Tuesday, September 11, 2012

'Junk DNA' Plays Crucial Role In Human Diseases

A lot more of our genome is biologically active than previously thought - about 80% - an international team involving over 400 scientists revealed yesterday. The researchers explained that only approximately 1% of our genome has gene regions that code for proteins, which has made them wonder what is going on with the rest of the DNA. Now that we know that four-fifths of the genome is biochemically active, in a way that regulates the expression of nearby genes, geneticists realize that much less of our genome consists of junk DNA as once believed.

9 Experts believe these new findings will help us better understand how several diseases develop and behave, which may lead to more effective and targeted treatments.

The human genome has twice as many genes than previously thought. Many of the previously unknown genes play a role in cellular control, which may impact on the development of human diseases.

The international consortium of scientists analyzed and experimented on sequencing data from 140 different types of human cells and identified thousands of DNA regions that help direct our genes' activities.

Manolis Kellis, an associate professor of computer science at MIT, and co-author of a report that has appeared in several scientific journals, including Nature, said:

"Humans are 99.9 percent identical to each other, and you only have one difference in every 300 to 1,000 nucleotides. What ENCODE allows you to do is provide an annotation of what each nucleotide of the genome does, so that when it's mutated, we can make some predictions about the consequences of the mutation."

What is ENCODE?

ENCODE (Encyclopedia of DNA Elements) is a public research conglomerate launched by the NHGRI (National Human Genome Research Institute) in the USA, and the EMBL-European Bioinformatics Institute (EMBL-EBI) in the UK, in 2003. Its aim is to identify all the functional components of the human genome. The NHGRI and EMBL-EBI pledged to release all project data immediately into public databases.

DNA Strand
What scientists initially thought was junk DNA is actually biochemically active.
One of the aims of ENCODE was to better understand the human genome beyond protein-coding genes. Scientists can do this by examining the chemical changes that occur in individual stretches of DNA - these stretches control when specific genetic regions become active. The chemical modifications vary by cell type, and can change the DNA directly, or just the histone proteins that DNA surrounds.

A pilot project was published in 2007, which had looked at 1% of the human genome.

To map these epigenomes (modifications), the researchers gathered data from various cell types. While some laboratories measured DNA histone modifications, others gauged the accessibility of various DNA stretches by cutting them into fragments with enzymes.

ENCODE is a collaboration of 442 scientists from 32 laboratories in Japan, Singapore, Spain, the USA and UK. Together, they generated and examined over 15 terabytes of raw data - all this data is now publicly available. They have used approximately 300 years' worth of computer time, focusing on 147 tissue types to find out what turns certain genes on and off, and the specific characteristics of switches in different cell types.

The ENCODE scientists found that about 80% of the human genome is involved in some type of biochemical event, such as protein binding, specifically binding to proteins that impact on how neighboring genes are used. They also found that the very same regulatory regions have different roles to play, depending on what kind of cell they are acting in.

The scientists analyzed the conservation of the A, T, C and G nucleotides in the new regulatory regions they had identified. Nucleotides are conserved if they stay the same over long periods during our evolution. This can be examined by either comparing how variations occur between different species, or among individuals of the same species.

In an online communiqué, the European Bioinformatics Institute, wrote:

"On 5 September, an international team of researchers reveal that much of what has been called 'junk DNA' in the human genome is actually a massive control panel with millions of switches regulating the activity of our genes. Without these switches, genes would not work - and mutations in these regions might lead to human disease."

Three Billion Pairs of Genetic Code

So far, all three billion pairs of genetic code that make up human DNA have been analyzed by ENCODE. Scientists at the European Bioinformatics Institute explained that they have identified the genome function of 4 million gene switches, which will help researchers hone-in on specific areas of human disease, and hopefully find ways to better treat or cure them. They added that the switches are frequently a long way along the genome from the gene they regulate.

Ewan Birney of the European Bioinformatics Institute, lead analysis coordinator for ENCODE, said: "Our genome is simply alive with switches: millions of places that determine whether a gene is switched on or off. The Human Genome Project showed that only 2% of the genome contains genes, the instructions to make proteins. With ENCODE, we can see that around 80% of the genome is actively doing something. We found that a much bigger part of the genome - a surprising amount, in fact - is involved in controlling when and where proteins are produced, than in simply manufacturing the building blocks."

Ian Dunham, also of European Bioinformatics Institute, said that ENCODE is a useful research tool for any researcher looking into human diseases. Scientists investigating diseases often have a good idea about which genes are involved, but need data on which switches play a role. In some cases the locations of these switches are not where they expected them to be. Dunham said "ENCODE gives us a set of very valuable leads to follow to discover key mechanisms at play in health and disease. Those can be exploited to create entirely new medicines, or to repurpose existing treatments."

A principal investigator on ENCODE, Dr Michael Snyder, professor and chair at Stanford University, explained that ENCODE provides us with the knowledge required so that we can look beyond the genome's linear structure to how the whole network is connected. Genome-wide association studies are helping us understand where certain genes are located, as well as which sequences control them. Snyder said "Because of the complex, three-dimensional shape of our genome, those controls are sometimes far from the gene they regulate and looping around to make contact. Were it not for ENCODE, we might never have looked in those regions. This is a major step toward understanding the wiring diagram of a human being. ENCODE helps us look deeply into the regulatory circuit that tells us how all of the parts come together to make a complex being."

Before, generating and storing enormous volumes of data was a problem in biomedical research. However, as productivity of genome sequencing has improved and become more economical, the focus has moved to analysis, i.e. interpreting data generated from genome-wide association studies. Cambridge University scientists said "ENCODE partners have been working systematically through the human genome, using the same computational and wet-lab methods and reagents in laboratories distributed throughout the world."

Ewan Birney said:

"Getting the best people with the best expertise together is what this is all about. ENCODE has really shown that leading life scientists are very good at collaborating closely on a large scale to produce excellent foundational resources that the whole community can use."

The scientists emphasized that it will be several years before doctors and patients see any tangible benefits from ENCODE.
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Popular Kids Smoke More

A new study shows heart disease, lung cancer, and emphysema may be more prevalent in popular youths. The University of California and the University of Texas collaborated on a study which found that popular students in seven different California high schools were more likely to smoke cigarettes than unpopular students.

This research, published online in the Journal of Adolescent Health, supports previous USC-led studies of pupils in the sixth through twelfth grades throughout Mexico and the United States.

"That we're still seeing this association more than 10 years later, despite marginal declines in smoking, suggests that popularity is a strong predictor of smoking behavior," said Thomas W. Valente, Ph.D., professor of preventive medicine at the Keck School of Medicine of USC and lead author of three prior studies on the subject.

In the most recent study, Valente and his team surveyed 1,950 students in the ninth and tenth grades in October of 2006 and 2007. Students were asked if they had ever smoked, how many students their age they believed to be smokers, how often in the last 30 days they had smoked, how they believed their close friends felt about smoking, and who their five best friends were. Popularity was calculated by how often participants mentioned a student as a friend.

Results found that pupils who believed their friends smoked were more likely to smoke, even if this assumption was incorrect. Popular students started to smoke earlier than non-popular students. Kids that became smokers between ninth and tenth grade were more likely to befriend other smokers. To the researchers surprise, student perception of the norm, (how often and how many of their peers smoked) was less likely to encourage smoking than the perceived behavior of their close friends.

In a separate study in 2012, published in a journal called Salud Publica de Mexico, Valente and a team of researchers surveyed 399 teens at a high school in Jalisco. In 2005, 1,486 youths in the sixth and seventh grades in Southern California were measured and in 2001, 2,525 high school students across the United States were also surveyed. Both studies appeared in the Journal of Adolescent Health.

Valente concluded that consistent samples have come from four different areas, and therefore, it is easy to see adolescents turn to their close friends when choosing what is important in their lives.
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Acupuncture Provides Relief For Chronic Pain, Say Researchers

Acupuncture for the treatment of chronic pain is better than placebo acupuncture (sham acupuncture) or no acupuncture at all, researchers from the Memorial Sloan-Kettering Cancer Center, New York, wrote in the JAMA journal Archives of Internal Medicine. This was their conclusion after gathering and analyzing data from 29 randomized controlled human studies.

The authors explained that acupuncture is used extensively for the treatment of chronic pain. However, its acceptance is mixed and there is controversy regarding its efficacy and value.

Several studies have shown that acupuncture can have a pain-lowering effect when administered by a qualified practitioner. In 2011, a German pain specialist, Dr. Winfried Meissner, found that acupuncture can help reduce pain in patients after surgery.

Other studies, however, have had unfavorable findings. In 2011, researchers from the Universities of Exeter & Plymouth, UK, and the Korea Institute of Oriental Medicine, found that there was very little compelling evidence that acupuncture reduces pain. They added that acupuncture was associated with some serious adverse events.

