The Michigan State University Gets USDA Grant to aid Michigan's Fledgling Farmers

                                                                  Image Credit: MSU
Michigan State University has long been a resource for small farms in Michigan. Thanks to a $750,000 grant from the United States Department of Agriculture, MSU will be able to help even more fledgling farmers get their start.

“This grant will enhance and create a vibrant network of farmer training across Michigan to help them negotiate the first five years of their endeavor,” said Mike Hamm, C.S. Mott Professor of Sustainable Agriculture and Director of MSU Center for Regional Food Systems. “Our programs will cater to different perspectives and needs while moving everyone who desires to farm along the path of building a viable business."

As part of the grant, the MSU Student Organic Farm will expand its Organic Farmer Training Program. Without programs like this, burgeoning farmers like Joannee DeBruhl, farm manager of Stone Coop Farm, may not have ever gotten her start.

DeBruhl, who spent much of her career in the insurance business, was laid off in 2009. Looking for a major change, she gravitated toward community gardening and eventually enrolled in MSU’s Organic Farmer Training Program.

“The program was great; it gave me lots of hands-on training and showed that it was possible and not just a dream,” DeBruhl said. “I think the USDA grant will be a huge benefit for small farmers because there’s not much money out there to help them get started.”

Training and help with startup costs are crucial, and this grant will be managed well by MSU, she added.

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Key to the project is MSU’s partnership with Michigan Food and Farming Systems, which runs the Women in Agriculture Collective Farming Initiative at Genesys Health System in Genesee County. This partnership will develop site- and people-appropriate training programs that help beginning women farmers build a successful business.

In addition to women, the grant also will develop training programs for Hispanic farmers. The number of Hispanic farms in Michigan continues to grow, and MSU will assist this historically underserved farmer population through training and site development assistance at the Farmers on the Move Cooperative in Battle Creek.

MSU also will launch new, and improve existing, programs that target the biggest challenges facing small-farm viability – land access, capital access, market access, business planning and strategizing for scaling up production.

Additional MSU contributors helping with this grant include: Jeremy Moghtader, Shakara Tyler. Michelle Napier-Dunnings, with Michigan Food and Farming Systems, also will be contributing to these efforts.

Source: Michigan State University

UA to Serve Up Fresh Approach to Health

The commitment of the Department of Nutritional Sciences to promoting and adapting Mediterranean diet principles will continue through all three areas of the University’s land grant mission: academic programs, research and Cooperative Extension outreach programs. Credit: UA

The Mediterranean diet has seen growing global popularity as researchers find that the dietary pattern can help prevent or reduce obesity, heart disease, type 2 diabetes and certain types of cancer.

Responsive to that popularity, the University of Arizona Department of Nutritional Sciences is hosting a series of events meant to explore and share current research related to the dietary pattern, which focuses on fresh fruits and vegetables, whole grains, beans and nuts, along with lesser amounts of lean fish, meats, dairy, olive oil and red wine.

"We want to emphasize how this pattern of eating has been demonstrated to contribute to disease prevention," said Donato Romagnolo, a professor in the Arizona Cancer Center and the nutritional sciences department, which is housed in the UA College of Agriculture and Life Sciences. 

National Geographic Blue Zones speaker Rudy Maxa, a Washington Post reporter and columnist, and five Tucson-area celebrity chefs will kick off the Jan. 28 opening-night reception, "A Food, Wine and Healthy Living Event," at the Tucson Museum of Art.

The 6-8 p.m. event is open to the public and will feature food prepared by the chefs, award-winning wine provided by the Arizona Wine Growers Association and live flamenco and Spanish guitar.

Then the UA will will host the Jan. 29-30 "Health Benefits of the Mediterranean Diet – Bringing Science to the Plate (With an Arizona Twist!)" scientific conference at the Student Union Memorial Center.

Supported in part by a grant from the U.S. Department of Agriculture, the conference is geared toward public health and nutrition professionals, nurses, physicians, physical therapists and chiropractors, and it is offered for continuing professional credit. The event is also open to students and features a student showcase.

A full agenda and registration for the conference are available online.

Promoting the health benefits of the Mediterranean lifestyle is just one of numerous initiatives sponsored by the UA Department of Nutritional Sciences to advance optimal health and well-being for Arizonans and to focus on ways of preventing and treating chronic diseases. 

After the conference, a four-part, hands-on cooking series will be offered to the public during February and March at the UA Cooperative Extension's Garden Kitchen, "The Many Faces of the Mediterranean Diet: Four Evenings," featuring the cuisines of Spain, France, Morocco and Italy. Information is available online. 

Also, the Mediterranean Diet and Health course will be offered for academic credit during summer 2015 (one week in Tucson and three weeks in Verona, Italy) for students through the UA Global Initiatives Study Abroad Program.

Much of the interest in the Mediterranean diet stems from evidence that it can reduce the risk of death associated with heart disease and cancer. Other research indicates that the diet can reduce the incidence of Parkinson's and Alzheimer's diseases.

Romagnolo, also the program director of the Mediterranean Diet and Health Study Abroad Program, said the benefits are especially important given pervasive health concerns across the nation. He noted that about 60 percent of people in the U.S. are overweight and 30 percent are obese.

"The latter is a risk factor for diabetes, cancer and metabolic syndrome," Romagnolo said.
During the conference, more than 20 presenters from the UA College of Agriculture and Life Sciences, the UA College of Medicine, national and international universities, institutes and organizations will talk. 

Presenters will cover four general areas: the Mediterranean diet and regional trends; obesity, diabetes and healthy aging; cancer prevention and control; and methods for translating science to the plate.

