MIT neuroscientists have shown that they can cure the symptoms of depression in mice by artificially reactivating happy memories that were formed before the onset of depression.
The findings, described in the June 18 issue of Nature, offer a possible explanation for the success of psychotherapies in which depression patients are encouraged to recall pleasant experiences. They also suggest new ways to treat depression by manipulating the brain cells where memories are stored. The researchers believe this kind of targeted approach could have fewer side effects than most existing antidepressant drugs, which bathe the entire brain.
“Once you identify specific sites in the memory circuit which are not functioning well, or whose boosting will bring a beneficial consequence, there is a possibility of inventing new medical technology where the improvement will be targeted to the specific part of the circuit, rather than administering a drug and letting that drug function everywhere in the brain,” says Susumu Tonegawa, the Picower Professor of Biology and Neuroscience, director of the RIKEN-MIT Center for Neural Circuit Genetics at MIT’s Picower Institute for Learning and Memory, and senior author of the paper.
In their new study, the researchers sought to discover if their ability to reactivate existing memories could be exploited to treat depression.
To do this, the researchers first exposed mice to a pleasurable experience. In this case, all of the mice were male and the pleasurable experience consisted of spending time with female mice. During this time, cells in the hippocampus that encode the memory engram were labeled with a light-sensitive protein that activates the neuron in response to blue light.
After the positive memory was formed, the researchers induced depression-like symptoms in the mice by exposing them to chronic stress. These mice show symptoms that mimic those of human sufferers of depression, such as giving up easily when faced with a difficult situation and failing to take pleasure in activities that are normally enjoyable.
However, when the mice were placed in situations designed to test for those symptoms, the researchers found that they could dramatically improve the symptoms by reactivating the neurons that stored the memory of a past enjoyable experience. Those mice began to behave just like mice that had never been depressed — but only for as long as the pleasant memory stayed activated.
BLOOMINGTON, Ind. — If you get a warm, fuzzy feeling after watching cute cat videos online, the effect may be more profound than you think.
The Internet phenomenon of watching cat videos, from Lil Bub to Grumpy Cat, does more than simply entertain; it boosts viewers’ energy and positive emotions and decreases negative feelings, according to a new study by an Indiana University Media School researcher.
The study, by assistant professor Jessica Gall Myrick, surveyed almost 7,000 people about their viewing of cat videos and how it affects their moods. It was published in the latest issue of Computers in Human Behavior. Lil Bub’s owner, Mike Bridavsky, who lives in Bloomington, helped distribute the survey via social media.
“Some people may think watching online cat videos isn’t a serious enough topic for academic research, but the fact is that it’s one of the most popular uses of the Internet today,” Myrick said. “If we want to better understand the effects the Internet may have on us as individuals and on society, then researchers can’t ignore Internet cats anymore.
“We all have watched a cat video online, but there is really little empirical work done on why so many of us do this, or what effects it might have on us,” added Myrick, who owns a pug but no cats. “As a media researcher and online cat video viewer, I felt compelled to gather some data about this pop culture phenomenon.”
Internet data show there were more than 2 million cat videos posted on YouTube in 2014, with almost 26 billion views. Cat videos had more views per video than any other category of YouTube content.
In Myrick’s study, the most popular sites for viewing cat videos were Facebook, YouTube, Buzzfeed and I Can Has Cheezburger.
Among the possible effects Myrick hoped to explore: Does viewing cat videos online have the same kind of positive impact as pet therapy? And do some viewers actually feel worse after watching cat videos because they feel guilty for putting off tasks they need to tackle?
Of the participants in the study, about 36 percent described themselves as a “cat person,” while about 60 percent said they liked both cats and dogs.
Participants in Myrick’s study reported:
They were more energetic and felt more positive after watching cat-related online media than before.
They had fewer negative emotions, such as anxiety, annoyance and sadness, after watching cat-related online media than before.
They often view Internet cats at work or during studying.
The pleasure they got from watching cat videos outweighed any guilt they felt about procrastinating.
Cat owners and people with certain personality traits, such as agreeableness and shyness, were more likely to watch cat videos.
About 25 percent of the cat videos they watched were ones they sought out; the rest were ones they happened upon.
They were familiar with many so-called “celebrity cats,” such as Nala Cat and Henri, Le Chat Noir.
Overall, the response to watching cat videos was largely positive.
“Even if they are watching cat videos on YouTube to procrastinate or while they should be working, the emotional pay-off may actually help people take on tough tasks afterward,” Myrick said.
The results also suggest that future work could explore how online cat videos might be used as a form of low-cost pet therapy, she said.
epa03907292 Belgian activists protest against the US chemical corporation Monsanto and their role in making Genetically Modified Organisms (GMOs) in Brussels, Belgium, 12 October 2013. Belgian anti-GMO activists joined a global protest against Monsanto who make GMOs as well as many toxic chemicals including pesticides, plastics and artificial food additives. EPA/THIERRY ROGE
From the 30 June 2015 article at The Conversation
Whether commanding the attention of rock star Neil Young or apparently being supported by the former head of Greenpeace, genetically modified food is almost always in the news – and often in a negative light.
GM divides opinion, and even individual people can find themselves pulled in two different ways. On the one hand it is a largely new technology and new tech often brings prosperity, solves problems and offers hope for the future. But this also makes it a step into the unknown and people are frightened of what they do not know, or what cannot be known.
In a study recently published in the journal Appetite, colleagues and I examined why some people reject GM technology. We were neither arguing for nor against GM, but rather we wanted to look at the characteristics which determine people’s views.
Specifically, we examined attitudes in the EU to two different types of genetic modifications made to apples. Both involve the introduction of genes to make them resistant to mildew and scab. The first is a gene that exists naturally in wild/crab apples. This is an example of what is called “cisgenesis”. In the second one the gene is from another species such as a bacterium or animal, and is an example of “transgenesis”.
As an idea of the gains available from this process, the production of a new apple cultivar may take 50 years or more. Gene transfer technologies can substantially shorten this. At the same time they may introduce characteristics from totally alien species which is virtually impossible to do naturally. This may then introduce many desirable qualities into the apple – for instance, in the hypothetical case we are analysing, the apples were made more resistant to disease.
We found people’s attitudes tend to be driven by their fears of risk, and their hopes of gain, with hopes being more important for cisgenesis (introduced genes from other apples) and the former for transgenesis (genes from other species).
But quite separate to risk and gain are perceptions that the technologies are “not natural”. Evidently people are disturbed when science takes us away from what they see as the laws of nature. People are also concerned about environmental impact.
People are more united in their disapproval of transgenesis (adding genes from other species). But, again, more educated people tend to be more approving as do men and the more prosperous, while older people tend to be more wary. Finally, for both technologies studying science, or having a father who studied science, impacted favourably on attitude
Objective -To determine whether trial publications of glucose lowering drugs are dominated by a small group of highly prolific authors (“supertrialists”) and to identify some of their characteristics.
ConclusionThe past two decades have seen an explosive increase in the number of published clinical trials regarding glucose lowering treatment. Some authors have made a disproportionate contribution to the therapeutic evidence base; one third of the RCT evidence base on glucose lowering drug treatment for diabetes was generated by<1% of authors. Of these, 44% were company employees and 56% were academics who work closely with the pharmaceutical companies.
What is already known on this topic
Honorary authors (authors with little or no contribution to the work described) and ghost authors (professional writers whose contribution is not acknowledged) threaten the integrity of the evidence base in medicine
Honorary authorship is known to be more frequent in research articles than in reviews
Anecdotally, a few highly prolific authors with multiple conflicts of interest have appeared to dominate clinical trial publications, but this has not previously been quantified
What this study adds
This analysis shows that 110 highly prolific authors contributed to one third of the evidence base for glucose lowering treatment; of these, 44% were company employees and 56% were academics who work closely with the pharmaceutical companies
Eleven authors, including nine academics—here designated supertrialists—contributed 10% of the entire evidence base
This concentration of influence adds to concerns about the independence and integrity of the evidence base for treatment for diabetes.