Andrew J. Vickers, D.Phil., and team carried out individual data meta-analyses, using information from several published randomized control studies from the USA, UK, Germany, Sweden and Spain involving 17,922 patients. Their aim was to find out what effect acupuncture has on some chronic pain conditions.

The authors wrote:

"We found acupuncture to be superior to both no-acupuncture control and sham acupuncture for the treatment of chronic pain. Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects."

An acupuncturist inserting needles into a patient's skin

Placebo acupuncture involved pretending to stick needles into the patient with retractable needles that did not really perforate the skin, or ones that just went slightly into the surface, rather than penetrating deeper as occurs in proper acupuncture. Proper acupuncture was also compared to deactivated electrical simulation or detuned laser.

The people who were administered real acupuncture had pain scores 0.23, 0.16 and 0.15 lower (SDs, standard deviations) than those receiving the pretend acupuncture for back and neck pain.

The scientists concluded:

"Our results from individual patient data meta-analyses of nearly 18,000 randomized patients in high-quality RCTs provide the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain."

Accompanying Commentary in the Same Journal

In the same journal, Andrew L. Avins, M.D., M.P.H., of Kaiser-Permanente, Northern California Division of Research, Oakland, wrote that there is still an ambiguous relationship between conventional allopathic medical care and alternative and complementary medicine.

Dr. Avins wrote:

"At the end of the day, our patients seek our help to feel better and lead longer and more enjoyable lives. It's ideal to understand the mechanism of action, which carries the potential for developing more and better interventions. But the ultimate questions is: does this intervention work (or, more completely, do its benefits outweigh its risks and justify its costs)?.

"At least in the case of acupuncture, Vickers et al have provided some robust evidence that acupuncture seems to provide modest benefits over usual care for patients with diverse sources of chronic pain. Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing."

What is acupuncture?

Acupuncture started off in China thousands of years ago. There are some records showing that some acupuncture was practiced in Europe a few hundred years ago, however, it did not really enter what we know as Western Society until after the 1950s, after which it spread rapidly throughout Western Europe, Canada and the USA.

Acupuncture involves inserting thin needles through the skin at carefully located points of the body at varying depths. Neurologists and other medical specialists are not sure how acupuncture works scientifically.

Most practitioners, even conventional medicine practitioners, have mostly accepted that acupuncture does provide some pain relief, as well as alleviating symptoms of other conditions, such as nausea caused by chemotherapy, or insomnia.

Chinese medical theory says there are meridian points in the body through which "Chi" vital energy runs - these are the acupuncture points. However, there is no anatomical, histological or scientific proof to back up this theory.

Because of the invasive nature of acupuncture, creating case studies with proper scientific controls is extremely difficult. A clinical study involved a placebo (sham product) which is compared to the targeted treatment.

Acupuncture involves the insertion of needles and advice on self-care. The qualified acupuncturist will also carry out a physical exam and make an assessment of the patient's condition. A session lasts about 30 minutes. In most cases, treatment is carried out in weekly or fortnightly sessions.

The acupuncturist uses single-use disposable sterile needles, which are inserted into the skin. When the needle reaches its target depth, there may be some slight pain. Some needles are stimulated with electric currents or heated up after insertion. They remain in their targeted positions for approximately 20 minutes.
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New Discovery Offers Hope For People Who Can't Smell

A recent study by researchers at the University of Michigan Medical School and their team from other universities and published online in Nature Medicine reports that gene therapy could help people restore their sense of smell. The research, conducted on mice, is a sign of hope for people who were born without the ability to smell or who have lost it due to some unfortunate reason.

The experts believe that fixing congenital anosmia, which is medical language for not being able to smell anything, may eventually lead to curing similar medical issues which also come from the cilia or small hair-like pieces which reside on the outside of cells and are present in diseases involving the kidneys, eyes, and other parts of the body.

According to the report, it may take a while for the evidence to be able to help humans and it will eventually be extremely significant for individuals who have lost the ability to smell because of some type of medical problem, and not so much for people who can't smell because of trauma to the nose, or simply old age. However, the new findings help researchers to understand anosmia on the cellular level, which gives hope to anyone who does not have a sense of smell that someday their ability to smell may be restored.

Jeffery Martens, Ph.D., senior author of the study commented:

"Using gene therapy in a mouse model of cilia dysfunction, we were able to rescue and restore olfactory function, or sense of smell. Essentially, we induces the neurons that transmit the sense of smell to regrow the cilia they'd lost."

The rodents involved in the study possessed some genetic defect that affected a protein named IFT88. This defect made the individuals have less- than-normal amounts of cilia in their bodies. When this problem occurs in mice, it results in early death and poor feeding habits, while for humans it can be fatal.

IFT88 genes were implanted into the cells in the mice when the researchers gave them a common cold virus which had plenty of normal DNA. This made it easy for the virus to infect them, and therefore, the researchers could insert the virus into the cells of the mice.

After this, the experts were able to analyze the feeding habits of the mice, as well as how they were growing, and the neuron signals which assist in the smelling process.

14 days after the mice were treated with 3 day therapy, the researchers found the mice to have increased in body weight by 60%, which meant their feeding habits had improved. When the mice were exposed to amyl acetate, or banana oil, the experts were able to see that their neurons were also working correctly.

Martens said: "At the molecular level, function that had been absent was restored.

First author Jeremy McIntyre, Ph.D., added:

"By restoring the protein back into the olfactory neurons, we could give the cell the ability to regrow and extend cilia off the dendrite knob, which is what the olfactory neuron needs to detect odorants."

People who have ciliopathies, diseases caused by the dysfunction of cilia, may benefit greatly from these findings. Examples of ciliopathies include:
  • nephronopthisis
  • dyskinesia
  • primary ciliary
  • Alström syndrome
  • Bardet-Biedl syndrome
The scientists say that almost all cells in the body have the ability to grow one or more cilia. For the olfactory system, more than one cilia come from the olfactory sensory neurons. These are sensory cells which are present in the olfactory epithelium, the tissue of the nasal cavity. When loss of smell occurs, receptors the connect odorants are restrained on the cilia, resulting the loss of cilia, and the loss of sense of smell.

Martens concludes:

"We hope this stimulates the olfactory research community to look at asnosmia caused by other factors, such as head trauma and degenerative diseases. We know a lot about how this system works - now have to look at how to fix it when it malfunctions."
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Our Brains Make Men And Women See Things Differently

According to a new study, published in BioMed Central's open access journal Biology of Sex Differences, men and women have different ways of using the visual centers of their brains. Experts suggest that while females are better at distinguishing colors, males are more sensitive to fine detail and rapidly moving stimuli.

There are high concentrations of the male sex hormone (androgen) receptors throughout the cerebral cortex in the brain, particularly in the visual cortex, which is in charge of processing images.

Guys have 25% more neurons in the visual cortex than females because, during embryogenesis, androgens are responsible for controlling the development of those neurons.

The vision of men and women was compared by a team of researchers from Brooklyn and Hunter Colleges of the City University of New York. The experts observed people over the age of 16 from both college and high school, including students and faculty. Both sexes needed to have normal color vision and 20/20 sight (with glasses or contacts was considered fine), in order to participate.

Scientists learned that the color vision of men was shifted, after they asked the volunteers to describe colors shown to them across the visual spectrum. It also became clear that male subjects needed a slightly longer wavelength to experience the same hue as the female subjects.

It was not as easy for men to discriminate between colors as it was for women, meaning that the males had a broader ranger in the center of the spectrum.

In order to measure contrast-sensitivity functions (CSF) of vision, the researchers used an image of light and dark bars that were either horizontal or vertical, asking the participants to decide which one they saw. When the light and dark bars were alternated in each image, the image appeared to flicker.

The investigators found, by varying how quickly the bars alternated or how close together they were, that at moderate rates of image change, volunteers lost sensitivity for bars that were close together, and gained sensitivity when the bars were farther apart.

Both males and females had a harder time resolving the images over all bar widths when the image change was faster. However, men had an easier time resolving more rapidly changing images that were closer together than the women.

Professor Israel Abramov, lead author, explained:

"As with other senses, such as hearing and the olfactory system, there are marked sex differences in vision between men and women. The elements of vision we measured are determined by inputs from specific sets of thalamic neurons into the primary visual cortex.

We suggest that, since these neurons are guided by the cortex during embryogenesis, that testosterone plays a major role, somehow leading to different connectivity between males and females. The evolutionary driving force between these differences is less clear."
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Friday, September 7, 2012

University Of Hawaii Cancer Researchers Discover Gene Defect Responsible For Cancer Syndrome

University of Hawai'i Cancer Center researchers have discovered germline BAP1 mutations are associated with a novel cancer syndrome characterized by malignant mesothelioma, uveal melanoma, cutaneous melanoma and atypical melanocytic tumors. Germline mutations are hereditary gene defects that are present in every cell.

