I remember studying the parasympathetic system in high school back in the 70’s. Basically we were taught that it exists and it balances the sympathetic system. Also recall we were taught that the nervous system and immune systems were separate, one did not “talk” to the other.
Kevin Tracey, a neurosurgeon based in New York, is a man haunted by personal events – a man with a mission. “My mother died from a brain tumor when I was five years old. It was very sudden and unexpected,” he says. “And I learned from that experience that the brain – nerves – are responsible for health.”
This background made him a neurosurgeon who thinks a lot about inflammation. He believes it was this perspective that enabled him to interpret the results of an accidental experiment in a new way.
In the late 1990s, Tracey was experimenting with a rat’s brain. “We’d injected an anti-inflammatory drug into the brain because we were studying the beneficial effect of blocking inflammation during a stroke,” he recalls. “We were surprised to find that when the drug was present in the brain, it also blocked inflammation in the spleen and in other organs in the rest of the body. Yet the amount of drug we’d injected was far too small to have got into the bloodstream and traveled to the rest of the body.”
After months puzzling over this, he finally hit upon the idea that the brain might be using the nervous system – specifically the vagus nerve – to tell the spleen to switch off inflammation everywhere.
It was an extraordinary idea – if Tracey was right, inflammation in body tissues was being directly regulated by the brain. Communication between the immune system’s specialist cells in our organs and bloodstream and the electrical connections of the nervous system had been considered impossible. Now Tracey was apparently discovering that the two systems were intricately linked.
A new study is the first to directly implicate the cerebellum in the creative process. As for the brain’s higher-level executive-control centers? Not so much.
Investigators at Stanford University have found a surprising link between creative problem-solving and heightened activity in the cerebellum, a structure located in the back of the brain and more typically thought of as the body’s movement-coordination center.
In designing the study, the researchers drew inspiration from the game Pictionary.
The cerebellum, traditionally viewed as the brain’s practice-makes-perfect, movement-control center, hasn’t been previously recognized as critical to creativity. The new study, a collaboration between the School of Medicine and Stanford’s Hasso Plattner Institute of Design, commonly known as the d.school, is the first to find direct evidence that this brain region is involved in the creative process.
Neuroscientists identify a brain circuit that controls decisions that induce high anxiety.
Some decisions arouse far more anxiety than others. Among the most anxiety-provoking are those that involve options with both positive and negative elements, such choosing to take a higher-paying job in a city far from family and friends, versus choosing to stay put with less pay.
MIT researchers have now identified a neural circuit that appears to underlie decision-making in this type of situation, which is known as approach-avoidance conflict. The findings could help researchers to discover new ways to treat psychiatric disorders that feature impaired decision-making, such as depression, schizophrenia, and borderline personality disorder.
The new study grew out of an effort to figure out the role of striosomes — clusters of cells distributed through the the striatum, a large brain region involved in coordinating movement and emotion and implicated in some human disorders. Graybiel discovered striosomes many years ago, but their function had remained mysterious, in part because they are so small and deep within the brain that it is difficult to image them with functional magnetic resonance imaging (fMRI).
From the 20 May 2015 University of Alabama news release
CreakyJoints, an online, nonprofit, patient support community with more than 80,000 members, has launched Arthritis Power, the first patient-led, patient-generated, patient-centered research registry for arthritis, bone, and inflammatory skin conditions. Focusing on rheumatoid arthritis, psoriasis, psoriatic arthritis as well as numerous other musculoskeletal conditions, the goal of Arthritis Power is to securely collect health data from tens of thousands of arthritis patients to support future research.
Arthritis Power includes a steering committee of patients called the Patient Governor Group that identifies research needs for study development and prioritizes research requests from the CreakyJoints patient community around the world. The new initiative is launched in partnership with the University of Alabama at Birmingham. Arthritis Power is supported in part by the Patient Centered Outcomes Research Institute (PCORI), a nonprofit, nongovernmental organization created by Congress as part of the Patient Protection and Affordable Care Act of 2010. Its overall goal is to enhance informed health-care decision-making and to improve health-care delivery.
Usually patients with rheumatoid, psoriatic arthritis or other chronic conditions learn about opportunities to participate in research from their health-care providers. Arthritis Power will offer a variety of clinical trial and other research opportunities, allowing patients to proactively decide when and how to participate. Securely donated data will be used by patients, universities, research facilities, and physicians to better understand how to fight these diseases and perhaps, contribute to finding elusive cures. Arthritis Power data will be collected using a smart phone, laptop, desktop or tablet where there is an Internet connection.
“Patient-centered research means that we can more effectively use big data to answer questions that are important to those living with these illnesses. This opportunity will produce results that help patients weigh the value of health-care options according to their personal circumstances, conditions, and preferences,” says Jeffrey Curtis, M.D., M.S., MPH, William J. Koopman Endowed Professor in Rheumatology and Immunology in the UAB Division of Clinical Immunology and Rheumatology.
Biometric technologies are on the rise. By electronically recording data about individual’s physical attributes such as fingerprints or iris patterns, security and law enforcement services can quickly identify people with a high degree of accuracy.
The latest development in this field is the scanning of irises from a distance of up to 40 feet (12 metres) away. Researchers from Carnegie Mellon University in the US demonstrated they were able to use their iris recognition technology to identify drivers from an image of their eye captured from their vehicle’s side mirror.
The developers of this technology envisage that, as well as improving security, it will be more convenient for the individuals being identified. By using measurements of physiological characteristics, people no longer need security tokens or cumbersome passwords to identify themselves.
Oral care products containing a natural chemical that stops bacteria harming teeth could help fight decay, research shows.
The plant natural product acts against harmful mouth bacteria and could improve oral health by helping to prevent the build-up of plaque.
The compound – known as trans-chalcone – is related to chemicals found in liquorice root.
This exciting discovery highlights the potential of this class of natural products in food and healthcare technologies.
The University study shows that it blocks the action of a key enzyme that allows the bacteria to thrive in oral cavities.
The bacteria – Streptococcus mutans – metabolise sugars from food and drink, which produces a mild acid and leads to the formation of plaque.
Without good dental hygiene, the combination of plaque and mouth acid can lead to tooth decay.
Researchers found that blocking the activity of the enzyme prevents bacteria forming a protective biological layer – known as a biofilm – around themselves.
Plaque is formed when bacteria attach themselves to teeth and construct biofilms.
Preventing the assembly of these protective layers would help stop bacteria forming plaque.
Oral care products that contain similar natural compounds could help people improve their dental hygiene.
Blocking enzyme function
The study is the first to show how trans-chalcone prevents bacteria forming biofilms.
The team worked out the 3D structure of the enzyme – called Sortase A – which allows the bacteria to make biofilms.
By doing this, researchers were able to identify how trans-chalcone prevents the enzyme from functioning.
The study, published in the journal Chemical Communications, was supported by Wm. Wrigley Jr. Company.
We were delighted to observe that trans-chalcone inhibited Sortase A in a test tube and stopped Streptococcus mutans biofilm formation. We are expanding our study to include similar natural products and investigate if they can be incorporated into consumer products.
But when children’s temper tantrums or mood swings are beyond the norm, or they are overwhelmed by homework organization, do parents speak up?
Today’s University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health finds that many parents of children age 5-17 wouldn’t discuss behavioral or emotional issues that could be signs of potential health problems with their doctors. While more than 60 percent of parents definitely would talk to the doctor if their child was extremely sad for more than a month, only half would discuss temper tantrums that seemed worse than peers or if their child seemed more worried or anxious than normal. Just 37 percent would tell the doctor if their child had trouble organizing homework.
The most common reason for not sharing these details with their children’s doctors? Nearly half of parents believed that these simply were not medical problems. Another 40 percent of parents say they would rather handle it themselves and about 30 percent would rather speak to someone other than a doctor.
“Behavioral health and emotional health are closely tied to a child’s physical health, well-being and development, but our findings suggest that we are often missing the boat in catching issues early,” says Sarah J. Clark, M.P.H., associate director of the National Poll on Children’s Health and associate research scientist in the University of Michigan Department of Pediatrics.
New research finds that misdiagnoses lead to increased risk of incorrect antibiotic use, threatening patient outcomes and antimicrobial efficacy, while increasing healthcare costs. The study was published online today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
“Antibiotic therapies are used for approximately 56 percent of inpatients in U.S. hospitals, but are found to be inappropriate in nearly half of these cases, and many of these failures are connected with inaccurate diagnoses,” said Greg Filice, MD, lead author of the study. “The findings suggest that antimicrobial stewardship programs could be more impactful if they were designed to help providers make accurate initial diagnoses and to know when antibiotics can be safely withheld.”
Additionally, researchers found that overall, only 58 percent of patients received a correct diagnosis, indicating that diagnostic errors were more prevalent in this study than in previous studies unrelated to antimicrobial use. The most common incorrect diagnoses identified by researchers were pneumonia, cystitis, urinary tract infections, kidney infections and urosepsis.
Contributing factors which the researchers said may lead to inaccurate diagnosis and inappropriate antibiotic use include:
Healthcare workers (HCWs) relying on intuitive processes, instead of analytical processes which are more reliable, safe and effective.