Live demonstrations by Arizona growers, vendors and educators will provide attendees with tasting opportunities, meal preparation ideas and information on where to find local products that help make healthful eating easy in the Southwest.

Also, prominent diet researchers from Spain, France and Greece will present current research on the health benefits of the traditional Mediterranean diet and offer ways to adapt it using local agricultural ingredients and cooking techniques. Speakers include:

Lluis Serra-Majem of the University of Las Palmas de Gran Canaria, Spain, who will present the keynote address on "The Mediterranean Diet as an Intangible and Sustainable Food Culture."

Mariette Gerber of the INSERM-Institut du Cancer de Montpellier, France, who will discuss "Implementing the Mediterranean Diet: The French Perspective." 

Antonia Trichopoulou of the University of Athens, Greece, who will speak on "Mediterranean Diet and Longevity."

"The conference is an opportunity to present ideas and concepts that may be adopted by the food industry, nutritionists, researchers and policymakers to help reduce the burden of these chronic diseases," Romagnolo said. "We want to show people how they can do it on their own and apply the basic tenets of the diet here in Arizona."

Source: University of Arizona

New Weight Loss Device Makes You Feel Full

People who are obese have a new tool in their arsenal for fighting excess weight.

The U.S. Food and Drug Administration approved a medical device called the Maestro Rechargeable System that is implanted in the stomach and, through an external, adjustable controller, helps obese people lose weight. It is approved for patients 18 and older who have a body mass index of 35 to 45, have a condition related to being obese such as type 2 diabetes, and have not been able to lose weight through traditional means. 

The Maestro Rechargeable System targets nerve pathways between the brain and the stomach that are responsible for making a person feel full. In a clinical trial, patients using the device lost 8.5% more weight than people who received an inactive version of it. About 53% of the patients with the device lost at least 20% of their excess weight, and 38% lost at least 25%.

But compared with bariatric surgery, the trial’s results are not as impressive. Eric T. Volckmann, M.D., who specializes in bariatric surgery at University of Utah Health Care, says that after gastric bypass surgery, patients can expect to lose 60% to 80% of their excess body weight.

Bariatric surgery is a highly invasive procedure. But so is implantation of the Maestro Rechargeable System. 

“Any procedure, no matter how small, is still risky,” Volckmann says.

Furthermore, Volckmann says the long-term effects of the device are not as well understood as those of bariatric surgery. He says more research is needed before he would recommend the Maestro Rechargeable System for a severely obese patient.

In the future, the device may make sense for a patient with a BMI between 30 and 35 who is not responding to medical weight loss measures such as lifestyle modifications.

Source: University of Utah

Platelets modulate clotting behavior by 'feeling' their surroundings

Researchers devised a way to separate the physical stiffness of the material where platelets spread out from its biochemical properties. Credit: Wilbur Lam

Platelets, the tiny cell fragments whose job it is to stop bleeding, are very simple. They don't have a cell nucleus. But they can "feel" the physical environment around them, researchers at Emory and Georgia Tech have discovered.

Platelets respond to surfaces with greater stiffness by increasing their stickiness, the degree to which they "turn on" other platelets and other components of the clotting system, the researchers found.

"Platelets are smarter than we give them credit for, in that they are able to sense the physical characteristics of their environment and respond in a graduated way," says Wilbur Lam, MD, PhD, assistant professor in the Department of Pediatrics at Emory University School of Medicine and in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University.

The results are published in Proceedings of the National Academy of Sciences. The first author of the paper is research associate Yongzhi Qiu. Lam is also a physician in the Aflac 

Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.

The researchers' findings could influence the design of medical devices, because when platelets grab onto the surfaces of catheters and medical implants, they tend to form clots, a major problem for patient care.

Modifying the stiffness of materials used in these devices could reduce clot formation, the authors suggest. The results could also guide the refinement of blood thinning drugs, which are prescribed to millions to reduce the risk of heart attack or stroke.

The team was able to separate physical and biochemical effects on platelet behavior by forming polymer gels with different degrees of stiffness, and then overlaying them each with the same coating of fibrinogen, a sticky protein critical for blood clotting. Fibrinogen is the precursor for fibrin, which forms a mesh of insoluble strands in a blood clot.

With stiffer gels, platelets spread out more and become more activated. This behavior is most pronounced when the concentration of fibrinogen is relatively low, the researchers found.

"This variability helps to explain platelet behavior in the 3D context of a clot in the body, which can be quite heterogenous in makeup," Lam says.

Qiu and colleagues were also able to dissect platelet biochemistry by allowing the platelets to adhere and then spread on the various gels under the influence of drugs that interfere with different biochemical steps.

Proteins called integrins, which engage the fibrinogen, and the protein Rac1 are involved in the initial mechanical sensing during adhesion, while myosin and actin, components of the cytoskeleton, are responsible for platelet spreading.

"We found that the initial adhesion and later spreading are separable, because different biochemical pathways are involved in each step," Lam says. "Our data show that mechanosensing can occur and plays important roles even when the cellular structural building blocks are fairly basic, even when the nucleus is absent."

Source: Emory Health Sciences

Patient's question triggers important study about blood thinners

Physicians around the world now have guidance that can help them determine the best oral blood thinners to use for their patients suffering from blood clots in their veins, thanks to a patient of The Ottawa Hospital who asked his physician a question he couldn't answer. This new guidance is found in a study published today by JAMA, the Journal of the American Medical Association.