The study investigated two unrelated families with BAP1 defects and found an increase in the occurrence of mole-like melanocytic tumors that are non-cancerous flat or slightly elevated and pigmented skin lesions. These benign skin lesions were found to carry the BAP1 mutation and it was concluded that people with this specific type of melanocytic lesion are at higher risk of developing melanoma and mesothelioma.

This discovery provides physicians with a visual marker in identifying individuals that may carry germline BAP1 mutations. People having this syndrome should reduce their exposure to environmental risk factors such as UV radiation for melanoma and avoid erionite and asbestos exposure for mesothelioma. It will also help identify individuals who are at higher risk for melanomas which is usually cured with timely detection and to assist in the early detection of mesothelioma which typically leads to better prognosis.

"Identifying this gene as a cause of several cancers can tell us who is at risk in a family before the cancer develops," said Michele Carbone, MD, PhD, director of the UH Cancer Center and professor of pathology, John A. Burns School of Medicine. "We can advise patients to undergo routine exams and genetic testing for early diagnoses and treatment." Carbone is the leading author of the paper included in the August 30, 2012 issue of the Journal of Translational Medicine, published by BioMed Central.

This novel gene-testing has been patented by Carbone and colleagues and is performed exclusively at The Queen's Medical Center in Honolulu, Hawaii where they receive genetic samples from across the entire United States. Carbone previously discovered that individuals who carry BAP1 mutations are susceptible to developing mesothelioma and melanoma of the eye. This latest discovery builds on this and other research on the BAP1 mutation.
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Students Create Low-Cost Biosensor To Detect Contaminated Water In Developing Nations

Diarrheal disease is the second-leading cause of death in children under five years old - killing as many as 1.5 million children worldwide every year. These startling statistics from the World Health Organization (2009) point to the reason why a group of undergraduate students from Arizona State University is working to develop a low-cost biosensor - a simple device that would detect contaminated drinking water.

An interdisciplinary team of nine students is participating in the 2012 International Genetically Engineered Machine (iGEM) competition - a prestigious global event that challenges students to design and build simple biological systems made from standard, interchangeable parts.

The ASU team started its research during the summer to prepare for the synthetic biology competition. Its goal is to create a user-friendly, DNA-based biosensor that can detect major pathogens. The low-cost device would be used in the field rather than in a laboratory.

"We are developing a biosensor that will detect pathogenic bacteria, such as Shigella, Salmonella and E. coli, that cause diarrhea," said Ryan Muller, an undergraduate student in ASU's School of Life Sciences and an iGEM team leader. "Ideally, you would use our biosensor to check different water supplies in third world-countries to determine whether the water is safe to drink."

The team is working on two biosensor designs.

"The first one targets DNA," explained Nisarg Patel, a molecular biosciences and biotechnology major in School of Life Sciences, as well as a political science major. "Since each type of pathogen has different DNA, we want to create complementary sequences - sequences that match a specific DNA. We will take bacterial samples from the water, pull out the DNA and check whether it complements our DNA probe. If it does, it will produce a color response and then we'll know that the water is contaminated."

Made for portability, Patel said the second design tests the membranes of bacteria. When using the device to test water, if certain proteins attach to a bacterial membrane, the sample will turn blue - indicating the water is contaminated with a pathogen and would not be safe to drink.

"The advantage of this design over previous designs in the field lies in the cheap production of probes and the enzymatic chain reaction," said Abhinav Markus, a biomedical engineering student in ASU's Ira A Fulton Schools of Engineering. "Samples can be tested in the field with minimal cost and high sensitivity."

When the ASU iGEM team first met this summer, Madeline Sands, an anthropology major in the university's School of Human Evolution and Social Change, pitched the idea to build a low-cost biosensor. Sands previously traveled to Guatemala as part of an ASU field experience. There, she conducted community health research under the direction of Jonathan Maupin, a medical anthropologist. Sands realized that contaminated water presents a serious health problem for developing countries.

"With constant earthquakes, landslides and rains in Guatemala, it can often be difficult to determine if a water source is contaminated," said Sands. "My time there made it clear that having a way to detect contaminated water could lead to a further reduction in the incidence and morbidity of diarrhea."

In October, the team will present its device during the iGEM regional competition at Stanford University. If successful, they will move on to the global competition in November at Massachusetts Institute of Technology.
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Expressing Your Emotions Can Reduce Fear, UCLA Psychologists Report

"Give sorrow words." - Malcolm in Shakespeare's "Macbeth"

Can simply describing your feelings at stressful times make you less afraid and less anxious?

A new UCLA psychology study suggests that labeling your emotions at the precise moment you are confronting what you fear can indeed have that effect.

The psychologists asked 88 people with a fear of spiders to approach a large, live tarantula in an open container outdoors. The participants were told to walk closer and closer to the spider and eventually touch it if they could.

The subjects were then divided into four groups and sat in front of another tarantula in a container in an indoor setting. In the first group, the subjects were asked to describe the emotions they were experiencing and to label their reactions to the tarantula - saying, for example, "I'm anxious and frightened by the ugly, terrifying spider."

"This is unique because it differs from typical procedures in which the goal is to have people think differently about the experience - to change their emotional experience or change the way they think about it so that it doesn't make them anxious," said Michelle Craske, a professor of psychology at UCLA and the senior author of the study. "Here, there was no attempt to change their experience, just to state what they were experiencing."

In a second group, the subjects used more neutral terms that did not convey their fear or disgust and were aimed at making the experience seem less threatening. They might say, for example, "That little spider can't hurt me; I'm not afraid of it."

"This is the usual approach for helping individuals to confront the things they fear," Craske said.

In a third group, the subjects said something irrelevant to the experience, and in a fourth group, the subjects did not say anything - they were simply exposed to the spider.

All the participants were re-tested in the outdoor setting one week later and were again asked to get closer and closer to the tarantula and potentially touch it with a finger. The researchers measured how close subjects could get to the spider, how distressed they were and what their physiological responses were, focusing in particular on how much the subjects' hands sweated, which is a good measure of fear, Craske said.

The researchers found that the first group did far better than the other three. These people were able to get closer to the tarantula - much closer than those in the third group and somewhat closer than those in the other two groups - and their hands were sweating significantly less than the participants in all of the other groups.

The results are published in the online edition of the journal Psychological Science and will appear in an upcoming print edition.

"They got closer and they were less emotionally aroused," Craske said. "The differences were significant. The results are even more significant given the limited amount of time involved. With a fuller treatment, the effects may be even larger.

"Exposure is potent," she added. "It's surprising that this minimal intervention action had a significant effect over exposure alone."

So why were the people in the first group - those who performed what the life scientists call "affect labeling" - able to get closer to the tarantula?

"If you're having less of a threat response, which is indicated by less sweat, that would allow you to get closer; you have less of a fear response," said study co-author Matthew Lieberman, a UCLA professor of psychology and of psychiatry and biobehavioral sciences. "When spider-phobics say, 'I'm terrified of that nasty spider,' they're not learning something new; that's exactly what they were feeling - but now instead of just feeling it, they're saying it. For some reason that we don't fully understand, that transition is enough to make a difference."

The scientists also analyzed the words the subjects used. Those who used a larger number of negative words did better, in terms of both how close they were willing to get to the tarantula and their skin-sweat response. In other words, describing the tarantula as terrifying actually proved beneficial in ultimately reducing the fear of it.

"Doing more affect labeling seemed to be better," Lieberman said.

"That is so different from how we normally think about exposure therapy, where you try to get the person to think differently, to think it's not so bad," Craske said. "What we did here was to simply encourage individuals to state the negative."

"We've published a series of studies where we asked people, 'Which do you think would make you feel worse: looking at a disturbing image or looking at that disturbing image and choosing a negative emotional word to describe it,'" Lieberman said. "Almost everyone said it would be worse to have to look at that image and focus on the negative by picking a negative word. People think that makes our negative emotions more intense. Well, that is exactly what we asked people to do here. In fact, it's a little better to have people label their emotions - multiple studies now show this. Our intuitions here are wrong."

This is the first study to demonstrate benefits for affect labeling of fear and anxiety in a real-world setting, Craske and Lieberman said.

"The implication," Craske said, "is to encourage patients, as they do their exposure to whatever they are fearful of, to label the emotional responses they are experiencing and label the characteristics of the stimuli - to verbalize their feelings. That lets people experience the very things they are afraid and say, 'I feel scared and I'm here.' They're not trying to push it away and say it's not so bad. Be in the moment and allow yourself to experience whatever you're experiencing."

Craske and Lieberman are studying how this approach can help people who have been traumatized, such as rape victims and victims of domestic violence. The approach potentially could benefit soldiers returning from war as well.