HCWs experiencing fatigue, sleep deprivation and/or cognitive overload more prevalent in inpatient settings.
HCWs receiving patients with a previous diagnosis from another provider.
Lack of clinical experience and minimal personal experience with adverse drug effects.
People have tried to print graphene before,” Shah said. “But it’s been a mostly polymer composite with graphene making up less than 20 percent of the volume.”
With a volume so meager, those inks are unable to maintain many of graphene’s celebrated properties. But adding higher volumes of graphene flakes to the mix in these ink systems typically results in printed structures too brittle and fragile to manipulate. Shah’s ink is the best of both worlds. At 60-70 percent graphene, it preserves the material’s unique properties, including its electrical conductivity. And it’s flexible and robust enough to print robust macroscopic structures. The ink’s secret lies in its formulation: the graphene flakes are mixed with a biocompatible elastomer and quickly evaporating solvents.
“It’s a liquid ink,” Shah explained. “After the ink is extruded, one of the solvents in the system evaporates right away, causing the structure to solidify nearly instantly. The presence of the other solvents and the interaction with the specific polymer binder chosen also has a significant contribution to its resulting flexibility and properties. Because it holds its shape, we are able to build larger, well-defined objects.”
Supported by a Google Gift and a McCormick Research Catalyst Award, the research is described in the paper “Three-dimensional printing of high-content graphene scaffolds for electronic and biomedical applications,” published in the April 2015 issue of ACS Nano. Jakus is the paper’s first author. Mark Hersam, the Bette and Neison Harris Chair in Teaching Excellence, professor of materials science and engineering at McCormick, served as coauthor.
The 3-D printed graphene scaffold appeared on the cover of ACS Nano.
An expert in biomaterials, Shah said 3-D printed graphene scaffolds could play a role in tissue engineering and regenerative medicine as well as in electronic devices. Her team populated one of the scaffolds with stem cells to surprising results. Not only did the cells survive, they divided, proliferated, and morphed into neuron-like cells.
“That’s without any additional growth factors or signaling that people usually have to use to induce differentiation into neuron-like cells,” Shah said. “If we could just use a material without needing to incorporate other more expensive or complex agents, that would be ideal.”
The printed graphene structure is also flexible and strong enough to be easily sutured to existing tissues, so it could be used for biodegradable sensors and medical implants. Shah said the biocompatible elastomer and graphene’s electrical conductivity most likely contributed to the scaffold’s biological success.
“Cells conduct electricity inherently — especially neurons,” Shah said. “So if they’re on a substrate that can help conduct that signal, they’re able to communicate over wider distances.”
The use of personalized music playlists with tempo-pace synchronization increases adherence to cardiac rehab by almost 70 per cent—according to a study published in Sports Medicine –Open.
“Cardiac rehab has been proven to improve long-term survival for someone who’s had a heart event by 20 per cent,” said Dr. David Alter, Senior Scientist, Toronto Rehab, University Health Network, and Institute for Clinical Evaluative Sciences. “Our challenge is there is a high drop-out rate for these programs and suboptimal adherence to the self-management of physical activity.”
In Dr. Alter’s study, each research subject’s personalized playlist was the music genre they enjoyed with tempos that matched their pre-determined walking or running pace.
“The music tempo-pace synchronization helps cue the person to take their next step or stride and helps regulate, maintain and reinforce their prescribed exercise pace,” explained Dr. Alter, who is also Research Chair in Cardiovascular Prevention and Metabolic Rehabilitation at Toronto Rehab, UHN.
BLOOMINGTON, Ind. — Over nearly 15 years spent studying ticks, Indiana University’s Keith Clay has found southern Indiana to be an oasis free from Lyme disease, the condition most associated with these arachnids that are the second most common parasitic disease vector on Earth.
He has also seen signs that this low-risk environment is changing, both in Indiana and in other regions of the U.S.
A Distinguished Professor in the IU Bloomington College of Arts and Sciences’ Department of Biology, Clay has received support for his research on ticks from over $2.7 million in grants from the National Science Foundation-National Institutes of Health’s Ecology and Evolution of Infectious Diseases Program and others.
Clay’s lab has found relatively few pathogens in southern Indiana ticks that cause common tick-borne diseases compared to the Northeast and states like Wisconsin and Minnesota.
But Lyme disease has been detected just a few hours north of the region around Tippecanoe River State Park and Lake Michigan’s Indiana Dunes, and Clay said the signs are there that new tick species, and possibly the pathogens they carry, are entering the area.
“Just in the past 10 years, we’re seeing things shift considerably,” Clay said. “You used to never see lone star ticks in Indiana; now they’re very common. In 10 years, we’re likely to see the Gulf Coast tick here, too. There are several theories for why this is happening, but the big one is climate change.”
A vector for disease
The conclusions are drawn from years of work spent mapping tick boundaries and disease risks, but the exact cause of the shifting borders is not clear. In addition to changing temperatures, Clay references changes in animal populations, including deer, which provide large, mobile hosts for the parasites.
Exploring a new frontier of cyber-physical systems: The human body
[Series of videos follows, unfortunately unable to insert videos]
Simulation of electrical impulse propagation through the heart during ventricular fibrillation. Colour represents the transmembrane potential–i.e. the voltage across the cell membrane–on the surface of the heart. Yellow indicates largest potential values while dark red represents resting level. This simulation was performed by Pras Pathmanathan and Richard A. Gray at the US Food and Drug Administration (FDA), using the software package Chaste, together with a high-resolution anatomically-detailed computational mesh of the rabbit ventricles, and was run on FDA’s high performance computing resources in the Center for Devices and Radiological Health (CDRH).
Credit: Pras Pathmanathan and Richard A. Gray, US Food and Drug Administration (FDA)
Ok, the emphasis is on “may”. “…[L]earning to swim early in life may give kids a head start in developing balance, body awareness and maybe even language and math skills.”
Am blessed to be able to swim at work during lunch. The campus has a gym, with swim privileges at the hotel pool on campus. Maybe the swim is keeping some math skills intact!
From the 20 May 2015 Science News article
Loosely based on something our mother told us, it’s that learning to swim early in life may give kids a head start in developing balance, body awareness and maybe even language and math skills.
Mom may have been right. A multi-year study released in 2012 suggests that kids who take swim lessons early in life appear to hit certain developmental milestones well before their nonswimming peers. In the study, Australian researchers surveyed about 7,000 parents about their children’s development and gave 177 kids aged 3 to 5 years standard motor, language, memory and attention tests. Compared with kids who didn’t spend much time in the water, kids who had taken swim lessons seemed to be more advanced at tasks like running and climbing stairs and standing on their tiptoes or on one leg, along with drawing, handling scissors and building towers out of blocks.
Hitting milestones related to motor skills isn’t so surprising, the authors note, since swimming is a very physical activity. A bit more unexpected, they say, are the swimming kids’ advanced skills in language and math — tasks like counting, naming objects and recognizing words and letters. Kids who swam also seemed to be better at following directions. And, in some areas, kids had proportionally better scores on the development tests relative to how long they had been taking lessons.
The authors admit that they can’t conclusively claim that swimming alone is responsible for the developmental advances because the analysis was based on survey data and limited testing with young children. “Simply, we can say that children who participate in swimming achieve a wide range of milestones … and skill, knowledge and dispositions … earlier than the normal population,” the researchers write.
Traits passed between generations are not decided only by DNA, but can be brought about by other materials in cells.
Edinburgh scientists studied proteins found in cells, known as histones, which are not part of the genetic code, but act as spools around which DNA is wound.
Histones are known to control whether or not genes are switched on.
Researchers found that naturally occurring changes to these proteins, which affect how they control genes, can be sustained from one generation to the next and so influence which characteristics are passed on.
The finding demonstrates for the first time that DNA is not solely responsible for how characteristics are inherited.
It paves the way for research into how and when this method of inheritance occurs in nature, and if it is linked to particular traits or health conditions.
It may also inform research into whether changes to the histone proteins that are caused by environmental conditions – such as stress or diet – can influence the function of genes passed on to offspring.
The research confirms a long-held expectation among scientists that genes could be controlled across generations by such changes.
However, it remains to be seen how common the process is, researchers say.
Scientists tested the theory by carrying out experiments in a yeast with similar gene control mechanisms to human cells.
They introduced changes to a histone protein, mimicking those that occur naturally, causing it to switch off nearby genes.
The effect was inherited by subsequent generations of yeast cells.
The study, published in Science, was supported by the Wellcome Trust and the EC EpiGeneSys Network.
We’ve shown without doubt that changes in the histone spools that make up chromosomes can be copied and passed through generations. Our finding settles the idea that inherited traits can be epigenetic, meaning that they are not solely down to changes in a gene’s DNA.
“Frontiers in Psychology is an open access journal that aims at publishing the best research across the entire field of psychology. Today, psychological science is becoming increasingly important at all levels of society, from the treatment of clinical disorders to our basic understanding of how the mind works. It is highly interdisciplinary, borrowing questions from philosophy, methods from neuroscience and insights from clinical practice – all in the goal of furthering our grasp of human nature and society, as well as our ability to develop new intervention methods. The journal thus welcomes outstanding contributions in any domain of psychological science, from clinical research to cognitive science, from perception to consciousness, from imaging studies to human factors, from animal cognition to social psychology.”