"Right there in the clinic, he identified an important knowledge gap for clinicians. We decided to act on it and find the answer," says hematologist Dr. Marc Carrier, who also a scientist at The Ottawa Hospital and associate professor at the University of Ottawa.

Dr. Carrier was treating Jamie Dossett-Mercer for major blood clotting in his leg veins, called deep vein thrombosis, that reached from his ankle to his groin. If one of these clots were to break off, it could travel to the lung and cause a pulmonary embolism, which is often fatal. These two common medical conditions are known together as venous thromboembolism and form the third leading cause of cardiovascular death.

In recent years, a number of new oral anticoagulants have been approved for use. Faced with eight possible therapies, Dossett-Mercer asked, "How do all these different blood thinners compare head to head?"

Dr. Carrier went looking for the answer. Although he found dozens of trials that studied the effect of different agents separately, none had analyzed all the results together.

His team reviewed 45 randomized trials (involving nearly 45,000 patients) using a process called network meta-analysis, which allows them to set a baseline treatment and compare all the other treatments to that. All the clinical trials they found compared the newer treatments to the standard of care, which is low-molecular-weight heparin (LMWH) with vitamin K antagonists.

Using the LMWH-vitamin K antagonist combination as the central node of the network, they compared safety and effectiveness with seven other anticoagulant therapies for venous thromboembolism: unfractionated heparin (UFH) with vitamin K antagonists; fondaparinux with vitamin K antagonists; LMWH with dabigatran; LMWH with edoxaban; rivaroxaban; apixaban; and LMWH alone.

While they found no major differences in effectiveness and safety, there were some notable variations.

• Patients taking the UFH-vitamin K antagonist combination had a higher percentage who experienced a recurrent blood clot within three months.
• Patients taking rivaroxaban and apixaban had a lower percentage who experienced a major bleeding event within three month.

"This will help physicians tailor their care according to patient characteristics," says Dr. Carrier. "For example, if I am worried about recurrent clotting, but I'm not too worried about the risk of bleeding, then I can select the drug with the best safety profile."

"I was already impressed with Dr. Carrier's exceptional care," says Dossett-Mercer. "But that he would do this research based on a patient question is just astounding."

Source: Ottawa Hospital Research Institute

Platelet-like particles augment natural blood clotting for treating trauma

Associate Professor Tom Barker and Research Scientist Ashley Brown examine bacteria growing on a plate, part of a technique for evolving antibodies in their work on platelet-like particles.
Credit: Georgia Tech Photo

A new class of synthetic platelet-like particles could augment natural blood clotting for the emergency treatment of traumatic injuries -- and potentially offer doctors a new option for curbing surgical bleeding and addressing certain blood clotting disorders without the need for transfusions of natural platelets.

The clotting particles, which are based on soft and deformable hydrogel materials, are triggered by the same factor that initiates the body's own clotting processes. Testing done in animal models and in a simulated circulatory system suggest that the particles are effective at slowing bleeding and can safely circulate in the bloodstream. The particles have been tested with human blood, but have not undergone clinical trials in humans.

Supported by the National Institutes of Health, the U.S. Department of Defense, and the American Heart Association, the research will be reported September 7, 2014, in the journal Nature Materials. Researchers from the Georgia Institute of Technology, Emory University, Children's Healthcare of Atlanta and Arizona State University collaborated on the research.

"When used by emergency medical technicians in the civilian world or by medics in the military, we expect this technology could reduce the number of deaths from excessive bleeding," said Ashley Brown, a research scientist in the Georgia Tech School of Chemistry and Biochemistry and first author of the paper. "If EMTs and medics had particles like these that could be injected and then go specifically to the site of a serious injury, they could help decrease the number of deaths associated with serious injuries."

The bloodstream contains proteins known as fibrinogen that are the precursors for fibrin, the polymer that provides the basic structure for natural blood clots. When they receive the right signals from a protein known as thrombin, these precursors polymerize at the site of the bleeding. The synthetic platelet-like particles use the same trigger, and so are activated only when the body's natural clotting process is initiated.

To create that trigger, the researchers followed a process known as molecular evolution to develop an antibody that could be attached to the hydrogel particles to change their form when they encounter thrombin-activated fibrin. The resulting antibody has a high affinity for the polymerized form of fibrin and a low affinity for the precursor material.

"Fibrin production is on the back end of the clotting process, so we feel that it is a safer place to try to interact with it," said Tom Barker, an associate professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, and one of the paper's co-corresponding authors. "The specificity of this material provides a very important advantage in triggering clotting at just the right time."

The effectiveness of the platelet-like particles has been tested in an animal model and in a microfluidic chamber designed to simulate conditions within the body's circulatory system. In the chamber, tubes about the thickness of a human hair were lined with endothelial cells as in natural blood vessels.

The chamber was used to study normal human blood, as well as human blood that had been depleted of its natural platelets. In platelet-rich blood, clots formed as expected, and blood without platelets did not form clots. When the platelet-like particles were added to the platelet-depleted blood, it was able to clot.

The researchers also tested blood from infants that had undergone open heart surgery, which requires that their blood be diluted, reducing its clotting ability. When platelet-like particles were added to the dilute neonate blood, it was able to form clots.

Finally, safety testing was done on blood from hemophiliac patients. Because that blood lacks the triggers needed to cause fibrin formation, the particles had no effect. Before they can be used in humans, the particles will have to undergo human trials and receive clearance from the U.S. Food & Drug Administration (FDA).

About one micron in diameter, the particles were originally developed to be used on the battlefield by wounded soldiers, who might self-administer them using a device about the size of a smartphone. But the researchers believe the particles could also reduce the need for platelet transfusions in patients undergoing chemotherapy or bypass surgery, and in those with certain blood disorders.