"I'm far more optimistic than I was before this study," Lieberman said. "I'm a believer that this approach can have real benefits for people.

"There is a region in the brain, the right ventrolateral prefrontal cortex, that seems to be involved in labeling our feelings and our emotional reactions, and it is also associated with regulating our emotional responses," he said. "Why those two go together is still a bit of a mystery. This brain region that is involved in simply stating how we are feeling seems to mute our emotional responses, at least under certain circumstances."

"There's a trend in psychology of acceptance-based approaches - honestly label your feelings. This study has that flavor to it," Craske said.

Katharina Kircanski, a former UCLA graduate student and current postdoctoral scholar at Stanford University, is lead author of the study; she conducted this research as a graduate student in Craske's laboratory.
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'I Knew It All Along...Didn't I?' - Understanding Hindsight Bias

The fourth-quarter comeback to win the game. The tumor that appeared on a second scan. The guy in accounting who was secretly embezzling company funds. The situation may be different each time, but we hear ourselves say it over and over again: "I knew it all along."

The problem is that too often we actually didn't know it all along, we only feel as though we did. The phenomenon, which researchers refer to as "hindsight bias," is one of the most widely studied decision traps and has been documented in various domains, including medical diagnoses, accounting and auditing decisions, athletic competition, and political strategy.

In a new article in the September 2012 issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science, psychological scientists Neal Roese of the Kellogg School of Management at Northwestern University and Kathleen Vohs of the Carlson School of Management at the University of Minnesota review the existing research on hindsight bias, exploring the various factors that make us so susceptible to the phenomenon and identifying a few ways we might be able to combat it. This article is the first overview to draw insights together from across different disciplines.

Roese and Vohs propose that there are three levels of hindsight bias that stack on top of each other, from basic memory processes up to higher-level inference and belief. The first level of hindsight bias, memory distortion, involves misremembering an earlier opinion or judgment ("I said it would happen"). The second level, inevitability, centers on our belief that the event was inevitable ("It had to happen"). And the third level, foreseeability, involves the belief that we personally could have foreseen the event ("I knew it would happen").

The researchers argue that certain factors fuel our tendency toward hindsight bias. Research shows that we selectively recall information that confirms what we know to be true and we try to create a narrative that makes sense out of the information we have. When this narrative is easy to generate, we interpret that to mean that the outcome must have been foreseeable. Furthermore, research suggests that we have a need for closure that motivates us to see the world as orderly and predictable and to do whatever we can to promote a positive view of ourselves.

Ultimately, hindsight bias matters because it gets in the way of learning from our experiences.

"If you feel like you knew it all along, it means you won't stop to examine why something really happened," observes Roese. "It's often hard to convince seasoned decision makers that they might fall prey to hindsight bias."

Hindsight bias can also make us overconfident in how certain we are about our own judgments. Research has shown, for example, that overconfident entrepreneurs are more likely to take on risky, ill-informed ventures that fail to produce a significant return on investment.

While our inclination to believe that we "knew it all along" is often harmless, it can have important consequences for the legal system, especially in cases of negligence, product liability, and medical malpractice. Studies have shown, for example, that hindsight bias routinely afflicts judgments about a defendant's past conduct.

And technology may make matters worse. "Paradoxically, the technology that provides us with simplified ways of understanding complex patterns - from financial modeling of mortgage foreclosures to tracking the flow of communications among terrorist networks - may actually increase hindsight bias," says Roese.

So what, if anything, can we do about it?

Roese and Vohs suggest that considering the opposite may be an effective way to get around our cognitive fault, at least in some cases. When we are encouraged to consider and explain how outcomes that didn't happen could have happened, we counteract our usual inclination to throw out information that doesn't fit with our narrative. As a result, we may be able to reach a more nuanced perspective of the causal chain of events.
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Promising New Drug Target For Inflammatory Lung Diseases

The naturally occurring cytokine interleukin-18, or IL-18, plays a key role in inflammation and has been implicated in serious inflammatory diseases for which the prognosis is poor and there are currently limited treatment options. Therapies targeting IL-18 could prove effective against inflammatory diseases of the lung including bronchial asthma and chronic obstructive pulmonary disease (COPD), as described in a review article published in Journal of Interferon & Cytokine Research, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free online at the Journal of Interferon & Cytokine Research website. (http://www.liebertpub.com/jir)

Tomotaka Kawayama and coauthors from Kurume University School of Medicine, Fukuoka, Japan, University of Ryukyus, Okinawa, Japan, and Frederick National Laboratory for Cancer Research, Frederick, MD, review the growing evidence to support the important role IL-18 has in inflammation and how it may help to initiate and worsen inflammatory disorders such as arthritis, dermatitis and inflammatory diseases of the bowel and immune system. In the article "Interleukin-18 in Pulmonary Inflammatory Diseases" (http://online.liebertpub.com/doi/full/10.1089/jir.2012.0029) they describe the potential benefits of therapies aimed at blocking the activity of IL-18 to treat inflammatory lung disease.

"This review provides an interesting and thorough summary of the biology and potential application of IL-18 in the setting of inflammatory pulmonary disease," says Co-Editor-in-Chief Thomas A. Hamilton, PhD, Chairman, Department of Immunology, Cleveland Clinic Foundation.
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Strategies To Prevent Noise-Induced Hearing Loss, Tinnitus In Soldiers To Be Presented

Antioxidants, dietary supplements and high-tech brain imaging are among some of the novel strategies that may help detect, treat and even prevent noise-induced hearing loss and tinnitus among American troops, according to researchers at Henry Ford Hospital.

A culmination of nearly 25 years of research on noise-induced hearing loss - a growing medical issue that affects more than 12 percent of American troops returning from conflicts around the globe - will be presented Sept. 9 at the American Academy of Otolaryngology-Head & Neck Surgery annual meeting in Washington, D.C.

Led by Michael Seidman, M.D., the research team is the first to identify how acoustic trauma from machinery and explosive devices damages the inner ear cells and breaks down cell growth, much like age-related hearing loss.

"Improvised explosive devices, aircraft and other weaponry being used by the military are frankly deafening our troops," says Dr. Seidman, director of the Division of Otologic/Neurotologic Surgery in the Department of Otolaryngology-Head & Neck Surgery at Henry Ford Hospital.

"Noise-induced hearing loss doesn't just impact a person's ability to hear; it can cause balance issues, make it difficult to sleep and communicate, and even raise the risk for heart disease by increasing a person's blood pressure, lipids and blood sugar."

As part of his presentation, Dr. Seidman will explain how noise-induced hearing loss, as well as tinnitus-related traumatic brain injury, occurs based on research from Wayne State University's Jinsheng Zhang, Ph.D.

Dr. Zhang has developed a model of blast-induced tinnitus and hearing loss using a shock tube that generates a 194 decibel shock wave similar to many of the explosive devices being deployed against troops.

Further, Dr. Seidman will discuss the use of nutraceuticals, such as acetyl-l-carnitine, alpha lipoic acid and resveratrol - a substance found in red wine and red grapes - to mitigate hearing-related issues.

Based on initial results, Dr. Seidman says a nutraceutical with a resveratrol-based component may possibly hold the potential to not only prevent, but reverse hearing loss in certain circumstances for soldiers. This research is based on animal models, but will soon be tested with humans, to see if a pill could soon be developed to prevent acoustic trauma in troops.

In addition, Dr. Seidman will highlight new research on tinnitus, a chronic ringing of the head or ears that affects more than 50 million patients.

A study co-authored by Susan Bowyer, Ph.D., senior bioscientific researcher at Henry Ford Hospital, found that an imaging technique called magnetoencephalography (MEG) can determine the site of perception of tinnitus in the brain, which could in turn allow physicians to target the area with electrical or chemical therapies to lessen symptoms.

Although is no cure for tinnitus, several interventions are available, including dietary modification, the use of specific herbs and supplements, sound therapies, centrally acting medications and electrical stimulation of the cochlea and brain using implantable electrodes and an implantable pulse generator.

To date, Dr. Seidman has treated six patients with direct electrical stimulation to the brain, reducing the tinnitus in four of those patients.

In all, the team's work on noise-induced hearing loss and tinnitus has led to more than 50 peer-reviewed publications and several patents.

According to Dr. Seidman, more research and funding are needed in order to generate critical data to facilitate an understanding of the damage caused by acoustic trauma and develop strategies to mitigate that damage.
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Predicting How Patients With Social Anxiety Disorder Will Respond To Cognitive Behavioral Therapy

A new study led by MIT neuroscientists has found that brain scans of patients with social anxiety disorder can help predict whether they will benefit from cognitive behavioral therapy.