It’s time to ask uncomfortable questions about the brain mechanisms that allow ‘ordinary’ people to turn violent, says Itzhak Fried.
What happens in the brains of people who go from being peaceable neighbours to slaughtering each other on a mass scale? Back in 1997, neurosurgeon Itzhak Fried at the University of California, Los Angeles, conscious of the recent massacres in Bosnia and Rwanda, described this switch in behaviour in terms of a medical syndrome, which he called ‘Syndrome E’ 2. Nearly 20 years later, Fried brought sociologists, historians, psychologists and neuroscientists together at the Institute of Advanced Studies in Paris to discuss the question anew. At the conference, called ‘The brains that pull the triggers‘, he talked to Nature about the need to consider this type of mass murder in scientific as well as sociological terms, and about the challenge of establishing interdisciplinary dialogue in this sensitive area.
What are the main features of the syndrome?
There was a myth that the primitive brain is held in check by our more-recently evolved prefrontal cortex, which is involved in complex analysis, and that the primitive, subcortical part takes over when we carry out brutal crimes such as repetitive murder. But I saw it the other way around. The signs and symptoms that I gathered in my research indicated that the prefrontal cortex, not the primitive brain, was responsible, because it was no longer heeding the normal controls from subcortical areas. I called it ‘cognitive fracture’ — the normal gut aversions to harming others, the emotional abhorrence of such acts, were disconnected from a hyper-aroused prefrontal cortex. I also proposed a neural circuitry in the brain that could perhaps account for this. In brief, specific parts of the prefrontal cortex become hyperactive and dampen the activity of the amygdala, which regulates emotion.
If mass murder happens because of activity in the brain, what does this say about personal responsibility?
Perpetrators of repeated killings have the capacity to reason and to solve problems — such as how best practically to kill lots of people rapidly. Proposing the existence of a syndrome does not absolve them of responsibility.
“..today we must assume that if our generation is suffering hardship, violence or the like, not only will we struggle to forget these difficult periods ourselves but our genes too will remember them, carrying traces to be passed on to the next generation or even several generations.”
From the 8 May 2015 post at Scilogs
The science behind a rapid paradigm shift
When the first human genome was decoded, popular thinking went: “If we know the genes, we know the person.” Today, barely 15 years later, science is in the middle of an exciting new area of research, which is entertaining interested members of the public with exciting, if not always serious, headlines. The field alleges that traumatic experiences can be passed down through the generations and even significantly affect the lives of grandchildren. As it turns out, the reality is that genes not only control, but are also controlled. And that is what epigenetics is all about – how are genes controlled and what factors can influence them?
Epigenetics refers to the meta-level of genetic regulation. Under the influence of external factors, epigenetic mechanisms regulate which genes are turned on and off. This helps our fixed genetic material to be more flexible. At the biochemical micro level, epigenetic regulators are responsible for how closely packed individual genomic regions are and therefore how accessible or not they are. This works by small adhered or detached chemical groups. The resulting marking of the genome is read by specialised enzymes that then cause the switching on or off of the genes.
As reasonable as this appears, one consequence is that we will have to say goodbye to a long-established dogma: the idea that genes are immutable in the creation of a living being. And, looking back through the history of science: was Lamarck right, after all? The 19th-century French biologist had claimed that organisms acquired traits to pass on to future generations . It is precisely this mechanism that epigeneticists are on the trail of today. Laboratory experiments with mice have demonstrated that a particular, targeted encoding of individual genes results in the changes being passed on to the offspring. Epigenetic changes, however, are so-called soft changes, as they can be undone. And that is medicine’s great hope – to be able to intervene in the control mechanism from the outside in order to be able to work against, for example, senile dementia.
At this point, the level of possible tension around this new field of research becomes clear. On the one hand, the idea that our human condition can be so strongly “manipulated” by environmental influences can be very disturbing. And rightly so. Previously, we may have had the upbeat expectation that although we are experiencing suffering, the next generation will have it better. However, today we must assume that if our generation is suffering hardship, violence or the like, not only will we struggle to forget these difficult periods ourselves but our genes too will remember them, carrying traces to be passed on to the next generation or even several generations.
A study often mentioned in this context is based on the analysis of data collected in the Netherlands over the years of hunger in 1944-45, during which the population there suffered particularly difficult conditions. The children born at this time were not only smaller, but, as adults, had an increased risk of obesity, cardiovascular problems and neuropsychiatric disorders. In turn, their offspring were again smaller than average – despite food being in ready supply and living conditions having greatly improved.
Use of Force against Inmates with Mental Disabilities in US Jails and Prisons
MAY 12, 2015
This 127-page report details incidents in which correctional staff have deluged prisoners with painful chemical sprays, shocked them with powerful electric stun weapons, and strapped them for days in restraining chairs or beds. Staff have broken prisoners’ jaws, noses, ribs; left them with lacerations requiring stitches, second-degree burns, deep bruises, and damaged internal organs. In some cases, the force used has led to their death.
EVANSTON, Ill. — Treatments used by traditional healers in Nigeria have inspired scientists at Northwestern University to synthesize four new chemical compounds that could one day lead to better therapies for people with psychiatric disorders.
In a paper published online in the journal Angewandte Chemie International Edition, the scientists detail how they created these natural compounds by completing the first total syntheses of two indole alkaloids — alstonine and serpentine. These alkaloids, found in various plant species used by healers in Nigeria to treat people with conditions such as schizophrenia and bipolar disorder, have antipsychotic properties that have potential to improve mental disorder treatments.
The current drugs used for schizophrenia effectively treat delusions and hallucinations but are only partially effective for cognitive impairment. Early experimental research of these new compounds in animal models shows promise in improving cognitive impairment, the Northwestern scientists said.
Traditional healers boil these special plants and produce an extract that they administer to people with symptoms of mental illness. However, this extract isn’t pure, and it contains other compounds and materials that may not be beneficial to people with mental disorders.
“Nature did not intend this plant to produce an antipsychotic drug on its own,” Meltzer said.
The collaborative work to create the compounds took place in the Center for Molecular Innovation and Drug Discovery (CMIDD) at Northwestern, using high-level purification resources and state-of-the-art research instrumentation and equipment. Scheidt is the director of CMIDD.
Through an efficient and stereo-selective synthesis, Scheidt and his team created four separate but related natural products. Now a template exists to continue making these compounds as needed for future studies and ultimately for use in clinical drug trials.
“We can make multi-gram quantities of any of the compounds we want,” Scheidt said. “We built the assembly line and are now uniquely positioned to explore their potential.”
Meltzer is already using these compounds in animal studies in his lab to better understand how they affect brain biology and chemistry in the schizophrenia disease model. Early results from his lab show that the compounds may increase the ability of other antipsychotic drugs to improve cognitive impairment.
Other study authors are Dr. Ashkaan Younai and Bi-Shun Zeng of Northwestern University. This study was supported the Chemistry of Life Processes Institute at Northwestern in the form of an Innovators Grant and the Weisman Family Foundation.
May 11, 2015 – What are the most influential studies on surgery of the lower (lumbar) spine? The “top 100″ research papers in lumbar spine are counted down in a special review in the May 15 issue of Spine, published by Wolters Kluwer.
Dr. Samuel K. Cho and colleagues of Icahn School of Medicine at Mount Sinai, New York City, performed a literature review to analyze and quantify the most important research papers on lumbar spine surgery. Their results raise some interesting “questions, trends and observations”–including the finding that the two most-cited studies focus on situations when spinal surgery should not be performed.
And the Top 100 Lumbar Spine Papers Are…
The goal of the analysis was to identify the 100 most frequently cited papers relevant to lumbar spine surgery and published in spine-related journals. Citation by subsequent papers is a key measure of the relevance and importance of medical studies.
Out of more than 16,500 papers matching the search criteria, 322 were cited at least 100 times. The top-ranked paper–cited more than 1,000 times–was a classic 1990 study showing that many people have common spinal abnormalities on magnetic resonance imaging (MRI) scans–despite having no back pain or other symptoms. A 1994 study on a similar topic was the second most-cited paper, highlighting the need for a “clear correlation” of patients’ symptoms and imaging findings
The third most-cited paper was a 2000 review of an important survey tool (the Oswestry Disability Index) for assessing the impact of low back pain on patients’ lives. Overall, low back pain was the most common topic, addressed by 23 of the top 100 papers. Other frequent topics included spinal biomechanics and degenerative disc disease.
About half of the papers were published during the 1990s, and most originated in the United States. Overall, 63 of the top 100 lumbar spine papers were published in Spine.
Reflecting the current emphasis on evidence-based practice, the most frequently cited author isn’t even a spinal surgeon. That researcher, Dr. Richard Deyo of Oregon Health and Science University, Portland, is a leading authority on patient outcomes research.