A team comprised of scientists at VIB, KU Leuven and UZ Leuven has made significant progress in uncovering the connection between psychological factors and the immune system. Their findings are based on an investigation of a massive drinking water contamination incident in Belgium in 2010, and are now published in the leading international medical journal Gut.
In December 2010, the Belgian communities of Schelle and Hemiksem in the province of Antwerp faced an outbreak of gastroenteritis, with more than 18,000 people exposed to contaminated drinking water. During the outbreak, VIB and KU Leuven set up a scientific task force to study the incident’s long-term effects, led by Guy Boeckxstaens (UZ Leuven / KU Leuven) and Adrian Liston (VIB / KU Leuven).
Seizing an unexpected opportunity
Adrian Liston (VIB/KU Leuven): “The water contamination in Schelle and Hemiksem was an ‘accidental experiment’ on a scale rarely possible in medical research. By following the patients from the initial contamination to a year after the outbreak we were able to find out what factors altered the risk of long-term complications.”
Anxiety and depression affect immune system
The scientists found that individual with higher levels of anxiety or depression prior to the water contamination developed gastrointestinal infections of increased severity. The same individuals also had an increased risk of developing the long-term complication of irritable bowel syndrome, with intermittent abdominal cramps, diarrhea or constipation a year after the initial contamination.
Guy Boeckxstaens (UZ Leuven / KU Leuven): “Irritable Bowel Syndrome is a condition of chronic abdominal pain and altered bowel movements. This is a common condition with large socio-economic costs, yet there is so much that still remains to be discovered about the causes. Our investigation found that that anxiety or depression alters the immune response towards a gastrointestinal infection, which can result in more severe symptoms and the development of chronic irritable bowel syndrome.”
Psychological factors key in preventing long-term complications
The study’s results provide valuable new insight into the cause of irritable bowel syndrome, and underscoring the connection between psychological factors and the immune system.
Adrian Liston (VIB/KU Leuven): “These results once again emphasize the importance of mental health care and social support services. We need to understand that health, society and economics are not independent, and ignoring depression and anxiety results in higher long-term medical costs.”
Think you’re a foodie? Adventurous eaters, known as “foodies,” are often associated with indulgence and excess. However, a new Cornell Food and Brand Lab study shows just the opposite –adventurous eaters weigh less and may be healthier than their less-adventurous counterparts.
The nationwide U.S. survey of 502 women showed that those who had eaten the widest variety of uncommon foods — including seitan, beef tongue, Kimchi, rabbit, and polenta— also rated themselves as healthier eaters, more physically active, and more concerned with the healthfulness of their food when compared with non-adventurous eaters. “They also reported being much more likely to have friends over for dinner,” said lead author Lara Latimer, PhD, formerly at the Cornell Food and Brand Lab and now at the University of Texas.
“These findings are important to dieters because they show that promoting adventurous eating may provide a way for people –especially women – to lose or maintain weight without feeling restricted by a strict diet,” said coauthor Brian Wansink, (author ofSlim by Design: Mindless Eating Solutions for Everyday Life). He advises, “Instead of sticking with the same boring salad, start by adding something new. It could kick start a more novel, fun and healthy life of food adventure.” The article is published in the journal Obesity. It is authored by former Cornell researchers, Lara Latimer, PhD, (currently a Lecturer at the University of Texas at Austin) and Lizzy Pope, PhD, RD (currently Assistant Professor at the University of Vermont), and Brian Wansink, (Professor and Director of the Food and Brand Lab at Cornell University.
Summary by Brian Wansink
***The Food and Brand Lab is an interdisciplinary group of graduate and undergraduate students from psychology, food science, marketing, agricultural economics, human nutrition, education, history, library science, and journalism along with a number of affiliated faculty.
Washington, D.C., July 1, 2015–The vast majority of consumers recognize that multivitamins, calcium and/or vitamin D supplements can help fill nutrient gaps but should not be viewed as replacements for a healthy diet, according to a new survey conducted on behalf of the Council for Responsible Nutrition (CRN). Conclusions from the survey of more than 2,000 U.S. adults were published in Nutrition Journal in a peer-reviewed article titled, “Consumer attitudes about the role of multivitamins and other dietary supplements: report of a survey,” authored by CRN consultant Annette Dickinson, Ph.D.; Douglas (Duffy) MacKay, N.D., senior vice president, scientific & regulatory affairs, CRN; and Andrea Wong, Ph.D., vice president, scientific & regulatory affairs, CRN.
“Our data suggest that policy makers and health professionals can recommend dietary supplements to help improve nutrient intakes without being concerned that this will cause consumers to discount the importance of eating a healthy diet,” Dr. Dickinson noted.
In the Nutrition Journal article, the authors cited U.S. government statistics indicating that a considerable percentage of U.S. adults fall short of recommended intakes for several nutrients, such as vitamins C, D and E. At the same time, Dr. Dickinson noted, “Surveys find that dietary supplement users tend to have better diets and adopt other healthy habits–suggesting that they view supplements as just one strategy in an array of health habits to help ensure wellness.” Further, CRN noted in the report that evidence demonstrates that incidence of over-nutrification with micronutrients is low.
Co-author Dr. MacKay advises the importance of CRN conducting this type of consumer research, noting, “As Americans continue to seek ways to stay healthy, dietary supplements play an important role, therefore, it’s important for our industry, as well as those in scientific, academic, health care practitioner and policy circles, to understand how consumers view that role.”
Information about label ingredients in more than 17,000 (most of 55,000 by 2016). selected brands of dietary supplements. It enables users to compare label ingredients in different brands. Information is also provided on the “structure/function” claims made by manufacturers.
Features include historic information on supplements, calculators to compare nutrients and Dietary Reference Intakes (DRIs).
These claims by manufacturers have not been evaluated by the Food and Drug Administration. Companies may not market as dietary supplements any products that are intended to diagnose, treat, cure or prevent any disease.
Longwood Herbal Task Force
This site has in-depth monographs about herbal products and supplements written by health professionals and students. It provides clinical information summaries, patient fact sheets, and information about toxicity and interactions as well as relevant links. The task force is a cooperative effort of the staff and students from Children’s Hospital, the Massachusetts College of Pharmacy and Health Sciences, and the Dana Farber Cancer Institute.
From the 6 July 2015 article at San Diego Newscape
“Culture teaches us which emotional states to value, which can in turn shape the emotions we experience,” said Stanford psychology Professor Jeanne Tsai, director of the Culture and Emotion Lab on campus. Stanford psychology postdoctoral fellow Tamara Sims was the lead author on the research paper, which was published in the Journal of Personality and Social Psychology.
Sims noted that a number of studies by other researchers have shown that people from Chinese and other East Asian cultures are more likely to feel both negative and positive – or “mixed emotions” – during good events, such as doing well on an exam.
On the other hand, Americans of European descent are more likely to just feel positive during good events. Tsai said this is explained by cultural differences in models of the “self.” Americans tend to be more individualistic and focus on standing out, whereas Chinese tend to be more collectivistic, focusing on fitting in.
“In multicultural societies like ours, this can lead to deep misunderstandings,” Tsai said.
For instance, Americans might view Chinese who feel bad during good events as being depressed, when in fact they are feeling how their culture expects them to feel.
In an interview, Sims said, “Although Americans know what it’s like to look for the good in the bad – the silver lining – they are less likely to see the bad in the good, compared to Chinese.”
Scientists have at their disposal a way to explore the possible prevention of genetic diseases before birth. But should they? Currently, the most promising path forward involves editing the genes of human embryos, a procedure rife with controversy. An article in Chemical & Engineering News (C&EN), the weekly newsmagazine of the American Chemical Society, parses the explosive issue.