Social anxiety is usually treated with either cognitive behavioral therapy or medications. However, it is currently impossible to predict which treatment will work best for a particular patient. The team of researchers from MIT, Boston University (BU) and Massachusetts General Hospital (MGH) found that the effectiveness of therapy could be predicted by measuring patients' brain activity as they looked at photos of faces, before the therapy sessions began.

The findings, published this week in the Archives of General Psychiatry, may help doctors choose more effective treatments for social anxiety disorder, which is estimated to affect around 15 million people in the United States.

"Our vision is that some of these measures might direct individuals to treatments that are more likely to work for them," says John Gabrieli, the Grover M. Hermann Professor of Brain and Cognitive Sciences at MIT, a member of the McGovern Institute for Brain Research and senior author of the paper.

Lead authors of the paper are MIT postdoc Oliver Doehrmann and Satrajit Ghosh, a research scientist in the McGovern Institute.

Choosing treatments

Sufferers of social anxiety disorder experience intense fear in social situations that interferes with their ability to function in daily life. Cognitive behavioral therapy aims to change the thought and behavior patterns that lead to anxiety. For social anxiety disorder patients, that might include learning to reverse the belief that others are watching or judging them.

The new paper is part of a larger study that MGH and BU ran recently on cognitive behavioral therapy for social anxiety, led by Mark Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at MGH, and Stefan Hofmann, director of the Social Anxiety Program at BU.

"This was a chance to ask if these brain measures, taken before treatment, would be informative in ways above and beyond what physicians can measure now, and determine who would be responsive to this treatment," Gabrieli says.

Currently doctors might choose a treatment based on factors such as ease of taking pills versus going to therapy, the possibility of drug side effects, or what the patient's insurance will cover. "From a science perspective there's very little evidence about which treatment is optimal for a person," Gabrieli says.

The researchers used functional magnetic resonance imaging (fMRI) to image the brains of patients before and after treatment. There have been many imaging studies showing brain differences between healthy people and patients with neuropsychiatric disorders, but so far imaging has not been established as a way to predict patients' responses to particular treatments.

Measuring brain activity

In the new study, the researchers measured differences in brain activity as patients looked at images of angry or neutral faces. After 12 weeks of cognitive behavioral therapy, patients' social anxiety levels were tested. The researchers found that patients who had shown a greater difference in activity in high-level visual processing areas during the face-response task showed the most improvement after therapy.

Gabrieli says it's unclear why activity in brain regions involved with visual processing would be a good predictor of treatment outcome. One possibility is that patients who benefited more were those whose brains were already adept at segregating different types of experiences, Gabrieli says.

The researchers are now planning a follow-up study to investigate whether brain scans can predict differences in response between cognitive behavioral therapy and drug treatment.

"Right now, all by itself, we're just giving somebody encouraging or discouraging news about the likely outcome" of therapy, Gabrieli says. "The really valuable thing would be if it turns out to be differentially sensitive to different treatment choices."
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Survival 'Excellent' Following Living Donor Liver Transplantation For Acute Liver Failure

Patients in Japan who underwent living donor liver transplantation (LDLT) for acute liver failure (ALF) were classified as having excellent outcomes, with ten-year survival at 73%. The findings, published in the September issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD), suggest that the type of liver disease or treatment plan does not affect long-term patient survival following LDLT. Donor and patient age, however, does impact long-term outcome post-transplant.

According to the AASLD, roughly 2,000 Americans develop ALF-formally called fulminant hepatitis-each year, with many of these cases caused by acetaminophen (Tylenol) overdose, drug-induced liver injury, autoimmune liver disease, or viral hepatitis. Previous studies report patient survival from ALF was less than 15% before the era of liver transplantation and significantly better at more than 65% following transplantation.

LDLT-when a portion of a healthy liver from a living donor is used for transplantation-was developed as an alternative treatment option to overcome the shortage of deceased donor organs. A 2007 study by de Villa et al. found that LDLT accounts for less than 5% of liver transplants in the U.S. and Europe compared to more than 90% in Asia excluding mainland China.

"ALF is a rare, life-threatening condition where the rapid deterioration of liver function causes changes in mental activity and disrupts the body's blood clotting capabilities," explains lead author Dr. Yasuhiko Sugawara, Associate Professor in the Graduate School of Medicine at the University of Tokyo in Japan. "Expanding knowledge of treatment options, such as LDLT, that improve patient outcome is imperative."

Using data from the Intractable Liver Disease Study Group of Japan, researchers identified 209 ALF candidates who underwent living donor liver transplantation. The authors report that in patients who underwent LDLT the cumulative one-year, five-year and ten-year survival rates following transplantation were 79%, 74%, 73%, respectively. Patient age impacted short-term and long-term mortality, while donor age only affected long-term patient mortality.

"Our study demonstrates the benefit of LDLT in a Japanese population, which has less access to deceased donor organs," concludes Dr. Sugawara. "Prospective studies are needed to determine the overall impact of LDLT in all patients with ALF."

In a related editorial also published in Liver Transplantation, Professor Chung-Mau Lo with the University of Hong Kong and Queen Mary Hospital in Hong Kong, China, notes that LDLT for ALF patients has generated debate among experts in several areas: (1) reports in Western countries of inferior outcome with LDLT in high-urgency situations; (2) likelihood of ALF patients receiving a liver in countries with developed deceased organ donation programs; and (3) concern with coercion of donors and a possible increase of donor risk when the evaluation process is rushed in such an urgent situation.

"Deceased donor liver transplantation is dictated by the availability of the organ, and high-risk marginal grafts are frequently used. LDLT allows for early transplant to avoid waitlist mortality and better timing of the operation, which can be performed at the first sign of patient deterioration," concludes Professor Lo. "LDLT for ALF has developed in Asia because there is no choice. Is it possible that it may in fact be a better choice?"
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Childhood Sexual Abuse Linked To Later Heart Attacks In Men

Men who experienced childhood sexual abuse are three times more likely to have a heart attack than men who were not sexually abused as children, according to a new study from researchers at the University of Toronto. The researchers found no association between childhood sexual abuse and heart attacks among women.

In a paper published online this week in the journal Child Abuse & Neglect, investigators examined gender-specific differences in a representative sample of 5095 men and 7768 women aged 18 and over, drawn from the Center for Disease Control's 2010 Behavioral Risk Factor Surveillance Survey. A total of 57 men and 154 women reported being sexually abused by someone close to them before they turned 18 and 377 men and 285 women said that a doctor, nurse or other health professional had diagnosed them with a heart attack or myocardial infarction. The study was co-authored by four graduate students at the University of Toronto, Raluca Bejan, John Hunter, Tamara Grundland and Sarah Brennenstuhl.

"Men who reported they were sexually abused during childhood were particularly vulnerable to having a heart attack later in life," says lead author Esme Fuller-Thomson, Professor and Sandra Rotman Chair at University of Toronto's Factor-Inwentash Faculty of Social Work. "We had expected that the abuse-heart attack link would be due to unhealthy behaviors in sexual abuse survivors, such as higher rates of alcohol use or smoking, or increased levels of general stress and poverty in adulthood when compared to non-abused males. However, we adjusted statistically for 15 potential risk factors for heart attack, including age, race, obesity, smoking, physical inactivity, diabetes mellitus, education level and household income, and still found a three-fold risk of heart attack."

Co-author and PhD candidate Sarah Brennenstuhl notes that, "It is unclear why sexually abused men, but not women, experienced higher odds of heart attack; however, the results suggest that the pathways linking childhood sexual abuse to physical health outcomes in later life may be gender-specific. For example, it is possible that females adopt different coping strategies than males as women are more likely to get the support and counselling needed to deal with their sexual abuse."

"These findings need to be replicated in future scientific studies before we can say anything definitive about this link," cautions Fuller-Thomson. "But if other researchers find a similar association, one possible explanation is that adverse child experiences become biologically embedded in the way individuals react to stress throughout their life, particularly with respect to the production of cortisol, the hormone associated with the "fight-or-flight" response. Cortisol is also implicated in the development of cardiovascular diseases.
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Bosulif Approved By The FDA For Treatment Of Chronic Myelogenous Leukemia

The US Food and Drug Administration approved Bosulif as treatment for a rare disease, found in older adults, which attacks the blood and bone marrow and is known as chronic myelogenous leukemia (CML).

Approximately 5,430 people will be diagnosed with CML in 2012. The majority of people with CML have the Philadelphia chromosome, a genetic mutation where the bone marrow produces an enzyme called tyrosine kinase. This enzyme sparks excess creation of unhealthy and irregular white blood cells named granulocytes, which fight infection.

Bosulif is aimed towards patients with chronic, accelerated, and blast phase (extremely high levels of granulocytes) Philadelphia chromosome positive CML and who are also not responding to other therapies. Bosulif works by obstructing the tyrosine kinase signal that helps produce the abnormal granulocytes.