The other two most frequently cited authors were Scott D. Boden of Emory University, Atlanta, and Dr. James Weinstein of the Dartmouth Institute, Lebanon, N.H. All three of these “most prolific” authors contributed to the SPORT study–a pivotal clinical trial comparing the benefits of surgery versus nonsurgical treatment for sciatica from herniated lumbar discs. Dr. Weinstein is Editor-in-Chief of Spine, and Dr. Boden and Dr. Deyo are Deputy Editors.
Over the years, rates of spinal surgery have risen, but with wide regional variations. Meanwhile, there are persistent questions about which patients truly benefit from surgery for the common and costly problem of low back pain. Many of the top-cited studies reflect the current emphasis on evidence-based practice–seeking to define groups of patients and characteristics associated with beneficial effects of spinal surgery.
Within the limitations of the review methods used, Dr. Cho and colleagues believe their study provides unique insights into the development and trends of the “challenging subspecialty” of lumbar spine surgery. The researchers add, “This paper identifies those individuals whose contributions to the ever-growing body of knowledge have provided guidance and suggestions for further investigation.”
From the 14 May 2014 Dartmouth College news release
A Dartmouth research laboratory is working to quantify the effects of playing games. In a study published online last month by the Games for Health Journal, Professor Mary Flanagan and her team found that attitudes toward public health issues shift to be more accepting and understanding after playing a game they developed calledRePlay Health.
“Sales of games have been steadily increasing for several years,” says Flanagan, the Sherman Fairchild Distinguished Professor in Digital Humanities at Dartmouth and the director of the Tiltfactor laboratory. “So economically, we have measured their impact, and now it’s time to measure their ability to change behaviors and attitudes.”
RePlay Health is a role-playing sport that requires players to assume different identities and carry out various activities to improve their health. The backdrop of the game is a fictional health care system, and the players learn how personal behaviors, workplace productivity, insurance (or lack of it), and all related health care costs are woven together within the system. Each player is presented with opportunities to not only improve their own health, but also the health of their community through policy initiatives that they vote on.
“We showed how active engagement with the game’s characters and events was crucial to the game’s ability to shift players’ mindsets and attitudes about health and health policy,” says Geoff Kaufman, a co-author of the study and Tiltfactor’s post-doctoral researcher in psychology.
The researchers asked a group of young adults to complete an online questionnaire two weeks prior to playing RePlay Health and again within a week after playing the game. Flanagan says that the results indicate that the game has the potential to have a lasting impact on the players.
RePlay Health was developed in collaboration with The Dartmouth Center for Healthcare Delivery Science and the Rippel Foundation. The game is part of a broad initiative to promote learning about public health policies and spending priorities. Flanagan and her team envision college students, medical students, doctors, local council leaders, government officials, and any other people interested broadly in public health playing the game to digest the issues and find ideas that resonate. “It’s not just students and public officials who can play this game, or benefit from playing,” says Flanagan.
A fecal sample analysis of 98 Swedish infants over the first year of life found a connection between the development of a child’s gut microbiome and the way he or she is delivered. Babies born via C-section had gut bacteria that showed significantly less resemblance to their mothers compared to those that were delivered vaginally.
The study, which appears May 11 in Cell Host & Microbe‘s special issue on “The Host-Microbiota Balance,” also found nutrition to be a main driver of infant gut microbiome development–specifically the decision to breast-feed or bottle-feed.
“Our findings surprisingly demonstrated that cessation of breastfeeding, rather than introduction of solid foods, is the major driver in the development of an adult-like microbiota,” says lead study author Fredrik Bäckhed of The University of Gothenburg, Sweden. “However, the effect of an altered microbiome early in life on health and disease in adolescence and adulthood remains to be demonstrated.”
Gut bacteria are suspected to be a source of nutrients and vitamins for a growing infant. Our intestinal tenants are able to interact with normal cellular processes to, for example, produce essential amino acids. Understanding the role individual gut microbes play in metabolism, immunity, and even behavior is an active area of investigation.
New bio-sensing technologies give us cheap, fast and convenient health data
Amsterdam, May 12, 2015
Wearable E-skin that can measure heart rate and blood pressure, and paper diagnostic machines the size of a credit card that can give instant readings on blood and saliva samples are two new bio-sensing technologies presented at Elsevier’s 4th International Conference on Bio-Sensing Technology in Lisbon, Portugal on 12 May 2015.
Bio-sensors can detect and analyze data to give patients information on their heart rate and blood pressure, blood sugar and hormone levels, and even test whether they are infected with antibiotic-resistant bacteria. This detection technology is a step forward in personal medicine, giving patients real-time information about how their bodies are functioning and suggesting the most suitable treatments.
Professor Anthony Turner, Head of the Biosensors & Bioelectronics Centre at Linköping University, Sweden, has developed an instrument the size of a credit card that can analyse blood and saliva samples. It is simple to use: you switch it on by pressing a button, then apply your sample to a circle in the bottom right corner and wait for a digital reading to be displayed and even sent to your mobile phone.
The whole instrument is printed on the card using a screen-printing technique. It could be used to monitor diabetes, kidney disease and heart disease, or to detect cancer. This, says Professor Turner, could turn a 2500-year-old paradigm on its head and put the power in the patient’s hands.
This means they have the potential to provide patients and doctors in developing countries with accessible, affordable medical tests. For example, the printed card could be made part of the packaging of antibiotics, helping determine which antibiotic would be best to treat a patient’s infection.
Such printable devices could also be worn like plasters or contact lenses, transmitting information to mobile phones. Similarly, e-skin devices are also designed to be wearable and portable, and to transmit data about how a patient’s body is functioning.
Professor Ting Zhang, from Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, China, is presenting a new kind of e-skin at the Conference. E-skin is developed based on flexible electronic technology and nanotechnology; because of its unique ability to detect tiny changes in pressure, e-skin can be used to monitor blood pressure, heart rate and wrist pulse.
Bio-sensing technologies are gaining momentum in areas like health, the environment and security. The conference brings together leaders from industry and academia to exchange and share their experiences, present research results, explore collaborations and spark new ideas, with the aim of developing new projects and exploiting new technology for bio-sensing applications.
About the 4th International Conference on Bio-Sensing Technology
Following the success of the first 3 conferences, the 4th International Conference on Bio-Sensing Technology will continue to bring together leaders from industry and academia to exchange and share their experiences, present research results, explore collaborations and to spark new ideas, with the aim of developing new projects and exploiting new technology for bio-sensing applications. www.biosensingconference.com.
Scientists at a U.S. Army research center have modified an assay that tests whether or not a sample of mosquitoes harbors the virus responsible for the disease known as chikungunya (CHIKV), long a problem in the Old World tropics but recently established in the Americas.
…“Chikungunya” is a term used by people of the Makonde Plateau, between Tanzania and Mozambique, where the disease was discovered in 1952. It means, “that which bends up,” referring to the way arthritis caused by the disease crooks posture of the victim’s body. Symptoms of chikungunya can be as brutal as its name is to pronounce, although it is seldom fatal. Victims experience fever and pain and swelling of muscles and joints. Headache and rash may occur. The disabling impact can last for months.
Approximate distribution of Aedes aegypti (left) and Aedes albopictus in the United States, according to the Centers for Disease Control.
The chikungunya virus belongs to a group known as alphaviruses, at least 30 of which can infect humans and other vertebrates, causing diseases such as equine encephalitis and a variety of rash-accompanied fevers. CHIKV is transmitted by mosquitoes of the genus Aedes, chiefly Aedes aegypti, the bane of humans in the tropics because it also carries viruses responsible for yellow fever and dengue fever. Scientists have identified three different lineages — genetically-related groups — of CHIKV linked to geographical areas: Asia, West Africa, and East/Central/South Africa. All of the lineages exist outside the geographical areas after which they are named. A member of the Asian lineage, for example, has infected people in the Americas.
Like many tropical diseases, chikungunya has been rampant in the developing world for many years, but only became the focus of intensive research after it threatened western nations. An outbreak on Reunion Island, a French Department in the Indian Ocean, during 2005 and 2006 attracted attention largely because it’s a hot tourist destination for Europeans. Perhaps not by coincidence, the first transmission from mosquitoes in the Americans occurred in December 2013, on the French half of St. Martin, and island in the Caribbean. Reported cases in the Americas have now passed 1.5 million.
It began to show up in the United States during 2014, with nearly 2,500 cases reported from 46 states. Nearly all, however, were in travelers who picked up the infection in the tropics. Eleven people on the U.S. mainland, all in South Florida, contracted the disease directly from mosquitoes in the U.S.
During 2014, more than 4,500 people in Puerto Rico and the U.S. Virgin Islands were infected by mosquitoes, although the number may have been higher because chikungunya was not officially reportable to the federal Centers for Disease Control and Prevention until this year. There have been 77 chikungunya cases reported this year — as of April 7, from 21 states — but all were contracted out of the country.
To date, tests for CHIKV require expensive equipment in a laboratory setting and technicians who have undergone extensive training. Not so the dipstick test. It can be done on site by a neophyte and, importantly, does not require electricity. The dipstick involved is not the kind used to check oil in an automotive motor. It’s a small strip, usually paper-like nitrocellulose, a compound that is used in gunpowder, nail polish, laboratory filter paper, and other products. On the surface of the stick are reagents that will react to CHIKV antigens if the virus is present in the test sample, which is in a liquid solution.
