs between production and excretion in terms of accountability, incentive creation, legal opportunities, substitution possibilities and costs. Herein, I review studies about industrial emissions of pharmaceuticals and the effects associated with exposure to such effluents. I contrast environmental pollution due to manufacturing with that due to excretion in terms of their risks and management and highlight some recent initiatives.
From the 8 October 2014 article
Despite recent advances in health care policy, American households continue to struggle with medical debt, and it’s only getting worse. Americans are putting more of their take-home pay toward medical costs than ever before.
- NerdWallet Health has found that Americans pay three times more in third-party collections of medical debt each year than they pay for bank and credit card debt combined. In 2014, roughly one in five American adults will be contacted by a debt collection agency about medical bills, but they may be overpaying – NerdWallet found rampant hospital billing errors resulting in overcharges of up to 26%.
- NerdWallet found 63% of American adults indicate they have received medical bills that cost more than they expected. At the same time, 73% of consumers agree they could make better health decisions if they knew the cost of medical care before receiving it.
- Between 2010 and 2013, American households lost $2,300 in median income, but their health care expenses increased by $1,814. Out-of-pocket spending is expected to accelerate to a 5.5% annual growth rate by 2023 – double the growth of real GDP.
In a follow-up to last year’s study that found medical debt is the largest cause of personal bankruptcy, NerdWallet Health investigated the mounting financial obstacles facing the American patient.
Obtaining access to private outpatient psychiatric care in the Boston, Chicago and Houston metropolitan areas is difficult, even for those with private insurance or those willing to pay out of pocket. Researchers, who posed on the phone as patients seeking appointments with individual psychiatrists, encountered numerous obstacles, including unreturned calls, and met with success only 26 percent of the time.
From the 14 October 2014 article
he foundation of evidence-based research has eroded and the trend must be reversed so patients and clinicians can make wise shared decisions about their health, say Dartmouth researchers in the journal Circulation: Cardiovascular Quality and Outcomes.
Drs. Glyn Elwyn and Elliott Fisher of The Dartmouth Institute for Health Policy & Clinical Practice are authors of the report in which they highlight five major problems set against a backdrop of “obvious corruption.” There is a dearth of transparent research and a low quality of evidence synthesis. The difficulty of obtaining research funding for comparative effectiveness studies is directly related to the prominence of industry-supported trials: “finance dictates the activity.”
The pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behavior that influences how medicine is practiced, the researchers say. The pharmaceutical industry has also spent billions of dollars in direct-to-consumer advertising and has created new disease labels, so-called disease-mongering, and by promoting the use of drugs to address spurious predictions.
Another problem with such studies is publication bias, where results of trials that fail to demonstrate an effect remain unpublished, but trials where the results are demonstrated are quickly published and promoted.
The authors offer possible solutions:
From the 14 October 2014 article
esponding to the large number of people with serious mental illnesses in the criminal justice system will require more than mental health services, according to a new report.
In many ways, the criminal justice system is the largest provider of mental health services in the country. Estimates vary, but previous research has found that about 14 percent of persons in the criminal justice system have a serious mental illness, and that number is as high as 31 percent for female inmates. Researchers are defining serious mental illnesses to include such things as schizophrenia, bipolar spectrum disorders and major depressive disorders.
“It has been assumed that untreated symptoms of mental illness caused criminal justice involvement, but now we’re seeing that there is little evidence to support that claim,” said Matthew Epperson, assistant professor at the University of Chicago School of Social Service Administration. Specialized interventions for people with mental illness in the criminal justice system have been developed over the past 20 years, such as mental health courts and jail diversion programs, Epperson said.
“But we need a new generation of interventions for people with serious mental health issues who are involved in the criminal justice system, whether it be interactions with police, jails, probation programs and courts,” he said. “Research shows that people with serious mental illnesses, in general, display many of the same risk factors for criminal involvement as persons without these conditions.”