"For a patient with insufficient platelets due to bleeding or an inherited disorder, physicians often have to resort to platelet transfusions, which can be difficult to obtain," said Dr. Wilbur Lam, another of the paper's co-authors and a physician in the Aflac Cancer and 
Blood Disorders Center at Children's Healthcare of Atlanta and the Department of Pediatrics at the Emory University School of Medicine. "These particles could potentially be a way to obviate the need for a transfusion. Though they don't have all the assets of natural platelets, a number of intriguing experiments have shown that the particles help augment the clotting process."

In addition to providing new treatment options, the particles could also cut costs by reducing costly natural transfusions, said Lam, who is also an assistant professor in the Coulter Department of Biomedical Engineering at Georgia Tech and Emory University.

What ultimately happens to the hydrogel particles circulating in the bloodstream will be the topic of future research, noted Brown. Particles of similar size and composition are normally eliminated from the body.

While the platelet-like particles lack many features of natural platelets, the researchers were surprised to find one property in common. Clots formed by natural platelets begin to contract over a period of hours, beginning the body's repair process. Clots formed from the synthetic particles also contract, but over a longer period of time, Brown noted.

Source: Georgia Institute of Technology

Stick out your tongue: Tongue appearance and illness

Physicians often ask their patients to "Please stick out your tongue." The tongue can betray signs of illness, which combined with other symptoms such as a cough, fever, presence of jaundice, headache or bowel habits, can help the physician offer a diagnosis. For people in remote areas who do not have ready access to a physician, a new diagnostic system is reported in the International Journal of Biomedical Engineering and Technology that works to combine the soft inputs of described symptoms with a digital analysis of an image of the patient's tongue.

Karthik Ramamurthy of the Department of Information Technology, Rajalakshmi Engineering College, in Chennai, India, and colleagues, have trained a neural network that can take soft inputs such as standard questions about symptoms and a digitized image of the patient's tongue and offer a likely diagnosis so that professional healthcare might then be sought if needed. The digitized images of the patient's tongue reveal discoloration, engorgement, texture and other factors that might be linked to illness.

Smoothness and "beefiness" might reveal vitamin B12, iron, or folate deficiency, and anemia. Black discoloration could be indicative of fungal overgrowth in HIV patients or prolonged antibiotic use. Longitudinal furrows on the tongue are associated with syphilis. 

Ulcers may indicate the presence of Crohn's disease or colitis and various other conditions. 

The team's automated diagnostic, however, utilizes the condition of the tongue in combination with other symptoms to identify whether a patient has any of various illnesses: common cold, flu, bronchitis, streptococcal throat infection, sinusitis, allergies, asthma, pulmonary edema, food poisoning and diverticulitis.

The current system allows diagnosis of fourteen distinct conditions but the team adds that they will be able to add eye images and use those as an additional hard input for their neural network and so extend its repertoire significantly.

Source: Inderscience Publishers

Diagnosis targets in primary care are misleading, unethical, UK experts say

Last month, there was public outcry at the news that GPs in England would be paid £55 for each case of dementia diagnosed.

Now come targets for six other conditions, including diabetes coronary heart disease, asthma and depression, writes Dr Martin Brunet, a GP in Surrey. "But the data on which they are based are flawed, and the approach incentivises potentially harmful overdiagnosis," he argues.

Every practice in England has been told its diagnosis rate for each condition, estimated from practice data and the expected prevalence, he explains. The intention is to exert pressure on general practitioners to increase diagnosis rates, but he believes the principles behind such a policy need to be questioned.

Brunet argues that applying error prone national prevalence data to an individual practice is problematic. Although attempts are made to account for local demographics, practices may be under pressure to "improve" diagnosis rates that are far better than the data would suggest, he warns.

He also questions the ethical implications for individual patients of unnecessary tests and treatments that "could do more harm than good" and divert resources away from people with symptoms.

Targets in healthcare always threaten to undermine trust in the doctor-patient relationship, says Brunet. "For this reason patients need to trust that the doctor will act solely in their best interests, unencumbered by competing interests."

"NHS England needs to hear the clear message from doctors and patients that setting targets for diagnosis is problematic, unscientific, and unethical," he argues. "Instead, it needs to trust doctors and their patients to know when to seek a diagnosis."

Source: BMJ-British Medical Journal

Anemia: One-minute point-of-care test shows promise in new study

Erika Tyburski is shown with a prototype device for point-of-care testing of anemia. The device could enable more rapid diagnosis of the common blood disorder and allow inexpensive at-home self-monitoring of persons with chronic forms of the disease. Credit: Gary Meek

A simple point-of-care testing device for anemia could provide more rapid diagnosis of the common blood disorder and allow inexpensive at-home self-monitoring of persons with chronic forms of the disease.

The disposable self-testing device analyzes a single droplet of blood using a chemical reagent that produces visible color changes corresponding to different levels of anemia. The basic test produces results in about 60 seconds and requires no electrical power. A companion smartphone application can automatically correlate the visual results to specific blood hemoglobin levels.

By allowing rapid diagnosis and more convenient monitoring of patients with chronic anemia, the device could help patients receive treatment before the disease becomes severe, potentially heading off emergency room visits and hospitalizations. Anemia, which affects two billion people worldwide, is now diagnosed and monitored using blood tests done with costly test equipment maintained in hospitals, clinics or commercial laboratories.

Because of its simplicity and ability to deliver results without electricity, the device could also be used in resource-poor nations.