Ed Ricciuti is a journalist, author, and naturalist who has been writing for more than a half century. His latest book is called Bears in the Backyard: Big Animals, Sprawling Suburbs, and the New Urban Jungle(Countryman Press, June 2014). His assignments have taken him around the world. He specializes in nature, science, conservation issues, and law enforcement. A former curator at the New York Zoological Society, and now at the Wildlife Conservation Society, he
From the 15 January 2015 article at The Conversation
Many people are aware that low levels of iron in their body can lead anaemia, with symptoms such as fatigue. But few realise that too much iron can result in a potentially fatal condition.
Normally, if we have enough iron in our body, then no further iron is absorbed from the diet, and our iron levels remain relatively constant.
But the body also has no way of excreting excess iron. In a condition called hereditary haemochromatosis, the most common cause of iron overload, the mechanism to detect sufficient iron in the body is impaired and people can go on absorbing iron beyond the normal required amount.
Untreated, haemochromatosis can result in scarring to the liver (cirrhosis), liver cancer, damage to the heart and diabetes. These problems are the result of excess iron being deposited in the liver, heart and pancreas. Haemochromatosis can also cause non-specific symptoms such as fatigue, loss of libido and arthritis. In some, it results in a shortened lifespan.
The most common cause of hereditary haemochromatosis is a mutation received from both parents, in a gene called HFE.
Around one in every 200 Australians of European heritage have a double dose of this gene fault and are at risk of developing the disorder. Haemochromatosis is much less common among people who aren’t of European ancestry.
Approximately 80% of men and 60% of women who have inherited this gene fault from both parents develop high iron levels. And of those who do, up to 40% of men and 10% of women will develop health problems.
Actual blood iron levels are generally normal in those with haemochromatosis, as excess iron in the body is stored in tissues like the liver. So haemochromatosis is diagnosed by testing blood iron indices called transferrin saturation and serum ferritin levels.
Image shows increased activity in the brains of ADRA2b deletion carriers.
From the 6 May 2015 University of British Columbia news release
Your genes may influence how sensitive you are to emotional information, according to new research by a UBC neuroscientist. The study, recently published in The Journal of Neuroscience, found that carriers of a certain genetic variation perceived positive and negative images more vividly, and had heightened activity in certain brain regions.
“People really do see the world differently,” says lead author Rebecca Todd, a professor in UBC’s Department of Psychology. “For people with this gene variation, the emotionally relevant things in the world stand out much more.”
The gene in question is ADRA2b, which influences the neurotransmitter norepinephrine. Previous research by Todd found that carriers of a deletion variant of this gene showed greater attention to negative words. Her latest research is the first to use brain imaging to find out how the gene affects how vividly people perceive the world around them, and the results were startling, even to Todd.
“We thought, from our previous research, that people with the deletion variant would probably show this emotionally enhanced vividness, and they did more than we would even have predicted,” says Todd, who scanned the brains of 39 participants, 21 of whom were carriers of the genetic variation.
Carriers of the gene variation showed significantly more activity in a region of the brain responsible for regulating emotions and evaluating both pleasure and threat. Todd believes this may help explain why some people are more susceptible to PTSD and intrusive memories following trauma.
“Emotions are not only about how feel about the world, but how our brains influence our perception of it,” says Adam Anderson, professor of human development at Cornell University and senior author of the study. “As our genes influence how we literally see the positive and negative aspects of our world more clearly, we may come to believe the world has more rewards or threats.”
Todd points out there are also benefits to carrying the gene variant. “People who have the deletion variant are drawing on an additional network in their brains important for calculating the emotional relevance of things in the world,” she says. “In any situation where noticing what’s relevant in the environment is important, this gene variation would be a positive.”
Todd says a prime example of a carrier of this variation was French novelist Marcel Proust: “He bit into the Madeleine cookie and then wrote seven volumes of memoirs,” she says. “He probably was emotionally sensitive too and he was certainly creative. He’s a classic deletion carrier.
From the 25 March 2015 University of Adelaide news release
Going for a walk instead of resting after eating could help to save older people from some falls caused by a sudden loss in blood pressure, according to new research.
Post-prandial hypotension is a fall in blood pressure seen within two hours of eating a meal. This health condition commonly affects older people – after a meal (usually breakfast), an older person may feel tired, dizzy or even experience a fall.
“Falls among older people often result in fractures, and those who experience a fall may lose confidence as well as lose their independence. Falls can also be fatal for older people,” she says.
Professor Visvanathan says researchers have been trying to better understand the reasons as to why this condition occurs, in the hopes of developing improved treatments or preventing post-prandial hypotension.
Research by University of Adelaide student Dr Shailaja Nair and University of South Australia student Ms Zoe Kopsaftis, working under the supervision of Professor Visvanathan and Dr Diana Piscitelli from the University of South Australia, has now confirmed that older people with post-prandial hypotension should be encouraged to walk intermittently at a normal pace for at least 120 minutes after a meal, as a means of reducing the fall in bloodpressure.
“This advice, coupled with other practical strategies, such as drinking a glass of water with meals, may help older people avoid the consequences of post-prandial hypotension,” Professor Visvanathan says.
“Much of the research conducted to date has been undertaken in healthy older people, but this new research has involved people with a confirmed diagnosis of the condition,” she says.
Professor Visvanathan says the University of Adelaide is considered a world leader in this field, but much more work is needed. “Simple, practical and cheap lifestyle interventions that older people can implement are highly desirable. The results showing that walking can be an effective strategy are pleasing, and will help in better understanding the overall picture of this common problem,” she says.
“We’re coming to recognize that meditation changes people’s brains,” said Wells, an assistant professor of neurology at Wake Forest Baptist Medical Center. “And we’re just beginning to gain understanding of what those changes mean and how they might benefit the meditator.”
In separate clinical studies, Wells has looked into the effectiveness of a meditation and yoga program called mindfulness-based stress reduction (MBSR) as a therapy for mild cognitive impairment – problems with memory or other faculties without yet having dementia – and for migraine headaches.
In the first study, the participants were adults between 55 and 90 with mild cognitive impairment. Those who practiced MBSR for eight weeks had significantly improved functional connectivity in the brain’s network that is active during introspective thought such as retrieving memories, along with trends of less atrophy in the hippocampus (the area of the brain responsible for emotions, learning and memory) compared with the participants who received conventional care. These findings indicate that meditation may positively affect the areas of the brain most impacted by Alzheimer’s and thus may be capable of slowing the progress of the disease.
Wells’ second study found that adults with migraines who practiced MBSR for eight weeks had shorter and less debilitating migraines than those in the control group who received standard medical care. The members of the MBSR group also had trends of less frequent and less severe attacks, and reported having a greater sense of self-control over their migraines.
A new analysis reported in JAMA Psychiatry raises serious questions about the increasingly common use of second-generation antidepressant drugs to treat anxiety disorders.
It concludes that studies supporting the value of these medications for that purpose have been distorted by publication bias, outcome reporting bias and “spin.” Even though they may still play a role in treating these disorders, the effectiveness of the drugs has been overestimated.
In some cases the medications, which are among the most widely prescribed drugs in the world, are not significantly more useful than a placebo.
The findings were made by researchers from Oregon State University, Oregon Health & Science University, and the University of Groningen in The Netherlands. The work was supported by a grant from the Dutch Brain Foundation.
Publication bias was one of the most serious problems, the researchers concluded, as it related to double-blind, placebo-controlled clinical trials that had been reviewed by the U.S. Food and Drug Administration. If the FDA determined the study was positive, it was five times more likely to be published than if it was not determined to be positive.
Bias in “outcome reporting” was also observed, in which the positive outcomes from drug use were emphasized over those found to be negative. And simple spin was also reported. Some investigators concluded that treatments were beneficial, when their own published results for primary outcomes were actually insignificant.
“These findings mirror what we found previously with the same drugs when used to treat major depression, and with antipsychotics,” said Erick Turner, M.D., associate professor of psychiatry in the OHSU School of Medicine, and the study’s senior author. “When their studies don’t turn out well, you usually won’t know it from the peer-reviewed literature.”
This points to a flaw in the way doctors learn about the drugs they prescribe, the researchers said.
“The peer review process of publication allows, perhaps even encourages, this kind of thing to happen,” Turner said. “And this isn’t restricted to psychiatry – reporting bias has been found throughout the medical and scientific literature.”
UNSW biomedical engineer Melissa Knothe Tate is using previously top-secret semiconductor technology to zoom through organs of the human body, down to the level of a single cell.
UNSW Paul Trainor Chair of Biomedical Engineering, Professor Melissa Knothe Tate. Photo: Grant Turner/Mediakoo
A world-first UNSW collaboration that uses previously top-secret technology to zoom through the human body down to the level of a single cell could be a game-changer for medicine, an international research conference in the United States has been told.
The imaging technology, developed by high-tech German optical and industrial measurement manufacturer Zeiss, was originally developed to scan silicon wafers for defects.