From the 13 October 2014 article
Jazz is good for you. Patients undergoing elective hysterectomies who listened to jazz music during their recovery experienced significantly lower heart rates, suggests a study presented at the ANESTHESIOLOGY™ 2014 annual meeting.
But the research also found that silence is golden. Patients who wore noise-cancelling headphones also had lower heart rates, as well as less pain.
The results provide hope that patients who listen to music or experience silence while recovering from surgery might need less pain medication, and may be more relaxed and satisfied, note the researchers.
“The thought of having a surgical procedure — in addition to the fears associated with anesthesia — creates emotional stress and anxiety for many patients,” said Flower Austin, D.O., anesthesiology resident, Penn State Milton S. Hershey Medical Center, Hershey, Pa., and lead study author. “Physician anesthesiologists provide patients with pain relief medication right after surgery. But some of these medications can cause significant side effects.”
From the 16 October 2014 press release
American Journal of Preventive Medicine supplement addresses critical challenges to public health
Ann Arbor, MI, October 16, 2014 – Although disease outbreaks and epidemics drawing worldwide attention emphasize the importance and acute need for public health professionals, the world faces a longer-term challenge—a public health workforce that is truly effective in the 21st century. In a new supplement to the American Journal of Preventive Medicine, ***experts address critical challenges to public health, from workforce development, capacity building, partnership and collaborations, and changes and needs in workforce composition.
As the U.S. healthcare system evolves and communities gain more access to care, diverse forces are driving change, and the practice of public health is adapting. Given the challenges to the public health system and those faced as a nation—including urgent health threats (e.g., antibiotic resistance, prescription drug use and overdose, global health security) and decreased funding for addressing public health concerns—having trust in public health practitioners, their scientific knowledge, and particularly the public health system, has never been more important.
“The public health workforce is now not only required to take a lead in protecting citizens’ health, but it also must provide the evidence base needed for linking public health information with clinical services and activities; offer targeted, scalable public health interventions; and support clinical services in a way that affects populations at large,” notes Guest Editor Fátima Coronado, MD, MPH, Deputy Associate Director for Science, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. “This supplement is both timely and important because it reviews some of the critical challenges faced by the public health workforce, discusses selected changes under way, and highlights data-driven research to advance the field of public health services and systems research.”
This groundbreaking supplement, The Public Health Workforce, includes 22 articles from more than 30 institutions, agencies, foundations and public companies and covers two major areas: public health workforce capacity building and public health workforce size and composition.
Key topics in the Supplement include:
- How to clearly define the public health workforce challenges using cause-and-effect diagrams and a concise roadmap.
- Use of Massive Open Online Courses (MOOCs) by the School of Public Health at Harvard and concerns about retention of the knowledge gained using that method of instruction.
- How the CDC conducts workforce development within its own organization.
- Do students who receive adequate training in Public Health and Community Medicine tend to practice in areas with physician shortages?
- How do we count public health workers? In the first study since 2000, 50% of all public health workers are employed at the local level, with 30% and 20% at the state and federal levels, respectively.
- How can we define public health workers properly? A taxonomy has been developed which is a necessary step to continuously monitor the size and composition of the workforce to ensure sufficient capacity to deliver essential public health services.
- Data show that part-time public health workers are a low percentage of the total workforce and the percentage has decreased over the last 5 years.
- Despite relatively uncompetitive pay, local health departments experience lower rates of employee turnover than state health agencies and lower rates than state and local government in general.
- How can we align public health workforce competencies with population health improvement goals?
- How the Public Health Accreditation Board (PHAB) developed the standards and measures to encourage health departments to strengthen the current public health workforce and strategically develop the workforce of tomorrow.
- Do Internal Medicine Residency Programs develop public health competencies?
- How a training program for racial and ethnic minorities for careers in public health sciences has resulted in 60% of the students entering public health careers.
- Will epidemiology education change rapidly enough to keep up with trends in communications and computing?
- How the growth of cities, “Big Data,” and cognitive computing will change the public health workforce.