"With the approval of tyrosine kinase inhibitors, we are seeing improvements in the treatment of CML based on a better understanding of the molecular basis of the disease," said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research.

The FDA has approved other drugs such as imanitib, dasatinib, and nilotinib to treat many forms of CML. Bosulif was evaluated in a single clinical trial that included 546 adult patients who have chronic, accelerated, or blast phase CML. All patients in the study had CML that continued to progress after being treated with imanitib and dasatinib and/or nilotinib, or could not tolerate side effects of these treatments. Participants were all given Bosulif.

The effectiveness of Bosulif was determined by the amount of patients who experienced a major cytogenetic response (MCyR) within the first 24 weeks of treatment for chronic level CML. Findings showed patients who previously used imanitib reached MCyR after the initial 24 weeks. 52.8 percent of the patients who achieved MCyR at any time had a response that lasted 18 months or longer. Of the patients who were previously treated using imatinib, followed by dasatinib and/or nilotinib, 27 percent reached MCyR within 24 weeks. Among those who achieved MCyR at anytime, 51.4 percent had a response that lasted nine months or longer.

Of those patients with accelerated CML previously treated with at least imatinib, 33 percent had their blood counts return to normal, while 55 percent reached normal blood counts with no evidence of leukemia within the beginning 48 weeks of treatment. In addition, 15 percent of participants with blast phase CML achieved normal blood counts, while 28 percent achieved normal blood counts with no evidence of leukemia.

Common side effects seen associated with Bosulif are diarrhea, nausea, low levels of platelets in the blood, abdominal pain, anemia, vomiting, fever, and fatigue.
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Brain Scans Help Predict Treatment For Social Anxiety Disorder

Brain scans of patients with social anxiety disorder can help determine if cognitive behavioral therapy (CBT) could be an effective treatment option, suggests researchers from MIT, Boston University (BU), and Massachusetts General Hospital (MGH) in the Archives of General Psychiatry.

Either CBT or medications are normally used to treat social anxiety, but scientists have not been able to identify which of these treatments will suit a particular individual best.

By looking at photos of faces and measuring brain activity, the usefulness of therapy could be determined before the sessions even start, according to the team.

With about 15 million people in the United States struggling with the disorder, authors believe these findings will help doctors decide which treatment is right for each patient.

"Our vision is that some of these measures might direct individuals to treatments that are more likely to work for them," said John Gabrieli, lead author, the Grover M. Hermann Professor of Brain and Cognitive Sciences at MIT, and a member of the McGovern Institute for Brain Research.

Choosing The Right Treatment

CBT is known for changing the thought and behavior patterns that give the sufferer anxiety, such as feelings of intense fear in social settings that impair their ability to act normally. Some patients have anxiety because they think that others are watching them, however, the therapy shows that their beliefs are false and no one is judging them.

The current study is part of a larger one that MGH and BU conducted recently on cognitive behavioral therapy for social anxiety.

Gabrieli explained:

"This was a chance to ask if these brain measures, taken before treatment, would be informative in ways above and beyond what physicians can measure now, and determine who would be responsive to this treatment."
Although some patients find the idea of taking pills easier than going to therapy, it is not an effective method of treatment. Some doctors, on the other hand, are currently making decisions about treatment based on what their patient's insurance covers or because of potential drug side effects.

"From a science perspective there's very little evidence about which treatment is optimal for a person," Gabrieli commented.

In order to image patients' brains before and after treatment, functional magnetic resonance imaging (fMRI) was used. Imaging has never before been used as a way to predict a patient's reactions to a certain treatment, although some imaging studies have shown brain differences between patients with nueropyschiatric disorders and their healthy counterparts.

Measuring Differences in Brain Activity

Experts in the new study had subjects look at images of angry or neutral faces, in order to identify differences in brain activity as they observed. Social anxiety levels were tested after undergoing 12 weeks of CBT.

Results showed that those who benefited the most from therapy were the individuals who had shown a greater difference in activity in high-level visual processing areas during the face-response task.

It is unclear why activity in brain regions involved with visual processing would be a good indicator of treatment outcomes, according to Gabrieli. He believes it could be because the patients who received more benefits were those whose brains were already adept at separating different types of experiences.

The authors are carrying out further research to determine if brain scans can predict differences in response between cognitive behavioral therapy and drug treatments.

Gabrieli concluded:

"Right now, all by itself, we're just giving somebody encouraging or discouraging news about the likely outcome of therapy. The really valuable thing would be if it turns out to be differentially sensitive to different treatment choices."
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America's Health System Wasted $750 Billion In One Year

America's health care system is inefficient, suffers from data overload, is complex and very costly, a report from the Institute of Medicine (IoM) revealed today. The authors added that too many negative factors are undermining health care quality and affecting the USA's global competitiveness and economic stability. Despite all this, there are knowhow and tools in place to correct the deep faults within the country's health system so that costs may be reduced and the quality of care improved.

The authors of the report (the Committee) estimated that $750 billion was wasted nationwide on administration costs, fraud, pointless services, and some other problems. Apart from the economic toll these deficiencies place, they also result in patients having to suffer needlessly. Some studies have indicated that in 2005, about 75,000 deaths could have been averted if each state had delivered healthcare at the quality and efficiency levels of the best performing state.

The Committee said that aiming for just incremental upgrades and alterations carried out by individual hospitals or health care providers will have little impact on improving the nation's overall health care service.

America's health care needs to transform into a "learning system"

The only way the USA's healthcare system can really improve is to transform it into a learning system that continuously improves itself by "systematically capturing and broadly disseminating lessons from every care experience and new research discovery."

Health care authorities will need to embrace and implement new technologies that gather and analyze clinical data at the point of care, encouraging patients and their loved ones to become active contributors, and working towards total transparency and teamwork within health care organizations. Financial and other types of incentives which focus on quality and results should be placed into the system.

Committee chair Mark D. Smith, president and CEO, California HealthCare Foundation, Oakland, said:

"The threats to Americans' health and economic security are clear and compelling, and it's time to get all hands on deck. Our health care system lags in its ability to adapt, affordably meet patients' needs, and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value."

Keeping up with new treatments and breakthroughs

One of the main problems today is that healthcare providers cannot keep up with the rapid pace of new research discoveries and technological breakthroughs.

In an online communiqué, the IoM wrote "How health care organizations approach care delivery and how providers are paid for their services also often lead to inefficiencies and lower effectiveness and may hinder improvement."

The Committee said for a health system to be able to continuously evolve, excellent use of data is vital. In the USA, approximately 75 million people have two or more chronic conditions - for proper treatment and control, good coordination among multiple specialists and therapies is vital. Otherwise, the risk of misdiagnoses, clashing interventions, and dangerous drug interactions grows.

Doctors and patients often do not have useful and relevant data at the point of care where decisions are made. Currently, for new breakthroughs to become widely accepted and adopted can take several years. Only after 13 years did beta blockers become standard practice for heart attack victims.

Embracing mobile technologies and electronic health records would contribute considerably to a competent capture of health data, as well as disseminating that information. They wrote that "The National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable, the report says. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care."

During the last 40 years, health care costs have increased at a higher rate than inflation or the economy as a whole for 31 of them. The main thrust has been volume rather than quality as far as reimbursements are concerned, instead of paying a flat rate or rewarding providers according to patient outcomes, the authors added.

The report urges insurance providers, professional societies, researchers, and health economists to work together to find ways of measuring quality performance and to design new payment models and incentives that reward quality rather than volume.

So far, not many health care organizations, clinics or medical practices encourage patients and their families to become engaged in care decisions and management of their conditions, even though studies and examples abroad have proven that they lead to better outcomes and value for money.

The Committee wrote:

"To facilitate these interactions, health care organizations should embrace new tools to gather and assess patients' perspectives and use the information to improve delivery of care. Health care product developers should create tools that assist people in managing their health and communicating with their providers.

Increased transparency about the costs and outcomes of care also boosts opportunities to learn and improve and should be a hallmark of institutions' organizational cultures, the committee said. Linking providers' performance to patient outcomes and measuring performance against internal and external benchmarks allows organizations to enhance their quality and become better stewards of limited resources, the report says. In addition, managers should ensure that their institutions foster teamwork, staff empowerment, and open communication."
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Toddlers Choking On Liquid Detergent Capsules

A growing number of toddlers are inadvertently swallowing liquid detergent capsules, known as Liquitabs, doctors from the Royal Hospital for Sick Children, Glasgow, UK, Scotland reported in Archives of Childhood Diseases. In what the authors describe as a "significant public health issue", they urge detergent makers and packagers to review their packaging and safety warnings.

Laundry and dishwasher detergent Liquitabs should have childproof packaging and better safety warnings, after several reports have come in of young children swallowing contents of the capsules, the authors explained.