…the team presents an in-depth analysis of the gut microbiome of the Matses, an Amazonian hunter-gatherer community, which is compared with that of the village of Tunapunco, who are highland small-scale farmers, as well as with urban city-dwellers in Norman, Okla.
In comparing the three groups to previously published studies in Africa and South America, the team observed a striking trend. Human gut microbiota cluster together based on subsistence strategy more than geographic proximity. Thus, hunter-gatherers in South America and Africa are more similar to each other than either are to rural agriculturalists or to urban-industrialists, even from neighboring populations.
It is now well accepted that human gut microbiomes are actively involved in health and that changes in our gut microbes from living more sanitized, industrialized lifestyles, has led to susceptibility to certain autoimmune disorders like asthma and allergies.
Also, it has become clear that industrialization has led to a decrease in gut microbiome diversity. Moreover, in the gut of industrialized peoples, one particular bacteria genus is conspicuously absent, Treponema. These bacteria have co-existed with humans and other primates for millions of years, so their absence in industrialized people is disconcerting.
Improved Decision-Making in How to Use New Technology May be Key to Decrease in Complications Associated with Fracture Healing Procedures
A team of orthopedic surgeons from the Perelman School of Medicine at the University of Pennsylvania has found that modern technology for healing distal femur fractures is as safe and effective as its more established alternative, without a potential shortfall of the older approach. The team found that when done correctly, there are no significant differences between the two approaches – “locked plating” and “non-locked plating” – in terms of healing rates, need for corrective surgery, or hardware failure. The findings are being presented on Thursday, March 26, 2015, at the American Academy of Orthopaedic Surgeons Annual Meeting in Las Vegas.
he team examined medical records of 95 patients who underwent surgery to repair distal femoral fractures. Though relatively uncommon in the general population, an increase in the number of these fractures is expected as the population ages. For 80 percent of the patients studied, the fracture healed within 3.5 months of surgery, while 20 percent needed corrective surgery. The researchers found that patients whose surgeons used locked plating – which historically required a second revision surgery roughly 40 percent of the time – had no more setbacks than patients whose providers used non-locked plating.
The two methods differ by virtue of their use of locking and non-locking screws, respectively, to attach metal plates to fractured bone in order to provide stability and promote healing. While locked plating virtually eliminates the possibility of the plate moving, it has been associated with pronounced stiffness and rigidity around the healing bone, which can prevent the broken bone from healing.
“Plates used in distal femur surgery come in various sizes, and have as many as 16 to 20 apertures, or screw holes,” explained the study’s senior author Samir Mehta, MD, chief of the division of Orthopaedic Trauma at the Perelman School of Medicine at the University of Pennsylvania. “In the early days of locked plating, some surgeons used screws in every one of these apertures, which we think lead to stiffness, rigidity and pain for patients. Today, surgeons are more judicious, using far fewer screws and picking and choosing which holes to insert the screws in based on factors in the case at hand. This improved decision-making on the part of surgeons is what we believe has resulted in the significant decrease in techincal problems associated with locked plating.”
According to the researchers, the one factor that had a significant impact on fracture healing was if the fracture was open. Additionally, two factors increased the risk of poor healing for the participant population, but did not reach statistical significance: diabetes and non-weight bearing status postoperatively. The latter finding points the way toward early weight-bearing by patients, typically within a few days of surgery, rather than remaining in bed.
“As surgeons become more adept at application of both established and developing implant technologies, outcomes will continue to improve,” said lead investigator Ryan M. Taylor, MD, a fifth-year resident in the department of Orthopaedic Surgery at the Perelman School of Medicine at the University of Pennsylvania. “However, we must remain cognizant of patient specific variables such as age, weight, and pre-existing comorbidities, which can affect overall care strategies and management.”
Achieving better health outcomes at a lower cost and succeeding with payment reforms that shift from volume to value is difficult without health information technology (IT). Health IT can engage and support health care providers, patients, and consumers with access to timely and accurate clinical information from electronic health records (EHRs) and other sources. It can also provide access to cost and coverage information that avoids burdensome administrative processes and unexpected costs. Health IT can achieve these benefits through interoperability across information and data exchange platforms – avoiding duplicative parallel systems and additional data entry. Engaged patients and providers, supported by flexible, usable and useful health IT, can make informed shared decisions about testing and treatment which can lead to more timely, efficient, and higher-value health care.
Changes in how medical diagnoses are coded under the latest international disease classification system – known as the ICD-10 codes – may complicate financial analysis, research projects and training programs that depend on look-back comparisons of health care data, report researchers at the University of Illinois at Chicago.
The report, a collaboration of researchers at UIC and at the University of Arizona, is online in the Journal of the American Medical Informatics Association (JAMIA).
Codes for diagnoses – used to justify payments, among other things – may not translate from ICD-10 back to ICD-9 in a simple way, says Andrew Boyd, assistant professor of biomedical and health information sciences at UIC and first author of the paper.
Boyd and his colleagues have been looking at issues that could come up as physicians and hospitals change from one system to the other. Previously they found that some ICD-9 codes map well to ICD-10, but many more have highly convoluted mappings, and some don’t map at all. This forward-mapping is needed for continuing payments of ongoing medical conditions.
“Now, we are taking the same methodology and looking backward,” Boyd said. Reverse-mapping from ICD-10 back to ICD-9 will be important for all sorts of retrospective analyses, he said, “because we have 30 years of data that we want. We don’t want to lose all this information.”
Clinical researchers and analysts conducting studies across datasets – and hospital administrators who manage growth and watch trends for strategic planning – will need to pull data under both the new and the old codes. Mapping back from ICD-10- to ICD-9 is just as complex as mapping from ICD-9 to ICD-10.
The researchers created a web portal tool and translation tables designed to provide guidance on ambiguous and complex translations and to reveal where analyses may be challenging or impossible. The tool lists all ICD-9-CM diagnosis codes related to the input of ICD-10-CM codes and classifies their level of complexity, which can be a one-to-one “identity,” or reciprocal (the simplest); class-to-subclass; subclass-to-class; “convoluted”; or “no mapping.”
A new study has found some scientists are unknowingly tweaking experiments and analysis methods to increase their chances of getting results that are easily published.
The study conducted by ANU scientists is the most comprehensive investigation into a type of publication bias called p-hacking.
P-hacking happens when researchers either consciously or unconsciously analyse their data multiple times or in multiple ways until they get a desired result. If p-hacking is common, the exaggerated results could lead to misleading conclusions, even when evidence comes from multiple studies.
“We found evidence that p-hacking is happening throughout the life sciences,” said lead author Dr Megan Head from the ANU Research School of Biology.
The study used text mining to extract p-values – a number that indicates how likely it is that a result occurs by chance – from more than 100,000 research papers published around the world, spanning many scientific disciplines, including medicine, biology and psychology.
“Many researchers are not aware that certain methods could make some results seem more important than they are. They are just genuinely excited about finding something new and interesting,” Dr Head said.
“I think that pressure to publish is one factor driving this bias. As scientists we are judged by how many publications we have and the quality of the scientific journals they go in.
“Journals, especially the top journals, are more likely to publish experiments with new, interesting results, creating incentive to produce results on demand.”
Dr Head said the study found a high number of p-values that were only just over the traditional threshold that most scientists call statistically significant.
“This suggests that some scientists adjust their experimental design, datasets or statistical methods until they get a result that crosses the significance threshold,” she said.
“They might look at their results before an experiment is finished, or explore their data with lots of different statistical methods, without realising that this can lead to bias.”
The concern with p-hacking is that it could get in the way of forming accurate scientific conclusions, even when scientists review the evidence by combining results from multiple studies.
For example, if some studies show a particular drug is effective in treating hypertension, but other studies find it is not effective, scientists would analyse all the data to reach an overall conclusion. But if enough results have been p-hacked, the drug would look more effective than it is.
“We looked at the likelihood of this bias occurring in our own specialty, evolutionary biology, and although p-hacking was happening it wasn’t common enough to drastically alter general conclusions that could be made from the research,” she said.
“But greater awareness of p-hacking and its dangers is important because the implications of p-hacking may be different depending on the question you are asking.”
In 28 countries, more medicine has unexpected effects
COLUMBUS, Ohio – Across much of the Western world, 25 years of expansion of the medical system has actually led to people feeling less healthy over time, a new study has found.
A researcher at The Ohio State University used several large multinational datasets to examine changes in how people rated their health between 1981 and 2007 and compared that to medical expansion in 28 countries that are members of the Organization for Economic Co-operation and Development.
During that time, the medical industry expanded dramatically in many of those countries, which you might expect would lead to people who felt healthier.
“Access to more medicine and medical care doesn’t really improve our subjective health. For example, in the United States, the percentage of Americans reporting very good health decreased from 39 percent to 28 percent from 1982 to 2006,” Zheng said.
In fact, Zheng conducted what is called a “counterfactual analysis” using the data to see what would have happened if the medical industry hadn’t expanded at all in these countries since 1982. In this analysis, other factors that are generally linked to improved health, such as economic development, were left unchanged.