Britt E. Erickson, a senior editor at C&EN, reports that at least one team of scientists has already published a study on altering disease-related genes of human embryos. The experiment was largely unsuccessful, but it stoked fears that such research on embryos could lead to potentially dangerous or unethical applications. Would parents start demanding designer babies engineered to be smarter or more attractive? What would be the long-term consequences of changing people’s genes before they’re born?
Without answers yet to these critical questions and others, many European countries have banned gene editing of human reproductive cells. In the U.S. — where federal dollars cannot go toward this type of work — and in China, scientists are allowed to pursue this type of research. But the landscape is likely going to change as scientists, ethicists and lawmakers hash out a path forward.
Agency Also to Examine Children’s Use of Cough, Cold Medications With Codeine
From the 7 July 2015 AAFP news release
On July 1, FDA officials moved to shut down the manufacture and sale of 16 unapproved prescription otic products used to relieve ear pain, inflammation and infection. Specifically, the agency notified(www.fda.gov) companies that produce and/or distribute these products that it will take enforcement action against them if they continue to make and market the ear drops.
In separate action, the agency said it also plans to scrutinize safety data pertaining to the use of codeine-containing products used to treat cough or colds in children younger than 18 years.
Prescription Ear Drops
Otic drops are frequently given to young children suffering from ear infections and other ailments that cause ear pain and swelling. A number of FDA-approved prescription otic products are available to manage these symptoms, as are legally marketed OTC ear drops. Those products are not affected by the agency’s action.
Products that have not been evaluated by the FDA for safety, quality and efficacy, on the other hand, increase patients’ risk for adverse effects, such as those due to contamination or varying dosage levels that stem from improper manufacturing practices. The unapproved products covered by this action contain the following ingredients:
benzocaine and antipyrine;
benzocaine, antipyrine and zinc acetate;
benzocaine, chloroxylenol and hydrocortisone;
chloroxylenol and pramoxine; and
chloroxylenol, pramoxine and hydrocortisone.
Patients who are using these unapproved products (or their parents) are advised to consult with their physician regarding other treatment options.
Codeine-containing Cough-and-Cold Products
In a Drug Safety Communication(www.fda.gov) issued July 1, FDA officials announced that the agency is investigating the safety of using cough-and-cold medications that contain codeine in children younger than 18 years. The agency cited concerns about the potential for severe side effects associated with use of these products, including slowed or difficult breathing.
Children with existing respiratory problems, such as asthma or other breathing disorders, may be particularly susceptible to these adverse effects.
The FDA’s action comes on the heels of an April announcement(www.ema.europa.eu) from the European Medicines Agency (EMA), which declared that the use of codeine-containing cough-and-cold medications was contraindicated in children younger than 12 years because of the risk of side effects. The agency also noted at the time that use of these products was not recommended in children ages 12-18 who have breathing problems.
Furthermore, EMA officials warned, patients of any age who are considered “ultra-rapid metabolizers” of the drug, which is converted into morphine in the body, must not use codeine to treat cough or colds.
The FDA announcement states that the agency will continue to evaluate the safety of using codeine products to treat cough or colds in children and young teens — including reviewing the EMA’s action and the evidence on which it was based — and will release final conclusions when that investigation is completed.
In the meantime, agency officials recommend caution when prescribing these medications for young patients, and they urge both physicians and patients to report adverse effects(www.accessdata.fda.gov) linked to use of the drugs via MedWatch, the FDA’s Safety Information and Adverse Event reporting Program.
From the 6 July 2015 University of San Francisco news release
Deleterious Effects of ‘Pro-Aging Factor’ Can Be Reversed in Mice
A blood-borne molecule that increases in abundance as we age blocks regeneration of brain cells and promotes cognitive decline, suggests a new study by researchers at UC San Francisco and Stanford School of Medicine.
The molecule in question, known as beta-2 microglobulin, or B2M, is a component of a larger molecule called MHC I (major histocompatibility complex class I), which plays a major role in the adaptive immune system. A growing body of research indicates that the B2M-MHC I complex, which is present in all cells in the body except red blood cells and plasma cells, can act in the brain in ways not obviously related to immunity—guiding brain development, shaping nerve cell communication, and even affecting behavior.
“We are in the process of elucidating the exact mechanism by which B2M works,” said Saul A. Villeda, PhD, a UCSF Faculty Fellow and co-senior author of the new study. “Since B2M increases with age, both in the blood and in the brain, we want to know what is the ‘traditional’ immune contribution to effects on cognition, and what is the non-traditional neural contribution.”
In 2014, highly publicized work in the laboratories of Villeda and Tony Wyss-Coray, PhD, professor of neurology at Stanford, showed that connecting the circulatory system of a young mouse to that of an old mouse could reverse the declines in learning ability that typically emerge as mice age.
Over the course of their long-term research on so-called young blood, however, the researchers had noted an opposite effect: blood from older animals appears to contain “pro-aging factors” that suppress neurogenesis—the sprouting of new brain cells in regions important for memory—which in turn can contribute to cognitive decline.
In the new research, published online on July 6, 2015 in Nature Medicine, Villeda and co-senior author Wyss-Coray again joined forces to follow up on these findings, as well as a range of studies correlating high B2M blood levels with cognitive dysfunction in Alzheimer’s disease, HIV-associated dementia, and as a consequence of chronic dialysis for kidney disease.
Members of the Villeda and Wyss-Coray labs first showed that B2M levels steadily rise with age in mice, and are also higher in young mice in which the circulatory system is joined to that of an older mouse. These findings were confirmed in humans, in whom B2M levels rose with age in both blood and in the cerebrospinal fluid (CSF) that bathes the brain.
When B2M was administered to young mice, either via the circulatory system or directly into the brain, the mice performed poorly on tests of learning and memory compared to untreated mice, and neurogenesis was also suppressed in these mice.
These experiments were complemented by genetic manipulations in which some mice were engineered to lack a gene known as Tap1, which is crucial for the MHC I complex to make its way to the cell surface. In these mice, administration of B2M in young mice had no significant effect, either in tests of learning or in assessments of neurogenesis.
The group also bred mice missing the gene for B2M itself. These mice performed better than their normal counterparts on learning tests well into old age, and their brains did not exhibit the decline in neurogenesis typically seen in aged mice.
Villeda emphasized that the effects on learning observed in the B2M-administration experiments were reversible: 30 days after the B2M injections, the treated mice performed as well on tests as untreated mice, indicating that B2M-induced cognitive decline in humans could potentially be treated with targeted drugs.
“From a translational perspective, we are interested in developing antibodies or small molecules to target this protein late in life,” said Villeda. “Since B2M goes up with age in blood, CSF, and also in the brain itself, this allows us multiple avenues in which to target this protein therapeutically.”
A guide to weighing up the benefits and harms of health screening programmes
Public expectations about screening don’t match what screening programmes can deliver. By addressing misconceptions about how screening works, its limitations and the calculation of benefits and harms, scientists and clinicians hope to bridge the gap between the active debates of the scientific community and the concerns raised by the public.
From the 6 July 2015 American Chemical news release
Carrying around a spare tire is a good thing — you never know when you’ll get a flat. Turns out we’re all carrying around “spare tires” in our genomes, too. Today, in ACS Central Science, researchers report that an extra set of guanines (or “G”s) in our DNA may function just like a “spare” to help prevent many cancers from developing.
Various kinds of damage can happen to DNA, making it unstable, which is a hallmark of cancer. One common way that our genetic material can be harmed is from a phenomenon called oxidative stress. When our bodies process certain chemicals or even by simply breathing, one of the products is a form of oxygen that can acutely damage DNA bases, predominantly the Gs. In order to stay cancer-free, our bodies must repair this DNA. Interestingly, where it counts — in a regulatory DNA structure called a G-quadruplex — the damaged G is not repaired via the typical repair mechanisms. However, people somehow do not develop cancers at the high rate that these insults occur. Cynthia Burrows, Susan Wallace and colleagues sought to unravel this conundrum.