- Building a Culture of Health – How the public health workforce will not only provide medical care but will help to establish a Culture of Health.
- Nursing as a critical driver of the Culture of Health.
Guest Editors Dr. Coronado and Denise Koo, MD, MPH, Office of Public Health Scientific Services, CDC, Atlanta, GA, and Kristine Gebbie, DrPH, RN, Faculty of Health Sciences, Flinders University, Adelaide, South Australia, write that “we are buoyed by the increased efforts to meet workforce challenges and the valuable contribution of researchers and practitioners to strengthen the public health workforce. Efforts to strengthen the public health workforce should be a continuing priority involving well-planned, evidence based, and coordinated actions from decision makers undaunted by the mission of transforming public health and improving the population’s health while facing the complex landscape of the 21st century.”###***The article may be available for free or low cost at your local public, academic, or hospital/medical center library. Call ahead and ask for a reference librarian.
From the 17 October 2014 BBC article
s fear of the Ebola virus escalates, Eric Topol thinks that we’re missing an important weapon. And you just need to reach into your pocket to find it. “Most communicable diseases can be diagnosed with a smartphone,” he says. “Rather than putting people into quarantine for three weeks – how about seeing if they harbour it in their blood?” A quicker response could also help prevent mistakes, such as the patient in Dallas who was sent home from hospital with a high fever, only to later die from the infection.
It’s a provocative claim, but Topol is not shy about calling for a revolution in the way we deal with Ebola – or any other health issue for that matter. A professor of genomics at the Scripps Research Institute in California, his last book heralded “the creative destruction of medicine” through new technology. Smartphones are already helping to do away with many of the least pleasant aspects of sickness – including the long hospital visits and agonising wait for treatment. An easier way to diagnose Ebola is just one example of these sweeping changes.
From the October 2014 press release
SAN DIEGO – When parents take a sick or injured child to the doctor or emergency room, they often expect tests to be done and treatments given. So if the physician sends them on their way with the reassurance that their child will get better in a few days, they might ask: “Shouldn’t you do a CT scan?” or “Can you prescribe an antibiotic?”
What families — and even doctors — may not understand is that many medical interventions done “just to be safe” not only are unnecessary and costly but they also can harm patients, said Alan R. Schroeder, MD, FAAP, who will present a plenary session at the American Academy of Pediatrics (AAP) National Conference & Exhibition. Titled “Safely Doing Less: A Solution to the Epidemic of Overuse in Healthcare,” the session will be held from 11:30-11:50 a.m. PDT Monday, Oct. 13 in Ballroom 20 of the San Diego Convention Center.
Dr. Schroeder, chief of pediatric inpatient services and medical director of the pediatric intensive care unit at Santa Clara Valley Medical Center in San Jose, Calif., will discuss some of the reasons why doctors provide unnecessary care (i.e., barriers to safely doing less), including pressure from parents and a fear of missing something.
“We all have cases where we’re haunted by something bad happening to a patient. Those tend to be cases where we missed something,” he said. “We tend to react by doing more and overtreating similar patients.”
He also will give examples of where overuse commonly occurs in pediatrics, such as performing a CT scan on a child with a minor head injury, and the negative consequences.
“You may find a tiny bleed or a tiny skull fracture, and once you’ve found that you’re compelled to act on it. And generally acting on it means at a minimum admitting the child to an intensive care unit for observation even if the child looks perfectly fine,” Dr. Schroeder said. “The term for that is overdiagnosis. You detect an abnormality that will never cause harm.”
Finally, he will suggest ways to minimize overtesting and overtreatment, highlighting the Choosing Wisely campaign. More than 60 medical societies including the AAP have joined the initiative and have identified more than 250 tests and procedures that are considered overused or inappropriate in their fields.
“I’ve devoted much of my research to identify areas in inpatient pediatrics where we can safely do less — which therapies that we are doing now are unnecessary or overkill,” Dr. Schroeder said.
The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.