A paper describing the device and comparing its sensitivity to gold-standard anemia testing was published August 30 in The Journal of Clinical Investigation. Development of the test has been supported by the FDA-funded Atlantic Pediatric Device Consortium, the Georgia Research Alliance, Children's Healthcare of Atlanta, the Georgia Center of Innovation for Manufacturing and the Global Center for Medical Innovation.

"Our goal is to get this device into patients' hands so they can diagnose and monitor anemia themselves," said Dr. Wilbur Lam, senior author of the paper and a physician in the Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta and the Department of Pediatrics at the Emory University School of Medicine. "Patients could use this device in a way that's very similar to how diabetics use glucose-monitoring devices, but this will be even simpler because this is a visual-based test that doesn't require an additional electrical device to analyze the results."

The test device was developed in a collaboration of Emory University, Children's Healthcare of Atlanta and the Georgia Institute of Technology -- all based in Atlanta. It grew out of a 2011 undergraduate senior design project in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University. In 2013, it was among the winners of Georgia Tech's InVenture Prize, an innovation competition for undergraduate students, and won first place in the Ideas to SERVE Competition in Georgia Tech's Scheller College of Business.

Using a two-piece prototype device, the test works this way: A patient sticks a finger with a lance similar to those used by diabetics to produce a droplet of blood. The device's cap, a small vial, is then touched to the droplet, drawing in a precise amount of blood using capillary action. The cap containing the blood sample is then placed onto the body of the clear plastic test kit, which contains the chemical reagent. After the cap is closed, the device is briefly shaken to mix the blood and reagent.

"When the capillary is filled, we have a very precise volume of blood, about five microliters, which is less than a droplet -- much less than what is required by other anemia tests," explained Erika Tyburski, the paper's first author and leader of the undergraduate team that developed the device.

Blood hemoglobin then serves as a catalyst for a reduction-oxidation reaction that takes place in the device. After about 45 seconds, the reaction is complete and the patient sees a color ranging from green-blue to red, indicating the degree of anemia.

A label on the device helps with interpretation of the color, or the device could be photographed with a smartphone running an application written by Georgia Tech undergraduate student Alex Weiss and graduate student William Stoy. The app automatically correlates the color to a specific hemoglobin level, and could one day be used to report the data to a physician.

To evaluate sensitivity and specificity of the device, Tyburski studied blood taken from 238 patients, some of them children at Children's Healthcare of Atlanta and the others adults at Emory University's Winship Cancer Institute. Each blood sample was tested four times using the device, and the results were compared to reports provided by conventional hematology analyzers.

The work showed that the results of the one-minute test were consistent with those of the conventional analysis. The smartphone app produced the best results for measuring severe anemia.

"The test doesn't require a skilled technician or a draw of venous blood and you see the results immediately," said Lam, who is also an assistant professor in the Coulter Department of Biomedical Engineering. "We think this is an empowering system, both for the general public and for our patients."

Tyburski and Lam have teamed up with two other partners and worked with Emory's Office of Technology Transfer to launch a startup company, Sanguina, to commercialize the test, which will be known as AnemoCheck™. The test ultimately will require approval from the FDA. The team also plans to study how the test may be applied to specific diseases, such as sickle cell anemia -- which is common in Georgia.

The device could be on pharmacy shelves sometime in 2016, where it might help people like Tyburski, who has suffered mild anemia most of her life. "If I'd had this when I was kid, I could have avoided some trips to the emergency room when I passed out in gym class," she said.

About a third of the population is at risk for anemia, which can cause neurocognitive deficits in children, organ failure and less serious effects such as chronic fatigue. Women, children, the elderly and those with chronic conditions such as kidney disease are more likely to suffer from anemia.

Source: Georgia Institute of Technology

How to sell the drugs of the future

Drugs
Credit: Getty Images

Only a decade ago, basing medical treatment on your DNA seemed like science fiction. Not any more. Thanks in part to the sequencing of the human genome, personalized medicine (PM), a specific course of treatment developed for the individual patient, is now science fact.

PM has already shown its effectiveness in the treatment of cancer, and medical professionals are eager to expand it to treat other chronic diseases. But first patients need to understand how PM can work for them.

Will they buy into it? "Yes -- but only if patients are armed with knowledge about their own disease and understand the relative advantages of PM," says Concordia University marketing professor Lea Prevel Katsanis, the co-author of a new study on the subject, published in the International Journal of Pharmaceutical and Healthcare Marketing. She adds that if patients are going to accept PM, doctor-patient communication is vital.

For the study, Katsanis and her co-author, Anja Hitz, a former John Molson School of Business MBA student and current head of medical compliance and prevention at the Military Hospital in Hamburg, Germany, polled 307 consumers through an online survey. 
They found that knowledge and the relative advantages of PM have the most significant influence on patient acceptance of PM.

"The more a patient knows about how she is being treated, the more likely she is to accept that treatment," says Katsanis. "So it's important to educate consumers on potential benefits and risks associated with PM."

Indeed, patient understanding is a key factor in getting healthcare professionals, governments and insurance companies to adopt and pay for PM, particularly when these targeted treatments are often more costly than traditional medical methods.

With PM, the same drug isn't given to millions of people. It's a targeted treatment regime. While that reduced patient pool means an increased cost, there can be long-term benefits. Increased efficiency and prevention may result in fewer drugs being prescribed. And PM may also result in the reduction of secondary costs as a result of overdosing, incorrect prescriptions and adverse drug reactions.

"If PM can be successfully integrated into the healthcare system at a reasonable cost, it represent a significant improvement in the treatment of chronic disease," says Katsanis.