The researchers scanned the sequences of known human oncogenes associated with cancer, and found that many contain the four G-stretches necessary for quadruplex formation and a fifth G-stretch one or more bases downstream. The team showed that these extra Gs could act like a “spare tire,” getting swapped in as needed to allow damage removal by the typical repair machinery. When they exposed these quadruplex-forming sequences to oxidative stress in vitro, a series of different tests indicated that the extra Gs allowed the damages to fold out from the quadruplex structure, and become accessible to the repair enzymes. They further point out that G-quadruplexes are highly conserved in many genomes, indicating that this could be a factory-installed safety feature across many forms of life.
Due to a premature posting of this paper online, the embargo is now lifted as of July 6.
A newborn’s first stool can signal the child may struggle with persistent cognitive problems, according to Case Western Reserve University Project Newborn researchers.
In particular, high levels of fatty acid ethyl esters (FAEE) found in the meconium (a newborn’s first stool) from a mother’s alcohol use during pregnancy can alert doctors that a child is at risk for problems with intelligence and reasoning.
Left untreated, such problems persist into the teen years, the research team from the Jack, Joseph and Morton Mandel School of Applied Social Sciences found.
“We wanted to see if there was a connection between FAEE level and their cognitive development during childhood and adolescence—and there was,” said Meeyoung O. Min, PhD, research assistant professor at the Mandel School and the study’s lead researcher. “FAEE can serve as a marker for fetal alcohol exposure and developmental issues ahead.”
Detecting prenatal exposure to alcohol at birth could lead to early interventions that help reduce the effects later, Min said.
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From the 14 July 2015 mHealth post
The following is a guest contributed post by Karen Holzberger, Vice President and General Manager for Diagnostics at Nuance.
The Joint Commission standards for diagnostic imaging, which recently went into effect, are designed to help prevent duplicate and unnecessary medical imaging of patients, and reduce potentially harmful exposure to radiation when patients need CT scans, MRI or a combination of these and other diagnostic tests. Beginning July 1, 2015, these standards require protocols, documentation and data collection, staff education and other criteria that raise the bar for quality and safety at ambulatory imaging sites, critical access hospitals and accredited hospitals. What do these standards really mean to the patient?
The new imaging standards focus primarily on the radiation dose index. There are a number of uncertainties tied to the long-term impact of imaging on patients, but researchers agree it impact patients differently depending upon sensitivities to radiation, age, body parts being tested, absorption rates and other factors and these are still being studied. In the meantime, to prevent undue risk, The Joint Commission has put a stake in the ground with these specific standards to help improve patient safety. The Joint Commission joins other accredited healthcare organizations, such as the American College of Radiology (ACR) and other clinical associations that are releasing new quality-focused recommendations,enhanced education tools and technologies to make it easier for healthcare teams to keep you safe from unintended risks while you receive diagnostic imaging that could shed light on serious health conditions.
WEST LAFAYETTE, Ind. — A new “smart capsule” under development could deliver medications directly to the large intestines to target certain medical conditions.
“Usually, when you take medication it is absorbed in the stomach and small intestine before making it to the large intestine,” said Babak Ziaie, a professor of electrical and computer engineering at Purdue University. “However, there are many medications that you would like to deliver specifically to the large intestine, and a smart capsule is an ideal targeted-delivery vehicle for this.”
Such an innovation might be used to treat of irritable bowel syndrome, Crohn’s disease and a potentially life-threatening bacterial infection called Clostridium difficile in which the body loses natural microorganisms needed to fight infection.
Findings are detailed in a research paper that appeared online and will be published in a future print issue of the Institute of Electrical and Electronics Engineers (IEEE) Transactions on Biomedical Engineering. The paper was authored by graduate students Wuyang Yu, Rahim Rahimi and Manuel Ochoa; Rodolfo Pinal, an associate professor of industrial and physical pharmacy; and Ziaie.
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.
With summer nearly here, U.S. consumers might think they have an abundance of sunscreen products to choose from. But across the Atlantic, Europeans will be slathering on formulations that manufacturers say provide better protection against the sun’s damaging rays — and skin cancer — than what’s available stateside, according to an article in Chemical & Engineering News (C&EN), the weekly newsmagazine of the American Chemical Society.
Marc S. Reisch, a senior correspondent at C&EN, reports that sunscreens on the U.S. market do protect users from some ultraviolet-A and -B rays. But there are eight sunscreen molecules approved for use in Europe that could boost the effectiveness of products in the U.S. and also give manufacturers more flexibility in making their lotions. Some have been in line for FDA approval since 2002.
Why the hold-up? In Europe, sunscreen molecules are considered cosmetic ingredients. In the U.S., they are subject to the same scrutiny as over-the-counter drugs, which go through a more rigorous review process than cosmetics. More than 10 years ago, the FDA introduced a streamlined process to speed up the review of sunscreens from overseas to bring them to the U.S. market. But the products’ makers are still waiting for approval, and some have given up.
The American Chemical Society is a nonprofit organization chartered by the U.S. Congress. With more than 158,000 members, ACS is the world’s largest scientific society and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.
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).
On 9 April, the 2015 Social Progress Index launched – it measures the social and environmental outcomes for 133 countries, covering 94% of the world’s population.
As a complement to economic measures such as GDP, the Social Progress Index provides a more holistic measure of country performance and helps to drive real and sustainable growth that is important for business and vital for building a prosperous society.
The CDC recently released an interesting map depicting the most “distinctive” cause of death in each state from 2001 through 2010. These causes of death are not the most common – that would be cancer or heart disease in every state – but rather unusual causes of death that are disproportionately common in each state.
Because these aren’t the most common cause of death, in some states just a few dozen people are dying of each condition. For example, the number of deaths range “from 15,000 deaths from HIV in Florida to 679 deaths from tuberculosis in Texas to 22 deaths from syphilis in Louisiana.”
Maps like this one can be helpful in elucidating unique health conditions or social issues in each state. We all know that as a country we are overweight; pointing out the number one killer (heart disease) on a map on seeks to reinforce what is already known. The “distinctive cause” of death points to other issues – like people in coal-mining states being disproportionately likely to die from pneumoconiosis (black lung).
For the physicians out there – the authors of the study noted the importance of categorizing causes of death accurately on death certificates. “It would not take many systematic miscodes involving an unusual cause of death for it to appear on this type of map,” they write.
You can also visit this article on Slate about fun with maps that go viral, which clearly shows how manipulating data can give you some interesting results.
Still believe physicians and other health care professionals should legally be able to ask if there are guns in the household. The presence of guns in a household does factor into increased accidents and injuries. Also, patients can refuse to answer the question if they so desire.
Down in Brazos, Texas, two ER doctors made local headlines by donating a pair of Mossberg shotguns to the local County Constable office. The guns were donated in memory of Constable Brian Bachmann, a 20-year law enforcement veteran, who was killed while attempting to serve an eviction notice onan enraged individual, the latter after shooting Bachmann then shot and killed a civilian, and wounded two other police officers before being killed himself.
What caught my eye about this story was the fact that it highlighted the relationship between law enforcement and medicine when we think about violence perpetrated with guns. After all, if we use a phrase like ‘gun violence’ to cover every incident in which someone suffers an injury from a gun, then three-quarters of all violence involving guns also happen to be crimes. In 2013, hospitals treated roughly 60,000 people who were victims of shootings and treated 135,000…
ancer, all by itself, is bad enough. Although cancer treatment, especially chemotherapy, has become much gentler than it was a decade ago, most interventions still carry significant risks and side effects.