Under this scenario, the analysis predicted that self-rated health would have increased in these 28 countries. For example, the percentage of Americans reporting very good health could have increased by about 10 percent.
“It seems counterintuitive, but that’s what the evidence shows. More medicine doesn’t lead to citizens feeling better about their health – it actually hurts,” Zheng said.
Zheng measured three kinds of medical expansion. One was medical investment, which includes health care spending per capita and total health employment; medical professionalization and specialization, which includes the number of practicing physicians and specialists; and expanded pharmaceutical industry, which includes pharmaceutical sales per capita.
Zheng said there are several reasons why medical expansion may actually lead people to feel less healthy. For one, more diseases are discovered or “created,” which increases the risk of being diagnosed with “new” diseases. Three examples, he said, include the rise in diagnoses of attention deficit hyperactivity disorder (ADHD), depression and autism.
In addition, there is more aggressive screening, which turns up more diseases in people. Overdiagnosis can potentially cause harm to perfectly healthy people, he said.
As more medical care becomes more widely available, people may expect better health, perhaps to an unrealistic degree, Zheng said.
“Consumers begin demanding more medical treatment because of the declines in subjective health and the increasing expectations of good health, and medical expansion continues. It is a cycle,” Zheng said.
In a separate but related study published online in Social Science Research, Zheng found that Americans’ confidence in medicine has declined over the last three decades, again at the same time as medical expansion.
“The decline in confidence has occurred at the same rate, regardless of gender, age, income or any other factor,” Zheng said.
LIVERMORE, Calif.—Technologies developed in Sandia National Laboratories’biosciences program could soon find their way into doctors’ offices — devices like wearable microneedles that continuously analyze electrolyte levels and a lab-on-a-disk that can test a drop of blood for 64 different diseases in minutes.
At a recent seminar for potential investors and licensees, part of the Sandia Technology Showcase series, Sandia bioscientists presented eight ready-to-license technologies in three key areas: medical diagnostics, biosurveillance and therapeutics and drug discovery.
The National Science Foundation (NSF or Foundation) has developed a plan outlining a framework for activities to increase public access to scientific publications and digital scientific data resulting from research the foundation funds. The plan, entitled “Today’s Data, Tomorrow’s Discoveries,” is consistent with the objectives set forth in the Office of Science and Technology Policy’s Feb. 22, 2013, memorandum, “Increasing Access to the Results of Federally Funded Research,” and with long-standing policies encouraging data sharing and communication of research results.
As outlined in section 3.1 of the plan, NSF will require that either the version of record or the final accepted manuscript in peer-reviewed scholarly journals and papers in juried conference proceedings or transactions must:
Be deposited in a public access compliant repository designated by NSF;
Be available for download, reading and analysis free of charge no later than 12 months after initial publication;
Possess a minimum set of machine-readable metadata elements in a metadata record to be made available free of charge upon initial publication;
Be managed to ensure long-term preservation; and
Be reported in annual and final reports during the period of the award with a persistent identifier that provides links to the full text of the publication as well as other metadata elements.
This NSF requirement will apply to new awards resulting from proposals submitted, or due, on or after the effective date of the Proposal & Award Policies & Procedures Guide (PAPPG) that will be issued in January 2016.
From the 12 March 2015 news release at Medical Xpress
Microbes in the human body are estimated to outnumber human cells by 10 to 1, yet research on how they affect health is still in its infancy. A perspective article published by Cell Press on March 12th in Trends in Biotechnology presents evidence that gut microbes produce gases that may contribute to gastrointestinal diseases and could be used as biomarkers for one’s state of health. As means to measure these potential biomarkers, the authors suggest two novel gas-sensing systems, one of which is an electronic gas sensor in the form of a pill you can swallow. These systems may offer a reliable and economical way to understand the impact of intestinal gases on human health, paving the way for the development of new diagnostic techniques and therapies.
Resource May Help Identify Mechanisms of Immune-Related Diseases
An extensive database identifying immune traits, such as how immune cell function is regulated at the genetic level in healthy people, is reported by researchers from the National Institutes of Health (NIH) and their collaborators in the journal Cell. While many genetic risk factors have been linked to various diseases, including autoimmune disorders, how a genetic change causes susceptibility to a disease is not always clear. By studying healthy people, researchers from the National Institute of Allergy and Infectious Diseases (NIAID) Vaccine Research Center, part of the NIH, and colleagues from King’s College London have created a reference resource for other scientists.
The team analyzed blood samples collected from 669 female twins and developed a screening method that could differentiate approximately 78,000 subsets of immune cells, or immune traits. By using twins, the researchers identified which immune traits were most likely to be heritable and thus regulated at the genetic level. They selected 151 promising traits and performed a genome-wide approach to identify which, if any, genetic changes regulated a trait. They discovered 19 immune traits that were regulated by more than 240 genetic changes clustered within 11 areas of the human genome.
The results of this study have far-reaching implications, especially for researchers studying autoimmune disorders like multiple sclerosis, lupus, type 1 diabetes and inflammatory bowel disease. For example, genetic changes in the FCGR2 gene are known risk factors for several autoimmune disorders, including those just noted. However, it remains unclear how FCGR2 influences such a range of disorders. Now, researchers can use this new database to see how a change in FCGR2 or another gene affects components of the immune system and, subsequently, incorporate this information in the design of future studies.
M Roederer, L Quaye, M Mangino et al. The genetic architecture of the human immune system: a bioresource for autoimmunity and disease pathogenesis. Cell DOI: 10.1016/j.cell.2015.02.046 (2015).
Mario Roederer, Ph.D., chief of the ImmunoTechnology Section in NIAID’s Vaccine Research Center, is available to discuss the findings.
“What’s published in medical journals doesn’t necessarily match what was reported in clinicaltrials.gov….In a significant proportion of cases, the results on cliniclaltrials.gov were reported more thoroughly than the results in corresponding journal articles,”
Despite legal and ethical mandates for disclosure, results from most clinical trials of medical products are not reported promptly atclinicaltrials.gov, according to Duke Medicine researchers.
Among all clinical trials of medical products, those funded by industry were the most likely to be publicly disclosed in a timely fashion, but even then, compliance was poor.
Research funded by the National Institutes of Health and academic institutions lagged further, according to findings published by Monique Anderson, MD, assistant professor of medicine (Cardiology), and her DCRI colleagues in the March 12, 2015, issue of The New England Journal of Medicine.
Read the findings: Compliance with Results Reporting at ClinicalTrials.gov.
From the results section
“From all the trials at ClinicalTrials.gov, we identified 13,327 HLACTs that were terminated or completed from January 1, 2008, through August 31, 2012. Of these trials, 77.4% were classified as drug trials. A total of 36.9% of the trials were phase 2 studies, and 23.4% were phase 3 studies; 65.6% were funded by industry. Only 13.4% of trials reported summary results within 12 months after trial completion, whereas 38.3% reported results at any time up to September 27, 2013. Timely reporting was independently associated with factors such as FDA oversight, a later trial phase, and industry funding. A sample review suggested that 45% of industry-funded trials were not required to report results, as compared with 6% of trials funded by the National Institutes of Health (NIH) and 9% of trials that were funded by other government or academic institutions.”
Read a blog post about the study at Rethinking Clinical Trials, the NIH Collaboratory’sRethinking Clinical Trials: A Living Textbook of Pragmatic Clinical TrialsExcerpts
““We were really surprised at how untimely the reporting was—and that more than 66 percent hadn’t reported at all over the 5 years [of the study interval],””Another unexpected result was the finding that industry-sponsored studies were significantly more likely to have reported timely results than were trials sponsored by the National Institutes of Health (NIH) or by other academic or government funding sources. The authors noted that despite a seemingly widespread lack of compliance with both legal and ethical imperatives for reporting trial results, there has so far been no penalty for failing to meet reporting obligations,””reporting clinical trials results in order to contribute to scientific and medical knowledge is as much an ethical obligation for researchers as a legal one: “It’s something we really promise to every patient when they enroll on a trial.””
Listen to a report, with quotes from Dr. Anderson and Mark Stacy, MD, vice dean for clinical research, on National Public Radio: Results Of Many Clinical Trials Not Being ReportedExcerpts
“Even counting the late entries and allowable exceptions, only about 50 percent of taxpayer-funded research has been reported back to the taxpayers on clinicaltrials.gov, ”
“The study doesn’t assess why universities are frequently failing to post their results.”
“scientists are generally more likely to publish good news and ignore bad news, which skews the scientific record.”
“What’s published in medical journals doesn’t necessarily match whatwas reported in clinicaltrials.gov.”In a significant proportion of cases, the results on cliniclaltrials.gov were reported more thoroughly than the results in corresponding journal articles,” he says.