Over a period of 18 months, five children had to be treated for swallowing the liquitab capsule contents in one hospital in Glasgow alone; they ranged in age from 10 months to 24 months. When they were hospitalized they had a high pitched wheeze (stridor), which is usually a sign of some airway blockage.

Liquitabs contain alkaline cleaning agents which have a strong solvent action that can damage tissue, cause inflammation and painful swelling.

In severe cases the airways can become completely blocked; there is also the risk of lung damage as tissue in the esophagus is eroded - a potentially fatal complication.

The oldest patient, a 24-month old child, was treated with steroids and antibiotics. The other four younger ones needed to be intubated for several days to treat ulceration and swelling. One of them required surgery because the swelling and ulceration was so extensive.

Although all the patients in Glasgow made full recoveries, the authors wrote that the incidents had "a catastrophic impact on the child and family", as well as using up valuable intensive care resources.

In 2011, in the United Kingdom alone, 647 phone calls were received at the National Poisoning Information Service regarding the swallowing or eating of liquid detergent capsules. The Service also received 4,000 website visits on this theme.

The authors explained that over the last five years, the number of inquiries regarding children swallowing washing machine or dishwasher Liquitabs has more than doubled.

Detergent capsules are not childproof

Liquitabs do not currently come in childproof containers. At the moment, manufacturers and packaging companies are encouraged to comply to safety standards, but the whole scheme is voluntary, there is nothing legally binding them to adhere to any strict national standards. The doctors said that the contents of these capsules also place young children at risk of severe eye injury.

The authors, who have written to manufacturers alerting them to the current problems, said:

"To help prevent future potentially life threatening injuries, improved safety warnings and childproof packaging are urgently required."

It is not only the manufacturers' responsibility to keep these products out of children's reach, parents should also be extremely careful.

They wrote "Dishwasher and washing machine Liquitabs are now a common finding in most homes, but unfortunately, seem very attractive to young children due to their bright colouring and soft sweetie-like texture. We feel that the increasing trend in liquid detergent capsule ingestion poses a significant public health issue."
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West Nile Virus, Worst Year Ever Says CDC, USA

So far, this has been the worst year on record for West Nile virus infections, says the Centers for Disease Control and Prevention (CDC). 48 states have reported infections in humans, birds and/or mosquitoes. 1,993 people have been confirmed nationwide with WNV (West Nile virus) infection, of whom 87 have died. 54% (1,069) were classified as neuroinvasive disease and 924 as non-neuroinvasive disease. In neuroinvasive disease, the patient went on to develop encephalitis or meningitis.

Up to September 4th, more cases have been reported this year than ever before, says the CDC. West Nile virus first infected humans in the USA in 1999.

Six states make up over 70% of all cases - Michigan, Louisiana, Oklahoma, Mississippi, South Dakota and Texas. Nearly 45% of all reported cases in the USA come from Texas.

Below is a breakdown by states of West Nile virus human infections reported to ArboNET, as of September 4th, 2012 (Source: CDC):
  • Alabama
    Total cases 16. Deaths 1
  • Arizona
    Total cases 25. Deaths 1
  • Arkansas
    Total cases 31. Deaths 3
  • California
    Total cases 55. Deaths 2
  • Colorado
    Total cases 23. Deaths 0
  • Connecticut
    Total cases 6. Deaths 0
  • Delaware
    Total cases 1. Deaths 0
  • District of Columbia
    Total cases 1. Deaths 1
  • Florida
    Total cases 19. Deaths 0
  • Georgia
    Total cases 22. Deaths 3
  • Idaho
    Total cases 4. Deaths 0
  • Illinois
    Total cases 48. Deaths 2
  • Indiana
    Total cases 26. Deaths 3
  • Iowa
    Total cases 7. Deaths 0
  • Kansas
    Total cases 24. Deaths 1
  • Kentucky
    Total cases 3. Deaths 0
  • Louisiana
    Total cases 73. Deaths 6
  • Maryland
    Total cases 14. Deaths 1
  • Massachusetts
    Total cases 4. Deaths 0
  • Michigan
    Total cases 95. Deaths 5
  • Minnesota
    Total cases 41. Deaths 1
  • Mississippi
    Total cases 113. Deaths 4
  • Missouri
    Total cases 6. Deaths 1
  • Montana
    Total cases 1. Deaths 0
  • Nebraska
    Total cases 29. Deaths 1
  • Nevada
    Total cases 0. Deaths 0
  • New Hampshire
    Total cases 1. Deaths 0
  • New Jersey
    Total cases 8. Deaths 0
  • New Mexico
    Total cases 9. Deaths 0
  • New York
    Total cases 26. Deaths 3
  • North Carolina
    Total cases 4. Deaths 2
  • North Dakota
    Total cases 35. Deaths 0
  • Ohio
    Total cases 53. Deaths 1
  • Oklahoma
    Total cases 113. Deaths 7
  • Oregon
    Total cases 1. Deaths 0
  • Pennsylvania
    Total cases 14. Deaths 1
  • South Carolina
    Total cases 8. Deaths 0
  • South Dakota
    Total cases 119. Deaths 2
  • Tennessee
    Total cases 10. Deaths 0
  • Texas
    Total cases 888. Deaths 35
  • Utah
    Total cases 2. Deaths 0
  • Virginia
    Total cases 5. Deaths 0
  • West Virginia
    Total cases 2. Deaths 0
  • Wisconsin
    Total cases 6. Deaths 0
  • Wyoming
    Total cases 2. Deaths 0
  • Total Nationwide
    Total cases 1,992. Deaths 87
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Monday, September 3, 2012

Abnormal Brain Structure In Both Siblings - Addiction Only Affects One

A study conducted by Dr. Karen Ersche, Department of Psychiatry, University of Cambridge, England, and published in Science, reveals that one sibling who is addicted to drugs, and the other who is not, have similar brain abnormalities. These abnormalities come from an area of the brain that is vital for aiding people in exhibiting self control.

This research will help people understand why it is more likely, for people who have a history of drug abuse in their families, to actually develop the addiction, than those without any family history of drug addiction or abuse.

The researchers compared 50 healthy participants' brain scans with the brain scans of 50 pairs of siblings. In the pairs of siblings, one was addicted to cocaine, and the other sibling did not use alcohol or drugs at all.

The findings determined that the person addicted to the cocaine, and their sibling, possessed brain abnormalities in an area of the brain called the frontal-striatal system.

The drug-dependent person and his/her non-dependent sibling displayed abnormalities in the frontal striatal region (yellow/blue), compared to healthy controls. The drug-dependent siblings had further abnormalities (green) which grew the longer their cocaine abuse went on for.

Dr. Karen Ersche says:

"It has long been known that not everyone who takes drugs becomes addicted, and that people at risk of drug dependence typically have deficits in self-control.

Our findings now shed light on why the risk of becoming addicted to drugs such as cocaine further exacerbates this problem, paving the way for addiction to develop from occasional use."

She adds:

"The next step will be to explore how the siblings who don't take drugs manage to overcome their brain abnormality in daily life."

The abstract of the journal says these findings support the idea of an underlying neurocognitive endophenotype for stimulant drug addiction.
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What are Blackheads? How to Get Rid of Blackheads

A blackhead, or open comedo is a wide opening on the skin with a blackened mass of skin debris covering the opening. Despite their name, some blackheads can be yellowish in color. A comedo is a widened hair follicle which is filled with skin debris (keratin squamae), bacteria and oil (sebum).

A closed comedo is a whitehead, while an open comedo is a blackhead. the plural of "comedo" is comedomes".

Blackheads are said to be the first stage of acne. They form before bacteria invade the pores of the patient's skin. A blackhead can develop into a pimple, which is also known as a papule or pustule.

Blackheads, and acne in general, usually develop after puberty, when hormone levels surge and reach the skin. The presence of higher levels of hormones in the skin triggers the stimulation of the sebaceous glands, which produce oily substances. The sebaceous glands produce too much oil in the pores, which accumulates and gets stuck. When the occluded oil is exposed to air it becomes black.

Several conditions and circumstances can cause blackheads, or make them worse, such as the use of topical oils and make up. Blackheads can affect people with any type of skin, but are generally more common in those with oily skin.

Blackheads on a man's nose

What are the causes of blackheads

The overproduction of oil is the main cause of the emergence of blackheads. This is likely to occur in a high proportion of humans during puberty. Spikes in hormone production can result in the high levels of DHT (dihydrotestosterone), a hormone which triggers overactivity in the oil glands, resulting in clogged pores.

Clean skin - if the skin is not cleaned properly, more blackheads can appear, especially during those milestones in life when they are more prevalent, such as puberty. Improperly cleaned skin makes it more likely that dead skin cells build up within the pores. The pore openings can become clogged, which accelerates the build up of oil inside - thus causing blackheads to form. However, many experts warn that dirt does not cause blackheads to form - which frequently confuses and frustrates patients. Blackheads are caused by oxidized oil, not dirt, experts add. Over-cleaning the skin can lead to irritation.