Recently, many physicians have focused on a different sort of hazard that they call “financial toxicity.” Along with the distress of a cancer diagnosis and the discomforts of treatment, patients increasingly have to deal with the cost, anxiety and loss of confidence inspired by large, unpredictable expenses, often compounded by decreased ability to work.
A team led by Jonas de Souza, MD, a head-and-neck cancer specialist at the University of Chicago Medicine, has developed the first patient-oriented website devoted to helping cancer patients understand and cope with financial toxicity (FT). Their goal is to increase awareness of this side effect prior to and during medical treatment so patients know what to expect and can better understand how costs impact them and their families.
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.
This illustration depicts the influenza virus. Graphic created by Dan J. Higgins, Division of Communication Services, CDC
The 13th Edition Epidemiology and Prevention of Vaccine-Preventable Diseases, a.k.a. the “Pink Book,” provides physicians, nurses, nurse practitioners, physician assistants, pharmacists, and others with the most comprehensive information on routinely used vaccines and the diseases they prevent.
Typical chapters include a description of the disease, pathogenesis, clinical features, laboratory diagnosis, medical management, epidemiology, vaccination schedule and use, contraindications and precautions, adverse reactions following vaccination, vaccine storage and handling, and references.
Six appendices contain a wealth of reference materials including: vaccine minimum ages and intervals, current and discontinued vaccines, vaccine contents, foreign vaccine terms, and more.
To view online or download to print specific sections, see links below.
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.
New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more.
The Affordable Care Act has transformed the health insurance options available to Americans who lack health benefits through a job. Numerous surveys have indicated that the law’s coverage expansions and protections have reduced the number of uninsured adults by as many as 17 million people.1
But Congress intended the Affordable Care Act to do more than expand access to insurance; it intended for the new coverage to allow people to get needed health care at an affordable cost. Accordingly, for marketplace plans, the law includes requirements like an essential health benefit package, cost-sharing subsidies for lower-income families, and out-of-pocket cost limits.2 For people covered by Medicaid, there is little or no cost-sharing in most states.
But most Americans—more than 150 million people—get their health insurance through employers.3 Prior to the Affordable Care Act, employer coverage was generally far more comprehensive than individual market coverage.4 However, premium cost pressures over the past decade have led companies to share increasing amounts of their health costs with workers, particularly in the form of higher deductibles.5
In this issue brief, we use a measure of “underinsurance” from the Commonwealth Fund’s Biennial Health Insurance Survey to examine trends from 2003 to 2014, focusing on how well health insurance protects people from medical costs. Adults in the survey are defined as underinsured if they had health insurance continuously for the proceeding 12 months but still had out-of-pocket costs or deductibles that were high relative to their incomes (see Box #1). The survey was fielded between July and December 2014. This means that we could not separately assess the effects of the Affordable Care Act on underinsurance because people who were insured all year in the survey had insurance that began before the law’s major coverage expansions and reforms went into effect. People who had new marketplace or Medicaid coverage under the Affordable Care Act would not have had that coverage for a full 12 months, as it would have begun in January 2014 at the earliest. Similarly, people with individual market coverage who were insured all year would have spent all or part of the period in plans that did not yet reflect the consumer protections in the law.6
Athens, Ga. – Early socioeconomic adversity, such as poverty, low education and disadvantaged community, has both direct and indirect long-term effects on young adults’ cardio-metabolic disease risk, according to researchers within the University of Georgia College of Family and Consumer Sciences.
K.A.S. Wickrama, the Athletic Association Endowed Professor in human development and family science, and his research team explored a “resource focused model” examining the positive psychosocial resources—self-esteem, personality and educational attainment—linking adolescents’ early life experiences to young adults’ health outcomes as measured by nine bio-markers including blood pressure, blood glucose level and body mass index.
The research showed that in addition to early adversity’s direct impact on cardio-metabolic health, it also negatively influenced the development of these psychosocial resources, which, in turn, proved detrimental to disease risk, including diseases such as diabetes, heart disease or stroke.
The study included data from more than 12,000 young adults currently aged 25-34 who participated in the National Longitudinal Study of Adolescent to Adult Health over a 13-year period. Wickrama has published extensively from this data set.
“Youth in a poor family or poor community likely feel less valuable, have lower self-worth and lower self-esteem than youth in families with more socioeconomic capital,” Wickrama said. “Also, early socioeconomic adversity manifests itself directly in the form of impaired cognitive development and educational attainment.”
This connection between psychosocial resources and disease risk is likely due to multiple factors, researchers said, including neurological pathways and poor health behaviors.
Researchers also found gender differences relative to the association between psychosocial resources and cardio-metabolic risk.
The association was statistically significant for women but not for men, they noted. For men, researchers said, early adversity impairs development of psychosocial resources, but those impaired resources do not seem to lead to cardio-metabolic risk for young adults as it does for women.
The paper, “Early socioeconomic adversity, youth positive development and young adults’ cardio-metabolic disease risk,” appeared in the March issue of Health Psychology and is one of three recent papers on the subject produced by Wickrama’s research team.
Co-authors include Catherine Walker O’Neal, a postdoctoral research associate, and Tae Kyoung Lee, a doctoral candidate, both in the human development and family science department within the college.
Another paper, “Stressful life experiences in adolescence and cardio-metabolic risk factors in young adulthood,” was published online in February by the Journal of Adolescent Health.
Using a stress-focused model, the paper links early adversity to poor physical health outcomes based on stressful events that can lead to a rush into adulthood, such as teenage pregnancy or dropping out of high school.
“There is a physical effect on your body from being in these stressful environments,” O’Neal said. “This is a long-term effect that you really can’t easily overcome.”
Researchers refer to this phenomenon as a person’s allostatic load, or weathering.
“Think of a rock continually exposed to the elements day after day,” O’Neal said. “It gets weathered and worn down, and you can’t restore the rock to its original state. In the same way, recovering from the physical effects of these stressors is incredibly difficult.”
A third paper, “Stress and resource pathways connecting early socioeconomic adversity to young adults’ physical health risk,” was published in the Journal of Youth Adolescence late last year.
This paper shows that both the resource and stress pathways connecting early socioeconomic adversity to cardio-metabolic health operate independently.
Researchers suggested through these studies that vulnerable groups of children can be identified early for prevention and intervention efforts.
“I think our findings definitely could be very applicable to intervention and prevention work,” O’Neal said. “I think we show multiple intervening points and areas where you could step in and stop the cycle.”
How Inauthenticity Produces Feelings of Immorality and Impurity
The five experiments reported here demonstrate that authenticity is directly linked to morality. We found that experiencing inauthenticity, compared with authenticity, consistently led participants to feel more immoral and impure. This link from inauthenticity to feeling immoral produced an increased desire among participants to cleanse themselves and to engage in moral compensation by behaving prosocially. We established the role that impurity played in these effects through mediation and moderation. We found that inauthenticity-induced cleansing and compensatory helping were driven by heightened feelings of impurity rather than by the psychological discomfort of dissonance. Similarly, physically cleansing oneself eliminated the relationship between inauthenticity and prosocial compensation. Finally, we obtained additional evidence for discriminant validity: The observed effects on desire for cleansing were not driven by general negative experiences (i.e., failing a test) but were unique to experiences of inauthenticity. Our results establish that authenticity is a moral state—that being true to thine own self is experienced as a form of virtue.
Whether people locate their sense of self in the brain or the heart can have a major influence on their decision-making, according to a new study by management and business experts at Rice University and Columbia University.
Overall, the study found people tend to locate the self in the brain.
The paper, “Who You Are Is Where You Are: Antecedents and Consequences of Locating the Self in the Brain or the Heart,” will be published in the journal Organizational Behavior and Human Decision Processes.