But she warns that marketers need to proceed with caution: "The promotion of personalized medications will increasingly focus on the healthy patient with a genetic disposition for a particular illness. While this might lead to new and potentially greater opportunities for marketers, it might also result in the targeting of healthy patients who don't actually need treatment for an active disease. Ultimately, this could increase healthcare costs and cause unnecessary patient treatment."

Source: Concordia University

Early results indicate potential for focused ultrasound to treat OCD

Dr. Chang (in sweater) and treatment team with the first patient in the OCD study. Credit: Image courtesy of Focused Ultrasound Foundation

A recently published report in the Journal of Molecular Psychiatry supports the potential of focused ultrasound to treat certain patients with obsessive-compulsive disorder (OCD).

In a study of feasibility, safety and preliminary efficacy, four patients with disabling OCD unresponsive to medical therapy were treated by ablating small targets deep in the brain (anterior internal capsule) using the InSightec ExAblate Neuro MR-guided focused ultrasound system. This proof-of-concept study is being conducted with 12 patients by Jin Woo Chang, MD, PhD, at the Yonsei University Medical Center in Seoul, Korea. The results of the first four patients with six months follow-up were published.

All four patients had the targeted areas of the brain successfully ablated. The procedures were accomplished without complications or side effects and resulted in gradual improvement in obsessive-compulsive thoughts and behaviors as well as showing the nearly immediate and sustained improvement in depression and anxiety over six months.

"There is a need for non-invasive treatment options for patients with OCD that cannot be managed through medication," says Dr. Chang. "Using focused ultrasound, we were able to reduce the symptoms for these patients and help them get some of their life back without the risks or complications of the more invasive surgical approaches that are currently available."

"If these initial results are confirmed in the remaining eight patients in this study as well as in a larger pivotal trial of safety and efficacy, focused ultrasound could emerge as an alternative to surgery for improving quality of life in a cost-effective manner for patients with OCD," said Foundation Chairman Neal F. Kassell, MD. "This could also serve as the predicate for non-invasive therapy for other psychiatric disorders."

Dr. Chang plans to start a study using focused ultrasound to treat depression in 2015.

Current Treatment for OCD

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by recurring anxiety-provoking thoughts (obsessions) that are alleviated only by ritualistic actions (compulsions) such as hand washing. OCD symptoms can be overwhelming and result in severe impairment and dysfunction. Patients also have a high risk for depression, with two-thirds of OCD patients developing major depression.

Although a large portion of OCD patients improve with drug therapy, some patients have debilitating symptoms that are resistant to treatment. For these patients, psychosurgery can be performed to destroy (ablate) a targeted region of the brain (anterior internal capsule) associated with the disorder. The currently available ablative approaches are invasive or involve radiation:

• Radiofrequency ablation requires drilling into the skull and inserting a probe through 
   the brain.

• Stereotactic radiosurgery takes months to achieve an effect and may be associated with
   side effects of radiation.

• Deep brain stimulation has been used as a reversible and adjustable alternative to ablation, but it involves the risks and complications of surgery to implant the system and additional operations for battery changes.

Source: Focused Ultrasound Foundation

Powerful imaging for optical point-of-care diagnostics

The new imaging system consists of a handheld probe (on the right), and an ultrasound scanning display system (on the left). It can be easily transported between rooms in a clinic. Credit: Pim van den Berg/ Khalid Daoudi

A new handheld probe developed by a team of university and industry researchers in the Netherlands and France could give doctors powerful new imaging capabilities right in the palms of their hands. The imaging system, which is described in a paper published in The Optical Society's (OSA) open-access journal Optics Express, shrinks a technology that once filled a whole lab bench down to a computer screen and a small probe about the size of a stapler.

The new device combines two imaging modalities: ultrasound and photoacoustics. Ultrasound is a well-established technology that analyzes how sound pulses echo off internal body parts. It is good at revealing anatomical structures and is, perhaps most familiarly, used to image a developing fetus in a mother's womb.

Photoacoustics is a relatively new imaging technique, still making its way toward widespread clinical applications. In photoacoustic imaging, short pulses of light heat up internal tissue. The slight temperature change leads to a change in pressure,
which in turn produces a wave of ultrasound that can be analyzed to reveal information about the body's internal workings. Since this technique ultimately produces ultrasound waves as well, existing technology can be used to analyze and display the images.

The advantage of photoacoustics is that it can reveal important medical information that other imaging techniques cannot, including the presence of molecules like hemoglobin and melanin and the sub-millimeter structure of networks of blood vessels several centimeters beneath the skin. When combined with spectroscopic measurements, photoacoustics can also quantify hemoglobin oxygen saturation within single vessels, providing metabolic information that could be helpful for monitoring tumor progression, for example.

Yet despite these benefits, the cost and size of most photoacoustic systems limit their widespread use, said Khalid Daoudi, a researcher in the Biomedical Photonic Imaging Group at the University of Twente in the Netherlands. Most systems on the market require costly and bulky lasers that make the systems impractical for point-of-care diagnostics. "Our research aimed to break through these hindering factors," Daoudi said.

The project started as collaboration between the University of Twente and three European companies: ESAOTE Europe, a maker of medical diagnostic systems, Quantel, a maker of solid state lasers, and SILIOS Technologies, a maker of optical components.

The team's key innovation, which allowed them to dramatically shrink the system, was the design of an ultra-compact laser based on an efficient and inexpensive laser diode. By stacking multiple diodes to increase the power and carefully designing optical elements to shape the laser beam, the team was able to generate laser pulses with energies higher than had ever been achieved before with diode technology.