In some cases, blackheads can emerge if moisturizers, sun screens, make up, or foundations are overused.

In the majority of cases, blackhead susceptibility is not heredity, with the exception of some severe acnes.

Food does not cause acne - although parents and grandparents commonly tell their teenage offspring not to eat chocolates and greasy foods, because they think they encourage the formation of acne - they do not cause blackheads or make them worse. Some studies have pointed towards a link between some dairy products and acne, but the evidence is not compelling.

Stress - stress does not directly affect blackhead occurrence. However, stress and anxiety can cause people to pick at their blackheads and acne, which may make them worse. Put simply, the behaviors resulting from stress and anxiety may worsen acne symptoms, but not the stress/anxiety itself.

What are the treatment options for blackheads

Hormonal treatments - contraceptives have often been used for the treatment of blackheads and acne, often with good results.

Cleaning the skin - clean your face with a good cleanser, ideally, one for oily skin, such as a salicylic acid cleanser.

Medications - adapalene is a third-generation topical retinoid, used mainly in the treatment of mild to moderate acne. Many patients with blackheads have had good results. In the USA adapalene is available under brand name Differin, in three preparations - 0.1% cream, 0.1% gel, and 0.3% gel. Since 2010, it has also been available in the USA under the generic name Teva, (0.1% gel). Only the 0.1% cream and 0.1% gel forms are available in Europe.

UV exposure - exposing the skin to sunlight or ultra-violet light encourages it to peel, which helps unblock pores. Sunbathing or using sunbeds may help. However, it is important to discuss this with your doctor. Exposing skin to sunlight, if overdone, also raises the risk of burning and developing skin cancer.

Hair - greasy hair touching the face of your skin can spread infection and in some cases encourage the spread of blackheads and acne. Keeping your hair away from your face may help keep blackheads to a minimum.
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10 Neglected Tropical Diseases - Target For End Of Decade

The aim is to eliminate or at least control 10 neglected tropical diseases by 2020 - it is a public and private partnership, including 13 drug companies, the UK, US and United Arab Emirate Governments, the World Bank, The Bill & Melinda Gates Foundation, and some other worldwide organizations.

The partners aim to work together to eliminate neglected tropical diseases (NTDs) in countries where they are endemic. They have pledged to liaise closely with affected countries. According to WHO (World Health Organization), 1.4 billion people are affected by the ten NTDs; the majority of them live in the poorest countries in the world.

In an official announcement made today at the Royal College of Physicians, London, the partners said they would combat NTDs by:
  • Expanding or at least sustaining drug donation programs so that demand is met right through to the end of 2020.
  • Share knowhow and new active ingredients to speed up R&D of new medications.
  • The allocation of over $785 million to improve R&D efforts and support drug distribution and implementation programs.
  • The endorsement of the "London Declaration on Neglected Tropical Diseases". The Declaration promises a new level of commitment and collaboration in the tracking of progress.
Bill Gates, co-chair of the Bill & Melinda Gates Foundation, said:

"Today, we have joined together to increase the impact of our investments and build on the tremendous progress made to date. This innovative approach must serve as a model for solving other global development challenges and will help millions of people build self-sufficiency and overcome the need for aid."

The Gates Foundation says it is donating $363 million over the next five years towards NTD product and operational research.

WHO has published its guide on how best to combat NTDs in a new report, called "Accelerating work to overcome the global impact of neglected tropical diseases - A roadmap for implementation" (PDF). The document lays out what target are achievable by 2020.

Dr. Margaret Chan, Director-General of the WHO:

"The efforts of WHO, researchers, partners, and the contributions of industry have changed the face of NTDs. These ancient diseases are now being brought to their knees with stunning speed. With the boost to this momentum being made today, I am confident almost all of these diseases can be eliminated or controlled by the end of this decade."

The partners have pledged more funds to close the shortfall gap in the drive to eradicate the following NTDs by 2020:
  • Blinding trachoma
  • Chagas disease
  • Guinea worm disease
  • Leprosy
  • Lymphatic filariasis
  • River blindness
  • Schistosomiasis
  • Sleeping sickness
  • Soil-transmitted helminthes
  • Visceral leishmaniasis
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River blindness (onchocerciasis) is endemic in some parts of the world. In this picture, children are leading blind adults
Sir Andrew Witty, CEO of GlaxoSmithKline, said on behalf of the partners from the pharmaceutical industry:

"Many companies and organizations have worked for decades to fight these horrific diseases. But no one company or organization can do it alone. Today, we pledge to work hand-in-hand to revolutionize the way we fight these diseases now and in the future."

The IFPMA (International Federation of Pharmaceutical Manufacturers & Associations) has pledged approximately $1.4 billion treatments annually for those in need.

11 pharmaceutical companies and some DNDi (Drugs for Neglected Diseases initiative) collaborators are making their data available to libraries. They are also working together with database companies and libraries to develop WIPO Re:Search, a database of compounds, expertise and knowledge.

The Gates Foundation, The Children's Investment Fund Foundation, and The Carter Center and His Highness Sheikh Khalifa bin Zayed Al Nahyan, President of the United Arab Emirates, have said they are donating $40 million to The Carter Center. The UK Government's Department for International Development (DFID) has pledged £20 million (approx. $30 million) as long as others also donate, as part of a £195 target towards NTDs.

With the extra $89 million announced by USAID, the organization will have given $212 towards the elimination of DNDs.

The World Bank has announced an extension of its financial and technical support for African countries so that they can improve and strengthen their health systems and more effectively eliminate NTDs, or control them. The Bank also says it is, along with other partners, expanding a trust fund to address the problem of river blindness, as well as other NTDs which are endemic in Africa.

Stephen O'Brien, U.K. Minister for International Development, said:

"The world has come together to end the neglect of these horrific diseases which needlessly disable, blind and kill millions of the world's poorest. Britain and other partners are leading the way to provide critical treatments to millions of people, which allow children to attend school and parents to provide for their families so that they can help themselves out of poverty and eventually no longer rely on aid."

The declaration and pledges made today are in response to Working to overcome the global impact of neglected tropical diseases, a WHO 2010 report.

Some national governments where NTDs are widespread, such as Tanzania, Mozambique, Brazil and Bangladesh, said they will implement comprehensive plans to eradicate NTDs - they have pledged government-level commitment towards this ultimate goal.

Dr. Alexandre Manguele, Health Minister, Mozambique, said:

"From the moment the evidence of the very heavy burden of NTDs in Mozambique was understood, the government of Mozambique has taken action and continuously increased its commitment and investment to control or eliminate these diseases. With the resources pledged today in the context of this partnership the government of Mozambique feels ever more assured that the mission can be accomplished."

Examples of partner commitments pledged include:
  • NTD drug program donors said they will continue to extend, or at least sustain the programs until 2020.
  • Global Lymphatic Filariasis Elimination program - the Bill & Melinda Gates Foundation, Eisai, and Sanofi pledge to donate 120 million DEC tablets. This means supplies should be enough to last until the end of the decade.
  • Chagas disease - Bayer says its donation of nifurtimox will double.
  • DEC tablets for lymphatic filariasis - Eisai says its donation will extend to 2.2 billion tablets.
  • Visceral leishmaniasis - Gilead's AmBisome donation for last year will continue (at cost). The company also pledges to continue investing in R&D and new technologies to help combat visceral leishmaniasis, as well as helping affected, resource-limited nations cope.
  • Soil-transmitted helminthes - GSK (GlaxoSmithKline) says its albendazole donation will be extended to 400 million tablets annually for an extra five years (through 2020).
  • Lymphatic filariasis - GSK's 600 million tablets per year will continue to the end of the decade.
  • Soil-transmitted helminthes - J&J (Johnson & Johnson) says it will extend its 200 million per year mebendazole donations through to the end of this decade.
  • River blindness and lymphatic filariasis - MSD says its ivermectin donations will continue through to 2020. The company is also looking into using ivermectin to combat other illnesses and conditions.
  • Schistosomiasis (snail fever) - Merck KGaA says its 25 million current donation of praziquantel tablets will increase to 250 million annually. The company adds that this will continue indefinitely.
  • Leprosy - Novartis says its commitment to provide rifampicin, clofazimine and dapsone will be extended.
  • Blinding trachoma - Pfizer says it will continue donating azithromycin until 2020. The company will also donate the medication and placebo for childhood mortality studies.
  • Sleeping sickness - Sanofi says it is extending its donations of eflornithine, melarsoprol and pentamidine. The company says it is also helping local in the logistical support so that patients get their medications free of charge.
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