“We view our research as a first step toward reviving the debate about which part of our body contains the seat of the self – a debate that dates back to the ancient Greek philosophers,” said Hajo Adam, an assistant professor of management at Rice’s Jones Graduate School of Business. “Our findings demonstrate not only that the preference for the brain versus the heart as the location of the self systematically depends on a person’s self-construal — meaning the perceptions that individuals have about their thoughts, feelings and actions in relation to others — but also that the location of the self has important implications for people’s opinions on contentious medical issues as well as prosocial contributions.”
Adam co-authored the paper with Otilia Obodaru, an assistant professor of management at the Jones School, and Adam Galinsky, the Vikram S. Pandit Professor of Business and chair of the management division at Columbia’s business school.
The authors’ research consisted of eight studies exploring the antecedents and consequences of whether people locate their sense of self in the brain or the heart. Their hypothesis was that although people generally tend to locate their sense of self in the brain, this preference is significantly stronger for people with an independent self-construal than for people with an interdependent self-construal.
People with an independent self-construal tend to assert the autonomous nature of the self, realize their internal attributes and influence their environment. In pursuit of these self-relevant goals, these people often engage in thoughts, conversations and behaviors that are conceptually related to the brain. In contrast, people with an interdependent self-construal tend to be part of a group, maintain harmonious relationships and adjust to others. In pursuit of these self-relevant goals, these people often engage in thoughts, conversations and behaviors that are conceptually related not only to the brain, but also to the heart.
Law would give family members and law enforcement tool to temporarily remove guns from someone believed dangerous
Gun violence restraining orders (GVROs) are a promising strategy for reducing firearm homicide and suicide in the United States, and should be considered by states seeking to address gun violence, researchers from the Johns Hopkins Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health and the University of California, Davis, argue in a new report.
The article is being published online in Behavioral Sciences and the Law on May 20.
GVROs allow family members and intimate partners who believe a relative’s dangerous behavior may lead to violence to request an order from a civil court authorizing law enforcement to remove any guns in the individual’s possession, and to prohibit new gun purchases for the duration of the order.
Three states have laws that authorize law enforcement to remove guns from someone identified as dangerous: Indiana, Connecticut and Texas. In 2014, California became the first state in the nation to allow family members and intimate partners to directly petition a judge to temporarily remove firearms from a family member if they believe there is a substantial likelihood that the family member is a significant danger to himself or herself or others in the near future. The law, passed by the California legislature, takes effect Jan. 1, 2016.
“GVROs allow family members or intimate partners who identify a pattern of dangerous behavior to intervene in advance of something bad happening,” says lead author Shannon Frattaroli, PhD, MPH, an associate professor with the Johns Hopkins Center for Gun Policy and Research. “Currently under federal law, those who have been involuntarily committed to inpatient treatment for mental illness or those who have been convicted of felonies are prohibited from purchasing or possessing firearms, but there is no temporary prohibition based on dangerousness,” Frattaroli said. “The limitation of this approach is that firearm removals do not go into effect until an extreme event that results in a criminal justice or mental health system response has already occurred.”
The benefits of eating slowly and chewing thoroughly have been proposed for over a century, but there has been little actual proof of the theory. Now, Naoyuki Hayashi and Yuka Hamada at Tokyo Institute of Technology have shown that, in the three-hour period after eating, energy expenditure is greater if the food was eaten slowly than if it was eaten quickly.
Health care that costs more than it needs to is not just an annoyance; it’s a big factor in income inequality in the United States. The financial, physical and emotional burden of disease are major drivers of poverty. At the same time, the high cost of health care even after the Affordable Care Act means that many people don’t access it when they need it, and this in turn deprives large swathes of the population of their true economic potential as entrepreneurs, workers and consumers. People who are burdened by disease and mental illness don’t start businesses; don’t show up for work; and don’t spend as much money on cars, smartphones and cool apartments. Unnecessary sickness is a burden to the whole economy.
How did we get this way? What was the mechanism that differentiated U.S. health care from all other advanced countries? The usual suspects (such as “We have the most sophisticated research and teaching hospitals,” or “It’s the for-profit health insurers” or “Doctors make too much”) all fail when we compare the United States with other sophisticated national systems such as those in Germany and France. Other countries have all of these factors in varying amounts — private health insurers, world-class research, well-paid physicians — and cost a lot, but still spend a far smaller chunk of their economy on health care. Blame has been leveled in every direction, but in reality no single part of health care has been the driver. The whole system has become drastically more expensive over the last three decades.
What’s the Mechanism?
Since the difference between the United States and other countries is so large and obvious, there should be some way we can look at health care spending that would make that mechanism jump out at us. And there is a way.
That first big leap is between 1982 and 1983. What was different in 1983 that was not there in 1982? DRGs, diagnosis-related groups — the first attempt by the government to control health care costs by attaching a code to each item, each type of case, each test or procedure, and assigning a price it would pay in each of the hundreds of markets across the country. The rises continue across subsequent years as versions of this code-based reimbursement system expand it from Medicare and Medicaid to private payers, from inpatient to ambulatory care, from hospitals to physician groups and clinics, to devices and supplies, eventually becoming the default system for paying for nearly all of U.S. health care: code-driven fee-for-service reimbursements.
Cost Control Drives Costs Up?
How can a cost control scheme drive costs up? In a number of ways: In an attempt to control the costs of the system, the DRG rubric controlled the costs of units, from individual items like an aspirin or an arm sling to the most comprehensive items such as an operation or procedure. The system did not pay for an entire clinical case across the continuum of care from diagnosis through rehab; or for an entire patient per year on a capitated basis, which would capture the economic advantages of prevention; or for an entire population. While it is more cost-effective (as well as better medicine) to provide a diabetes patient with medical management, in-home nursing visits and nutritional counseling rather than, say, waiting until the patient needs an amputation, the coding system actually punished that efficiency and effectiveness. Under this system, we got paid for our inefficiencies, and even for our mistakes: Do-overs would often drop far more to the bottom line than the original procedure did.
The system punished, rather than rewarded, spending more time with patients, trying to help patients before their problems became acute, or maintaining a long-term, trusted relationship with patients. Under a code-driven fee-for-service system, getting serious about prevention and population health management would be a broad road to bankruptcy.
If extra items were deemed necessary (an extra test or scan, say), there were codes for that, and reimbursements awaiting. In so doing, the system rewarded doing more (“volume”) rather than whatever would be the best, most appropriate, most efficient treatment path (“value”). It provided a written, detailed catalog of reimbursements which rewarded diagnoses of greater complexity, rewarded new techniques and technologies with new and usually higher reimbursements, and especially rewarded systems that invested in a greater capability to navigate the coding system. At the same time, the reimbursements were constantly open to pressure from the industry. Each part of the industry, each region, each specialty, each part of the device industry, became fiercely focused on keeping those reimbursements up, and getting new codes for more costly procedures.
The business and strategic side of health care became a matter of making money by farming the coding system. Do more of what gets better reimbursement, less of what does not. Make sure every item gets a code and gets charged for. The codes became a manual for success, a handbook for empire.
The Smoking Gun
The smoking gun is right there in the chart, at the big split between the trajectories of the United States and other countries. And today, at this moment, the code-based fee-for-service payment system is still by far the basis of the majority of all revenue streams across health care.
The unifying factor between multiple new strategies unfolding in health care right now, including patient-centered medical homes, pay for performance, bundled prices, reference prices, accountable care organizations, direct pay primary care and others, is to find some way around the strict code-based fee-for-service system, either by avoiding it entirely or by adding epicycles and feedback loops to it to counter its most deleterious effects.
There is no perfect way to pay for health care. All payment methods have their drawbacks and unintended consequences. But the code-based fee-for-service system got us here, and any path out of the cost mess we are in has to get us off that escalator one way or another.
I believe the concept of value-based care is good for healthcare. VBC encourages providers to make changes that put the patient at the center of care, so that different services can be provided across providers in a collaborative way. If all went according to the VBC vision, there would be fewer redundant tests, more emphasis on preventative care, and an effort to keep high-risk patients out of the emergency room. It’s also better for costs, something we desperately need in the US, where healthcare spending per capita is more than twice the OECD average.