Diode lasers can also provide many laser pulses per second, which in turn allows real time imaging, another advantage of the new system, Daoudi noted.

The researchers tested the imaging performance of the system in different types of phantoms -- materials designed to mimic a tissue's optical properties -- and in a healthy human finger joint.

The new compact probe and imaging system can be easily transported between rooms in a clinical setting, an attractive feature for future commercialization, the researchers said.

The team is currently working with a European consortium of industrial and academic partners to take the next steps from the research to the commercialization phase. The current system operates at a single wavelength in the near infrared, but the team has plans to expand the design to multi-wavelength imaging.

"Some applications targeted are rheumatoid arthritis in finger joints, oncology, cardiovascular disease and burn wounds," Daoudi said.

Source: The Optical Society

CT scans could bolster forensic database to ID unidentified remains

Cranium image reconstructed from CT scans. Credit: North Carolina State University

A study from North Carolina State University finds that data from CT scans can be incorporated into a growing forensic database to help determine the ancestry and sex of unidentified remains. The finding may also have clinical applications for craniofacial surgeons.

"As forensic anthropologists, we can map specific coordinates on a skull and use software that we developed -- called 3D-ID -- to compare those three-dimensional coordinates with a database of biological characteristics," says Dr. Ann Ross, a professor of anthropology at NC State and senior author of a paper describing the work. "That comparison can tell us the ancestry and sex of unidentified remains using only the skull -- which is particularly valuable when dealing with incomplete skeletal remains."

However, the size of the 3D-ID database has been limited by the researchers' access to contemporary skulls that have clearly recorded demographic histories.

To develop a more robust database, Ross and her team launched a study to determine whether it was possible to get good skull coordinate data from living people by examining CT scans.

The University of Pennsylvania Museum's Morton Collection provided the NC State researchers with CT scans of 48 skulls. Researchers mapped the coordinates of the actual skulls manually using a digitizer, or electronic stylus. Then they compared the data from the CT scans with the data from the manual mapping of the skulls.

The researchers found that eight bilateral coordinates on the skull -- those found on either side of the head -- were consistent for both the CT scans and manual mapping.

"This will allow us to significantly expand the 3D-ID database," Ross says. "And these bilateral coordinates give important clues to ancestry, because they include cheekbones and other facial characteristics."

However, the five midline coordinates the researchers tested showed inconsistencies between the CT scans and manual mapping. Midline coordinates are those found along the center of the skull, such as the bridge of the nose.

"More research is needed to determine what causes these inconsistencies, and whether we'll be able to retrieve accurate midline data from CT scans," says Amanda Hale, a former master's student at NC State and lead author of the paper.

This research may also help craniofacial surgeons. "An improved understanding of the flaws in how CT scans map skull features could help surgeons more accurately map landmarks for reconstructive surgery," Hale says.

Source: North Carolina State University

Live adaptation of organ models in the OR

The non-deformed liver model (red) adapts to the deformed surface profile (blue). Credit: Graphics: Dr. Stefanie Speidel, KIT, in Medical Physics, 41

During minimally invasive operations, a surgeon has to trust the information displayed on the screen: A virtual 3D model of the respective organ shows where a tumor is located and where sensitive vessels can be found. Soft tissue, such as the tissue of the liver, however, deforms during breathing or when the scalpel is applied. Endoscopic cameras record in real time how the surface deforms, but do not show the deformation of deeper structures such as tumors. Young scientists of the Karlsruhe Institute of Technology (KIT) have now developed a real-time capable computation method to adapt the virtual organ to the deformed surface profile.

The principle appears to be simple: Based on computer tomography image data, the scientists construct a virtual 3D model of the respective organ, including the tumor, prior to operation. During the operation, cameras scan the surface of the organ and generate a stiff profile mask. To this virtual mold, the 3D model then is to fit snuggly, like jelly to a given form. The Young Investigator Group of Dr. Stefanie Speidel analyzed this geometrical problem of shape adaptation from the physical perspective. "We model the surface profile as electrically negative and the volume model of the organ as electrically positive charged," Speidel explains. "Now, both attract each other and the elastic volume model slides into the immovable profile mask." The adapted 3D model then reveals to the surgeon how the tumor has moved with the deformation of the organ.

Simulations and experiments using a close-to-reality phantom liver have demonstrated that the electrostatic-elastic method even works when only parts of the deformed surface profile are available. This is the usual situation at the hospital. The human liver is surrounded by other organs and, hence, only partly visible by endoscopic cameras. "Only those structures that are clearly identified as parts of the liver by our system are assigned an electric charge," says Dr. Stefan Suwelack who, as part of Speidel's group, wrote his Ph.D. thesis on this subject. Problems only arise, if far less than half of the deformed surface is visible. To stabilize computation in such cases, the KIT researchers can use clear reference points, such as crossing vessels. Their method, however, in contrary to others does not rely on such references from the outset.

In addition, the model of the KIT researchers is more precise than conventional methods, because it also considers biomechanical factors of the liver, such as the elasticity of the tissue. So for instance, the phantom liver used by the scientists consists of two different silicones: A harder material for the capsule, i.e. the outer shell of the liver, and a softer material for the inner liver tissue.

As a result of their physical approach, the young scientists also succeeded in accelerating the computation process. As shape adaptation was described by electrostatic and elastic energies, they found a single mathematical formula. Using this formula, even conventional computers equipped with a single processing unit only work so quickly that the method is competitive. Contrary to conventional computation methods, however, the new method is also suited for parallel computers. Using such a computer, the Young Investigator Group now plans to model organ deformations stably in real time.