In these images, the ability of the new Cas9 approach to differentiate stem cells into brain neuron cells is visible. On the left, a previous attempt to direct stem cells to develop into neuronal cells shows a low level of success, with limited red–colored areas indicating low growth of neuron cells. On the right, the new Cas9 approach shows a 40–fold increase in the number of neuronal cells developed, visible as red-colored areas on the image. Credit: Wyss Institute at Harvard University
New mechanism for engineering genetic traits governed by multiple genes paves the way for various advances in genomics and regenerative medicine
When it comes to gene expression – the process by which our DNA provides the recipe used to direct the synthesis of proteins and other molecules that we need for development and survival – scientists have so far studied one single gene at a time. Anew approach developed by Harvard geneticist George Church, Ph.D., can help uncover how tandem gene circuits dictate life processes, such as the healthy development of tissue or the triggering of a particular disease, and can also be used for directing precision stem cell differentiation for regenerative medicine and growing organ transplants.
The findings, reported by Church and his team of researchers at the Wyss Institute for Biologically Inspired Engineering at Harvard University and Harvard Medical School in Nature Methods, show promise that precision gene therapies could be developed to prevent and treat disease on a highly customizable, personalized level, which is crucial given the fact that diseases develop among diverse pathways among genetically–varied individuals. Wyss Core Faculty member Jim Collins, Ph.D. was also a co-author on the paper. Collins is also the Henri Termeer Professor of Medical Engineering & Science and Professor in the Department of Biological Engineering at the Massachusetts Institute of Technology.
A new study has found women who smoke when pregnant are putting their daughters at a greater risk of developing ovarian and breast cancer later in life.
The Australian National University (ANU) study, published in Human Reproduction, found mothers who reported smoking most days while pregnant had daughters who had an earlier age of first menstruation, or menarche.
Lead researcher Dr Alison Behie said reaching menarche at an earlier age increases the number of ovulation cycles a woman will have in her life, and puts her at greater risk of developing reproductive cancers possibly due to increased exposure to hormones such as oestrogen.
“We’re discovering more and more that major aspects of our biology, and even our behaviour, are set before we are born,” said Dr Behie, a biological anthropologist from the ANU School of Archaeology and Anthropology.
“We know the mother’s exposure to stress, such as smoking in this case, can influence the long-term health of the child.
Major rethink in order for some of us, including me? Or is the jury still out, so to speak. Perhaps a major rethink of some substances in light of the emerging role of personalized medicine.
Personal flashback to 1979 and Peace Corps training in Nashville TN. We were housed in motel rooms during our 1 1/2 month stateside training. One evening I returned to my room, where my two roommates were lounging. One told me the other was tripping on LSD (it had come to her on the back of the postage stamp from a mailed letter from a friend). Well, I about lost it, I had smoked (but not inhaled!) some marijuana once, but my perception of LSD was that it, well, took control of you and made you do things you wouldn’t normally do. The other roommate told me I just had to accept it. I said I didn’t have to and left the room for a few others and hung out with other volunteers. I was well, a bit scared that if the roommate was caught or reported, I could get kicked out of the Peace Corps program. Well, we never talked about the LSD, and had about 3 weeks to go in the program. And we all managed to get along fairly well after this incident. Stayed home while I attended college, so I guess this was a version of college roommate “drama”.
U.S. adults with a history of using some nonaddictive psychedelic drugs had reduced likelihood of psychological distress and suicidal thoughts, plans, and attempts, according to data from a nationwide survey.
While these psychedelic drugs are illegal, a Johns Hopkins researcher and study author recommends reconsidering their status, as they may be useful in treating depression.
Some people have serious adverse reactions to these drugs, which may not stand out in the survey data because they are less numerous than positive outcomes.
The observational nature of the study cannot definitively show that psychedelics caused these effects, Johnson says, because those who chose to use psychedelics may have been psychologically healthier before using these drugs. However, the results probably reflect a benefit from psychedelics — the study controlled for many relevant variables and found that, as the researchers expected, other drugs assessed in the study were linked to increased harms, he says. The use of nonaddictive psychedelic drugs may exacerbate schizophrenia or other psychotic disorders and can sometimes elicit feelings of anxiety, fear, panic and paranoia, which can lead to dangerous behavior, Johnson says. But these instances of individual harm, while serious, may not stand out in the survey data because they occur less often than the positive outcomes that some people experience.
“Our general societal impression of these drugs is they make people go crazy or are associated with psychological harm, but our data point to the potential psychological benefits from these drugs,” he says. Current research at Johns Hopkins and several other universities is examining the therapeutic potential of one of the psychedelics, psilocybin, when administered in carefully controlled, monitored medical studies.
The use of psychedelics, such as LSD and magic mushrooms, does not increase a person’s risk of developing mental health problems, according to an analysis of information from more than 135,000 randomly chosen people, including 19,000 people who had used psychedelics. The results are published today in Journal of Psychopharmacology.
Clinical psychologist Pål-&Ostroke;rjan Johansen (http://www.EmmaSofia.org) and neuroscientist Teri Krebs (Norwegian University of Science and Technology) used data from the US National Health Survey (2008-2011) to study the relationship between psychedelic drug use and psychological distress, depression, anxiety, suicidal thoughts, plans, and attempts. The researchers found no link.
Johansen and Krebs previous population study, which used data from 2001-2004, also failed to find evidence for a link between psychedelic use and mental health problems.
“Over 30 million US adults have tried psychedelics and there just is not much evidence of health problems,” says Johansen.
“Drug experts consistently rank LSD and psilocybin mushrooms as much less harmful to the individual user and to society compared to alcohol and other controlled substances,” adds Krebs. In contrast to alcohol, psychedelics are not addictive.
Johansen and Krebs found that, on a number of measures, the use of psychedelic drugs is correlated with fewer mental health problems. “Many people report deeply meaningful experiences and lasting beneficial effects from using psychedelics,” says Krebs. However, “Given the design of our study, we cannot exclude the possibility that use of psychedelics might have a negative effect on mental health for some individuals or groups, perhaps counterbalanced at a population level by a positive effect on mental health in others,” adds Johansen.
Psychedelics and human rights
“With these robust findings, it is difficult to see how prohibition of psychedelics can be justified as a public health measure,” Johansen argues. Krebs adds that the prohibition of psychedelics is also a human rights issue: “Concerns have been raised that the ban on use of psychedelics is a violation of the human rights to belief and spiritual practice, full development of the personalty, and free-time and play.”
Lots of potentially useful medical information is getting lost. McGill researchers discovered this when they looked into the lack of reporting of information from “stalled drug” trials in cancer, cardiovascular and neurological diseases.
“Stalled drugs” are drugs that fail to make it to the market either because they prove to be ineffective or unsafe or both. Because only one in ten of the drugs that goes into human testing actually gets licensed, most of the information collected in developing new drugs is currently being lost. This is despite the fact that this information is critical for effective care, protecting patients, and discovering better drugs.
Findings from trials of stalled drugs:
1. Allow drug developers to discover what didn’t work, and then adjust the compound or method of delivery so that it might work for other conditions. For example, the drug Viagra failed initially as a drug for treatment of angina. We now know it to be a very effective drug for erectile dysfunction.
2. Help us learn about the safety of other approved drugs. Often, trials of experimental drugs generate valuable evidence about the safety of approved drugs – especially if the approved drugs are in the same chemical family.
3. Help drug discoverers learn about the limits of animal models and other experimental techniques. “When a drug works in animal models but not in patients, we have an opportunity to study why our model fell short and to improve it,” says Amanda Hakala, a Master’s student who is first author on the study.
4. Contain safety and efficacy information that might be useful in other parts of the world. Often, drugs that are considered unsafe and ineffective in one part of the world are approved in another. “Failure to publish these trials deprives patients in those other jurisdictions of state of the art evidence of safety and efficacy,” says Kimmelman.
Households can serve as a reservoir for transmitting methicillin-resistant Staphylococcus aureus (MRSA), according to a study published this week inmBio®, the online open-access journal of the American Society for Microbiology. Once the bacteria enters a home, it can linger for years, spreading from person to person and evolving genetically to become unique to that household.
The researchers found that isolates within households clustered into closely related groups, suggesting a single common USA300 ancestral strain was introduced to and transmitted within each household. Researchers also determined from a technique called Bayesian evolutionary reconstruction that USA300 MRSA persisted within households from 2.3 to 8.3 years before their samples were collected, and that in the course of a year, USA300 strains had a 1 in a million chance of having a random genetic change, estimating the speed of evolution in these strains. Researchers also found evidence that USA300 clones, when persisting in households, continued to acquire extraneous DNA.
“We found that USA300 MRSA strains within households were more similar to each other than those from different households,”
We’re also getting hints at how it evolves inside households. Decolonization of household members may be a critical component of prevention programs to control USA300 MRSA spread in the United States.”
Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers.“Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed.”
The extract of onion bulb, Allium cepa, strongly lowered high blood glucose (sugar) and total cholesterol levels in diabetic rats when given with the antidiabetic drug metformin, according to a new study. The study results will be presented Thursday at The Endocrine Society’s 97th annual meeting in San Diego.
“Onion is cheap and available and has been used as a nutritional supplement,” said lead investigator Anthony Ojieh, MBBS (MD), MSc, of Delta State University in Abraka, Nigeria. “It has the potential for use in treating patients with diabetes.”
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner. (For those wishing to see pictures of a 2009 Friends of Liberia service trip to this West African country, please visit www.fol.org. My photo album is included).
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My professional work experience and education includes over 10 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
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