But Lisa’s story, at the leading edge of the value-based experiment, is not good at all. ACOs and most other value-based models are new, constantly changing, and unproven. ACOs report on 33 metrics that are supposed to represent the quality of care provided by their networks of providers. While still extremely limited in scope, any more than 33 metrics would have made Lisa’s job impossible. So far, few ACOs have reported any savings. Worse — the metrics are unproven. What if they overemphasize standardized process over patient outcomes? And what if efficiency measures result in neglectful and impersonal care? A lot is riding on Lisa’s testing ground.
The administrative challenge
By engaging with and learning from people like Lisa, I have begun to understand the problems frontier administrators face — the same problems countless others will face if we don’t address the administrative burden early on. Here are a few of the top headaches being rolled out in the name of value:
For ACOs, 33 metrics are tracked today. Inevitably, these will expand and change as accountable care evolves. There are also countless other systems of metrics encouraged by other incentive programs: the Physician Quality Reporting System measures, Meaningful Use metrics, Agency for Healthcare Research and Quality Indicators, the Consumer Assessment of Healthcare Providers and Systems for patient experience metrics, indicators for each specialty (Stroke and Stroke Rehabilitation Physician Performance Measurement Set, Endoscopy and Polyp Surveillance Physician Performance Measurement Set, and the Heart Failure Performance Measurement Set, to name a few). The document outlining protocols for the Physician Quality Reporting System is 18 pages long, with a mouthful of a title to match: “The 2015 Physician Quality Reporting System (PQRS) Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures.” Got that? A new piece of legislation that passed the House of Representatives last week — the “doc fix” bill — is about to revamp many of these requirements once again.
Lisa had to fumble through different electronic systems and paper charts to extract the relevant data for each patient in her panel at dozens of different clinics. In many cases, it was clear that care had been provided (e.g. an unstable patient had been upgraded from a cane to a walker), but the documentation wasn’t there (to fulfill the “Screening for Future Fall Risk” metric, documentation must state whether the patient had no falls, one fall without major injury, two or more falls, or any fall with major injury.) Therefore, even though care was provided to prevent future falls, the documentation did not meet the CMS requirement and no credit was given.
For the next reporting year, Lisa is designing her own reporting mechanisms for clinics and doctors. She says that her first reporting experience “was invaluable in learning ways to improve the reporting for year 2015 and beyond,” and she is putting processes in place to facilitate reporting next year. But each clinic is different: some need a page at the front of their paper chart with check boxes, and some have templates in their electronic health records. Her new processes may improve the situation, but additional tracking could also cut into time doctors spend with patients and add to the squeeze they already feel.
Lisa integrated all the data from each clinic manually, and this is a problem for small institutions who are trying to communicate and coordinate with each other. Right now it takes a long time and is not very scalable. Even at larger institutions with leading electronic health record systems, the data is locked away within proprietary databases, often in incompatible formats. Clinical data is rarely integrated with financial and patient-reported data in the way required to tie outcomes and claims to reimbursements in a value-based model.
After all of her data collection, Lisa still had to submit her data to a third part to produce reports, and she will wait many months for the results. The CMS websites are comically complex ; the instruction manual for using the CMS metric reporting interface is 127 pages long.
Putting patients at the center
If these problems aren’t addressed, we’re in for a long and painful healthcare reform. Administrative costs will continue to rise, along with another generation of frustrated physicians and admins. Moreover, value-based care could be deemed a failure not because it’s a bad idea but because of poor implementation. Instead of putting patients at the center of care, it could breed more bureaucracy and force doctors to spend more time reporting on metrics and less time with patients.
We can address these issues and we must — to give value-based care a chance at moving the US toward more patient-centered, less exorbitant healthcare.
A few days ago, we wrote an editorial for US News and World Reports on the scant or dubious evidence used to support some healthcare policies (the editorial is reproduced in full below).In that case, we focused on studies and CMS statements about a select group of Accountable Care Organizations and their cost savings. Our larger point however is about the need to reconsider the evidence we use for all healthcare-related decisions and policies. We argue that an understanding of research design and the realities of measurement in complex settings should make us both skeptical and humbled.Let’s focus on two consistent distortions.
Evidence-based Medicine (EBM). Few are opposed to evidence-based medicine.What’s the alternative? Ignorance-based medicine? Hunches?However, the real world applicability of evidence-based medicine (EBM) is frequently overstated. Our ideal research model is the randomized controlled trial, where studies are conducted with carefully selected samples of patients to observe the effects of the medicine or treatment without additional interference from other conditions. Unfortunately, this model differs from actual medical practice because hospitals and doctors’ waiting rooms are full of elderly patients suffering from several co-morbidities and taking about12 to 14 medications, (some unknown to us). It is often a great leap to apply findings from a study under “ideal conditions” to the fragile patient. So wise physicians balance the “scientific findings” with the several vulnerabilities and other factors of real patients.Clinicians are obliged to constantly deal with these messy tradeoffs, and the utility of evidence-based findings is mitigated by the complex challenges of the sick patients, multiple medications taken, and massive unknowns. This mix of research with the messy reality of medical and hospital practice means that evidence, even if available, is often not fully applicable.
Relative vs. Absolute Drug Efficacy:
Let’s talk a tiny bit about arithmetic. Say we have a medication (calledX) that works satisfactorily for 16 out of a hundred cases, i.e., 16% of the time.Not great, but not atypical of many medications.Say then that another drug company has another medication (called “Newbe”) that works satisfactorily 19% of the time. Not a dramatic improvement, but a tad more helpful (ignoring how well it works, how much it costs, and if there are worse side effects).But what does the advertisement for drug “Newbe” say? That “Newbe” is almost 20% better than drug “X.” Honest. And it’s not a total lie.Three percent (the difference between 16% and 19%) is 18.75%, close enough to 20% to make the claim legit. Now, if “Newbe” were advertised as 3% better (but a lot more expensive) sales would probably not skyrocket. But at close to 20% better, who could resist?
Policy:So what does this have to do with healthcare policy?We also want evidence of efficacy with healthcare policies but it turns out that evaluation of these interventions and policies is often harder to do well than are studies of drugs. Interventions and policies are introduced into messy pluralistic systems, with imprecise measures of quality and costs, with sick and not-so-sick patients, with differing resources and populations, with a range of payment systems, and so on and so on. Sometimes, randomized controlled trials are impossible.But sometimes they are possible but difficult to effect. Nevertheless, we argue they are usually worth the effort. Considering the billions or trillions of dollars involved in some policies (e.g., Medicare changes, insurance rules) the cost is comparatively trivial.
But there’s another question: What if a decent research design is used to measure the effects of a large policy in a select population but all you get is a tiny “effect?”What do we know? What should policymakers do? Here’s what we wrote in our recent editorial in the US News and World Report….
Interaction of warming climate with a growing, shifting population could subject more people to sweltering conditions
NATIONAL CENTER FOR ATMOSPHERIC RESEARCH/UNIVERSITY CORPORATION FOR ATMOSPHERIC RESEARCH
BOULDER – U.S. residents’ exposure to extreme heat could increase four- to six-fold by mid-century, due to both a warming climate and a population that’s growing especially fast in the hottest regions of the country, according to new research.
The study, by researchers at the National Center for Atmospheric Research (NCAR) and the City University of New York (CUNY), highlights the importance of considering societal changes when trying to determine future climate impacts.
“Both population change and climate change matter,” said NCAR scientist Brian O’Neill, one of the study’s co-authors. “If you want to know how heat waves will affect health in the future, you have to consider both.”
Extreme heat kills more people in the United States than any other weather-related event, and scientists generally expect the number of deadly heat waves to increase as the climate warms. The new study, published May 18 in the journal Nature Climate Change, finds that the overall exposure of Americans to these future heat waves would be vastly underestimated if the role of population changes were ignored.