Source: Karlsruhe Institute of Technology

How does the brain react to virtual reality? Completely different pattern of activity in brain

Illusions (stock image). UCLA neurophysicists have found that space-mapping neurons in the brain react differently to virtual reality than they do to real-world environments. Credit: © agsandrew / Fotolia

UCLA neurophysicists have found that space-mapping neurons in the brain react differently to virtual reality than they do to real-world environments. Their findings could be significant for people who use virtual reality for gaming, military, commercial, scientific or other purposes.

"The pattern of activity in a brain region involved in spatial learning in the virtual world is completely different than when it processes activity in the real world," said Mayank Mehta, a UCLA professor of physics, neurology and neurobiology in the UCLA College and the study's senior author. "Since so many people are using virtual reality, it is important to understand why there are such big differences."

The study was published today in the journal Nature Neuroscience.

The scientists were studying the hippocampus, a region of the brain involved in diseases such as Alzheimer's, stroke, depression, schizophrenia, epilepsy and post-traumatic stress disorder. The hippocampus also plays an important role in forming new memories and creating mental maps of space. For example, when a person explores a room, hippocampal neurons become selectively active, providing a "cognitive map" of the environment.

The mechanisms by which the brain makes those cognitive maps remains a mystery, but neuroscientists have surmised that the hippocampus computes distances between the subject and surrounding landmarks, such as buildings and mountains. But in a real maze, other cues, such as smells and sounds, can also help the brain determine spaces and distances.

To test whether the hippocampus could actually form spatial maps using only visual landmarks, Mehta's team devised a noninvasive virtual reality environment and studied how the hippocampal neurons in the brains of rats reacted in the virtual world without the ability to use smells and sounds as cues.

Researchers placed a small harness around rats and put them on a treadmill surrounded by a "virtual world" on large video screens -- a virtual environment they describe as even more immersive than IMAX -- in an otherwise dark, quiet room. The scientists measured the rats' behavior and the activity of hundreds of neurons in their hippocampi, said UCLA graduate student Lavanya Acharya, a lead author on the research.

The researchers also measured the rats' behavior and neural activity when they walked in a real room designed to look exactly like the virtual reality room.

The scientists were surprised to find that the results from the virtual and real environments were entirely different. In the virtual world, the rats' hippocampal neurons seemed to fire completely randomly, as if the neurons had no idea where the rat was -- even though the rats seemed to behave perfectly normally in the real and virtual worlds.

"The 'map' disappeared completely," said Mehta, director of a W.M. Keck Foundation Neurophysics center and a member of UCLA's Brain Research Institute. "Nobody expected this. The neuron activity was a random function of the rat's position in the virtual world."

Explained Zahra Aghajan, a UCLA graduate student and another of the study's lead authors: 

"In fact, careful mathematical analysis showed that neurons in the virtual world were calculating the amount of distance the rat had walked, regardless of where he was in the virtual space."

They also were shocked to find that although the rats' hippocampal neurons were highly active in the real-world environment, more than half of those neurons shut down in the virtual space.

The virtual world used in the study was very similar to virtual reality environments used by humans, and neurons in a rat's brain would be very hard to distinguish from neurons in the human brain, Mehta said.

His conclusion: "The neural pattern in virtual reality is substantially different from the activity pattern in the real world. We need to fully understand how virtual reality affects the brain."

Neurons Bach would appreciate

In addition to analyzing the activity of individual neurons, Mehta's team studied larger groups of the brain cells. Previous research, including studies by his group, have revealed that groups of neurons create a complex pattern using brain rhythms.

"These complex rhythms are crucial for learning and memory, but we can't hear or feel these rhythms in our brain. They are hidden under the hood from us," Mehta said. "The complex pattern they make defies human imagination. The neurons in this memory-making region talk to each other using two entirely different languages at the same time. One of those languages is based on rhythm; the other is based on intensity."

Every neuron in the hippocampus speaks the two languages simultaneously, Mehta said, comparing the phenomenon to the multiple concurrent melodies of a Bach fugue.

Mehta's group reports that in the virtual world, the language based on rhythm has a similar structure to that in the real world, even though it says something entirely different in the two worlds. The language based on intensity, however, is entirely disrupted.

When people walk or try to remember something, the activity in the hippocampus becomes very rhythmic and these complex, rhythmic patterns appear, Mehta said. Those rhythms facilitate the formation of memories and our ability to recall them. Mehta hypothesizes that in some people with learning and memory disorders, these rhythms are impaired.

"Neurons involved in memory interact with other parts of the hippocampus like an orchestra," Mehta said. "It's not enough for every violinist and every trumpet player to play their music flawlessly. They also have to be perfectly synchronized."

Mehta believes that by retuning and synchronizing these rhythms, doctors will be able to repair damaged memory, but said doing so remains a huge challenge.

"The need to repair memories is enormous," noted Mehta, who said neurons and synapses -- the connections between neurons -- are amazingly complex machines.

Previous research by Mehta showed that the hippocampal circuit rapidly evolves with learning and that brain rhythms are crucial for this process. Mehta conducts his research with rats because analyzing complex brain circuits and neural activity with high precision currently is not possible in humans.

Other co-authors of the study were Jason Moore, a UCLA graduate student; Cliff Vuong, a research assistant who conducted the research as a UCLA undergraduate; and UCLA postdoctoral scholar Jesse Cushman. The research was funded by the W.M. Keck Foundation and the National Institutes of Health.

Source: University of California - Los Angeles