The total number of people exposed to extreme heat is expected to increase the most in cities across the country’s southern reaches, including Atlanta, Charlotte, Dallas, Houston, Oklahoma City, Phoenix, Tampa, and San Antonio.
he average annual exposure to extreme heat in the United States during the study period is expected to be between 10 and 14 billion person-days, compared to an annual average of 2.3 billion person-days between 1971 and 2000.
Of that increase, roughly a third is due solely to the warming climate (the increase in exposure to extreme heat that would be expected even if the population remained unchanged). Another third is due solely to population change (the increase in exposure that would be expected if climate remained unchanged but the population continued to grow and people continued to moved to warmer places). The final third is due to the interaction between the two (the increase in exposure expected because the population is growing fastest in places that are also getting hotter).
“We asked, ‘Where are the people moving? Where are the climate hot spots? How do those two things interact?'” said NCAR scientist Linda Mearns, also a study co-author. “When we looked at the country as a whole, we found that each factor had relatively equal effect.”
At a regional scale, the picture is different. In some areas of the country, climate change packs a bigger punch than population growth and vice versa.
For example, in the U.S. Mountain region–defined by the Census Bureau as the area stretching from Montana and Idaho south to Arizona and New Mexico–the impact of a growing population significantly outstrips the impact of a warming climate. But the opposite is true in the South Atlantic region, which encompasses the area from West Virginia and Maryland south through Florida.
Exposure vs. vulnerability
Regardless of the relative role that population or climate plays, some increase in total exposure to extreme heat is expected in every region of the continental United States. Even so, the study authors caution that exposure is not necessarily the same thing as vulnerability.
“Our study does not say how vulnerable or not people might be in the future,” O’Neill said. “We show that heat exposure will go up, but we don’t know how many of the people exposed will or won’t have air conditioners or easy access to public health centers, for example.”
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.
Making yet another commitment to go meatless 2 days/week. Also again thinking about a year round smallish green house.
Like the idea of farmers/agricultural sector as being redefined as service industries – accent on social responsibility.
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.
Study finds doctors must make great effort to provide patients more useful information to help them make medical choices
Patients faced with a choice of surgical options want to engage their physicians and take a more active role in decision-making, according to a study (abstract 567) released at Digestive Disease Week® (DDW) 2015. Further, those physicians must provide better support tools to help patients participate in the decision-making process. The study found that patients consult multiple sources (Internet, family, friends, doctors, etc.) and say that while doctors provide the most believable information, it was also the least helpful.
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.”
Law would give family members and law enforcement tool to temporarily remove guns from someone believed dangerous
Gun violence restraining orders (GVROs) are a promising strategy for reducing firearm homicide and suicide in the United States, and should be considered by states seeking to address gun violence, researchers from the Johns Hopkins Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health and the University of California, Davis, argue in a new report.
The article is being published online in Behavioral Sciences and the Law on May 20.
GVROs allow family members and intimate partners who believe a relative’s dangerous behavior may lead to violence to request an order from a civil court authorizing law enforcement to remove any guns in the individual’s possession, and to prohibit new gun purchases for the duration of the order. Three states have laws that authorize law enforcement to remove guns from someone identified as dangerous: Indiana, Connecticut and Texas. In 2014, California became the first state in the nation to allow family members and intimate partners to directly petition a judge to temporarily remove firearms from a family member if they believe there is a substantial likelihood that the family member is a significant danger to himself or herself or others in the near future. The law, passed by the California legislature, takes effect Jan. 1, 2016.
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.
New research shows that infections can impair your cognitive ability measured on an IQ scale. The study is the largest of its kind to date, and it shows a clear correlation between infection levels and impaired cognition.
“Infections can affect the brain directly, but also through peripheral inflammation, which affects the brain and our mental capacity. Infections have previously been associated with both depression and schizophrenia, and it has also been proven to affect the cognitive ability of patients suffering from dementia. This is the first major study to suggest that infections can also affect the brain and the cognitive ability in healthy individuals.”
“We can see that the brain is affected by all types of infections. Therefore, it is important that more research is conducted into the mechanisms which lie behind the connection between a person’s immune system and mental health,” says Michael Eriksen Benrós.
He hopes that learning more about this connection will help to prevent the impairment of people’s mental health and improve future treatment.
Along with other functions, mainly in the formation of mother-infant bonding, the rosy glow of the “love hormone” seems to know no bounds – and its potential application for helping to cement and maintain loving relationships is clear. Its effects on facilitating social interaction have made it an appealing possible therapeutic tool in patients who struggle with social situations and communication, including in autism, schizophrenia and mood or anxiety disorders.
Even better, it is very easy to use. All the human studies on it use intranasal sprays to boost oxytocin levels. These sprays are readily available, including through the internet, and appear safe to use, at least in the short term – no one yet knows whether there is any long-term harm.
In the past few years, however, concerns expressed by some researchers have begun to rein in the enthusiasm about the potential applications of oxytocin as a therapeutic tool.
Recent studies are showing that the positive effects can be much weaker – or even detrimental – in those that need it the most. In contrast to socially competent or secure individuals, exposure can reduce cooperativeness and trust in those prone to social anxiety. It also increases inclination for violencetowards intimate partners. Although this is seen only in people who tend to be more aggressive in general, these would be the same people who might have most to gain from such a treatment, were it available.
These apparently paradoxical effects are hard to explain, particularly since the brain mechanisms responsible are still poorly understood. But a new study may help to provide the answer. A team from the University of Birmingham decided to tackle the issue by comparing studies on the effects of oxytocin with those of alcohol and were struck by the incredible similarities between the two compounds.
Alcohol and Oxytocin
Like oxytocin, alcohol can have helpful effects in social situations. It increases generosity, fosters bonding within groups and suppresses the action of neural inhibitions on social behavior, including fear, anxiety and stress.
But, of course, acute alcohol consumption also comes with significant downsides. Aside from the health implications of chronic use, it interferes with recognition of emotional facial expression, influences moral judgementsand increases risk-taking and aggression. And as with oxytocin, the increase in aggression is limited to those who have an existing disposition to it.
The researchers argue that the striking similarities in behavioral outcome tell us something about the biological mechanisms involved. Although oxytocin and alcohol target different brain receptors, activation of these receptors appear to produce analogous physiological effects. Indeed, they also note similarities with how other compounds work, including benzodiazepines, which are commonly used to treat anxiety. Our understanding of how one chemical elicits its effects might thus help us to understand the action of the others.
But, if this new interpretation is correct, it may presage further bad press for the love hormone. It may be that the darkening clouds that threaten to tarnish its reputation are only just beginning to gather. At the very least, it should give us cause for careful evaluation before we rush into using it as a remedy.
…Safer Choice is our label for safer chemical-based products, like all-purpose cleaners, laundry detergents, degreasers, and many others. Each day, consumers, custodians, cleaning staffs, and others use these products, and families, building occupants, and visitors are exposed to them. The Safer Choice program ensures that labeled products—and every ingredient in them—meet the program’s stringent health and environmental criteria—and perform well, too.
So how can you help people make safer choices?
First, look for products with the Safer Choice label in stores this summer. By choosing products with the Safer Choice label, you’re driving the development of greener chemicals and supporting over 500 manufacturers and retailers that participate in our program.
This database links over 14,000 consumer brands to health effects from Material Safety Data Sheets (MSDS) provided by manufacturers and allows scientists and consumers to research products based on chemical ingredients. The database is designed to help answer the following typical questions:
What are the chemical ingredients and their percentage in specific brands?
Which products contain specific chemical ingredients?
Who manufactures a specific brand? How do I contact this manufacturer?
What are the acute and chronic effects of chemical ingredients in a specific brand?
What other information is available about chemicals in the toxicology-related databases of the National Library of Medicine?
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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